<b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) is a pandemic viral infection that has ravaged the world in recent times, and the associated morbidity and mortality have been much more pronounced in those with noncommunicable disease. Diabetes mellitus is one of commonest noncommunicable diseases associated with worsening clinical status in COVID-19 patients. <b><i>Summary:</i></b> The aim of this review was to evaluate the receptors and pathogenetic link between diabetes and COVID-19. Both disease conditions involve inflammation with the release of inflammatory markers. The roles of angiotensin-converting enzyme molecule and dipeptidyl peptidase were explored to show their involvement in COVID-19 and diabetes. Pathogenetic mechanisms such as impaired immunity, microangiopathy, and glycemic variability may explain the effect of diabetes on recovery of COVID-19 patients. The effect of glucocorticoids and catecholamines, invasion of the pancreatic islet cells, drugs used in the treatment of COVID-19, and the lockdown policy may impact negatively on glycemic control of diabetic patients. The outcome studies between diabetic and nondiabetic patients with COVID-19 were also reviewed. Some drug trials are still ongoing to determine the suitability or otherwise of some drugs used in diabetic patients with COVID-19, such as dapagliflozin trial and linagliptin trial.
Background: Diabetes distress (DD) is a common worldwide problem in diabetic patients irrespective of age and type of treatment. In the DAWN 2 study (Diabetes Attitudes, Wishes, and Needs), DD was reported by 44.6% of participants. Objectives: The purpose of this study was to assess the prevalence and level of DD and its associated factors among adult diabetic patients in South East Nigeria. Methods: The present study was cross-sectional and descriptive. Patients attending the adult diabetes clinic were enrolled. The questionnaire was administered by the investigators. All patients were eligible. Their demographic and clinical data were obtained. They were screened for DD using the DD Scale (DDS)-2 and DDS-17. Data were tabulated and analyzed using SPSS version 21. Results: There were 110 subjects (38 males and 72 females), aged 36–85 years (60.5 ± 10.0). Only 9 (8.2%) had diabetes mellitus (DM) type 1, while the rest had type 2 DM. Twenty-five subjects (22.7%) were on insulin injection. Hypertension was coexistent in 72%, and they were prescribed 3–10 medications (5.9 ± 1.5) at the time of assessment. The male and female subjects were comparable. Moderate to severe DD was present in 51.9% (DDS-17). The average scores were for DDS-2, 3.1; DDS-17, 2.3; emotional burden, 2.9; physician-related distress, 1.4; regimen-related distress, 2.5, and interpersonal distress, 2.2. Distress was significantly associated with a younger age, T1DM, longer duration of diabetes, use of insulin injection, and HbA1C level. Conclusion: DD is a common consequence of living with diabetes and impairs diabetes self-care behavior and glycemic control. Active screening for DD should be an integral part of diabetes care. Diabetes self-management education and support should be implemented at diagnosis and as needed thereafter, especially when DD is diagnosed.
Metformin has been used for a long time as an antidiabetic medication for type 2 diabetes. It is used either as a monotherapy or in combination with other antidiabetic medications. The drug came into prominence in diabetes and other conditions with cardiovascular risk after the landmark study of 1995 by the United Kingdom Prospective Diabetes Study which emphasized its importance. However, the drug has been used in experimental trials in various aspects of medicine and pharmacology such as in reproductive medicine, cancer chemotherapy, metabolic diseases, and neurodegenerative diseases. It has been in use in the treatment of polycystic ovarian disease and obesity and is being considered in type 1 diabetes. This study seeks to evaluate the relevance of metformin in cancer management. Different mechanisms have been proposed for its antitumor action which involves the following: (a) the activation of adenosine monophosphate kinase, (b) modulation of adenosine A1 receptor (ADORA), (c) reduction in insulin/insulin growth factors, and (d) the role of metformin in the inhibition of endogenous reactive oxygen species (ROS); and its resultant damage to deoxyribonucleic acid (DNA) molecule is another paramount antitumor mechanism.
Background: Type 2 diabetes constitutes more than 90% of cases seen in Nigeria. Previous reports had shown that patients were poorly controlled and failed to meet management target across a broad range of parameters. Objectives of this study evaluated the characteristics and practices of patients attending the outpatient diabetes clinic. The study also examined to what extent they achieved management goals and what practices by the patients impacted negatively on treatment outcome.Methods: This was a cross sectional descriptive study. All patients were eligible. Consecutive patients attending the Diabetes Clinic were evaluated. Their demographic, behavioural, social, clinical and laboratory data were obtained. Data analysis was done with SPSS V 21.Results: There were 193 subjects, 78 males and 115 females aged 35-82(59.8± 9.1) years. T2DM was diagnosed in 93.4%. Hypertension was coexistent in 74%. Present or past foot ulcer was recorded in 11.9%. Only 37% of the subjects had an exercise program, 35% did the daily foot exam, and 45% had ophthalmology consult. Skipping medication was widespread (64%), mainly due to self-titration of medications (44%) and cost (23%). Fear of hypoglycemia (83%) and hypotension (79%) was prevalent. Their body mass index was 18.2-41.2(27.6±4.8) kg/m2. Subjects were prescribed a total of 2-14 medications (5.5±1.6). Metformin was the most commonly used glucose lowering medication (88.6%), followed by sulfonylureas (64%) and insulin (27.5%). HbA1c ranged from 5.3-16; 9.0±2.4%(33-151; 75±2.7 mmol/mol).Conclusion: Glycaemic control was poor in the study population. Intermittent medication to avoid hypoglycemia played a major role. The patients lacked competence to manage their diabetes from day to day. Diabetes Self-Management Education and Support (DSMES) and early use of insulin are recommended.
Background: HIV/AIDS is a multi-system disease that has been associated with several endocrinopathies including thyroid dysfunction. Thyroid dysfunction in patients with HIV/AIDS, among other factors, may arise from the direct cytopathic effects of HIV on the thyroid gland in addition to the adverse effects of highly active anti-retroviral drugs (HAART). Study objective: The study aimed to determine the prevalence and pattern of thyroid dysfunction in HAART naïve HIV patients in Enugu. Materials & methods: Study was cross sectional, casecontrol based, involving 250 HAART naïve HIV sero-positive patients and 250 HIV sero-negative subjects. Anthropometric measurements and physical examination were done. Assay for fT3, fT4, TSH (for thyroid function) was done using the Enzyme Linked Immunoassay (ELISA) method. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Results: The HAART naïve sero-positive cohorts comprised 112 males and 138 females while the control subjects consisted of 125 males and 125 females. Mean ages (years) of test and control groups were 38.84± 10.60 and 39.58 ±11.68 respectively. Prevalence of thyroid dysfunction among the study subjects was 36.4% and 7.6% in the controls. Subclinical hypothyroidism was the most common prevalent type of thyroid dysfunction in both test and control groups at 17.6% and 7.2% respectively. In the test group, sick euthyroid syndrome (17.2%) ranked second while in the controls, primary hypothyroidism (7.2%) was the second commonest dysfunction. Conclusion: Thyroid dysfunction was more common in HAART-naïve HIV sero-positive subjects than in the general population with subclinical hypothyroidism emerging as the commonest abnormality.
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