Eugene Sobngwi

Primary Health Care for Hypertension by Nurses in Rural and Urban Sub-Saharan Africa

To implement a nurse‐led protocol for the care of hypertension, 5 clinics were established in Yaounde (urban) and Bafut (rural) in Cameroon. International guidelines were adapted and 10 nurses were trained. The initial cohort of patients was referred from a field survey. The program proceeded for 26u2003months and 454 patients (45% urban) were registered in the clinics. Relative to urban participants, rural participants were more often women (59% vs 45%, P=.002) and less likely to have diabetes (7.2% vs 41.2%, P<.001). Between baseline and final visits, systolic and diastolic blood pressures dropped by 11.7 mm Hg (95% confidence interval, 8.9–14.4) and 7.8 (95% confidence interval, 5.9–9.6), respectively (P<.001). These changes were consistent in subgroups and after adjustment. Most dropouts occurred around the initial visit and among urban participants and nondiabetics. Nurse‐led clinics are effective for improving hypertension care in these settings and require implementation and validation through controlled trials.

Type 2 diabetes management in nurse-led primary healthcare settings in urban and rural Cameroon

AIMSnTo implement a protocol-driven primary nurse-led care for type 2 diabetes in rural and urban Cameroon.nnnMETHODSnWe set-up three primary healthcare clinics in Yaounde (Capital city) and two in the Bafut rural health district. Participants were 225 (17% rural) patients with known or newly diagnosed type 2 diabetes, not requiring insulin, referred either from a baseline survey (38 patients, 17%), or secondarily attracted to the clinics. Protocol-driven glucose and blood pressure control were delivered by trained nurses. The main outcomes were trajectories of fasting capillary glucose and blood pressure indices, and differences in the mean levels between baseline and final visits.nnnRESULTSnThe total duration of follow-up was 1110 patient-months. During follow-up, there was a significant downward trend in fasting capillary glucose overall (p<0.001) and in most subgroups of participants. Between baseline and final visits, mean fasting capillary glucose dropped by 1.6 mmol/L (95% CI: 0.8-2.3; p< or =0.001). Among those with hypertension, blood pressure also decreased significantly for systolic and marginally for diastolic blood pressure. No major significant change was noticed for body weight.nnnCONCLUSIONSnNurses may be potential alternatives to improve access to diabetes care in settings where physicians are not available.

Diabetes in sub-Saharan Africa: from clinical care to health policy

Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA (Prof R Atun FRCP, Prof T Bärnighausen MD, I Postolovska ScD, S Vollmer PhD, B Ammon, A Annamreddi, A Awasthi, S Bhadriraju, J Chai MPH, J Ho BS, S S Kakarmath MBBS MS, R Kharel, M A Kyle, S C Lee MD, A Lichtman MD, J Manne-Goehler MD, M Nair MPH, O L O Okafor MPH, O Okunade MD, D Sando, A Sharma MPH, A S Syed MPH); Harvard Medical School, Harvard University, Boston, MA, USA (Prof R Atun, A Binagwaho MD, P Chipendo MD, J Manne-Goehler); Centre for Global Health, King’s College London, Weston Education Centre, London, UK (J I Davies MD); MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa (J I Davies); University of Bristol, Bristol, UK (E A M Gale FRCP); Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania (Z G Abbas MMed); Institute of Public Health, Faculty of Diabetes in sub-Saharan Africa: from clinical care to health policy

Admission trends over 8 years for diabetic foot ulceration in a specialized diabetes unit in cameroon

High rates of foot complications have been reported in people with diabetes in sub-Saharan Africa (SSA). However, there is a paucity of data in support of the changing pattern with time. We report here data on trends in hospitalization for foot ulceration over an 8-year consecutive period in a specialized diabetes unit in SSA. Admission and discharge registers of the diabetes and endocrine unit of the Yaounde Central hospital, Cameroon, were reviewed for the period 2000 through 2007. Data were collected on the status for diabetes, presence of foot ulcer, age, sex, duration of hospitalization, amputation, and deaths.We found that 1841 patients with diabetes were admitted during the study period. The prevalence of foot ulceration was 13% (95% confidence interval [CI] = 11%-15%) and varied significantly by year of study (P = .001). The mean duration of hospitalization significantly decreased with time. Foot ulcer was associated with 115% (95% CI = 87%-148%) more bed use than other conditions in diabetes. Foot ulcer was associated with a nonsignificantly lower risk of death or dropout, with evidence of some attenuation with time. With one exception, the amputation rate of 16% (95% CI = 11%-20%) was similar across years. Foot ulcer is a major cause of hospital admission and bed use for diabetes in Cameroon.

Association of serum leptin and adiponectin with anthropomorphic indices of obesity, blood lipids and insulin resistance in a Sub-Saharan African population

BackgroundThere is little data on the metabolic effects of adipokines in sub-Saharan African populations. This study aimed to explore the potential relationship of leptin and adiponectin, with obesity, plasma lipids and insulin resistance in a Cameroonian population.MethodsWe enrolled 167 men and 309 women aged ≥18xa0years from the general population in Cameroon. Data were collected on waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), body fat (BF%), fasting blood glucose, plasma lipids, adiponectin, leptin, insulin and homeostasis model for assessment of insulin resistance (HOMA-IR). Pearson’s correlation and multiple stepwise linear regression analyses were used to determine correlates of leptin and adiponectin serum levels.ResultsThe prevalence of obesity was higher in women compared to men (pu2009<u20090.0001), and Central obesity which is more prevalent particularly in women (WCu2009=u200942.4xa0%, WHRu2009=u200942.3xa0%), is almost for 90xa0% comparable to %BF (42.7xa0%).Adiponectin negatively with BMI (ru2009=u2009−0.294, pu2009<u20090.0001), WC (ru2009=u2009−0.294, pu2009<u20090.0001), %BF (ru2009=u2009−0.122, pu2009=u20090.028), WHR (ru2009=u2009−0.143, pu2009=u20090.009), triglycerides (ru2009=u2009−0.141, pu2009=u20090.011), HOMA-IR (ru2009=u2009−0.145, pu2009=u20090.027) and insulin (ru2009=u2009−0.130, pu2009=u20090.048). Leptin positively correlated with BMI (ru2009=u20090.628), WC (ru2009=u20090.530), BF% (ru2009=u20090.720), (all pu2009<u20090.0001); with DBP (ru2009=u20090.112, pu2009=u20090.043), total cholesterol (ru2009=u20090.324, pu2009<u20090.0001), LDL-cholesterol (ru2009=u20090.298, pu2009<u20090.0001), insulin (ru2009=u20090.320, pu2009<u20090.001 and HOMA-IR (ru2009=u20090.272, pu2009<u20090.0001).In multiple stepwise regression analysis, adiponectin was negatively associated with WC (βu2009=u2009−0.38, pu2009=u20090.001) and BF% (βu2009=u20090.33, pu2009<u20090.0001), while leptin was positively associated with BF% (βu2009=u20090.60, pu2009<u20090.0001), total cholesterol (βu2009=u20090.11, pu2009=u20090.02) and HOMA-IR (βu2009=u20090.11, pu2009=u20090.02). When controlled for gender, HOMA-IR was found significantly associated to adiponectin (βu2009=u20090.13, pu2009=u20090.046), but not BF%, while the association previously found between leptin and HOMA-IR disappeared; BMI and WC were significantly associated with leptin (βu2009=u20090.18, pu2009=u20090.04 & βu2009=u20090.19, pu2009=u20090.02 respectively).ConclusionThis study, which includes a population who was not receiving potentially confounding medications, confirms the associations previously observed of adiponectin with reduced adiposity especially central adiposity and improved insulin sensitivity. Confirmatory associations were also observed between leptin and obesity, blood lipids and insulin resistance for the first time in an African population. Gender was significant covariate interacting with insulin sensitivity/insulin resistance and obesity indexes associations in this population.

Coincidence of diabetes mellitus and hypertension in a semi-urban Cameroonian population: a cross-sectional study

BackgroundHypertension and diabetes mellitus are increasingly common in population within Africa. We determined the rate of coincident diabetes and hypertension and assessed the levels of co-awareness, treatment and control in a semi-urban population in Cameroon.MethodsA total of 1702 adults (967 women) self-selected from the community were consecutively recruited in Bafoussam (West region of Cameroon) during November 2012. Existing diabetes and hypertension and treatments were investigated and blood pressure and fasting blood glucose measured. Multinomial logistic regressions models were used to investigate the determinants of prevalent diabetes and hypertension.ResultsAge-standardized prevalence rates (95% confidence intervals) men vs. women were 40.4% (34.7 to 46.1) and 23.8% (20.4 to 27.2) for hypertension alone; 3.3% (1.5 to 5.1) and 5.6% (3.5 to 7.7) for diabetes alone; and 3.9% (2.6 to 5.2) and 5.0% (3.5 to 6.5) for hypertension and diabetes. The age-standardized awareness, treatment and control rates for hypertension alone were 6.5%, 86.4% and 37.2% for men, and 24.3%, 52.1% and 51.6% in women. Equivalent figures for diabetes alone were 35.4%, 65.6% and 23.1% in men and 26.4%, 75.5% and 33.7% in women; and those for hypertension and diabetes were 86.6%, 3.3% and 0% in men, and 74.7%, 22.6% and 0% in women. Sex, age and adiposity were the main determinants of the three conditions.ConclusionsCoincident diabetes and hypertension is as high as diabetes alone in this population, driven by sex, age and adiposity. Awareness, treatment and control remain unacceptably low.

Association between the TCF7L2 rs12255372 (G/T) gene polymorphism and type 2 diabetes mellitus in a Cameroonian population: a pilot study

BackgroundTo study the relationship between the rs12255372 (G/T) polymorphism of the transcription factor 7-like 2 (TCF7L2) and type 2 diabetes mellitus (T2DM) in a Cameroonian population.MethodsThis case–control study included 60 T2DM patients and 60 healthy normoglycemic controls, all unrelated and of Cameroonian origin, aged above 40xa0years (range 40–87). The Restriction Fragment Length Polymorphism - Polymerase Chain Reaction (RFLP-PCR) was used for genotyping.ResultsThe T allele frequency was significantly higher in the diabetic group (0.44) than in the control group (0.17). This allele was significantly associated to a greater risk of developing T2DM as compared to the G allele (ORu2009=u20093.92, 95% CI 2.04 – 7.67, pu2009<u20090.0001). The codominant (additive) model explained best the risk of developing the disease, as the TT genotype was significantly associated to T2DM when compared to the GG genotype (ORu2009=u20094.45, 95% CI 1.64 – 12.83, pu2009=u20090.0014). By logistic regression adjusted for age, this OR was 4.33 (95% CI: 1.57 – 11.92, pu2009=u20090.005).ConclusionOur findings suggest that the rs12255372 (G/T) polymorphism of the TCF7L2 gene is an important risk factor for T2DM in the Cameroonian population.

Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population

AbstractBackgroundLow-dose spironolactone has been proven to be effective for resistant hypertension in the general population, but this has yet to be confirmed in type 2 diabetic (T2DM) patients. We assessed the efficacy of a low-dose spironolactone on resistant hypertension in a sub-Saharan African population of T2DM patients from Cameroon.MethodsThis was a four-week single blinded randomized controlled trial in 17 subjects presenting with resistant hypertension in specialized diabetes care units in Cameroon. They were randomly assigned to treatment with a daily 25xa0mg of spironolactone (nxa0=xa09) or to an alternative antihypertensive regimen (nxa0=xa08), on top of any ongoing regimen and prevailing lifestyle prescriptions. They were seen at the start of the treatment, then 2 and 4xa0weeks later. The primary outcome was change in office and self-measured blood pressure (BP) during follow-up, and secondary outcomes were changes in serum potassium, sodium, and creatinine levels.ResultsCompared with alternative treatment, low-dose spironolactone was associated with significant decrease in office systolic BP (−33 vs.xa0−14xa0mmHg; pxa0=xa00.024), and in diastolic BP (−14 vs. −5xa0mmHg; pxa0=xa00.006). After 1xa0month of spironolactone, all the patients were controlled based on BP below 130/80xa0mmHg, with significant office BP reduction from 158xa0±xa017/86xa0±xa011 to 125xa0±xa011/72xa0±xa08, vs. 158xa0±xa08/94xa0±xa08 to 144xa0±xa017/89xa0±xa012xa0mmHg in the alternative treatment group. There was no significant variation in sodium and creatinine levels in both groups, but a mild increase of potassium levels in the spironolactone group.InterpretationAdd-on low-dose spironolactone was effective in reducing BP to optimal levels in T2DM Cameroonian patients despite mild increase in serum potassium.n Trial registration ClinicalTrials.gov Identifier NCT02426099. Date of registration April 2015

Fructosamine measurement for diabetes mellitus diagnosis and monitoring: a systematic review and meta-analysis protocol

Introduction Fructosamine is a marker of glucose control reflecting the average glycaemic level over the preceding 2–3u2005weeks. Fructosamine has not gained as much popularity as glycated haemoglobin (HbA1c) for diabetes mellitus (DM) control monitoring, and the related underlying reasons remain unclear. We aim to search for and summarise available evidence on the accuracy of fructosamine measurements to diagnose and monitor DM. Methods and analysis This systematic review will include randomised control trials, controlled before-and-after studies, time series designs, cohort studies, case–control studies and cross-sectional surveys reporting the diagnosis and/or monitoring of DM (type 1 DM, type 2 DM and gestational DM) with fructosamine compared with other measures of glycaemia (fasting glucose, oral glucose tolerance test, random glucose, HbA1c), without any language restriction. We will perform electronic searches in PubMed, Scopus and other databases, supplemented with manual searches. Articles published from 1 January 1980 to 30 June 2015 will be eligible for inclusion in this review. Two authors will independently screen, select studies, extract data and assess the risk of bias with discrepancies resolved by consensus. We will assess clinical heterogeneity by examining the types of interventions and outcomes in each study, and pool studies judged to be clinically homogeneous. We will also assess statistical heterogeneity using the χ2 test of homogeneity and quantify it using the I2 statistic. Absolute accuracy measures (sensitivity, specificity) will be pooled in a bivariate random-effects model, allowing for intersetting variability. Negative and positive predictive values will be computed for fructosamine, compared with another measure of glycaemia from the pooled estimates of sensitivity and specificity, using Bayes’ theorem. Ethics and dissemination This systematic review will use data from published studies and does not require ethics approval. Findings will be published in a peer-reviewed journal and presented at scientific conferences. Trial registration number PROSPERO (ID=CRD42015015930).

Ketosis-prone atypical diabetes in Cameroonian people with hyperglycaemic crisis: frequency, clinical and metabolic phenotypes

It is unclear whether ketosis‐prone diabetes is a specific type or a subtype of Type 2 diabetes. We aimed to describe the clinical and metabolic features of ketosis‐prone diabetes in a sub‐Saharan population.