Diabetes mellitus associated with epidemic of infectious hepatitis in Nigeria

Viral Hepatitis and Diabetes: Clinical Implications of Diabetes Prevention Through Hepatitis Vaccination

Viral hepatitis has been posited to play a role in the development of type 2 diabetes. Thus, prevention of viral hepatitis through vaccination has the potential to reduce the burden of type 2 diabetes. We have shown that successful hepatitis B vaccination reduces the risk of diabetes by 33 %. Although diabetes can be prevented by behavior modification and pharmaceutical agents, these require significant personal commitment and cost. In contrast, diabetes prevention through hepatitis B vaccination would require little personal commitment and relatively low cost. In this review, we discuss hepatitis viruses A, B, and C and their interaction with diabetes; explore the potential underlying mechanisms and potential for hepatitis vaccination to reduce diabetes; and estimate the medical expense savings that would result from such an intervention. Given the projected increase of diabetes prevalence in the developing regions, where hepatitis B is endemic, exploration of such an intervention is very timely.

Seasonality in diabetes in Yaounde, Cameroon: a relation with precipitation and temperature

Background

Diabetes is a growing health concern in developing countries, with Cameroon population having an estimated 6% affected. Of note, hospital attendees appear to be increasing all over the country, with fluctuating numbers throughout the annual calendar. The aim of the study was to investigate the relationship between diabete hospitalization admission rates and climate variations in Yaounde.

Methods

A retrospectively designed study was conducted in four health facilities of Yaounde (Central Hospital, University teaching hospital, Biyem-Assi and Djoungolo District Hospitals), using medical records from 2000 to 2008. A relationship between diabetes (newly diagnosed diabetes patients or decompensated diabetics) hospitalization admissions and climate variations was determined using the “2000–2008” national meteorological database (precipitation and temperature).

Results

The monthly medians of precipitation and temperature were 154mm and 25 °C, respectively. The month of October received 239mm of precipitation. The monthly medians of diabetic admissions rates (newly diagnosed or decompensated diabetes patients) were 262 and 72 respectively. October received 366 newly diagnosed diabetics and 99 decompensated diabetics. Interestingly, diabetic hospitalization admissions rates were higher during the rainy (51 %, 1633/3232) than the dry season, though the difference was non-significant. The wettest month (October) reported the highest cases (10 %, 336/3232) corresponding to the month with the highest precipitation level (239mm). Diabetes hospitalization admissions rates varied across health facilities [from 6 % (189/3232) in 2000 to 15 % (474/3232) in 2008].

Conclusion

Diabetes is an important epidemiological disease in the city of Yaounde. The variation in the prevalence of diabetes is almost superimposed to that of precipitation; and the prevalence seems increasing during raining seasons in Yaoundé.

Type 2 diabetes in adult Nigerians: a study of its prevalence and risk factors in Port Harcourt, Nigeria

OBJECTIVES

This study aimed to assess the prevalence rates of type 2 diabetes and to determine potential associated risk factors of the disease in Port Harcourt, Nigeria.

RESEARCH DESIGN AND METHODS

Five hundred and two (502) subjects aged above 40 years, obtained by a two-stage cluster sampling technique participated in this survey. Casual (random) plasma glucose estimations were done for all subjects after relevant personal data were obtained. Subjects with casual plasma glucose (CPG) > or =7.0 mmol/l had oral glucose tolerance tests (OGTT) done. Fasting and 2 h post glucose load blood samples were analyzed for plasma glucose levels.

RESULTS

Thirty-four (34) subjects had diabetes, giving a crude prevalence rate of 6.8% (CI=4.6-9.0%), and standardized rate of 7.9%. The crude prevalence rates were 7.7 and 5.7% for males and females, respectively. Of the 34 diabetic subjects seen, 14 (41.2%) of them were not previously known to have diabetes; 83.7% of these were asymptomatic. Body mass index (BMI) > or = 25 kg/m2 and WHR > or = 0.85, family history of diabetes, physical inactivity, heavy consumption of alcohol, older age as well as high social status and Hausa-Fulani or Ibibio origin were associated with significantly higher prevalence of type 2 diabetes.

CONCLUSION

The prevalence of type 2 diabetes in Port Harcourt is relatively high. Changing lifestyle associated with industrialization may explain this. A significant proportion of the diabetic subjects are asymptomatic and undiagnosed. The risk factors as shown in our study clearly emphasize the point that type 2 diabetes is to a large extent a preventable disease.

Post-liver transplantation diabetes mellitus: an association with hepatitis C

A retrospective study was performed on all liver transplant recipients from British Columbia from 1989 to March 2000 to determine the prevalence and predictive factors of diabetes mellitus (DM) post-liver transplantation. DM was defined as hyperglycemia requiring treatment with insulin or oral hypoglycemic agents. Patient characteristics, cause of liver disease at transplantation, and immunosuppression regimen were considered. Both univariate and multiple logistic regression analyses were performed. Posttransplantation DM (PTDM) occurred in 43 of 177 transplant recipients (24%). Of these, 13 transplant recipients had DM pretransplantation, whereas 30 patients developed de novo PTDM. The majority of patients were treated with insulin (80%). In univariate analysis, transplantation for hepatitis C virus (HCV) liver disease was associated with a greater incidence of PTDM (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.46 to 6.23) and de novo PTDM (OR, 5.20; 95% CI, 2.25 to 11.99). Patients administered tacrolimus had a greater incidence of PTDM (OR, 2.04; 95% CI, 1.01 to 4.13), and there was a trend toward increased PTDM in older patients (mean age, 49 years). Recipient sex, steroid dosage, and acute rejection were not predictive of PTDM. The incidence of graft loss and death rates were similar between the two groups. On logistic regression, HCV was the only independent predictor of PTDM (OR, 4.12; 95% CI, 1.91 to 8.90) and de novo PTDM (OR, 6.02; 95% CI, 2.55 to 14.20). In conclusion, DM post-liver transplantation is a common occurrence and is associated with HCV.

Higher incidence of diabetes in liver transplant recipients with hepatitis C

We assessed the clinical and biochemical parameters associated with the development of posttransplantation diabetes (PTDM) in 52 liver transplant recipients followed up for 1 year. Diabetes was present before transplantation in 9.6% (5 of 52) of patients, and PTDM occurred in 23% (11 of 47) of the remaining liver transplant recipients. Of the 13 patients who had hepatitis C as the cause of their liver failure (HC-LD), 8 (62%) developed PTDM; of the 34 patients with other causes of liver failure, 3 (9%) developed PTDM (p < 0.001). Posttransplantation diabetes was also associated with the development of early posttransplantation hyperglycemia, a higher number of liver rejection episodes, and lower serum albumin levels at 6 months. The association of PTDM with HC-LD remained significant in a logistic regression model after adjustment for potential confounding variables. We conclude that PTDM is common in liver transplant recipients. Associated clinical parameters predictive of PTDM include a diagnosis of HC-LD before transplantation, the development of early hyperglycemia after transplantation, multiple episodes of posttransplantation liver rejection and low serum albumin levels at 6 months. The fact that HC-LD remained an independent risk factor for the development of PTDM may suggest a direct or immune-mediated pancreatic effect of the virus.

Occurrence of IDDM during interferon therapy for chronic viral hepatitis

We report a case of IDDM which occurred during interferon therapy for chronic hepatitis. A 31-year-old man intermittently received 2.5 x 10(8) units of alpha-IFN and 1 x 10(8) units of beta-IFN for treatment of chronic viral hepatitis type B. Four years after the beginning of IFN therapy, he acutely developed moderate hyperglycemia and severe ketonuria with positive islet cell antibody, and then 28 units/day of insulin injection was started. After the start of insulin therapy, there was a remission period for about 3 years but insulin-dependency recurred thereafter. The clinical course of this case indicates that IFN therapy precedes IDDM. During and after IFN therapy we should consider the possibility of occurrence of IDDM as well as other autoimmune diseases and observe the clinical course carefully.

Seasonal incidence of diabetes mellitus in tropical Africa

During a 6-year period from 01 June 1981 to 30 May 1987, 1250 newly diagnosed African diabetic patients were registered at Muhimbili Medical Centre, Dar es Salaam, Tanzania. A seasonal pattern in the presentation of patients for both insulin-requiring and non-insulin-requiring diabetic patients was observed (p less than 0.001). The peak months of presentation were August through to November, with the greatest number of patients presenting in September (170 patients in 6 years) and the smallest number in June (55 patients). Similar patterns were found for month of onset of symptoms, with the peak month August (180 patients) and the trough month May (56 patients) (p less than 0.001). A similar pattern of presentation was observed in Morogoro, a town in another region of Tanzania. Seasonality in the presentation of insulin-requiring and non-insulin-requiring diabetes may therefore occur in tropical as well as temperate climates.

Detection of HBsAg in the pancreas

Hepatitis B surface antigen (HBsAg) has been reported to be present in other organs than the liver. 3,9 So far as our knowledge is concerned, however, any report of cases dealing with pancreatic diseased induced by hepatitis B virus (HBV) has not been described in the English and Japanese literature. We report an autopsy case with a pancreatic lesion characterized by damage of both exocrine and endocrine epithelial cells with inflammatory responses, which were immunohistochemically found to be positive for HBsAg, and electron-microscopically to possess core-like particles in the nucleus and cytoplasm.

Jaundice during pregnancy in Ibadan, Nigeria

The clinical features of hepatitis during pregnancy and the effect of this complication on the mother and the fetus were evaluated in 45 patients with jaundice who were treated at the University College Hospital, Ibadan, Nigeria, from July 1976 to January 1978. Viral hepatitis was the cause of jaundice in 23 of the 45 patients in this prospective study. Three of these patients had the fulminant type of jaundice which resulted in maternal deaths. The peak incidence of the disease occurred in the last trimester. Hepatitis had a deleterious effect on the outcome of pregnancy; the effect was directly related to the severity of the disease, especially when associated with pyrexia. It is postulated that, by lowering resistance to infection, malnutrition may play a significant role in the pathogenesis of hepatitis during pregnancy.

Rubella infection and diabetes mellitus

The incidence of diabetes mellitus was increased in patients with congenital rubella. Experimental congenital rubella infection in rabbits caused histological changes in the beta-cells of the pancreatic islets similar to those found in mice made diabetic by the M variant of the encephalomyocarditis virus. It is concluded that the diabetes seen in congenital rubella is due to viral infection of the pancreatic islet cells.