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1.  The metabolic syndrome in thyroid disease: A report from Nigeria 
The objective of this study was to determine the prevalence of the metabolic syndrome and its components in people with thyroid disorders.
Materials and Methods:
112 subjects with a history of thyroid disorders were consecutively enrolled for the study. Clinical data were obtained by interviewing the patients and referring to their case folders and prescriptions. The subjects were categorized into three: thyrotoxic, those with hypothyroidism and those with nontoxic goiters, based on clinical parameters and or thyroid function tests. The study subjects were weighed and their anthropometric indices were documented. The laboratory parameters that were analyzed included total cholesterol, high-density and low-density cholesterol and triglyceride. Statistical analysis was performed using Student's t test, one-way analysis of variance (ANOVA) test and chi-square test.
The study subjects were aged between 14 and 76 years, with a mean age of 44.5 years, and the female:male ratio was 97:15. The mean age and anthropometric indices were comparable in subjects with thyrotoxicosis, hypothyroidism and euthyroidism. The overall prevalence of the metabolic syndrome was 28% and the frequency of occurrence of the metabolic syndrome in subjects with thyrotoxicosis, hypothyroidism and nontoxic goiter was 24%, 40% and 42%, respectively. The commonest occurring metabolic syndrome defining criterion was dysglycemia, while hypertension and elevated triglyceride were the least documented of the criteria.
Metabolic syndrome occurs in 1 in every 4 persons with thyroid disorders, and as such, routine screening for this cardiovascular risk factor may be of benefit in this group of people, especially in those with hypothyroidism.
PMCID: PMC3354852  PMID: 22629511
Metabolic syndrome; Nigeria; thyroid
2.  Insulin use, prescription patterns, regimens and costs.-a narrative from a developing country 
Achieving good glycemic control is of paramount importance in the reduction of diabetes mellitus (DM) associated morbidity and mortality. Insulin plays a key role in the management of DM but unfortunately whilst some healthcare providers present insulin as a treatment of last resort , patients on insulin often have insulin related issues such as needle phobias, fear of hypoglycaemia, weight gain and in developing countries, costs. This Report aims at assessing insulin prescription pattern, insulin costs and issues associated with adherence.
This was a Cross-sectional observation Study whereby 160 patients with DM who were on insulin solely or in combination with oral hypoglycaemic agents were recruited over a 6 month period. Information obtained from the Study subjects pertained to their histories of DM, types of insulin, insulin costs, adherence issues and insulin delivery devices. Long and short term glycaemic control were determined and evaluated for possible relation to insulin adherence. Test statistics used were chi square, t test and binary regression.
Insulin adherence was noted in 123-77% of the Study subjects and this was comparable between persons with type 1 DM and those with type 2 DM. The mean glycosylated haemoglobin values were significantly higher in those who admitted to non insulin adherence compared to those who adhered to their insulin regimen (9.7% (2.3) Vs 8.6% (2.1), p = 0.01). Reasons proffered by Respondents for non insulin adherence included high costs-15(41%), inconvenience −15 (41%) and needle pain-79)18%. A greater proportion of persons who self injected insulin adhered to insulin prescriptions compared to those who did not self inject and thus had better glycaemic control. Shorter duration of DM and older age were found to be predictors of adherence to insulin prescription.
The monthly mean costs of insulin for those who earned an income was 5212.8 Nigerian naira which is equivalent to 33.1 US dollars and we estimated that persons on a minimum wage would spend 29% of their monthly income on the procurement of insulin.
Health related costs, age, duration of DM and insulin associated side effects are some of the factors implicated in adherence to insulin prescription.
PMCID: PMC3538575  PMID: 23199230
3.  Latent Autoimmune Diabetes Mellitus in Adults (LADA) and it’s characteristics in a subset of Nigerians initially managed for type 2 diabetes 
Latent autoimmune diabetes in adults (LADA) is an entity characterized by the presence of GAD autoantibodies. LADA is largely understudied and underreported amongst Nigerians with Diabetes Mellitus (DM). We undertook to document the Prevalence, clinical and biochemical characteristics of LADA in a subset of Nigerians who hitherto had been treated for type 2 DM.
This is a cross-sectional study conducted on 235 patients being managed for type 2 DM. The diagnosis of LADA was made in the presence of Glutamic Acid Decarboxylase autoantibody (GADA) positivity in the study subjects. Thereafter persons with LADA were compared with those without LADA. Clinical parameters such as demographic data, history of diabetes mellitus (DM) and its complications were obtained, biochemical parameters including Fasting blood glucose (FBG), C-peptide, glycated haemoglobin (HbA1c) and lipid parameters were compared in both groups of Study subject. Test statistics used were Student t- test and χ 2. SPSS was used for data analysis.
Thirty three out of 235 of the Study subjects were GADA positive, giving a prevalence of 14%. The mean age (SD) of the subjects with LADA is 53.24(7.22) with an age range of 30–63 years. Majority (48%) of LADA subjects were in the 50–59 age category. There was no significant difference in the proportion of males and females with LADA (p = 0.3). 37% of patients with LADA were on insulin for glycaemic control. Three (3) LADA subjects had history/clinical evidence of autoimmune thyroid disease. 66% of LADA were in the overweight/obese category. LADA subjects had significant poor long term glycaemic control compared with anti-GAD negative subjects (p = 0.026). About half of LADA subjects were insulinopaenic. LADA subjects had lower levels of total cholesterol than GADA-ve subjects (p = 0.03). A higher proportion of LADA had evidence of microvascular complications of DM compared with antiGAD negative individuals.
The diagnosis of LADA should be entertained in overweight/obese persons from the fourth decade of life presenting with DM. Pharmacotherapy with insulin is a potential means of managing hyperglycaemia in this group of patients especially since a significant proportion are insulinopaenic. The Prevalence of LADA in our patients is comparable to what obtains in Ghanaian and Caucasian populations.
PMCID: PMC3464687  PMID: 22894705
LADA; Prevalence; Complications; Nigerians
4.  Understanding asthma and the metabolic syndrome - a Nigerian report 
Nigeria is a developing country that is currently witnessing an upsurge in diabetes mellitus and obesity with its antecedent consequences. There is also a fairly high prevalence of asthma affecting an estimated 10.7% of the population. There is no data presently on the possible presence of metabolic syndrome in Nigerian living with asthma. The study was conceived to determine the prevalence of metabolic syndrome among a population of asthmatics seen in our practice. We also attempt to compare asthma severity, control and pulmonary function tests in asthmatics with metabolic syndrome and those without.
This cross-sectional study was carried out at the asthma clinic of a tertiary teaching hospital. Ethical clearance was obtained from the research and ethics committee of the hospital. Written consent was obtained from the participants. Interviewer based questionnaire was used to obtain required information, anthropometric indices were recorded and clinical examinations done. Pulmonary function tests were carried out using desktop Alpha Spirometer model 6000 made by Vitalograph UK (2007). Blood pressure was measured using sphygmomanometer in mmHg. Fasting venous blood was taken for blood sugar and lipid profile. Metabolic syndrome was defined by the international diabetes Federation (IDF) criteria.
One hundred and fifty eight (158) asthmatics participated in the study comprising of 63 (39.9%) males and 95(60.1%) females. The age range was 14-78 years with a mean of 46.48+/-17.00 years. The mean duration of asthma diagnosis was 13.95+/-12.14 years. The prevalence of hypertension was 29.1%. 17 (10.8%) had fasting blood sugar above 100 mg/dl. Abdominal obesity was present in 78 (49.5%). The mean total cholesterol was 192.63+/-40.7 mg/dl. HDL was low in 21(22%) of female and 3 (4.8%) male. The prevalence of metabolic syndrome was 17.7%, affecting 28 asthma patients. Asthma control was affected by the presence of metabolic syndrome. P < 0.05. The pulmonary function test was not significantly affected by presence of metabolic syndrome.
Metabolic syndrome prevalence is high in the population of asthma patients studied. It is therefore important to screen patient with asthma for this condition and treat to improve outcome.
PMCID: PMC3499319  PMID: 22726248
5.  Acute phase reactant dynamics and incidence of microvascular dysfunctions in type 2 diabetes mellitus 
Acute Phase Reactants (APRs) have a wide range of activities that contribute to host defense. The aim of this report was to evaluate the dynamics and magnitude of these proteins in various microvascular complications in diabetes mellitus (DM). We also sought to assess the predictive values of APRs and other clinical variables for microvascular complications in DM.
This was a case control study carried out in 200 Nigerian subjects with type 2 DM and 100 sex and age matched healthy controls. The studied APRs included C-reactive protein, beta 2 microglobulin, fibrinogen and lipoprotein (a).
The mean values of the APRs were significantly higher in type 2 DM compared with the controls and were observed in higher concentrations in those with microvascular complications, except beta 2 microglobulin. Presence of microvascular complications was observed in those with dilated fundus examination (retinopathy), symptom score of 3.0 (neuropathy), urea and creatinine levels above 50mg% and 1.5mg%, respectively, with significant proteinuria (nephropathy). Significant increase in mean ± SEM values of lipoprotein (a) was observed in diabetic retinopathy in comparison with those without complications (25.76 ± 1.13 mg/dl vs. 22.37 ± 0.73 mg/dl, p = 0.005). Elevated C-reactive protein was observed in diabetic neuropathy in comparison with those without complications (11.43 ± 2.33 u/ml vs. 8.30 ± 1.15 u/ml, p = 0.048). Increased beta 2 microglobulin levels were observed in patients with diabetic foot ulcers in comparison with those without complications (3.04 ± 0.51 mg/dl vs. 2.54 ± 0.14 mg/dl, p = 0.049). Circulating levels of Lipoprotein (a) predicted retinopathy in DM with both good and poor long-term glycemic control while duration of DM predicted the occurrence of foot ulcers..
Increased level of APRs was associated with a number of microvascular complications and may play a role in the pathogenesis.
PMCID: PMC3430019  PMID: 22973323
Acute Phase Reactants; Type 2 Diabetes Mellitus; Microvascular Complications
6.  Advanced age, altered level of consciousness and a new diagnosis of diabetes are independently associated with hypernatreamia in hyperglycaemic crisis 
There is limited literature on hypernatreamia in the setting of hyperglycaemic crisis. This is despite the fact that the presence of hypernatreamia may impact on the classification of hyperglycaemic crisis and its management particularly with regards to the nature of fluid therapy. We determined the prevalence of hypernatreamia and its associated factors at presentation for hyperglycaemic crisis.
This was a retrospective review of data for hyperglycaemic crisis admissions in Nelson Mandela Academic Hospital, Mthatha, South Africa. The prevalence of hypernatreamia (uncorrected Serum Sodium at presentation >145 mmol/L) was determined. Hyperosmolality was defined by calculated effective osmolality >320 mosmols/Kg. Multivariate logistic regression was undertaken using variables that were statistically significant in univariate analysis to ascertain those that were independently associated (Odds Ratio (OR) with 95% Confidence Interval (CI)) with hypernatreamia.
The prevalence of hypernatreamia in our admissions for hyperglycaemic crisis was 11.7% (n = 32/273 including 171 females and 102 males). All admissions with hypernatreamia met the criteria for hyperosmolality. Age ≥ 60 years (OR = 3.9 95% CI 1.3-12.3; P = 0.018), Altered level of consciousness (OR = 8.8 95% CI 2.3-32.8; P < 0.001) and a new diagnosis of diabetes (OR = 3.7 95%CI 1.2-11.5; P = 0.025) were independently associated with hypernatreamia.
The prevalence rate of hypernatreamia in hyperglycaemic admissions was high with all hypernatreamic admissions meeting the criteria for hyperosmolality. Advanced age, altered conscious level and a new diagnosis of diabetes were independently associated with hypernatreamia.
PMCID: PMC3103444  PMID: 21501465
Hypernatreamia; Hyperglyceamic crisis; prevalence; determinants; South Africa
7.  Lipoprotein (a), C-reactive protein and some metabolic cardiovascular risk factors in type 2 DM 
Lipoprotein (a) (LP (a) is an independent cardiovascular risk factor that is not widely studied in people of sub-Saharan African origin. The aim of this report is to determine the frequency of occurrence of elevated Lp (a) and possible relationship with total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), C reactive protein (CRP) and serum uric acid (SUA).
This is a cross sectional study carried out in 200 Nigerian patients with type 2 DM and 100 sex and age matched healthy Controls aged between 32-86 years. We determined the frequency of occurrence of elevated Lp (a) levels in the study subjects and compared clinical and biochemical variables between type 2 diabetic patients and non-diabetic patients. Clinical and biochemical parameters were also compared between subjects with type 2 DM who had elevated LP (a) and normal LP (a) levels. Long term glycaemic control using glycosylated haemoglobin was determined and compared in the study subjects. Test statistics used include chi square, correlation coefficient analysis and Student's t test.
The mean Lp(a) concentration differed significantly between type 2 diabetic patients and the Control subjects (18.7 (5.8) mg/dl vs 23 (6.8) mg/dl, 0.00001). Similarly, the prevalence of high LP (a) levels in type 2 DM patients was significantly higher than that of the Control subjects (12.5% vs 4%, p-0.019). The mean levels of the lipid profile parameters (TCHOL, LDL-C, TG, LDL/HDL) and CRP were significantly higher in DM patients than in the Control subjects. The mean LP (a) levels were comparable in both sexes and in DM subjects with and without hypertension. TG was the only parameter that differed significantly between subjects with elevated Lp (a) levels and those with normal Lp (a) levels. There was a significant positive correlation (r) between Lp(a) levels and TG, LDL-C. TCHOL, LDL/HDL and uric acid. No association was found between Lp(a) and clinical parameters such as age and anthropometric indices.
We have showed that Lp (a), CRP and other CVS risk factors cluster more in patients with DM than non DM patients. Serum Lp (a) levels are not associated with anthropometric and glycaemic indices.
PMCID: PMC2919447  PMID: 20663222
8.  Hyperuricaemia and the metabolic syndrome in type 2 DM 
Elevated serum uric acid levels (SUA) have been associated with an increased risk of cardiovascular diseases and the metabolic syndrome (MetS) and are often reported to be higher in females than in males. The aim of this report is to determine the prevalence and clinical correlates of hyperuricaemia and also to evaluate associations with the MetS in people with type 2 diabetes mellitus (DM).
This was a cross-sectional study conducted in people with type 2 DM in Lagos, Nigeria. Hyperuricaemia was defined by cut-off values of > 7 mg/dl for men and > 6 mg/dl for women. The diagnosis of MetS was made using the new definition by the American Heart Association and other related bodies. Clinical and biochemical parameters were compared between subjects with hyperuricaemia and normouricaemia. Statistical analysis included usage of Student's t test, Pearson correlation coefficients, multivariate regression analysis and chi square.
601 patients with type 2 DM aged between 34-91 years were recruited for the study. The prevalence rates of hyperuricaemia and the MetS were 25% and 60% respectively. The frequency of occurrence of hyperuricaemia was comparable in both genders (59% vs 41%, p = 0.3). Although, the prevalence of the MetS in subjects with hyperuricaemia and normouricaemia was comparable (61 vs 56%, p = 0.1), a higher proportion of hyperuricaemic subjects had 3 or more components of the Mets compared with normouricaemic subjects. Possible predictors of hyperuricaemia include central obesity, smoking and elevated serum triglycerides (TG). SUA levels were found to be positively and significantly associated with serum TG (r = 0.2, p = 0.0001) and total cholesterol (r = 13, p = 0.001).
The prevalence of hyperuricaemia in subjects with type 2 DM is comparable in both genders and possible predictors of hyperuricaemia are potentially modifiable. SUA is positively and significantly associated with serum TG and total cholesterol.
PMCID: PMC2864200  PMID: 20406485
9.  Prevalence and gender distribution of the metabolic syndrome 
The Metabolic syndrome (MetS) is a cardiovascular risk factor of public health significance and of recent has become a topical issue. The prevalence of diabetes mellitus (DM) is on the increase and with this scenario, a possible increase in burden of DM which may be largely attributed to cardiovascular complications is expected. The objective of this report is to determine the prevalence of the MetS and compare gender characteristics in subjects with type 2 DM.
Subjects with type 2 DM were recruited from an urban hospital for the study. Clinical data was obtained by interviewing the patients and referring to their Case folders. The anthropometric indices and blood pressure measurements were documented. Laboratory parameters analysed for included total cholesterol, high density and low density cholesterol, triglyceride and glycosylated haemoglobin. Statistical analysis included usage of Student's t test and chi square.
963 patients with type 2 DM aged between 35-85 years were recruited for the study. The main outcome measures included the prevalence of the metabolic syndrome and the gender differences of its components. The prevalence of the metabolic syndrome was 86%. The frequency of occurrence of the MetS was similar for men (83%) and women (86%) and increased with age in both sexes. The prevalence of MetS increased from 11% among participants aged 20 through 29 years to 89% in participants aged 70 through 79. In our patients with DM, the commonest occurring and least detected MetS defining parameters are central obesity and elevated triglyceride levels respectively. The components of the MetS that differed significantly in both sexes was HDL-C. The combination of the components of the MetS were comparable in both genders and 5.8% of the subjects with the MetS had all components of the MetS.
The prevalence of the MetS in type 2DM is high in both genders and increases with age thus posing a potential high cardiovascular risk in this group of patients. The modifiable risk factors for the MetS should be a focus point in the management of subjects with type 2 DM,
PMCID: PMC2836983  PMID: 20180954
10.  Characterization of lipid parameters in diabetes mellitus – a Nigerian report 
Diabetes mellitus (DM) is a disorder that is often associated with cardiovascular events and underlying lipid abnormalities. Cardiovascular complications are common causes of DM deaths in Nigeria yet dyslipidaemia is one aspect of DM that is underdiagnosed and undertreated in our patients. This report seeks to determine the prevalence and pattern of lipid abnormalities in Nigerians with types I and 2 DM.
A total of 600 patients with DM aged between 22 – 79 years were evaluated for lipid abnormalities. The anthropometric indices, glycosylated haemoglobin, pattern of DM treatment and co-morbidities were noted. Total cholesterol (TCHOL), triglyceride (TG), high density lipoproteins (HDL-C), low density lipoproteins cholesterol (LDL-C) levels and the atherogenic indices levels were documented. Test statistic used included student's t test and χ2.
Well over half (89%) of the study subjects had lipid abnormalities and there was no statistically significant difference in the proportions of subjects with type 1 and 2 DM with lipid abnormalities. Elevated LDL-C, TCHOL, TG and reduced HDL-C were noted in 74%, 42%, 13%, and 53% respectively of the study subjects. The commonly noted combined lipid abnormalities were elevated TG and reduced HDL-C. Hypertension, significant histories of smoking and alcohol ingestion were found to be potential determinants of the occurrence of dyslipidaemia. Age, sex, type of DM and anthropometric indices were found to be determinants of the the pattern of dyslipidaemia. Only a small proportion – (8%)-of the subjects with dyslipidaemia were on treatment for it.
Having defined the scope of dyslipidaemia in our patients and also highlighting its gross undertreatment, we hope that our data will help sensitize health care practitioners on screening for and treating dyslipidaemia. Elevated LDL-C and reduced HDL-C should be the primary targets of treatment in our patients with dyslipidaemia.
PMCID: PMC2734749  PMID: 19619328
11.  Clinical features, predictive factors and outcome of hyperglycaemic emergencies in a developing country 
Hyperglycaemic emergencies are common acute complications of diabetes mellitus (DM) but unfortunately, there is a dearth of published data on this entity from Nigeria. This study attempts to describe the clinical and laboratory scenario associated with this complication of DM.
This study was carried out in DM patients who presented to an urban hospital in Nigeria with hyperglycaemic emergencies (HEs). The information extracted included biodata, laboratory data and hospitalization outcome. Outcome measures included mortality rates, case fatality rates and predictive factors for HEs mortality. Statistical tests used are χ2, Student's t test and logistic regression.
A total of 111 subjects with HEs were recruited for the study. Diabetes ketoacidosis (DKA) and hyperosomolar hyperglycaemic state (HHS) accounted for 94 (85%) and 17 (15%) respectively of the HEs. The mean age (SD) of the subjects was 53.9 (14.4) years and their ages ranged from 22 to 86 years. DKA occurred in all subjects with type 1 DM and 73 (81%) of subjects with type 2 DM. The presence of HSS was noted in 17 (19%) of the subjects with type 2 DM.
Hypokalaemia (HK) was documented in 41 (37%) of the study subjects. Elevated urea levels and hyponatraemia were noted more in subjects with DKA than in those subjects with HHS (57.5%,19% vs 53%,18%). The mortality rate for HEs in this report is 20% and the case fatality rates for DKA and HHS are 18% and 35% respectively.
The predictive factors for HEs mortality include, sepsis, foot ulceration, previously undetected DM, hypokalaemia and being elderly.
HHS carry a higher case fatality rate than DKA and the predictive factors for hyperglycaemic emergencies' mortality in the Nigerian with DM include foot ulcers, hypokalaemia and being elderly.
PMCID: PMC2661082  PMID: 19272167

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