South African Journal of Diabetes and Vascular Disease - latest Issue
Volume 13, Issue 1, 2016
Author F.A. MahomedSource: South African Journal of Diabetes and Vascular Disease 13 (2016)More Less
This issue looks at important aspects of the epidemiology of diabetes in Africa and India. Studies by Akintunde et al. from Nigeria (page 13), Pessinaba et al. from Senegal (page 27), Mondo et al. from Uganda (page 31) and Das et al. from West Bengal (page 37) all show a striking similarity in the high prevalence of hypertension, the metabolic syndrome and other cardiovascular risk factors in patients in these countries. This represents a significant health risk for diabetes and cardiovascular diseases in their populations, and specific programmes for the management and prevention of non-communicable diseases in these countries need to be urgently addressed.
Validity and reliability of the Zambian version of the Problem Areas in Diabetes (PAID) scale : a triangulation with cognitive interviews : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 4 –12 (2016)More Less
This study aimed to examine the psychometric properties of the Zambian version of the Problem Areas in Diabetes (PAID) scale and to determine the levels of diabetes-specific emotional distress in Zambian people with diabetes. A total of 157 Zambians living with type 1 and 2 diabetes completed the 20-item PAID, self-care inventory (SCI), fear for hypoglycaemia scale (HFS) and the major depression inventory (MDI) in study 1. In addition to exploratory factor analysis (EFA), reliability and validity tests were also conducted. In study 2, eight patients participated in cognitive interviews, in order to evaluate the extent to which participants were able to comprehend the scale items. EFA showed that a one-factor solution was the best interpretable solution and the PAID was a valid and reliable measure. Cognitive interviews showed that the participants were able to comprehend question intent, while a few faced some challenges with the meaning of words such as 'anxious' and 'physician', and with comprehension of some items. The Zambian version of the PAID is a reliable and valid measure to assess diabetes-specific distress. These Zambian participants with diabetes expressed high levels of diabetes-specific distress, and some items needed to be simplified or clarified to enhance comprehensibility.
The metabolic syndrome among newly diagnosed non-diabetic hypertensive Nigerians : prevalence and clinical correlates : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 13 –16 (2016)More Less
Background: Hypertension is the commonest cardiovascular risk factor worldwide. Clustering of cardiovascular risk factors has been noted to increase the risk of developing type 2 diabetes mellitus and cardiovascular diseases. There are few reports on the prevalence of the metabolic syndrome among hypertensives African subjects.
Methods: One hundred and forty newly diagnosed hypertensive subjects and 70 apparently healthy controls were recruited consecutively for this study. Demographic and clinical parameters were assessed using a pretested data-collection form. Fasting blood glucose and fasting serum lipid levels were determined. The metabolic syndrome was defined according to NCEP ATP III. Statistical analysis was performed using SPSS 16.0. Intergroup comparisons were done using t-test and chi-squared tests, as appropriate.
Results: The hypertensive and control subjects were similar in age (55.14 ± 10.83 years vs 54.67 ± 10.89 years, p = 0.8) and gender distribution [females 75 (53.6%) vs males 37 (52.9%), p = 0.3]. The metabolic syndrome was diagnosed in 44 (31.4%) of the hypertensive subjects and 11 (15.7%) of the controls. Systolic blood pressure, body mass index and prevalence of left ventricular hypertrophy were higher among subjects with the metabolic syndrome than in those without it. Prevalence of the metabolic syndrome increased with age and was more common among female subjects.
Conclusion: This study shows that prevalence of the metabolic syndrome was high among newly diagnosed hypertensive subjects in Osogbo, Nigeria. It was, however, lower than that described among many Caucasian populations. Presence of the metabolic syndrome in hypertensive Nigerian subjects was closely related to and influenced by demographic and clinical factors.
Study of the effect of altitude on the measurement of glycated haemoglobin using point-of-care instruments : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 17 –19 (2016)More Less
We measured the glycated haemoglobin (HbA1c) levels of a total of 24 non-diabetic volunteers and diabetic patients using a point-of-care (POC) analyser in three Cameroonian cities at different altitudes. Although 12 to 25% of duplicates had more than 0.5% (8 mmol/mol) difference across the sites, HbA1c values correlated significantly (r = 0.89-0.96). Further calibration studies against gold-standard measures are warranted.
Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria : data from the Abeokuta Heart Failure Registry : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 20 –26 (2016)More Less
Background: Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa's most populous country, Nigeria. We examined the six-month outcomes (including case fatality) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria.
Methods: The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%).
Results: There were a number of differences according to the subject's gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also have greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4-7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7-11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once.
Conclusions: The characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.
Prevalence and determinants of hypertension and associated cardiovascular risk factors : data from a population-based, cross-sectional survey in Saint Louis, Senegal : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 27 –30 (2016)More Less
Background: The incidence of cardiovascular disease is growing worldwide and this is of major public health concern. In sub-Saharan Africa, there is a lack of epidemiological data on the prevalence and distribution of risk factors of cardiovascular disease. This study aimed at assessing the prevalence of hypertension and other cardiovascular risk factors among an urban Senegalese population.
Methods: Using an adaptation of the WHO STEPwise approach to chronic disease risk-factor surveillance, we conducted a population-based, cross-sectional survey from 3 to 30 May 2010 on 1 424 participants aged over 15 years. Socio-demographic and behavioural risk factors were collected in step 1. Physical anthropometric measurements and blood pressure were documented in step 2. Blood tests (cholesterol, fasting blood glucose, and creatinine levels) were carried out in step 3.
Results: The prevalence of hypertension was 46% (95% CI: 43.4-48%), with a higher prevalence in females (47.9%) than males (41.7%) (p = 0.015), and 50% of these hypertensive were previously undiagnosed. Mean age was 53.6 years (SD: 15.8). In known cases of hypertension, the average length of its evolution was 6 years 9 months (range 1 month to 60 years). Hypertension was significantly associated with age (p = 0.001), socio-professional category (p = 0.003), dyslipidaemia (p < 0.001), obesity (p < 0.001), physical inactivity (p < 0.001), diabetes (p < 0.001) and stroke (p < 0.001).
Conclusion: We found a high prevalence of hypertension and other cardiovascular risk factors in this population. There is need of a specific programme for the management and prevention of cardiovascular disease in this population.
The prevalence and distribution of non-communicable diseases and their risk factors in Kasese district, Uganda : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 31 –36 (2016)More Less
Background: To date there has been no population-based survey of the major risk factors for non-communicable diseases (NCD) in Uganda. Hospital-based data from urban centres report an increasing burden of NCDs in Uganda. Our population-based survey aimed to describe the prevalence of risk factors for NCDs in a rural Ugandan district.
Methods: The survey was conducted using the WHO STEP wise approach to surveillance of non-communicable diseases (STEPS) methodology. Participants (n = 611) were residents of the Kasese district selected in a one-step, complete survey of a rural district. Standardised international protocols were used to record history of disease, and measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity), physical characteristics [weight, height, waist and hip circumferences, blood pressure (BP)], fasting blood glucose (BG) and total cholesterol (TC) levels. Data were analysed using simple descriptive analysis.
Results: In this sample, the prevalence of hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg) was 22.1% for men and 20.5% for women. Fifteen per cent of men and 16.8% of women were overweight [body mass index (BMI) ≥ 25 kg/m2] and 4.9% of men and 9.0% of women were obese (BMI ≥ 30 kg/m2). Nine per cent of participants were diabetic, 7.2% ate five or more combined servings of fruit per day while only 1.2% ate five or more combined servings of vegetables per day. Fifty-one per cent of the population were physically inactive and 9.6% were daily smokers. Thirty-one per cent of females had fasting blood sugar levels (FBS) ≥ 6.1 mmol/l while 10% of males had FBS > 6.1 mmol/l.
Conclusion: This study presents evidence on the magnitude of NCDs, their risk factors and gender distribution in a rural population in Uganda, a poor country in east-central Africa. These data, when combined with urban population data, could be useful in the formulation and advocacy of NCD policy and plans of action in Uganda.
Prevalence of the metabolic syndrome in people of Asian Indian origin : outcomes by definitions : research articleSource: South African Journal of Diabetes and Vascular Disease 13, pp 37 –39 (2016)More Less
Background: The prevalence of the metabolic syndrome (MS) is high among south Asian Indians. In order to better comprehend the MS, its definition and modifications require region-specific cut-off values and common minimum criteria for people of Indian origin.
Methods: To define the MS, the criteria as defined in the National Cholesterol Education Program (NCEP): expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) (ATP III 2001), followed by the modified ATP III of 2005 were used, along with a modified version specific to the people of south Asian origin (ATP III SAS, 2009).
Results: The three definitions showed differences in prevalence of the MS among the adult Asian Indians. According to the criteria of NCEP ATP III 2001, the prevalence was found to be 32.3%. Using the modified ATP III 2005, the prevalence was 48.3%, and for south Asian-specific (SAS) ATP III, it was 31.4%. For all three definitions, females had a considerably higher prevalence of the MS than males. It was also observed that that a large number of individuals were misclassified due to lack of common minimum criteria.
Conclusion: In order to curb the growing threat of the MS, and to aid clinical management among people of Indian origin, a more comprehensive definition of the MS is urgently required.
Diagnostic and prognostic values of B-type natriuretic peptides (BNP) and N-terminal fragment brain natriuretic peptides (NT-pro-BNP) : reviewSource: South African Journal of Diabetes and Vascular Disease 13, pp 40 –43 (2016)More Less
B-type natriuretic peptide (BNP) is a member of a four-natriuretic peptide family that shares a common 17-peptide ring structure. The N-terminal fragment (NT-pro-BNP) is biologically inert, but both are secreted in the plasma in equimolar quantities and both have been evaluated for use in the management of congestive heart failure. BNP and NT-pro-BNP are frequently used in the diagnosis of congestive heart failure and the distinction between patients with dyspnoea of cardiac or pulmonary origin. Values of NT-pro-BNP are affected by age or the presence of one or several co-morbidities such as chronic renal failure, type 2 diabetes, and acute coronary syndrome. 'Normal' values of these peptides also vary depending on the type of test used. The performance characteristics of these tests vary depending on the patients on whom they are used and the manufacturer. For this reason, the determination of reference values for this peptide represents such a challenge.
Drug Trends in Diabetes - Hypoglycaemia in type 2 diabetes increases the risk of cardiovascular events : drug trendsSource: South African Journal of Diabetes and Vascular Disease 13 (2016)More Less
In type 2 diabetes, careful control of blood glucose can help prevent or delay micro- and macrovascular complications. Initially this may be adequately achieved with lifestyle changes and oral medication, but because of the progressive nature of diabetes, characterised by gradual decline in β-cell function and density, most patients will eventually require insulin to achieve glycaemic goals. The benefits of control achieved early in the disease remain for many years, despite it becoming more difficult to maintain target glucose levels.