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BACKGROUND: Physical exercise helps to mitigate cardiovascular risks in people with diabetes mellitus (DM), but there are limited data in Nigeria. This study aimed to assess cardiovascular risk awareness, exercise practices and metabolic outcomes among Nigerians with diabetes. MATERIALS AND METHODS: We conducted a cross-sectional study at five tertiary hospitals using questionnaire interviews and clinical assessments. Participants' knowledge of cardiovascular risk factors and knowledge of exercise were assessed on 12- and 5-item scores, while exercise practices were classed as adequate if performed regularly on 3 or more days weekly for a total of 150 min or more based on the American Diabetes Association recommendations. Mean body mass index (BMI), blood pressure (BP), fasting blood glucose, serum haemoglobin A1C (HbA1c), lipid profile, urea, creatinine and uric acid were then compared among participant groups. RESULTS: We studied 426 participants with DM, 58.7% females. The mean age was 52.9 ± 13.1 years, with males significantly older than females (54.6 ± 12.2 vs. 51.8 ± 13.5 years; 95% confidence interval: 0.27-5.28, P = 0.03). The mean age at diabetes diagnosis was 44.8 ± 11.7 years, and the median duration of diabetes was 84 months. There was low knowledge of cardiovascular risk factors and low knowledge of exercise (mean scores of 2.94 and 2.31, respectively). Forty-three per cent of participants reported adequate exercise, which was significantly associated with younger age (P = 0.007), male gender (P = 0.001) and formal education (P = 0.021). Participants with adequate exercise had lower systolic BP and serum urea compared to those with inadequate exercise, but there were no significant differences in BMI, fasting glucose, HbA1c, serum lipids, creatinine or uric acid. CONCLUSION: Participants had low knowledge of cardiovascular risks and the appropriate exercise practices for diabetes patients. There is a need for better patient education on diabetes self-care and exercise at clinic visits.
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Enfermedades Cardiovasculares , Ejercicio Físico , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Nigeria , Ejercicio Físico/fisiología , Adulto , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/epidemiología , Factores de Riesgo de Enfermedad Cardiaca , Anciano , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisis , Encuestas y Cuestionarios , Diabetes Mellitus/epidemiología , Glucemia/metabolismo , Factores de Riesgo , Índice de Masa CorporalRESUMEN
OBJECTIVE: The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU. METHODS: The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing. RESULTS: The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004-0.332). This was followed by PAD (OR 0.093; 95% CI 0.028-0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030-0.395), anemia (OR 0.179; 95% CI 0.056-0.571). CONCLUSION: Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.
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Diabetes Mellitus/epidemiología , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Hospitalización/estadística & datos numéricos , Cicatrización de Heridas/fisiología , Adulto , Anciano , Amputación Quirúrgica/estadística & datos numéricos , Pie Diabético/fisiopatología , Pie Diabético/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Pronóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores SocioeconómicosRESUMEN
BACKGROUND: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria. METHODS: The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical, and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number. RESULTS: Three hundred and twenty-three type 2 DM subjects with mean age and mean duration of DM of 57.2 ± 11.4 years and 8.7 ± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and the majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > 1 month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p < 0.001), positive blood cultures (p < 0.001), low HDL (p < 0.001), shock at presentation (p < 0.001), cardiac failure (p 0.027), and renal impairment (p < 0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349-5.971) were significantly predictive of mortality independent of other variables. CONCLUSIONS: This study showed high intra-hospital mortality among patients with DFU, with the majority of deaths occurring among those with advanced ulcers, bacteraemia, cardiac failure, and renal impairment. Prompt attention to these factors might help improve survival from DFU in Nigeria.
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Pie Diabético/mortalidad , Mortalidad Hospitalaria , Adulto , Anciano , Amputación Quirúrgica/mortalidad , Amputación Quirúrgica/estadística & datos numéricos , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/mortalidad , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/terapia , Angiopatías Diabéticas/complicaciones , Angiopatías Diabéticas/mortalidad , Angiopatías Diabéticas/terapia , Pie Diabético/diagnóstico , Pie Diabético/terapia , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/mortalidad , Nefropatías Diabéticas/terapia , Femenino , Úlcera del Pie/diagnóstico , Úlcera del Pie/mortalidad , Úlcera del Pie/terapia , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Pronóstico , Factores de Riesgo , Sepsis/complicaciones , Sepsis/mortalidad , Sepsis/terapiaRESUMEN
BACKGROUND: Diabetes is a life-long and debilitating disease that is fraught with both acute and chronic complications. Of particular concern to sufferers of the disease is the development of foot problems. These problems range from foot deformities to slowly healing or non-healing ulcers (that may necessitate amputation) and in the worst-case scenario, to death. Identification and prompt treatment of comorbid conditions, such as anemia may improve outcome in patients with diabetic foot ulcers (DFU). We determined the prevalence of anemia in Nigerians with DFU and its impact on disease outcome. METHODS: We prospectively followed 336 patients with diabetes hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. We evaluated each patient for neuropathy, vasculopathy and medical co-morbidities. Relevant laboratory and imaging studies were performed. We present the results of the sub-group analysis of patients with anemia to determine its prevalence and impact on disease outcome in patients with DFU in the MEDFUN study. RESULTS: Anemia was detected in 180(53.6%) subjects with 88(48.9%) of them requiring blood transfusion. Significant demographic and clinical determinants of anemia were ulcer duration more than one month prior to hospitalization (p<0.009), PAD (p<0.001) and presence of gangrene (p<0.001). The comorbid conditions that were significantly associated with anemia included proteinuria (p<0.003), osteomyelitis (p<0.006), moderate (p<0.002) as well as severe (p<0.001) vascular stenosis, history of stroke (p<0.014) and renal impairment (p<0.002). Anemia was significantly associated with poor wound healing (p<0.009), amputation (p<0.036) and risk of death (p<0.034). CONCLUSION: We detected anemia in more than half of our cohort with DFU. We found significant association between anemia and poor wound healing, amputation and mortality among our studied subjects. Future studies should explore whether prompt correction of anemia in subjects hospitalized for DFU would improve outcome.
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Anemia/complicaciones , Pie Diabético/complicaciones , Adulto , Anciano , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , PronósticoRESUMEN
BACKGROUND: Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU. METHODS: The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation. RESULTS: One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization (P < 0.001), PAD (P < 0.001), Wagner grade ≥ 4 (P < 0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis (P < 0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055-26.132), PAD (O.R. 2.8, 95% C.I. 1.520-5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930-10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population. CONCLUSION: We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients.
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Amputación Quirúrgica/estadística & datos numéricos , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/cirugía , Úlcera del Pie/cirugía , Extremidad Inferior/cirugía , Adulto , Anciano , Pie Diabético/patología , Femenino , Úlcera del Pie/etiología , Úlcera del Pie/patología , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Estudios Prospectivos , Factores de Riesgo , Centros de Atención TerciariaRESUMEN
BACKGROUND: Nigeria bears the greatest burden of diabetes prevalence in Sub-Saharan Africa. Diabetic foot ulcer (DFU) is a serious and potentially life-threatening complication of diabetes. Significant improvements in diabetic foot incidence and outcomes have been recorded in many Western countries in the past decade. However, the current burden of DFU in Nigeria is largely unknown. AIM: To evaluate the patients' profile, ulcer characteristics, associated co-morbidities and outcome of patients with DFU in Nigeria. METHODS: Multicenter evaluation of diabetic foot ulcer in Nigeria was a one year multicenter observational study of patients hospitalized for DFU in six tertiary health institutions in Nigeria from March 2016 to March 2017. Demographic and diabetes information, ulcer characteristics and associated co-morbidities were assessed. Relevant laboratory and imaging studies were performed. All patients received appropriate multi-disciplinary care and were followed up until discharge or death. Outcome variables of interest were ulcer healing, lower extremity amputation (LEA), duration of hospitalization and mortality. RESULTS: A total of 336 patients (55.1% male) with mean age of 55.9 ± 12.5 years were enrolled into this study. Majority (96.1%) had type 2 diabetes. Only 25.9% of the subjects had prior foot care knowledge. Most of the subjects presented late to the hospital and median (IQR) duration of ulcer at presentation was 39 (28-54) d. Ulcers were already advanced (Wagner grades ≥ 3) in 79.2% of the subjects while 76.8% of the ulcers were infected at the time of admission. The commonest co-morbidities were systemic hypertension, anemia and hyperglycemic emergencies. One hundred and nineteen subjects (35.4%) suffered LEA while 10.4% left against medical advice. The median (IQR) duration of hospitalization was 52.0 (29-66) d with case fatality rate of 20.5%. CONCLUSION: The burden of DFU in Nigeria is very high. The major gaps include low level of foot care knowledge among diabetic patients, overdependence on self-medication and unorthodox medicine following development of foot ulceration, late hospital presentation, and high amputation and mortality rates. Extensive foot care education within the framework of a multi-disciplinary foot care team is highly desirable.
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Background: Diabetic foot infection (DFI) is a dreaded complication of diabetes mellitus, which usually occurs following foot ulceration. It may starts as a monomicrobial infection and end up as a polymicrobial infection. Antimicrobial regimens are usually selected empirically initially, based on local epidemiological and antimicrobial susceptibility pattern. Objective: The aim is to investigate the microbiological profile of patients admitted with DFIs in our institution and determine the antimicrobial susceptibility pattern of the isolates. Materials and Methods: A 2year retrospective observational study of patients admitted with DFI into our institution. The microbiological culture and antimicrobial susceptibility results of swab specimens from the patients were retrieved and reviewed. These were correlated with the clinical stage of the disease. Results: Fiftysix patients' medical records were reviewed. There were 35 males and 21 females. The mean age of the patients was 56.2 years (range 4875 years). Three patients had bilateral lesions. The Wagner grades of the lesions were Grades IIV, with Grade IV being predominant. Eight bacteria species and a fungus were isolated from the 59 swab specimens studied. Four specimens yielded no growth, whereas 7 specimens yielded contaminants. Monomicrobial cultures were predominant, with Gramnegative bacteria being preponderant.Staphylococcus aureus was the most common isolate, followed by Proteus species. The isolates showed greater susceptibility to levofloxacin and ciprofloxacin. Conclusion: The findings suggest that either levofloxacin or ciprofloxacin should be the anchor antimicrobial agent in empirical treatment of DFI in our locality
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Pie Diabético , Susceptibilidad a EnfermedadesRESUMEN
INTRODUCTION: Latent autoimmune diabetes in adult (LADA) is a form of Type 1 diabetes mellitus (T1DM) that occurs in adult or with advancing age. It commonly occurs in people aged ≥30 years and is characterized by initial response to oral hypoglycemic agents, lean body mass, and presence of glutamic acid decarboxylase autoantibody (GAD-Ab). It exhibits rapid deterioration of the pancreatic ß-cells secretory function due to the destructive action of the autoantibodies. The prevalence of LADA among T2DM patients varies among population due to different diagnostic criteria, patients' characteristics, the assay used, and genetic predisposition. In this study, we intend to document prevalence and clinical characteristics of LADA subset patients in Northern Nigeria. METHODS: Two-hundred noninsulin-requiring T2DM patients were recruited from the diabetes clinic based on the selection criteria. Their clinical characteristics were documented, and we measured their serum GAD-Ab, glycated hemoglobin (HbA1c), fasting C-peptide, fasting plasma glucose, and fasting serum lipids. The mean (standard deviation) of these clinical and biochemical parameters was compared between GAD-Ab+ and GAD-Ab- groups. The data were analyzed using SPSS version 20 with P< 0.05 as statistically significant. RESULTS: The prevalence of LADA among the T2DM patients studied was found to be 10.5% (21/200); there were more males than females (15 [71%]:6 [29%], χ2 = 4.2, P< 0.05). The mean age of the GAD-Ab+ was 52.0 (11.0), and there was no statistical difference with GAD-Ab- group. GAD-Ab+ was found more common in the age group of 40-49 years 10/21 (48%). The body mass index, waist circumference, and serum C-peptide were found to be significantly lower in GAD-Ab+ than in GAD-Ab- group (22.1 [51], 80.1 [12.4], 0.84 [0.05] vs. 27.3 [4.9], 93.2 [10.9], 1.72 [0.43]), P< 0.05. The HbA1c was found to be significantly higher in GAD-Ab+ than in GAD-Ab- (8.3 [1.4] vs. 7.0 [2.1]). Other clinical and metabolic parameters were found not to be significantly different between the two groups. CONCLUSION: We conclude that the prevalence of LADA among T2DM patients in Northern Nigeria is 10.5%. It is more common among males aged 40-49 years and lean subjects. The male sex and decreasing central adiposity are predictors of GAD-Ab+ among T2DM subjects.