Nigerian Endocrine Practice

A review of peripheral arterial disease in diabetes mellitus

PO Akinwusi, OO Okunola, AT Oyedeji — Tue, 04 Feb 2014 00:00:00 +0000

There is an unrelenting global increase in the incidence and prevalence of diabetes mellitus (DM) with its attendant cardiovascular complications. Macrovascular complications such as peripheral arterial disease (PAD) are major consequences of DM. This review briefly summarizes the broader literature on the burden of PAD in persons with diabetes. It focuses on useful investigations especially the role and the appropriateness of the ankle brachial pressure index (ABPI) in a resource constrained setting. Furthermore it also discusses the pertinent pathophysiological principles and ideal wholistic management strategies with emphasis on the cost effective management of the cardiovascular risk factors.

Pattern of diabetes admissions in a Northern Nigerian tertiary health centre

AE Uloko, AF Adeniyi, LY Abubakar, SM Yusuf, A Abdu, ID Gezawa, AT Uloko — Tue, 04 Feb 2014 00:00:00 +0000

Background: The pattern of diabetes admissions in tertiary health care facilities in northern Nigeria is poorly documented. We aimed to review the clinical presentation, complications and mortality of diabetes admissions at the Aminu Kano Teaching Hospital (AKTH) Kano.

Methods: A retrospective review of cases of diabetes mellitus (DM) admitted into the medical wards of AKTH over 30 months was done. Data extracted from patients’ case notes, ward admission/discharge register and death certificates included total medical ward admissions, DM admissions and indications for admission, DM patients’ demographic and clinical / laboratory parameters, mortality rates and clinical outcome.

Results: Of the 3,157 patients admitted, 204 (6.46%) were diabetics. The mean (SD) age of DM patients was 54.32 (16.18) years (range 17 – 86 years); males 53.39 (15.91) years; females 55.11 (16.44) years. Of the 204 DM patients, 93(45.6%) were males while 111(54.4%) were females. Mean duration of DM was 6.53 (7.61) years. There were more Type 2 DM 168 (82.4%) than Type 1 DM 36 (17.6%) patients, p< 0.05. Mean body mass index of the DM patients was 26.41 (4.99) Kg/m2 (range 16.16 – 42.86). Most of the DM patients (83%) were admitted for hyperglycaemic emergencies with a mean admission random plasma glucose (RPG) of 21.32 (10.89) mmol/l which improved to 7.87 (4.34) mmol/l at discharge. Frequent indications for admission were sepsis 63(30.9%), hyperglycaemic hyper-osmolar state 29(14.2%), cerebrovascular accident 19(9.3%), DM foot ulcer 15(7.4%), diabetes ketoacidosis 15(7.4%), hypoglycaemia 12(5.9%), nephropathy 29(14.2%) and severe hypertension 22(10.8%). Chronic complications found in the DM admissions included peripheral
neuropathy 69(33.8%), CVA 19(9.3%), retinopathy 35(17.2%), nephropathy 29(14.2%), cataract 19(9.3%), DM Foot ulcer 15(7.4%), ischaemic heart disease 7(3.4%) and erectile dysfunction 6(2.9%). Total mortality rate among medical admissions was 16.04% with DM accounting for 2.6% of total deaths.

Conclusion: Most of the DM patients admitted on to the medical wards of AKTH have chronic complications of DM and were overweight. Acute metabolic complications of DM and sepsis were the main indications for admission and accounted for the common causes of death.

Keywords: Diabetes mellitus, admissions, pattern, tertiary healthcare, Northern Nigeria

Assessment of diabetes-related knowledge among health care providers in a tertiary health institution in Nigeria

MA Olamoyegun, SO Iwuala, OM Akinlade, KD Olamoyegun, B Kolawole — Tue, 04 Feb 2014 00:00:00 +0000

Background: Management of diabetic patients cut across many specialties because of the diverse presentations and complications of the disease. About a third of patients with type 2 diabetes are on insulin either alone or
in combination with oral anti- diabetic agents. Also, all patients with type 1 diabetes are on insulin. This study assessed diabetes- related knowledge of health care professionals in a tertiary institution with particular emphasis
on inpatient diabetes management skills and insulin therapy.

Methodology and design: This cross- sectional study utilised a 42- item questionnaire in assessing diabetesrelated knowledge of specialists, resident doctors and nurses in departments of medicine, surgery, and gynaecology at LAUTECH Teaching Hospital, Ogbomoso, Nigeria.

Results: Of the 185 subjects approached, 155 completed the questionnaire. Knowledge was highest among specialists and lowest among nurses. Participants from the Internal Medicine service (specialists, residents and nurses) had the highest level of knowledge score (44±12%). The mean score (%) of study participants on knowledge of insulin therapy was 36%; highest scores was obtained among specialists in internal medicine (55%) and lowest scores were recorded among nurses in gynaecology (27%). Similar low knowledge scores were found among participants on ketoacidosis (38%) and hypoglycaemia (34%). There was a significant difference between resident doctors in medicine and residents’ doctors in gynaecology (55% vs. 39%, p< 0.05) in the knowledge of diabetic ketoacidosis. Although comfort level was highest among specialists in gynaecology (5.09), this did not translate to better knowledge in most domains assessed.

Conclusion: The knowledge of diabetes in patient care was fair and acceptable among specialists and resident doctors in internal medicine but significantly poor among specialists and resident doctors in other fields/
specialties. Nurses on the other hand, had very low knowledge in diabetes. This correlated with comfort levels (except in gynaecology) in dealing with issues pertaining to diabetes care.

Prolactinoma in a Nigerian male: case report and review of the literature

KB Sada, KM Anka, AA Sabir, AE Uloko — Tue, 04 Feb 2014 00:00:00 +0000

Prolactinomas present late in males due to absence of classical features in women such as cessation of menstruation and galactorrhoea. High index of suspicion will aid early diagnosis and prevent complications. Dopaminergic agonists, surgery and Radiotherapy are the treatment modalities. Dopaminergic agonists are the first option of therapy in noneasily resectable macroprolactinomas.

Bardet-biedel syndrome: a case report and a review of literature

SO Iwuala, MA Olamoyegun, OA Fasanmade, AE Ohwovoriole — Tue, 04 Feb 2014 00:00:00 +0000

Background: Bardet- Biedl syndrome (BBS) is a group of autosomal recessive conditions with overlapping phenotype of rod-cone dystrophy, central obesity, mental retardation, and hypogonadism. There are very few
reports of BBS from Sub-Saharan Africa.

Objective: To report a case of BBS and review existing literature on BBS, highlighting the challenges in its management in a resource poor setting.

Methods: A 17 year old girl presented for evaluation. A full history and physical examination were performed. Investigations carried out include basal hormonal profile, pelvic ultrasound, bone age determination and brain imaging.

Results: The patient presented with blindness worse at night, obesity, delayed developmental milestones, learning difficulties and delayed puberty. She had a short neck, acanthosis nigricans, brachydactyly and hirsuitism. There was a positive family history of similar problems in her younger sister who also had polydactyly and bladder instability but had not been investigated. The parents had difficulty coping with their care especially their educational needs in view of the multiplicity of their problems. The patient weighed 80kg, was 1.43 m tall (BMI-39.1kg/m²), had arm span 1.23m, crown-pubis 0.73m, pubis-heel 0.70m, waist circumference 0.88m, hip circumference 1.22m. Opthalmologic evaluation revealed rotary nystagmus, astigmatism, reduced visual acuity and retinal pigment mottling. Oral glucose tolerance test (OGTT) revealed normal glucose tolerance. Basal hormone profile showed hypogonadotrophic hypogonadism, normal thyroid function and hyperinsulinaemia. Her bone age was appropriate for chronological age. Her parents sought contact with BBS groups due to the challenges in educational needs and care being experienced.

Conclusion: Management of BBS involves a multidisciplinary approach the burden of which can be overwhelming for care- givers, moreso in a resource constraint setting as ours.

Keywords: Biedl- Bardet syndrome, night blindness, Nigeria