Metabolic control in type 2 diabetes mellitus patients attending a tertiary diabetes clinic in Nigeria

Fasanmade, O.A ; Fasanmade, O.O ; Odeniyi, I.A ; Iwuala, S.O (2016)

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BACKGROUND: Persons with Type 2 Diabetes Mellitus (T2DM) have two to four fold increased risk for developing cardiovascular disease than non-diabetics. They also have increased risk of co-morbidities like hypertension, dyslipidemia and obesity. Complications of diabetes can be prevented or progression delayed by tight glycemic, blood pressure and lipid control. Glycemic control has been demonstrated in the UKPDS, MRFIT and STENO studies to reduce microvascular and macrovascular complications3-6. AIMS AND OBJECTIVES: The purpose of the study was to determine the percentage of patients who had their HbA1c, BP and Lipids treated among patients attending a tertiary government medical centre in Lagos, Nigeria. SUBJECT, METHODS, MATERIAL: Type 2 diabetes mellitus patients attending the Lagos University Teaching Hospital (LUTH) diabetes clinic, Lagos, Nigeria were recruited. The recruitment occurred for 2 months (July 1st – August 31st 2012). Information such as; gender, age, duration of diabetes mellitus, blood pressure, HbA1c, fasting lipids values were obtained from clinical examination and case notes. Data collected was analyzed using SPSS version 17, HBA1c was determined using a point of care device employing boronate affinity method. Fasting lipids wee determined using kits band blood sugar to determined using glucose oxidase Trinder techniques. RESULTS: 218 subjects (41.3% males, 58.7% females) seen in the diabetes clinic in July and August 2012 were recruited for the study. Mean age of the cohort was 59.08+11.02 years. Mean diabetes duration was 8.51 ± 7.37years. 47.7% of patients had good glycemic control using HbA1c of <7%, 40.8 % of patients had good BP Control of < 130/80mmHg and 80.7% had dyslipidemia. 78.9% had central obesity. 1.8% of patients were under-weight, 21.6% had normal weight, 43.6 % were overweight, 23.4% had obesity class 1, 7.8% had obesity class 2 while 1.4% had obesity class 3. DISCUSSION: In our study of 218 subjects, a third of who were obese, almost half overweight we found that only 47.7% of our study population had HbA1c <7%. Mean HbA1c was 7.56 ± 2.42%. This level of glycaemic control is similar to another study done by Unadike et al in Benin, Nigeria (2010), which reported poor glycemic control in 46% of subjects. Probable reasons for poor control in that study included; poor health seeking behavior, low level of literacy, poverty, poor adherence with follow up visits and medications amongst others. A similar study, the multiceatred Diabcare Nigeria study had only 32.4% of the subjects well controlled and a mean HBA1c of 8.2%. Coker and Fasanmade (2006) also documented poor glycemic control in their study amongst persons with diabetes in Lagos, Nigeria with a mean HbA1c level of 10.5%.Ogbera and Fasanmade et al also demonstrated high prevalence of dyslipidaemia with >80% having at least one abnormal lipid fraction. More recently Oguejiofor et al and Ogunleye et al described dyslipidaemia affecting two thirds of their DM cohort in the South South and South West part of the country respectively. Blood pressure control was noted to be sub-optional control despite all being on various antihypertensive CONCLUSION: Metabolic control in our environment though improving compared to a similar study 6 years earlier is still sub-optimal, and dyslipidemia seems to be the least well controlled metabolic parameter.The poor lipid control can be attributed to under treatment of this problem as POC machines to measure lipids are not readily available and where lipids are measured this is the costliest metabolic parameter to monitor and treat in DM. Concerted efforts (use of point of care devices for blood sugars, HBA1c and lipids, greater dietary management and lifestyle changes) need to be put in place to address poor metabolic control especially dyslipidemia. The poor blood pressure control is also of great concern considering that this is the most important factor in stroke aetiopathogenesis in Nigeria. It is believed that achieving all round metabolic and BP control with improve all cause DM mortality rates by reducing heart attacks, strokes and lower extremely amputations.