Evaluation of predominant risk factors for type 2 diabetes mellitus among out-patients in two Nigerian secondary health facilities

BackgroundPrevention of type 2 diabetes is enabled by identification and effective management of risk factors.ObjectivesTo evaluate the predominant risks for type 2 diabetes and identify persons at highest risk in a population; to facilitate the understanding of implications for practice.MethodsCross-sectional survey using Canadian diabetes risk assessment questionnaire was conducted among non-diabetic persons who visited two secondary hospitals. SPSS version 18 was used for data analysis.ResultsA total of 300 respondents participated in the study, with 25.7% having family history of type 2 diabetes, while 160 (53.3%) were at high risk of developing the disease. Males (62.5%), overweight (65.1%) and obese (82.6%) participants, were at higher risk. Others found to be at high risk were respondents with high waist circumference (55.6%), respondents who did not exercise (77.0%), those who did not eat fruits/vegetable daily (54.4%), those with high blood pressure (67.5%) and those who have had raised blood sugar in the past (71.0%).ConclusionMajority of the study participants was at high risk for type 2 diabetes, male participants had higher risks and lifestyles/habits were the major risks for developing the disease..     

Influence of gender on the distribution of type 2 diabetic complications at the obafemi awolowo teaching hospital,Ile-Ife,Nigeria

BackgroundSex specific differences appear particularly relevant in the management of type 2 DM.ObjectiveWe determined gender specific differences in cardio-metabolic risk, microvascular and macrovascular complications in patients with type 2 diabetes.MethodsFour hundred type 2 diabetes patients, males and females, matched for age and disease duration were recruited from the diabetes clinic. Relevant clinical and laboratory information were obtained or performed.Results190(47.5%) were male and 210 (52.5%) were female respectively. The mean age of the study population was 60.6 + 9.93 years. Women had higher prevalence of hypertension (and obesity. Mean total cholesterol was significantly higher in women but men were more likely to achieve LDL treatment goals than women (69.5% vs 59.0%, p<0.05). More women (47.1% & 31.4%) reached glycaemic goals of <10mmol/l for 2HPP and HBA1c of <7.0%.There were no gender differences in the distribution of microvascular and macrovascular complications (p>0.05) but women were more likely to develop moderate and severe diabetic retinopathy (p= 0.027).ConclusionWomen with T2DM had worse cardiometabolic risk profile with regards to hypertension, obesity and lipid goals. Men achieved therapeutic goals less frequently than did women in terms of glycaemia. Microvascular and macrovascular complications occurred commonly in both sexes.     

C反应蛋白表达在2型糖尿病大血管病变中意义

目的:探讨C反应蛋白(CRP)与2型糖尿病(T2DM)大血管病变发生的关系。方法:将T2DM患者60人随机分为合并大血管并发症组与无大血管并发症组,每组各30例,正常对照组30例。检测病人血清中血脂、糖化血红蛋白(HbA1c)和CRP水平。结果:2型DM患者的CRP水平明显高于正常对照组(P<0.05),其中有大血管并发症组显著高于无大血管并发症组(P<0.05),Logstic回归分析显示,CRP水平是T2DM患者大血管并发症发生的独立危险因素。结论:CRP与T2DM的发生相关,升高的CRP是促使T2DM并发大血管病变的独立危险因素。     

Treatment non-adherence among patients with poorly controlled type 2 diabetes in ambulatory care settings in southwestern Nigeria

Background

Poor adherence to prescribed therapy among patients with chronic diseases is a growing concern which undermines the benefits of current medical care.

Objectives

To evaluate the pattern of treatment non-adherence among ambulatory patients with poorly controlled type 2 diabetes in southwestern Nigeria, and to determine the possible factor(s) that accounted for such non-adherence with a view to identifying areas of future intervention to improve outcome.

Methods

A prospective cross-sectional interview using the concept of RIM (Recognize, Identify and Manage) model was used to evaluate adherence to treatment recommendations among 176 consented patients recruited from the endocrinology out-patient clinics of two teaching hospitals in southwestern Nigeria between November, 2010 and January, 2011.

Results

Overlaps of non-adherence behavior were obtained. More than three-quarter (153; 88.4%) were not aware of indication for each of the prescribed medications, 26 (15.3%) correctly described regimen as prescribed. The factorsidentified as possible barriers to medication adherence include practical (145; 40.1%), knowledge (103; 28.5%), and attitudinal (114; 31.5%) barriers. Dietary non-adherence was mostly due to inappropriate guidance (62; 33.7%).

Conclusions

The arrays of non-adherence behavior among the cohort further emphasize the need for patient-centered approach as a reasonable strategy in resolving non-adherence problems in routine clinical practice.     

Peroxiredoxin isoforms are associated with cardiovascular risk factors in type 2 diabetes mellitus

The production of oxygen free radicals in type 2 diabetes mellitus contributes to the development of complications, especially the cardiovascular-related ones. Peroxiredoxins (PRDXs) are antioxidant enzymes that combat oxidative stress. The aim of this study was to investigate the associations between the levels of PRDX isoforms (1, 2, 4, and 6) and cardiovascular risk factors in type 2 diabetes mellitus. Fifty-three patients with type 2 diabetes mellitus (28F/25M) and 25 healthy control subjects (7F/18M) were enrolled. We measured the plasma levels of each PRDX isoform and analyzed their correlations with cardiovascular risk factors. The plasma PRDX1, -2, -4, and -6 levels were higher in the diabetic patients than in the healthy control subjects. PRDX2 and -6 levels were negatively correlated with diastolic blood pressure, fasting blood sugar, and hemoglobin A1c. In contrast, PRDX1 levels were positively correlated with low-density lipoprotein and C-reactive protein levels. PRDX4 levels were negatively correlated with triglycerides. In conclusion, PRDX1, -2, -4, and -6 showed differential correlations with a variety of traditional cardiovascular risk factors. These results should encourage further research into the crosstalk between PRDX isoforms and cardiovascular risk factors.     

2型糖尿病患者抑郁患病情况与危险因素调查

目的:调查2型糖尿病患者抑郁的患病情况及评价2型糖尿病合并抑郁与无抑郁两组患者相关因素的差异。方法:T2DM患者151例采用汉密顿抑郁量表(17项)测评。根据评分临床诊断:合并有抑郁的患者59例为抑郁组,无抑郁的糖尿病患者92例为对照组。调查两组患者年龄、性别、身高、体重、收入情况、糖尿病病程、并发症、饮食习惯、生活习惯、糖尿病治疗情况、血糖、糖化血红蛋白(HBA1C)、血脂等。结果:调查的151例2型糖尿病患者中抑郁患病率为39.1%。抑郁组(病例组)女性(44.3%VS27.8%,P=0.035,病例组和对照组比较),独居或丧偶(35.6%VS 8.7%,P<0.001),低收入(81.4%VS 40.2%,P<0.001),有并发症的患者(98.3%VS 88.0%,P=0.023)的比率都显著高于非抑郁组。抑郁组HBA1C(98.3%VS 22.8%,P<0.001)显著高于对照组。注射胰岛素者(45.8%VS 28.3%,P=0.028)均显著多于非抑郁组;而缺少锻炼的人的比率显著超过无抑郁组(55.9%VS20.7%,P<0.001)。结论:2型糖尿病患者中抑郁的患病率较高,女性、丧偶或独居、低收入、血糖控制不良、并发症、和注射胰岛素、及缺少锻炼和抑郁关系密切。     

Thromboxane production and platelet aggregation in type 2 diabetes mellitus without vascular complications

Summary Diabetic individuals frequently have platelet hyperaggregability and increased thromboxane (TXB₂) production. To evaluate whether improvement of metabolic control or changes in fatty acid composition of serum lipids might alter thromboxane (TXB₂) formation and platelet function, we followed up 25 newly diagnosed type 2 diabetics without angiopathy for about 6 months. Improvement of metabolic control (HbA₁, fell from 12.0±0.3 to 9.0±0.3%;p<0.01) was associated with significant decrease in total cholesterol, triglycerides, and ratios of total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol. Palmitic acid of phospholipids decreased significantly, whereas eicosapentaenoic acid increased. Regardless of this, the ADP-induced platelet aggregability and sensitivity were not altered. There was no effect whatever on the TXB₂ synthesis capacity of clotting whole blood (204.9±25.0 vs 222.8±32.0 ng/ml) over 6 months of treatment. Platelet aggregability and TXB₂ formation were not correlated to the degree of metabolic control, nor were there any correlations to serum lipids and their fatty acid composition. Thus, we are tempted to speculate that glucose metabolism in diabetes itself does not affect platelet aggregation or TXB₂ formation in type 2 diabetes mellitus.Abbreviations TXB₂ Thromboxane B₂ - HbA₁ Glycosylated hemoglobin A₁ - HDL High density lipoproteins - LDL Low density lipoproteins - ADP Adenosine diphosphate - P/S Ratio Polyunsaturated fatty acids/saturated fatty acids ratio - ECG Electrocorticogram - TAC 50 Threshold aggregating concentration eliciting 50% of maximal response Presented in part at the 23rd Annual Meeting of the European Society for Clinical Investigation, April 19–22 1989, Athens, Greece.     

老年2型糖尿病合并肺部感染患者免疫状态和预后的危险因素分析

目的:探讨影响老年2型糖尿病(type 2 diabetes,T2DM)合并肺部感染患者预后的相关因素。方法:选取2019年8月至2020年6月南京医科大学附属淮安第一医院收治的单纯T2DM患者135例,单纯肺部感染患者128例及T2DM合并肺部感染患者124例,分别记为T2DM组、肺部感染组及T2DM合并肺部感染组。...     

2型糖尿病患者糖尿病足的危险因素分析

目的总结分析2型糖尿病患者糖尿病足（DF）的患病情况及相关危险因素,为临床治疗和预防DF提供依据。方法选择2型糖尿病患者189例为研究对象,根据病情分为DF组和非DF组,回顾分析其性别、年龄、病程、入院时血压、空腹血糖、餐后2h血糖、糖化血红蛋白、血肌酐、尿素氮,以及尿白蛋白、糖尿病肾病、糖尿病视网膜病变、周围神经病变等因素。结果 DF所占比例为15%。DF组与非DF组相比,病程、餐后2h血糖、糖化血红蛋白、血肌酐、尿素氮、尿白蛋白、糖尿病肾病、糖尿病视网膜病变、周围神经病变等因素差异均有统计学意义（P〈0.05）。其中病程、糖尿病肾病、糖尿病视网膜病变、周围神经病变进入回归模型亦有统计学意义（P〈0.05）。结论 2型糖尿病的病程、肾病、视网膜病变、周围神经病变是DF发生的独立危险因素。     

Patients' perspectives on foot complications in type 2 diabetes: a qualitative study

BACKGROUND: Foot ulceration is a major health problem for people with diabetes. To minimise the risk of ulceration, patients are advised to perform preventive foot self-care. AIM: To explore beliefs about diabetic foot complications and everyday foot self-care practices among people with type 2 diabetes. DESIGN OF STUDY: Qualitative study using one-to-one interviews. SETTING: A suburban primary care health centre. METHOD: Semi-structured interviews with a purposive sample of adults with type 2 diabetes but with no experience of foot ulceration. RESULTS: Most participants were unsure of what a foot ulcer is and unaware of the difficulties associated with ulcer healing. Prevention of accidental damage to the skin was not considered a priority, as few participants knew that this is a common cause of foot ulceration. Although it was recognised that lower-limb amputation is more common in people with diabetes, this was perceived to be predominantly caused by poor blood supply to the feet and unrelated to foot ulceration. Therefore, preventive foot care focused on stimulating blood circulation, for example by walking barefoot. Consequently, some of the behaviours participants considered beneficial for foot health could potentially increase the risk of ulceration. In some cases the uptake of advice regarding preventive foot care was hampered because participants found it difficult to communicate with health professionals. CONCLUSION: Patients with type 2 diabetes may have beliefs about foot complications that differ from medical evidence. Such illness beliefs may play a role in foot-related behaviours that have previously been unrecognised. Health professionals need to explore and address the beliefs underlying patients' foot self-care practices.     

Inflammation,diet, and type 2 diabetes: a mini-review

ABSTRACT

Inflammation is a common feature of type 2 diabetes (T2D). Inflammatory cytokines increase in patients with type 2 diabetes, metabolic syndrome, and heart disease. Various types of cells can produce inflammatory cytokines and then release them into the bloodstream, where their complex interactions with target tissues raise a tissue-specific immune response. This review focused on C-reactive protein (CRP), tumor necrosis factor (TNF)-α as an inflammatory cytokine, and adiponectin produced by adipose tissues. Despite the major role of cytokines in the development of T2D, further studies are required to investigate the possible effects of the macronutrient composition of diet on these cytokines.     

Cytokine profile and lymphocyte subsets in type 2 diabetes

Type 2 diabetes mellitus (T2D) is a metabolic disease with inflammation as an important pathogenic background. However, the pattern of immune cell subsets and the cytokine profile associated with development of T2D are unclear. The objective of this study was to evaluate different components of the immune system in T2D patients'' peripheral blood by quantifying the frequency of lymphocyte subsets and intracellular pro- and anti-inflammatory cytokine production by T cells. Clinical data and blood samples were collected from 22 men (51.6±6.3 years old) with T2D and 20 nonsmoking men (49.4±7.6 years old) who were matched for age and sex as control subjects. Glycated hemoglobin, high-sensitivity C-reactive protein concentrations, and the lipid profile were measured by a commercially available automated system. Frequencies of lymphocyte subsets in peripheral blood and intracellular production of interleukin (IL)-4, IL-10, IL-17, tumor necrosis factor-α, and interferon-γ cytokines by CD3⁺ T cells were assessed by flow cytometry. No differences were observed in the frequency of CD19⁺ B cells, CD3⁺CD8⁺ and CD3⁺CD4⁺ T cells, CD16⁺56⁺ NK cells, and CD4⁺CD25⁺Foxp3⁺ T regulatory cells in patients with T2D compared with controls. The numbers of IL-10- and IL-17-producing CD3⁺ T cells were significantly higher in patients with T2D than in controls (P<0.05). The frequency of interferon-γ-producing CD3⁺ T cells was positively correlated with body mass index (r=0.59; P=0.01). In conclusion, this study shows increased numbers of circulating IL-10- and IL-17-producing CD3⁺ T cells in patients with T2D, suggesting that these cytokines are involved in the immune pathology of this disease.     

Differences in glycemic control and cardiovascular risk in primary care patients with type 2 diabetes in West Indies

There are limited resources and facilities at primary care clinics in most developing countries. Medical professionals are often faced with the challenges of providing standard health care delivery in the absence of adequate resources. We aimed to evaluate the long-term glycemic control and risk of cardiovascular disease in multi-ethnic groups of diabetic patients attending primary care clinics in Trinidad. One hundred and ninety-one (127 females, 64 males, mean age 56.6 years) patients with type 2 diabetes (mean duration 9.2 years) attending primary care clinics in Trinidad were studied after a 12 to 14-h overnight fast. Weight, height, waist and hip circumferences, and blood pressure were measured, and a blood sample was taken for glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and creatinine determinations. About 85% of patients had glycated hemoglobin levels >7.0%, 31% had central obesity, 49% had diastolic blood pressure >83 mmHg, while 40% had a total-cholesterol/high-density lipoprotein-cholesterol ratio greater than 6. In comparison with males, female patients had significantly higher levels of total-cholesterol and low-density lipoprotein-cholesterol independent of obesity (P<0.01) while male patients of East Indian descent had the highest risk of cardiovascular disease compared with males of any other ethnic group (P<0.01). In conclusion patients with type 2 diabetes attending primary care clinics in Trinidad had poor glycemic control. Female and male patients of Indian ethnic group were at the highest risk of cardiovascular disease. Efforts at strict glycemic control and protection against microvascular complications should be intensified at primary care levels. Received: 17 October 2000 / Accepted: 30 May 2001     

A 5 - year surveillance of wound infections at a rural tertiary hospital in Nigeria

Background

Wound infections are associated with increased morbidity and mortality.

Objectives

To determine the prevalence, aetiology and susceptibility profile of bacterial agents of wound infection among in- and- out patients at a rural tertiary hospital in Nigeria, within a 5 year period.

Methods

Wound swabs collected from 156 out-patients and 353 in-patients were, cultured and microbial isolates identified using standard methods. Antibiotic susceptibility testing was done on bacterial isolates.

Results

The prevalence of wound infection in 2006, 2007, 2008, 2009 and 2010 was 71.4%, 76.2%, 74.5%, 61.5%, and 67.0% respectively. The overall prevalence of wound infection was 70.1%. In all the years studied, out-patients had a higher prevalence of wound infection, but this was significant in 2007, 2009, and 2010 only. Staphylococcus aureus was the most prevalent pathogen in both in- and out - patients with the exception of 2009 where both Staphylococcus aureus and Pseudomonas aeruginosa had the same prevalence (24.4%) among in - patients. The flouroquinolones were the most potent antimicrobial agents against bacterial isolates from both in - and out -patients.

Conclusion

Staphylococcus aureus was the most predominant etiologic agent of wound infection among in and out patients. A generally higher resistance pattern was observed among nosocomial bacterial pathogens. Prudent use of antibiotics is recommended.     

NAT2基因多态性与2型糖尿病的关系

目的探讨NAT2基因多态性与2型糖尿病易感性的关系,为糖尿病的有效防治提供科学依据。方法采用PCR及测序技术对174例2型糖尿病患者和174例健康者的NAT2基因4个常见突变位点进行检测。结果糖尿病组中NAT2等位基因频率分别为：Wt（69.54%）,M2（16.37%）,M3（10.63%）,M1（3.44%）。与正常对照组比较差异无显著性。NAT2基因型（WT/WT,WT/Mx,Mx/Mx）在糖尿病组中分布频率分别为44.82%,49.42%,5.74%,两组间比较差异显著。糖尿病组中快乙酰化者164例（占94.25%）,慢乙酰化者10例（占5.75%）,两组间比较有差异。携带NAT2快乙酰化基因型者患2型糖尿病的风险是携带NAT2慢乙酰化基因型者的3.98倍。结论本研究提示快乙酰化代谢表型可能是糖尿病的一个遗传易感因素,而慢乙酰化代谢表型可能对糖尿病的发生具有一定保护作用。     

Declining structured diabetes education in those with type 2 diabetes: A plethora of individual and organisational reasons

Objective

to identify the expressed reasons adults with type 2 diabetes decline structured diabetes education (SDE).

Turkish validity and reliability study of type 2 diabetes stigma assessment scale

Background/aim Stigma has a high incidence and adversely affects people with diabetes. In this context, patients face difficulties such as fear of losing their jobs, travel restrictions, isolation from social life, problems related to mental health, and feeling of wellness. The aim of this study was to investigate the validity and reliability of the stigma assessment scale in individuals with type 2 diabetes.Materials and methods The study sample consisted of 153 diabetic individuals. The validity of language, content, and construct were examined to evaluate the validity of the type 2 diabetes stigma assessment scale. Cronbach’s alpha was used to assess internal consistency reliability. Results The content validity index of 19 items which were detected as significant was found to be 0.86. The Cronbach’s alpha coefficient of the scale is 0.92. The results of the item analysis show that all factor loads are significant (t-value > ±1.96). The coefficient of correlation between type 2 diabetes stigma assessment scale and test–retest technique was 0.82. Conclusion It was concluded that the stigma assessment scale is a valid and reliable measurement tool in individuals with type 2 diabetes mellitus. Nurses may use this tool to better understand and help relieve the prevalence and severity stigma of individuals with type 2 diabetes in Turkey.     

Clinical features of patients with type 2 diabetes mellitus and hepatitis C infection

The objective of the present cross-sectional study was to assess the prevalence and the clinical and laboratory features of hepatitis C virus (HCV)-positive patients with type 2 diabetes mellitus (DM) attending either an outpatient clinic or hemodialysis units. Serologic-HCV testing was performed in 489 type 2 DM patients (303 outpatients and 186 on dialysis). A structured assessment of clinical, laboratory and DM-related complications was performed and the patients were then compared according to HCV infection status. Mean patient age was 60 years; HCV positivity (HCV+) was observed in 39 of 303 (12.9%) outpatients and in 34 of 186 (18.7%) dialysis patients. Among HCV+ patients, 32 were men (43.8%). HCV+ patients had higher serum levels of aspartate aminotransferase (0.90 ± 0.83 vs 0.35 ± 0.13 μKat/L), alanine aminotransferase (0.88 ± 0.93 vs 0.38 ± 0.19 μKat/L), gamma-glutamyl transferase (1.57 ± 2.52 vs 0.62 ± 0.87 μKat/L; P < 0.001), and serum iron (17.65 ± 6.68 vs 14.96 ± 4.72 μM; P = 0.011), and lower leukocyte and platelet counts (P = 0.010 and P < 0.001, respectively) than HCV-negative (HCV-) patients. HCV+ dialysis patients had higher diastolic blood pressure than HCV- patients (87.5 ± 6.7 vs 81.5 ± 6.0 mmHg; P = 0.005) and a lower prevalence of diabetic retinopathy (75 vs 92.7%; P = 0.007). In conclusion, our study showed that HCV is common among subjects with type 2 DM but is not associated with a higher prevalence of chronic diabetic complications.