|Year : 2021 | Volume
| Issue : 2 | Page : 78-83
Clinical profile of patients with diabetes mellitus in gusau, Northwestern, Nigeria
Kabiru Bello Sada1, AA Sabir2, AM Sakajiki2, MT Umar2, U Abdullahi1, YA Sikiru1
1 Department of Medicine, Federal Medical Centre, Gusau, Nigeria
2 Department of Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
|Date of Submission||22-Mar-2020|
|Date of Acceptance||04-Feb-2021|
|Date of Web Publication||30-Jun-2021|
Dr. Kabiru Bello Sada
Department of Medicine, Federal Medical Centre, Gusau
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: There are variable reports of glycemic control and complications among patients living with diabetes mellitus (DM). Aim: The aim of this study was to determine the glycemic control and complications among patients with DM seen at the medical outpatient department of a tertiary health institution in Northwestern Nigeria. Methodology: This was a descriptive cross-sectional study of 236 patients attending DM Clinic at Federal Medical Centre Gusau. A questionnaire was administered that contains sociodemographic characteristics of the patients, duration of DM, adherence to management, and complications. Anthropometry, blood pressures, and fasting plasma glucose (FPG) were recorded. Data were analyzed using SPSS version 20.0. Results: Eighty-six (36%) males and 150 (64%) females patients with DM were evaluated. Their mean (standard deviation [SD]) age was 53.5 ± 12.3 years with mean (SD) duration of DM of 7.9 ± 6.2 years. The mean FPG was 8.85 ± 3.8 mmol/L (males 8.21 ± 3.6, females 9.49 ± 3.8). Forty-seven (20%), 75 (32%), 113 (48%) of the patients had good, fair, and poor glycemic control, respectively. The major complications observed were peripheral neuropathy (61%) and visual impairment (51%). Glycemic control was significantly better among males and those with good adherence to medications. There was a positive association between the longer duration of DM with complications. Conclusion: Only 20% of our patients achieved good glycemic control and many have complications. Majority of the patients adhered more with medications as compared to dietary management and exercise. There is a need for clinicians to educate patients more on the need for lifestyle modifications.
| Abstract in French|| |
Concernant les origines de la situation: Il y a des variables rapports glycémie de contrôle et des complications parmi les patients qui vie avec le diabète mellitus(DM). BUT: Le but de cet étude était pour déterminer le contrôle et les complications glycémie parmi les patients avec le DM vue dans le service de consultation tertiaire dans l'établissement de santé au Nord-ouest du Nigéria. Méthodologie: C'était une description transversale d'étude de 236 patients qui ont assistait à l'événement clinique de la DM au centre médical fédérale à Gusau.Un questionnaire était gérer à contenu de socio démographe de trait de caractère des patients, durée de la DM, hypertension, et le FPG qui se lit “Fasting plasma glucose” en anglais ont été enregistré. Les données ont été analysé avec l'utilisation de la SPSS version 20.0. Résultat: Quatre-vingt huit(36%) mâles et 150(64%) femelles des patients avec la DM ont été évalué. Leurs âges (écart-type) [ET]) moyenne était 53.5±12.3 ans avec une moyenne (ET) et avec une durée de DM de 7.9±6.2 ans. La moyenne et pauvre contrôle du glycémie respectivement. Les complications majeur observé était les périphériques neuropathie(61%) et malvoyants(51%). Le contrôle glycémie était sensiblement mieux parmi les mâles et avec ceux de bonnes médications. Il y avait une association positive entre une longue durée de la DM avec complication. Conclusion: Seul 20% de nos patients ont obtenu un bon contrôle de glycémie et d'autre avec beaucoup de complications. La majorité des patients se sont adhérent plus avec la médication comparer à la gestion diététique et exercice. Il y a la nécessité des clinicien d'instruire ou éduquer les patients plus suis la mode de vie de modification.
Keywords: Complications, diabetes mellitus, glycemic control, North-Western Nigeria
|How to cite this article:|
Sada KB, Sabir A A, Sakajiki A M, Umar M T, Abdullahi U, Sikiru Y A. Clinical profile of patients with diabetes mellitus in gusau, Northwestern, Nigeria. Ann Afr Med 2021;20:78-83
|How to cite this URL:|
Sada KB, Sabir A A, Sakajiki A M, Umar M T, Abdullahi U, Sikiru Y A. Clinical profile of patients with diabetes mellitus in gusau, Northwestern, Nigeria. Ann Afr Med [serial online] 2021 [cited 2022 Aug 15];20:78-83. Available from: https://www.annalsafrmed.org/text.asp?2021/20/2/78/320033
| Introduction|| |
The prevalence of diabetes mellitus (DM) is rising in Nigeria. DM and hypertension clinics are becoming the busiest in many of our tertiary health centers. A number of factors have contributed to the rising prevalence of DM in Nigeria with a current prevalence estimate of 5.77%. Some of these factors include a rising burden of overweight/obesity, sedentary living, unhealthy diet, stress, advancing age, and urbanization.
It is established that the management of DM is a lifelong endeavor that requires a combination of dietary measures, regular exercise, and the use of medications. A weight reduction of 5%–10% of original body weight through caloric restriction, exercise, or bariatric surgery improve glycaemic control and can even make type 2 diabetes go into remission.,
Poor adherence to medications among patients with DM has been reported to range from 38 to 93% and is a major cause of poor glycemic control which leads to complications. The causes of nonadherence varies from financial constrain, pill burden and fear of hypoglycemia.
Glycaeted hemoglobin is the gold standard for assessing glycemic control and has good correlation with fasting and postprandial plasma glucose. Many studies have reported poor glycemic control among patients with DM Worldwide and most especially in resource-poor countries., Optimising glycemic control is known to significantly reduce the incidence of complications. To the best of our knowledge, there are few published works on the quality of glycemic control and clinical profile of persons with DM in North-West Nigeria, and none from Gusau, Zamfara state. The number of persons living with DM in this part of the country continues to increase with a concomitant increase in chronic complications. It is our belief that this study will bridge these gaps in knowledge of DM in the region and form a baseline for future work.
The aim of this study was to determine the status of glycemic control and complications of patients with DM attending DM clinic at a tertiary hospital in Northwestern, Nigeria.
| Methodology|| |
This was a descriptive cross-sectional study of patients attending the DM Clinic at Federal Medical Centre (FMC) Gusau, Northwest Nigeria. Its a public hospital that holds DM clinic every Thursday except on government-declared public holidays. The study was conducted over 3 weeks.
The clinic attends to an average of 120 patients with DM weekly. Eight doctors administered a structured questionnaire to 10 patients each per clinic day throughout the study period. Patients that consented to participate in the study were recruited consecutively over a period of 3 weeks and their folders labeled to avoid repetition until a total sample size of 236 was obtained. Pregnant women and those who declined consent were excluded from the study.
Data were captured through the application of an interviewer administered-questionnaire which contained sociodemographic characteristics of patients, duration of DM, complications, adherence to dietary advice, exercise, medications, and clinic follow-up visits.
Body mass index (BMI) was determine by calculating weight and height ratio square using stadiometer, Blood pressures were measured with accoson sphygmomanometer, and fasting plasma glucose (FPG) was measured using the standard method.
Data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, version 20 (IBM SPSS Inc. Chicago Illinois, USA). software version 20.0. Categorical variables were expressed in percentages, while continuous variables were expressed as mean (standard deviation [SD]). Chi-square was used to determine the association of categorical variables and independent Student's t-test for continuous variables. A P < 0.05 was considered statistically significant.
- Status of glycemic control: Good control: FPG 4–6 mmol/L, Fair control: FPG 6.1–8 mmol/L, Poor control: FPG >8 mmol/L. Fair and poor control were categorized as uncontrolled glycemic status
- Classification of BMI.
Obesity: BMI ≥30 kg/m2
Overweight: BMI 25–29.9 kg/m2
Normal weight: BMI 18.5–24.9 kg/m2
Underweight: BMI ≤18.5 kg/m.2
- 1. Adherence: Adherence was determined using Likert rating scale principle.
- Adherence to exercise.
- Adequate (Good): Aerobic exercise for at least 150 min/week
- Poor: Exercise less than 150 min/week.
- Adherence to medications:
- Good: Takes medications every day at the prescribed dosage
- Poor: Not consistent with taking medications.
- Adherence to dietary management:
- Good: Adhere strictly to dietary advice given by nutritionist
- Poor: Doesn't adhere.
- Adherence to follow-up:
- Good: Visit hospital on schedule appointment regularly
- Poor: Only visit hospital when feeling unwell.
Ethical approval was obtained from the research and ethical committee of FMC, Gusau. A signed informed consent was obtained from each of the participants and confidentiality was assured based on the Helsinki declaration of bioethics.
| Results|| |
Two hundred and thirty-six patients with DM comprising 86 (36%) males and 150 (64%) females were studied. The mean (SD) age was 53.5 ± 12.3 years with males 57.01 (±11.9) being significantly older than the females 51.5 (±12.5), P = 0.001.
The mean (SD) duration of DM was 7.9 ± 6.2 years (males 8.2 ± 6.4, females 7.6 ± 6.1) P = 0.47, with the duration of living with DM ranging from 1 to 40 years. One hundred and one (42.8%) subjects had DM <5 years while 135 (57.2%) had it for more than 5 years.
[Table 1] shows the distribution of subjects based on BMI and gender. One hundred and eight (72%) females were either obese or overweight compared to 37 (43%) males. P = 0.001.
The mean (SD) FPG was 8.85 ± 3.8 mmol/L (males 8.21 ± 3.6, females 9.49 ± 3.8) P = 0.01. The distribution of glycemic control is shown in [Figure 1]. Only 20% of the patients had good glycemic control.
The DM-related complications observed are shown in [Figure 2]. The most common complications observed were peripheral neuropathy (61%), visual impairment (51%), and erectile dysfunction (41%).
One hundred and sixty-nine (72%) subjects had good adherence to medications, 147 (62%) to follow-up, 127 (54%) to dietary management, but only 66 (28%) had good adherence to exercise.
There was significant association between good glycemic control with male gender (P = 0.001) and good adherence to medications (P = 0.005) [Table 2].
Males had better adherence to dietary management (63% vs. 49%) and medications (81% vs. 66%) compared to their female counterparts [Table 3].
Patients living with DM for more than 5 years had more visual impairment (P = 0.002) and erectile dysfunction (0.001) [Table 4].
| Discussion|| |
More females participated in the study than their males counterparts because they attend clinic follow-up more than males. This is in keeping with some studies that show higher attendance of females in clinics. This may be explained by the busy schedules of the males who are usually the breadwinners in our communities however in this study males adhered more with follow-up visit compared to females though insignificant.
The finding that about 62% of the subjects were either obese or overweight and females having higher BMI is in keeping with the finding by Fadupin et al. in Ibadan who reported that 83% of their patients with DM were either obese or overweight with more proportion of females in the obese and overweight categories. This may be attributed to the fact that females in Nigeria are generally less physically active and obesity may be considered as a sign of good living.
About twenty percent of our subjects had good glycaemic control which is in keeping with the Diabcare multicenter study in Nigeria held in Lagos, Ibadan, Kano, Enugu, and Port Harcourt that showed that only 20.4% of the patients with DM they evaluated had good glycaemic control. Forty seven percent (47%) of our subjects had poor control; this is similar to the findings of Unadike et al. who reported poor control in 46% of the patients with DM they evaluated in Benin city, Nigeria. Poor glycemic control has been reported even in some cohorts in developed countries. This is a wakeup call for caregivers to provide more enlightenment to patients on the need for good glycemic control since poor glycemic control leads to many complications.
The finding that those that were obese and overweight had poorer glycaemic control is similar to the findings of Khalid et al. in Saudi Arabia. Obesity and adiposity are the main culprits of Insulin resistance and poor glycemic control. The finding that males had better glycaemic control despite being older than the females studied may be attributed to their lower BMI and better adherence to dietary management and medications because aging is known to increase insulin resistance and leads to worsening glycemic control.
Lifestyle modifications by changes to a healthy diet and exercise are the mainstay in the management of type 2 DM. The dietary changes required are diets with complex carbohydrates, vegetables, low fat, and low calories while the exercise recommended is at least 150 min of exercise per week.,
Our patients observed less lifestyle modifications and gave more emphasis on medications, this finding is similar to that of Edah et al. in Jos they reported that only 52.2% of their studied patients with DM exercise and the exercise was inadequate in 91.5% of them.
Poor exercise performance is thought to arise due to lack of physical training background, time restriction, and inability to maintain motivation. Encouraging sporting activities among youth in schools will make them to develop sporting habits and may assist in curbing the rise of noncommunicable diseases in adulthood.
Peripheral neuropathy was seen in 61% of our patients. A study in Yola Nigeria reported 87% prevalence of peripheral neuropathy among patients with DM and Ugoya et al. in Jos reported a prevalence of 75%. A study from Kilimanjaro in Tanzania reported a prevalence of 72.2% while the prevalence is about 34% among patients in the UK. The high prevalence of peripheral neuropathy seen in our study and other studies in Nigeria and Africa could be attributed to the late diagnosis of DM in the continent and subsequent suboptimal control among the patients in Africa.
The 51% prevalence of visual impairment among our patients is higher than the 22.2% reported by Kohloun et al. in Tunisia. Oluwatoyin reported a prevalence of 21.6% among patients with DM in Southwestern Nigeria. Nwosu et al. reported that 18% of the patients with DM they studied in Nnewi Nigeria had total blindness, 30% had visual impairment and 47% of the patients did not know that DM could lead to visual loss. The higher prevalence seen in our study could be attributed to poor access to healthcare in Northern Nigeria and late diagnosis.
The 41% prevalence of erectile dysfunction observed in this study is lower than the 94.7% prevalence reported by Ugwumba et al. in Enugu and 51.3% reported by Selvin et al. in the USA. This may be attributed to the difference in cultural perceptions of erectile dysfunction or barriers in communication. Oladiji et al. study in Ilorin has shown that the prevalence of erectile dysfunction can be affected by age, length of marriage, and spousal social status.
| Conclusion|| |
Only 20% of our patients achieved good glycemic control and many have varying complications. Majority of the patients were either obese or overweight and complied more with medications as compared to dietary management and exercise. There is a need for clinicians to educate patients more on the need for lifestyle modifications.
The authors thank all the staff of the medical outpatient department FMC, Gusau who assisted in carrying out the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dahiru T, Aliyu AA, Shehu AU. A review of population-based studies of diabetes mellitus in Nigeria. Sub-Saharan Afr J Med 2016;3:59-64. [Full text]
Uloko AE, Musa BM, Ramalan MA, Gezawa ID, Puepet FH, Uloko AT, et al
. Prevalence and risk factors for diabetes mellitus in Nigeria: A systematic review and meta-analysis. Diabetes Ther 2018;9:1307-16.
Ogbera AO, Ekpebegh C. Diabetes mellitus in Nigeria: The past, present and future. World J Diabetes 2014;5:905-11.
Olokoba AB, Obateru OA, Olokoba LB. Type 2 diabetes mellitus: A review of current trends. Oman Med J 2012;27:269-73.
Lim EL, Hollingrowth KG, Aribisala BS, Chen MJ, Malters JL, Taylor R. Reversal of type 2 diabetes: Normalization of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011;54:2506-14.
Pories WJ, Mehaffey JH, Station KM. The surgical treatment of type 2 diabetes mellitus. Surg Clin North Am 2011;91:821-36.
Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of adherence and persistence in treatment of diabetes, hypertension and dyslipidaemia: A review. Int J Clin Pract 2008;62:76-87.
William HP, Robert RH. Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016;10:1299-307.
Zahra G, Ali AH, Sakineh MA, Jamileh A, Farzaneh Z. A comparison of HbA1c and fasting blood sugar test in general population. Int J Prev Med 2010;1:187-94.
Blonde L, Aschner P, Bailey C, Ji L, Leiter LA, Matthaei S, et al
. Gaps and barriers in the control of blood glucose in people with type 2 diabetes. Diab Vasc Dis Res 2017;14:172-83.
Afroz A, Ali L, Karim MN, Alramadan MJ, Alam K, Magliano DJ, et al
. Glycaemic control for people with Type 2 diabetes mellitus in Bangladesh-An urgent need for optimization of management plan. Sci Rep 2019;9:10248.
Uloko AE, Yusuf SM, Puepet FH, Adeniyi AF, Gezawa ID, Sada K, et al
. Assessment of quality of glycaemic control and chronic complications of diabetes mellitus in Kano, North-Western Nigeria. Arch Diab and Cardio Med 2012;1:40-6.
Louis M, Claude C. Target for glycaemic control, concentrating on glucose. Diabetes Care 2009;32:199-204.
Executive summary of the clinical guidelines on identification, evaluation and treatment of overweight and obesity in adults. Arch Intern Med 1998;158:1855-67. Doi: 10.1001/archinte.158.17.1855.PMID:9759681.
Likert R. A technique for measurement of attitudes. Arch Psychol 1932;140:1-55.
American Diabetes Association. Foundation of care and comprehensive medical evaluation. Diabetes Care 2016;39:23-35.
Oyegbade OO, Abioye EA, Kolawole BA, Ezoma IT, Bello IS. Screening for diabetes mellitus in a Nigerian family practice population. SA Fam Pract 2007;4915a-d.
Fadupin GT, Joseph EU, Keshinro OO. Prevalence of obesity among type 2 diabetics in Nigeria a case study of patients in Ibadan, Oyo State, Nigeria. Afr J Med Med Sci 2004;33:381-4.
Kandala NB, Stranges S. Geographical variation of overweight and obesity among women in Nigeria. A case for nutritional transition in sub-Saharan Africa. PLoS One 2014;9:e 101103.
Uloko AE, Ofoegbu EN, Chinenye S, Fasanmade OA, Fasanmade AA, Ogbera AO, et al
. Profile of Nigerians with diabetes mellitus-Diabcare Nigeria study group (2008): Results of multicentre study. Indian J Endocrinol Metab 2012;16:558-64.
Unadike BC, Eregie A, Ohwovoriole AE. Glycaemic control amongst person with diabetes mellitus in Benin City. Niger Med J 2010;51:164-6. [Full text]
Laiteerapong N, Fairchild PC, Chou CH, Chin MH, Huang ES. Revisiting disparities in quality of care among US adults with diabetes in the era of individualized care, NHANES 2007-2010. Med Care 2015;53:25-31.
Khalid SJ, Samia AB, Muneera AA, Patan MK, Bandari KA. Glycaemic control of obese patients with type 2 diabetes mellitus. Int J Diabetes Metab Disord 2018;3:1-6.
Barbara BK, Jeffery SF. Obesity and insulin resistance. J Clin Invest 2000;106:473-81.
Mohammaed RR, Nagy A, Sayed A, Ataa MB, Mohammed YA, Mohammed HE. Aging is an inevitable risk factor for insulin resistance. J Taibah Univ Med Sci 2006;1:30-41.
Nita GF, Anoop M, Viswanathan M, Roy T, William Y. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018;361:k2234.
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al
. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39:2065-79.
Edah JO, Odoh G, Kumtap CY, Onwukeme OC, Ojo SO, Okpara UC, et al
. Exercise and other lifestyle habits of patients with type 2 diabetes mellitus in Jos, Nigeria. Jos J Med 2015;9:9-15.
Miyauchi M, Toyoda M, Kaneyama N, Miyatake H, Tanaka E, Kimura M, et al
. Exercise therapy for management of type 2 diabetes mellitus: Superior efficacy of activity monitors over pedometers. J Diabetes Res 2016;2016:5043964. Doi: 10.1155/2016/5043964.
Salawu F, Shadrach L, Adenle T, Martins O, Bukbuk D. Diabetic peripheral neuropathy and its risk factors in a Nigerian population with type 2 diabetes mellitus. Afr J Diabetes Med 2018;26:16-20.
Ugoya SD, Echejoh GO, Ugoya TA, Agaba EI, Puepet FH, Ogunniyi A. Clinically diagnosed diabetic neuropathy: Frequency, types and severity. J Nat Med Assoc 2006;98:1763-6.
Ahlam AA, Chamba N, Johnstone K, Isaack AL, Dekker M. Prevalence, pattern and factors associated with peripheral neuropathies among diabetic patients at tertiary hospital in Kilimanjaro region: Int J Endocrinol 2019;1-8. Doi:10.1155/2019/5404781.
Caroline AA, Rayaz AM, Ernest RE, Van R, Jai K, Andrew J. Prevalence and chararcteristics of painful diabetic neuropathy in large community based diabetic population in the UK. Diabetes Care 2011;10:220-24.
Kahloun R, Jelliti B, Zaouali S, Attia S, Ben Yahia S, Resnikoff S, et al
. Prevalence and causes of visual impairment in diabetic patients in Tunisia, North Africa. Eye (Lond) 2014;28:986-91.
Onakpoya OH, Adeoye AO, Kolawole BA. Determinants of previous dilated eye examination among type II diabetics in Southwestern Nigeria. Eur J Intern Med 2010;21:176-9.
Nwosu SN. Low vision in Nigerians with diabetes mellitus. Doc Ophthalmol 2000;101:51-7.
Ugwumba FO, Okafor CI, Nnabugwu II, Udeh EI, Echetabu KN, Okoh AD, et al
. Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria. Ann Afr Med 2018;17:215-20.
] [Full text]
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med 2007;120:151-7.
Oladiji F, Kayode OO, Parakoyi DB. Influence of socio-demographic characteristics on prevalence of erectile dysfunction in Nigeria. Int J Impot Res 2013;25:18-23.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]