Diabetes Mellitus in adult Nigerians: patients’ characteristics, laboratory profile, practices and management outcome

Abstract

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.

Cardiovascular Risk Factors and Prescription Pattern Among Patients With Type 2 Diabetes Mellitus in North-East Nigeria

“…Furthermore, it was also noted that some older studies conducted in Nigeria reported lower prevalence of hypertension (25% to 54.2%) (Osuntokun et al, 1972;Okesina et al, 1995;Chuhwak et al, 2002;Unadike et al, 2011;Odeyinka and Ajayi, 2017), but not less than 30% occurrence of dyslipidaemia and obesity (Awosan et al, 2013). But in agreement with our findings, more recent studies in the country have shown higher proportions of hypertension (74% and 85.5%) and obesity (60% and 51.2%) in patients with T2DM (Onyenekwe et al, 2019;David et al, 2019). This steady increase in cardiovascular risk factors among diabetic population in Nigeria from 25% in 1972 (Osuntokun et al, 1972) to 85.5% in 2019 (David et al, 2019) may be related to westernised lifestyle, nutrition transition, rapid urbanization, increased sedentary lifestyle, physical inactivity, ageing population and poor glycaemic control (Hu et al, 2011;ADA, 2022).…”

Left Ventricular Geometry and Function in Normotensive and Hypertensive Patients with Type 2 Diabetes Mellitus without Overt Cardiac Symptoms

“…The cardiovascular system in particular accounts for about 75% of hospitalizations and mortality from complications of diabetes in diabetics. Diabetes tends to cluster with other CVD risk factors particularly HTN which occurs in 50-70% of diabetics and is known [1][2][3][4][5][12][13][14][15] to worsen pathological changes in the end organs. This study set out to determine the left ventricular geometry and function in normotensive and hypertensive type 2 diabetics without overt cardiac symptoms and associated factors.…”

“…Diabetic heart disease is a spectrum that involves a progression from the normal heart to preclinical cardiac dysfunction (detectable by echocardiography), symptomatic cardiac dysfunction [6][7][8][9][10][11] and finally congestive cardiac failure. Hypertension which occurs in about 50-70% of patients with T2DM is [1][2][3][4][5][12][13][14][15] known to accelerate and worsen these changes. Studies have been ambivalent with regards to LV geometry/function in normotensive/hypertensive [16][17][18][19][20] T2DM patients without cardiac symptoms.…”

Gender Disparity in the Management of Diabetes among Residents of Sabon Gari Local Government Area of Kaduna State, Nigeria

“…Skipping medication in effort to prevent hypoglycaemia, which is said to occur more in men, has been pointed out to play a major role in under-management of diabetes. This study was therefore set up to investigate these claims and determine which gender has DM undermanaged, and requiring more attention among diabetic patients in Sabon Gari LGA of Kaduna State, Nigeria, and a probable reason why it is so [4][5][6].…”