Mortality patterns among type 2 diabetes mellitus patients in Ilorin, Nigeria

Incidence and predictors of hypertension among diabetic patients attending a diabetic follow-up clinic in Ethiopia: a retrospective cohort study

OBJECTIVE

To assess the incidence and predictors of hypertension among patients with diabetes attending a diabetes follow-up clinic.

METHODS

This institution-based retrospective cohort study was conducted among patients with diabetes who attended a diabetic follow-up clinic at Asella Referral and Teaching Hospital between January 2017 and December 2021. Patients diagnosed with hypertension prior to diabetes, or diagnosed with hypertension at the start of follow-up, were excluded. Data were extracted from medical records and analysed.

RESULT

A total of 351 patients with diabetes were included. The incidence density rate (IDR) of hypertension during 688.98 person-years of observation was 58.05 per 1000 (95% confidence interval [CI] 42.58, 79.14) person-years. The cumulative incidence of hypertension was 11.4% (95% CI 8.05, 14.7%) over 5 years. The 25th percentile survival time to hypertension development was 4.6 years. Multivariable Cox proportional hazard regression analysis showed that older age (adjusted hazard ratio [HR] 6.24, 95% CI 3.13, 12.45), family history of hypertension (adjusted HR 1.67, 95% CI 1.22, 9.65), comorbidity (adjusted HR 2.20, 95% CI 1.94, 5.21) and higher body mass index (adjusted HR 2.07, 95% CI 1.23, 5.63) were statistically significant predictors of hypertension development.

CONCLUSION

Among patients with diabetes in Ethiopia, the IDR of hypertension was high; and older age, family history of hypertension, comorbidity and higher body mass index were statistically significant predictors of hypertension development.

In-Hospital Mortality and Its Predictors among Hospitalized Diabetes Patients: A Prospective Observational Study

Background. Diabetes mellitus (DM) is one of the leading health emergencies of the 21st century and among the top ten causes of death among adults globally in 2017. Although Ethiopia has been victimized by the growing prevalence of DM, data regarding in-hospital mortality among admitted diabetic patients in Ethiopia, specifically in Jimma Medical Center (JMC), are lacking. Objective. The aim of the study is to assess in-hospital mortality and its predictors among DM patients admitted to Jimma Medical Center. Methods. A hospital-based prospective observational study was employed involving 120 diabetes patients admitted to JMC from October 01, 2020, to June 30, 2021. Data were collected on variables related to the patient, disease, medication, and clinical outcomes. Data were entered into Epidata version 4.6.0.4 for cleaning and exported to SPSS version 23.0 for analysis. Kaplan–Mayer and cox-regression analyses were used to compare the survival experience and to determine the predictors of clinical outcomes, respectively. Hazard ratio with its two-sided $p$ value <0.05 was considered to declare the statistical significance. Result. Of 120 DM patients, 81 (67.5%) of them were males. The in-hospital mortality was 13.34% (16/120). Rural residence (AHR: 3.46; 95% CI (1.12, 9.81)), age (AHR: 1.03; 95% CI: (1.001, 1.059)), admission with diabetic ketoacidosis (AHR: 5.01; 95% CI (1.12, 21.88)), and multiple comorbidities: five comorbidities (AHR: 9.65; 95% CI (1.07, 19.59)) and six comorbidities (AHR: 14.02; 95% CI (1.74, 21.05)) were independently associated with in-hospital mortality. On the other hand, exposure to nonantidiabetic medications decreased the hazard of mortality by 86.5% (AHR: 0.135; 95% CI (0.04, 0.457)). Conclusion. This study showed the rate of in-hospital mortality was noticeably high. The study showed that rural residence, age, DKA, and having comorbidities (five and six) were the statistically significant predictors of in-hospital mortality. In contrast, the use of nonantidiabetic medications such as statins, ASA, and other antihypertensive agents before admission remained protective. Thus, proper strategies have to be devised to improve in-hospital mortality among admitted DM patients.

Overall Clinical Features of Type 2 Diabetes Mellitus With Respect to Gender

Introduction Since patients with type 2 diabetes are frequently misdiagnosed, provided inappropriate management, or poorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients with respect to gender. Methods This was a multicenter, cross-sectional study that was conducted at various hospitals, using a non-probability sampling technique. The duration of the study was about six months, from January 1, 2022 to June 30, 2022. The study included 590 type 2 diabetes patients, ranging in age from 35 to 70 years. Age, gender, socioeconomic status, health status, co-morbidities, and diabetes symptoms were documented. A chi-square was applied to determine the association between overall symptoms associated with type 2 diabetes and gender. An independent t-test was applied to determine the significance level between means of demographic parameters. Results The study findings showed that out of 590 patients with diabetes, 310 (52.5%) were males and 280 (47.5%) were females. The male and female mean ages were 57.46±14.93 and 50.38±14.85 years, respectively, with a statistically significant gender difference (p<0.001). The prevalence of renal manifestation in type 2 patients with diabetes revealed a significant relationship (p<0.05) for both genders. The prevalence of ocular manifestations revealed a significant relationship with both genders (p<0.05) in terms of distortion and blurred vision. The prevalence of ocular manifestations revealed a significant relationship observed with both genders (p<0.05) in terms of shortness of breath, dyspnea severity, and severity of chest pain. Conclusion This study concluded that women with type 2 diabetes mellitus have a significantly higher frequency of muscular pain, urinary symptoms, neurological symptoms, and dermatological manifestations than men. In contrast, respiratory symptoms were significantly more pronounced in males than in females. The presence of comorbidities such as dyslipidemia significantly increased the probability of developing type 2 diabetes in both genders.

A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings

Background

Globally, there is an increased need to provide patient-centred care for people diagnosed with type 2 diabetes mellitus. In Nigeria, a poorly financed health system has worsened the difficulties associated with managing type 2 diabetes mellitus in clinical settings, causing a detrimental effect on patient-centred care.

Aims

We aimed to develop a conceptual model to promote patient-centred type 2 diabetes mellitus care in clinical settings. We explored nurses’ contextual perceptions of clinical practices and operations in light of type 2 diabetes mellitus management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimisation for people diagnosed with type 2 diabetes mellitus.

Methods

We adopted a qualitative approach. Using the constant comparison method and semi-structured questions and interviewed practice nurses, with over one year’s experience and who were working in public hospitals across Lagos, Nigeria. The framework method was used to analyse the data obtained.

Results

Nurses provided insight into four areas of patient-centred type 2 diabetes mellitus management in clinical settings: empowering collaboration; empowering flexibility; empowering approach; and empowering practice. Nurses discussed an empowering pathway through which health settings could provide patient-centred care to individuals diagnosed with type 2 diabetes mellitus. The pathway entailed the integration of macro, meso and micro levels for patient management. Nurses’ accounts have informed the development of a conceptual model for the optimisation of patient care.

Conclusions

The model developed from this research sits within the patient-centred care model of healthcare delivery. The research sits within the patient-centred care model of healthcare delivery. inform patient-centred care, not only in countries with poorly financed healthcare systems, but in developed countries with comparatively better healthcare.

Acute Complications of Diabetes and its Predictors among Adult Diabetic Patients at Jimma Medical Center, Southwest Ethiopia

BACKGROUND

Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia resulting from impairment in insulin secretion, insulin action, or both. It is responsible for a wide range of acute and chronic complications. In this study, we aimed to assess acute complications of diabetes and its predictors among adult DM patients at Jimma Medical Center (JMC), southwest Ethiopia.

METHODS

A facility-based cross-sectional study involving 348 diabetic patients was conducted from February to May 31, 2019 at JMC. Logistic regression was conducted to identify predictors of acute complications of diabetes. Variables with P≤0.25 on bivariate logistic regression were considered candidates for multivariate regression. ORs and 95% CIs  with P<0.05 were considered statistically significant.

RESULTS

Of the 348 patients, 225 (64.7%) were male, and the mean age of study participants was 46±15.5 years. Most (281, 80.7%) had type 2 DM. More than two-thirds (240, 69%)had diabetes duration of <5 years. During the study period, 92 (26.4%) patients developed acute complications of diabetes. Of these, 68 (73.9%) had diabetic ketoacidosis, 21 (22.8%) a hyperglycemic hyperosmolar state, and three (3.3%) hypoglycemia. Presence of comorbidity (AOR 5.6, 95% CI 2.80-11.19), type 1 DM (AOR 9.3, 95% CI 4.36-19.82), uncontrolled blood glucose (AOR 1.91, 95% CI 1.05-3.45), and lack of access to a health facility within a reasonable distance (AOR 1.96, 95% CI 1.11-3.45) were independent predictors of acute complications of diabetes.

CONCLUSION

The magnitude of acute complications among DM patients at JMC was high. Comorbidity, type 1 DM, uncontrolled blood sugar, and lack of access to a health facility within a reasonable distance were independent predictors of acute complications. Clinicians should follow up this subgroup of DM patients closely.

Anil Kumar N, Sharopov F, Ramírez-Alarcón K, Ruiz-Ortega A, Abdulmajid Ayatollahi S, Valere Tsouh Fokou P, Kobarfard F, Amiruddin Zakaria Z, Iriti M, Taheri Y, Martorell M, Sureda A, N. Setzer W, Durazzo A, Lucarini M, Santini A, Capasso R, Adrian Ostrander E, -ur-Rahman A, Iqbal Choudhary M, C. Cho W, Sharifi-Rad J. Antidiabetic Potential of Medicinal Plants and Their Active Components

Diabetes mellitus is one of the major health problems in the world, the incidence and associated mortality are increasing. Inadequate regulation of the blood sugar imposes serious consequences for health. Conventional antidiabetic drugs are effective, however, also with unavoidable side effects. On the other hand, medicinal plants may act as an alternative source of antidiabetic agents. Examples of medicinal plants with antidiabetic potential are described, with focuses on preclinical and clinical studies. The beneficial potential of each plant matrix is given by the combined and concerted action of their profile of biologically active compounds.

Long-term mortality in outpatients with type 2 diabetes in a reference hospital in Cameroon: a retrospective cohort study

OBJECTIVES

There are limited data on mortality in patients with type 2 diabetes mellitus (T2DM) in Sub-Saharan Africa. We aimed at determining the mortality rate, and the causes and the predictors of death in patients with T2DM followed as outpatients in a reference hospital in Cameroon.

DESIGN

Retrospective cohort study.

SETTING

A reference hospital in Cameroon.

PARTICIPANTS

From December 2015 to March 2016, patients with T2DM aged 18 years and older and who consulted between January 2009 and December 2014, were contacted directly or through their next of kin, and included in this study. All participants with less than 75% of desired data in files, those who could not be reached on the phone and those who refused to provide consent were excluded from the study. Of the 940 eligible patients, 628 (352 men and 276 women) were included and completed the study, giving a response rate of 66.8%.

OUTCOME MEASURES

Death rate, causes of death and predictors of death.

RESULTS

Of the 628 patients (mean age: 56.5 years; median diabetes duration: 3.5 years) followed up for a total of 2161 person-years, 54 died, giving a mortality rate of 2.5 per 100 person-years and a cumulative mortality rate of 8.6%. Acute metabolic complications (22.2%), cardiovascular diseases (16.7%), cancers (14.8%), nephropathy (14.8%) and diabetic foot syndrome (13.0%) were the most common causes of death. Advanced age (adjusted HR (aHR) 1.06, 95% CI 1.02 to 1.10; P=0.002), raised glycated haemoglobin (HbA1c) (aHR 1.16, 95% CI 1.00 to 1.35; P=0.051), low blood haemoglobin (aHR 1.06, 95% CI 1.02 to 1.10; P=0.002) and proteinuria (aHR 2.97, 95% CI 1.40 to 6.28; P=0.004) were identified as independent predictors of death.

CONCLUSIONS

The mortality rate in patients with T2DM is high in our population, with acute metabolic complications as the leading cause. Patients with advanced age, raised HbA1c, anaemia or proteinuria are at higher risk of death and therefore represent the target of interest to prevent mortality in T2DM.

Diabetic Complications among Adult Diabetic Patients of a Tertiary Hospital in Northeast Ethiopia

Background.The diabetic complications are becoming common community problems. The outcomes of diabetic complications are increased hospitalization, increased direct patient costs, and mortality. In Dessie, the prevalence of the diabetic complications is not well studied so far. Thus, the aim of this study is to assess prevalence of diabetic complications and associated factors among adult diabetic patients of Dessie Referral Hospital, Northeast Ethiopia.Methods.Cross-sectional study was conducted in the diabetic clinic of Dessie Referral Hospital from April to May 31, 2013. All diabetic patients who visited the clinic during the study period were included. Data was collected using interview guided self-administered questionnaire. Presence of complications and the type of medications the patient was on were identified through review of patient records. Data were cleaned, coded, and entered into SPSS for Windows version 17.0. Descriptive statistics and chi-square tests were carried out to meet the stated objective.The Results.Overall 129 (59.7%) of the patients were found to have been affected by one or more of the diabetic complications. Complications were identified mainly among type II diabetic patients. The age of patients (Pvalue-0.048), type of diabetes (Pvalue-0.00), and medication (Pvalue-0.00) were strongly associated with the occurrence of diabetic complication but self-reported adherence, attitude, and knowledge level of patients and the family history were not associated with the presence of complication.Conclusion.The prevalence of complications among diabetic patients in Dessie Referral Hospital was high. Targeted counseling and health information provision to the patients by the clinical staff will be helpful in reducing avoidable morbidity and mortality in the patients.