Chidum E. Ezenwaka

A comparative study of the prevalence of the metabolic syndrome and its components in type 2 diabetic patients in two Caribbean islands using the new International Diabetes Federation definition.

Abstract Background and aim: Tobago and Trinidad are two Caribbean islands with distinct genetic background and lifestyles; while Tobago is serene and a tourist centre, Trinidad is characterized by a hustling and bustling lifestyle. The study was aimed at determining and comparing the prevalence of the metabolic syndrome (MetS) and its critical components in type 2 diabetic patients using the new International Diabetes Federation (IDF) definition. Methods: Four hundred and thirteen (166 Tobago, 247 Trinidad) type 2 diabetic patients visiting 10 lifestyle disease clinics were studied. Blood pressure, anthropometric parameters (height, weight, body mass index and waist circumference) and overnight fasting blood samples were taken. Plasma glucose and serum triglycerides, total cholesterol, LDL- and HDL-cholesterol, insulin, and adiponectin were determined. Insulin resistance (IR) was determined using the HOMA method. Results: The patients in Tobago were significantly older than patients in Trinidad (p < 0.001) but the duration of diabetes (9.4 ± 0.5 vs. 11.1 ± 0.7 yr), medications, generalized (31.7 vs. 38.8%) and central (78.5 vs. 83.7%) obesity were similar (p > 0.05). In comparison with patients in Tobago, diabetic patients in Trinidad, irrespective of gender, had significantly higher prevalence of IDF critical components such as raised BP, raised triglycerides and reduced HDL-cholesterol (all, p < 0.001). Thus, while more patients in Trinidad were diagnosed with MetS based on three or four components, more patients in Tobago were diagnosed based on two components (p < 0.001). Conclusions: There were high prevalence rates of the components of the MetS in both the islands of Tobago and Trinidad. Quantitatively, the aggregation of the components is higher in patients in Trinidad, which constitute greater risk for adverse cardiovascular outcome. Controlling central obesity should be the target in preventing MetS in the two islands.

Prevention of diabetes complications in developing countries: time to intensify self-management education.

The IDF report has indicated that about 80% of four million diabetes-related deaths that occur every year comes from the developing world. The IDF report suggests the need to focus more on preventing diabetes complications in poor countries. Thus, considering the economic constraints in combating the explosion of diabetes complications in the developing regions of the world, it appears that exploring culturally adaptable educational intervention programmes for specific regions would be the appropriate strategy. We believe that diabetes-related deaths could be reduced in developing countries through intensified diabetes self-management education.

Anaemia and kidney dysfunction in Caribbean Type 2 diabetic patients

BackgroundAnaemia has been shown in previous studies to be a risk factor for cardiovascular disease in diabetic patients with chronic kidney disorder. This study was aimed to assess the prevalence of anaemia and kidney dysfunction in Caribbean type 2 diabetic patients that have been previously shown to have a high prevalence of the metabolic syndrome.Methods155 type 2 diabetic patients and 51 non-diabetic subjects of African origin were studied. Anthropometric parameters were measured and fasting blood samples were collected for glucose, creatinine, glycated hemoglobin and complete blood count. Anaemia was defined as haemoglobin < 12 g/dl (F) or < 13 g/dl (M). Kidney function was assessed using glomerular filtration rate (GFR) as estimated by the four-variable Modification of Diet in Renal Disease (MDRD) study equation. Subjects were considered to have chronic kidney disease when the estimated GFR was < 60 ml/min per 1.73 m2. Comparisons for within- and between-gender, between diabetic and non-diabetic subjects were performed using Students t-test while chi-square test was employed for categorical variables.ResultsThe diabetic patients were older than the non-diabetic subjects. While male non-diabetic subjects had significantly higher red blood cell count (RBC), haemoglobin and hematocrit concentrations than non-diabetic female subjects (p < 0.001), the RBC and hematocrit concentrations were similar in male and female diabetic patients. Furthermore, irrespective of gender, diabetic patients had significantly higher prevalence rate of anemia than non-diabetic subjects (p < 0.05). Anaemic diabetes patients had significantly lower GFR (67.1 ± 3.0 vs. 87.9 ± 5.4 ml/min per 1.73 m2, p < 0.001) than non-anaemic patients.ConclusionA high prevalence of anaemia was identified in this group of type 2 diabetic patients previously shown to have a high prevalence of the metabolic syndrome. It is therefore recommended that diagnostic laboratories in developing countries and elsewhere should include complete blood count in routine laboratory investigations in the management of diabetic patients.

Abdominal obesity in type 2 diabetic patients visiting primary healthcare clinics in Trinidad, West Indies

Objective - To compare the blood pressure and metabolic parameters of type 2 diabetic patients with high waist circumference (WC) with those of type 2 diabetic patients with normal WC. Design - After 10-14 h overnight fasting, weight, height, waist and hip circumferences and blood pressure were measured, and blood samples taken for glucose, glycated haemoglobin, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol and insulin determinations. Insulin resistance was calculated using the homeostatic model assessment (HOMA) method, while high WC was considered as WC > 102 cm and 89 cm for males and females, respectively. Setting - Two primary care clinics in Trinidad, West Indies. Patients - 190 confirmed type 2 diabetic patients with mean duration of 9.2 years were studied. Results - About 75% and 17% of female and male patients, respectively, had high WC. Although blood pressure and lipid levels did not differ (p > 0.05) between patients with high and normal WC, the former group of patients had significantly higher mean levels of basal insulin and insulin resistance in each gender group (p < 0.001). However, female patients had an overall higher prevalence rate of hypercholesterolaemia (75% vs 52%) and higher LDL-cholesterol (84% vs 68%) than male patients (p < 0.001). Conclusions - Although there was similarity in the control of blood pressure and metabolic parameters irrespective of WC, patients with high WC might be at a comparatively higher risk of cardiovascular disease owing to greater basal insulin resistance. Early detection and treatment of abdominal obesity should therefore be encouraged in the primary healthcare setting.

Insulin resistance, leptin and monocyte chemotactic protein-1 levels in diabetic and non-diabetic Afro-Caribbean subjects

Aim: To determine how the levels of leptin and monocyte chemotactic protein-1 (MCP-1) are associated with insulin resistance (IR) in obese, non-obese, diabetic and non-diabetic subjects. Methods: 112 type 2 diabetics and 43 non-diabetics were studied fasting. Anthropometric indices were measured and glucose, insulin, leptin and MCP-1 were measured in blood. IR was calculated. Results: MCP-1 level was significantly higher in diabetics than non-diabetics irrespective of gender (p < 0.05). Irrespective of diabetes status, the serum leptin concentration was significantly higher (p < 0.05) in obese and females subjects than in non-obese and male subjects respectively. There were no significant correlations between IR and MCP-1 or leptin in all subgroups of subjects studied. General linear modelling analysis showed that only diabetes state significantly predicted MCP-1 levels (p < 0.05) whereas non of the factors predicted leptin levels (p > 0.05). Conclusion: Routine measurement of leptin and MCP-1 would be potentially useful in assessment of patients for the metabolic syndrome or coronary heart disease especially in black population.

Cardiovascular Risk in Obese and Nonobese Patients with Type 2 Diabetes in the West Indies

OBJECTIVE To evaluate the impact of obesity on glycemic control and the risk of progressing to cardiovascular disease (CVD) in obese and nonobese type 2 diabetic patients in primary care settings. METHODS One hundred and ninety patients (64 men, 126 women) with type 2 diabetes (mean duration 9.2 years) were studied after an overnight fast. Weight, height, waist and hip circumferences and blood pressure were measured and blood samples were taken for glucose, glycated hemoglobin (HbA(1c)), total cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and creatinine determinations. RESULTS About 85% of the patients had HbA(1c) levels > 7.0%, and 48% had a diastolic blood pressure (BP) >83 mm Hg, while 40% had a total cholesterol/HDL-cholesterol ratio greater than 6. The prevalence rates of hypercholesterolemia, hypertriglyceridemia, high BP and ratios of total cholesterol to HDL-cholesterol between the obese and nonobese patients were similar irrespective of sex (p > 0.05). Multiple linear regression analysis confirmed that ethnicity, sex, age and duration of diabetes had significant impact on the cardiovascular risk in this population. CONCLUSION Both obese and nonobese diabetic patients had poor glycemic control and their risk of CVD was not independent of age, sex, ethnicity and duration of diabetes. We suggest strict metabolic control and improved diabetes health education at the primary care level.

Evaluation of features of syndrome X in offspring of Caribbean patients with Type 2 diabetes

Objective: To determine whether the features of metabolic syndrome X are more common in offspring of patients with Type 2 diabetes than in control subjects without immediate family history of diabetes. Materials and methods: Thirty-four young offspring of patients with Type 2 diabetes and 27 healthy control subjects underwent a standard oral glucose tolerance tests (OGTT; 75 g glucose in 300 ml water). Anthropometric indices, blood pressure, plasma glucose, serum lipids and insulin levels were measured. Homeostasis model assessment (HOMA) was used to assess basal insulin resistance (IR) and sensitivity (%S). Results:OBJECTIVE To determine whether the features of metabolic syndrome X are more common in offspring of patients with Type 2 diabetes than in control subjects without immediate family history of diabetes. MATERIALS AND METHODS Thirty-four young offspring of patients with Type 2 diabetes and 27 healthy control subjects underwent a standard oral glucose tolerance tests (OGTT; 75 g glucose in 300 ml water). Anthropometric indices, blood pressure, plasma glucose, serum lipids and insulin levels were measured. Homeostasis model assessment (HOMA) was used to assess basal insulin resistance (IR) and sensitivity (%S). RESULTS The offspring had significantly higher mean+/-SD BMI (p<0.01) and basal serum triglyceride (p<0.05), insulin (p<0.05), insulin/glucose ratio (p<0.01), and lower %S (p<0.001) than the control subjects, in spite of similar fasting plasma glucose concentrations. Multiple linear regression analysis showed that these differences were independent of BMI. Although, the two groups of subjects had similar serum HDL-Cholesterol, LDL-cholesterol and blood pressure levels, %S was significantly related to diastolic BP (p<0.01) and serum triglyceride levels (p<0.01). CONCLUSIONS In comparison with the healthy control subjects, the insulin resistant offspring have higher levels of the identified syndrome X features independent of obesity. These features were quantitatively lower than the values reported in offspring of white Caucasian and African-American patients.

Perceptions of Caribbean type 2 diabetes patients on self-monitoring of blood glucose

Context: The views of type 2 diabetes (T2DM) patients have not been considered in the debate on the role of self-monitoring of blood glucose (SMBG) in the management of T2DM. Objective: To assess the views of T2DM patients on SMBG. Methods: Two previously trained research assistants used a structured pre-tested questionnaire to interview 416 T2DM patients practising SMBG in out-patient clinics in the privacy of the patients after they have consented to be interviewed. Results: 79% of patients were unemployed with mean duration of diabetes of 11.8 ± 0.5 year. 94% of patients did not have health insurance policies while 86% did not belong to any diabetes support group. Although 70% of the patients identified SMBG as expensive, 94% believed it assists glycaemic control, while 89% thought it was worth the expense. Conclusion: Caribbean T2DM patients believe SMBG was beneficial for the management of their diabetes and empowering them may reduce diabetes complications.

Determination of the differences in 2-h plasma glucose values after ingestion of carbohydrate foods and oral glucose in Caribbean non-diabetic subjects.

It has been reported that mixed meals are used in clinics in developing and developed countries in screening and diagnosis of diabetes. Thus, we aimed to determine the differences in 2-h plasma glucose values after non-diabetic subjects ingested 75 g pure glucose and its equivalent content in frequently consumed carbohydrate foods in Caribbean subjects. Twenty-seven apparently healthy non-diabetic subjects (nine males, 18 females) consumed 75 g pure glucose and its carbohydrate equivalent in three ethnic test foods (bread, rice and roti) at 7 days apart. Plasma glucose and insulin levels were determined in blood samples collected before and after 60, 90, 120 and 150 min of ingestion of these foods. In comparison with each of the test foods, the postprandial 1-h and 2-h plasma glucose values and the 60, 90, 120 and 150 min incremental glucose concentrations after oral glucose load were significantly higher than the corresponding values for each of the test foods (all P<0.01). In spite of these higher postprandial glucose concentrations, the postprandial insulin responses following the oral glucose load and the test foods did not significantly differ at any time point (all P>0.05). However, the test food, roti, tended to stimulate higher absolute and incremental insulin secretions than pure glucose or any other test food (all P>0.05). Generally, the correlation between 2-h plasma glucose value after the ingestion of the pure glucose and each of the test foods was significant (all correlation coefficients were greater than 0.70, P<0.01). In conclusion, different ethnic mixed meals could serve as an alternative to glucose in routine screening and diagnosis of diabetes if its available carbohydrate content is known and quantified.

Implementing diabetes self-management education (DSME) in a Nigerian population: perceptions of practice nurses and dieticians

Abstract Hyperglycaemic complication is the most common cause of hospitalization amongst diabetes patients in Nigeria. Research showed that diabetes self-management education (DSME) assists in controlling hyperglycaemia in diabetes patients. We assessed the opinions of practice nurses and dieticians on implementing DSME in a Nigerian population. 517 nurses and dieticians completed a self-administered questionnaire tool. Results showed that the majority of the participants agreed that DSME in a Nigerian population will assist patients (88.3%) and assist to reduce diabetes complications (91.4%). While only 34% of all participants believed that their establishments were prepared to implement DSME, a large proportion of the participants agreed that their work places do not have enough qualified health personnel (62.4%), educational facilities (65.8%) and economic resources (65.6%) to embark on DSME. These constitute significant barriers for effective DSME and demand that strategic investment in human and material resources for DSME is needed in this population of a developing country.