|Year : 2016 | Volume
| Issue : 1 | Page : 19-22
Clinical and biochemical characteristics of newly diagnosed diabetics in South-South Nigeria
Andrew E Edo1, Gloria O Edo2
1 Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||12-Feb-2016|
Andrew E Edo
Department of Medicine, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Background: Diabetes mellitus (DM) patients are often referred to tertiary care centre after prior management in a primary or secondary health centre. Data on newly diagnosed DM are few in our locality. Objective: To determine the clinical and biochemical characteristics of newly diagnosed DM. Subjects and Methods: The present study was a retrospective study of newly diagnosed DM patients seen at a tertiary hospital in Nigeria. Data on patient's age, sex, body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose and fasting lipid profile were retrieved and extracted from their medical records. Results: One hundred and thirty patients with DM were recruited in the study. Seventy-nine (60.8%) diabetic subjects were females. The mean ± standard deviation age of all the diabetic subjects was 55.09 ± 12.56 years. Obesity and hypertension were found in 34 (26.2%) and 50 (38.5%) of the diabetics, respectively. Female diabetic patients had significantly larger mean BMI than that of the male diabetics. High-density lipoprotein cholesterol dyslipidaemia, low-density lipoprotein-cholesterol dyslipidaemia, serum total cholesterol dyslipidaemia and triglyceride dyslipidaemia were found in 38 (29.2%), 35 (26.9%), 17 (13.1%) and 12 (9.2%) of diabetics, respectively. Conclusion: Hypertension, obesity and dyslipidaemia are common features in persons with newly diagnosed DM.
Keywords: Dyslipidaemia, hypertension, newly diagnosed diabetes mellitus, Nigerians, obesity
|How to cite this article:|
Edo AE, Edo GO. Clinical and biochemical characteristics of newly diagnosed diabetics in South-South Nigeria. Niger J Basic Clin Sci 2016;13:19-22
|How to cite this URL:|
Edo AE, Edo GO. Clinical and biochemical characteristics of newly diagnosed diabetics in South-South Nigeria. Niger J Basic Clin Sci [serial online] 2016 [cited 2023 Mar 31];13:19-22. Available from: https://www.njbcs.net/text.asp?2016/13/1/19/172146
| Introduction|| |
Diabetes mellitus (DM) is a chronic metabolic disorder that has assumed pandemic proportion. It is associated with significant morbidity and mortality. Its prevalence in Nigeria is 2.2%. Chronic complications of DM include neuropathy, cataract, coronary artery disease, diabetic foot ulcers and erectile dysfunction. Co-morbidities of DM include hypertension, obesity and dyslipidaemia. These cardiovascular risk factors increase the risk of dying from cardiovascular events. Early diagnosis and prompt management of DM and its co-morbidities are desirable to delay or prevent DM complications and death. DM is treated at both primary and secondary healthcare facilities with the main emphasis being to achieve a good glycaemic control. DM comorbidities such as obesity and dyslipidaemia are often overlooked. Patients are often referred to tertiary care centre after being managed for a period at either a primary or secondary healthcare centre when they developed DM complications or when they are unable to achieve a good glycaemic control. Therefore, it is often difficult to characterise newly diagnosed diabetic patients, especially with respect to the presence of some cardiovascular risk factors in them. Data on newly diagnosed DM patients are few in our locality and indeed in Nigeria. The aim of the study was to document the clinical and biochemical characteristics of newly diagnosed diabetic patients seen in a tertiary hospital in Nigeria.
| Subjects And Methods|| |
The present study was a retrospective study of newly diagnosed (≤1 year) DM patients seen at the Diabetes Clinic of the University of Benin Teaching Hospital, Benin City over a 36 months period. Medical records of the all newly diagnosed diabetic subjects were retrieved and included in the study. Data extracted and recorded included age, gender, history of hypertension, family history of DM, blood pressure, occupation, waist circumference (WC), body mass index (BMI), fasting serum lipid profile and fasting plasma glucose.
Statistical analysis was carried out using the Statistical Package for Social Sciences version 16 (SPSS, Chicago, IL, USA). Data are expressed as mean ± standard deviation (SD). Comparison of means was done using Student's t-test for continuous data. Level of statistical significance was set at P < 0.05.
This study was approved by the Ethics and Research Committee of the Hospital.
Definition of terms
DM was defined according to the 2011 World Health Organisation criteria.
Using World Health Organisation criteria, abdominal obesity was defined as WC ≥88 cm in women and WC ≥102 cm in men, while generalised obesity was BMI >30 kg/m −2 in both genders. Dyslipidaemia was defined using the National Cholesterol Education Program (Adult Treatment Panel III) criteria  as total cholesterol level >5.17 mmol/l, low-density lipoprotein (LDL)-cholesterol >2.59 mmol/l, triglyceride level >1.7 mmol/l and high-density lipoprotein (HDL)-cholesterol level <1.29 mmol/l in females and <1.03 mmol/l in males.
Peripheral neuropathy was defined as diminished or lack of perception of touch/pain stimuli, loss of joint position sense, vibration sense (assessed using a 128 Hz tuning fork) and pressure sense over the metatarsal heads of the feet using 10-g monofilament and ankle reflexes. Peripheral neuropathy was regarded as present when at least two of these tests were abnormal.
| Results|| |
The study population consisted of 130 persons with DM. Of these, 79 (60.8%) were females and 46 (35.4%) were males giving a female to male of 1.7:1. The mean ± SD age of all the study subjects was 55.09 ± 12.56 years (min–max: 18–92 years). Among 130 study subjects, 2 (1.6%) had type 1 DM, and 128 (98.4%) had type 2 DM (T2DM). Obesity and hypertension were found in 34 (26.2%) and 50 (38.5%) of them, respectively. Abdominal obesity was found in 54 (41.5%) of female and 30 (23.1%) of male participants. A family history of DM was documented in 25 (19.2%) of the diabetics. Thirty (23.1%) patients had peripheral neuropathy. The baseline characteristics of the diabetic subjects are summarised in [Table 1]. Female diabetic patients had significantly larger mean BMI than that of the male diabetics. Other characteristics of male and female diabetic subjects are comparable and are shown in [Table 2]. The prevalence rates of the different types of dyslipidaemias in the diabetics are shown in [Figure 1]. Low HDL-cholesterol dyslipidaemia was the most common dyslipidaemia.
|Table 2: Comparison of characteristics of newly diagnosed diabetic patients by sex|
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|Figure 1: Types and frequency of dyslipidaemia among newly diagnosed diabetics|
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| Discussion|| |
The study showed that the majority (98.4%) of the newly diagnosed diabetic patients had T2DM. The female to male sex ratio of 1.7:1 is also in keeping with previous Nigerian reports , that DM is more common among females than male counterparts. This may be due to differences in health seeking behaviour of the two groups. Females patronise the public hospitals, whereas males may be more willing to pay for healthcare services in private health facilities. This study was conducted in a public hospital.
The 38.5% prevalence of hypertension in our newly diagnosed diabetic patients was lower than the 41.6% reported by Ikem et al. and the 60.9% prevalence found in a multicentre study in Nigeria by Uloko et al. The difference in prevalence rate of hypertension could be due to the fact that the mean duration of DM in the multicentre study was 8.8 ± 6.6 years. Hypertension is more prevalent in persons with DM of longer duration and those with complications, especially renal impairment. Agaba  reported a 71.4% prevalence rate of hypertension among type 2 diabetics presenting with end-stage renal disease. Hypertension worsens the prognosis in DM subjects by accelerating development of cardiovascular events and renal impairment. Control of the blood pressure to desirable target blood pressure of 130/80 mmHg is, therefore, imperative.
Obesity is a common feature in persons with T2DM and is believed to be the driving force behind the increasing prevalence of T2DM worldwide., Obesity is an independent risk factor for cardiovascular disease., It is associated with hyperinsulinaemia, which is the hallmark of T2DM., Obesity has the potential of hindering the attainment of good glycaemic control and accelerating progression of DM complications. Prevalence of generalised obesity of 34 (26.2%) in this study is lower than the 42.5% obesity rate found among T2DM patients in Isezuo and Ezunu  and also lower than the 32.9% rate of generalised obesity documented among type 2 diabetic patients seen in a secondary healthcare centre in Benin City. Abdominal obesity rate of 41.5% in females was also lower than the 76.2% in female type 2 diabetic patients in the study by Edo and Edo. Obesity was more prevalent in females than in males in the study as also documented in previous Nigerian studies.,,,,, Management of obese diabetic patients should include weight-reducing diet and increased physical activity. For these patients, metformin should be included as the first-line oral hypoglycaemic agents in addition to weight-reducing diet therapy. Other glucose-lowering antidiabetic agents that associated with weight gain are best avoided in these patients.
The common dyslipidaemias were those of low HDL-cholesterol dyslipidaemia and elevated LDL-cholesterol dyslipidaemia. The pattern of dyslipidaemias in this study was similar to other studies ,,, on lipid profile in diabetic patients with low HDL-cholesterol being the most common dyslipidaemia. However, the prevalence of the individual dyslipidaemia was higher in this study that those in oil workers with DM reported by Edo and Adediran. There was no difference in the mean values of the lipid fractions between male and female subjects. It is, therefore, important that newly diagnosed DM patients are encouraged to do their lipid profile as there are usually no 'symptoms' of dyslipidaemia until the development of coronary artery disease and peripheral artery disease.
The finding of peripheral neuropathy in 30 (23.1%) of the patients at presentation is significant because peripheral neuropathy is a major risk factor for diabetic foot ulcerations. Many previously undiagnosed cases of DM present with diabetic foot ulcer as their mode of the first presentation. These patients with peripheral neuropathy need to be educated about avoiding application of hot compress to the feet or putting the feet near fire to soothe numbness to minimise the risk of diabetic foot ulcerations. Their first hospital visit should be used to educate them on proper foot care and foot wears.
| Conclusion|| |
The present study showed that there were high prevalence rates of hypertension, obesity and dyslipidaemia in our newly diagnosed diabetic patients. The combination of these cardiovascular risk factors put the patients at an increased risk of DM morbidity and mortality if appropriate measures are not put in place to address these co-morbidities beyond glycaemic control. Therefore, a comprehensive diabetes care should be instituted for all newly diagnosed DM patients beyond mere glycaemic control.
We would to like to thank Dr. J. Odiase of the Department of Mathematics, the University of Benin for his statistical inputs into our work, and the house officers and resident doctors in our units who helped to run the Diabetes Clinic. We also thank our Medical Record Staff who helped us to retrieve our patients' medical records for this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]