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Ekpor E, Addo-Mensah D, Akyirem S. Prevalence of dyslipidemia among persons with type 2 diabetes in Africa: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:3468-3477. [PMID: 38846843 PMCID: PMC11152840 DOI: 10.1097/ms9.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/20/2024] [Indexed: 06/09/2024] Open
Abstract
Background Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown. This systematic review and meta-analysis aimed to determine the prevalence of dyslipidemia among persons with T2D in Africa. Methods Medline, Embase, Global Health, Scopus, and Web of Science were searched on 5 December 2023. This review adhered to the PRISMA guidelines and was prospectively registered on PROSPERO. The prevalence data for dyslipidemia was pooled through a random-effects meta-analysis. The authors assessed heterogeneity and publication bias using I 2 statistics and Egger's test, respectively. Results Our search identified 8035 records, of which 60 articles involving 20 034 individuals with T2D were included in this review. The pooled prevalence of dyslipidemia recorded 38.6% (95% CI: 34.1-43.4) for high TC (≥ 5.2 mmol/l), 52.7% (95% CI: 44.2-61.1) for high low-density lipoprotein cholesterol (LDL-C) (≥ 2.6 mmol/l), 43.5% (95% CI: 37.1-50.0) for low high-density lipoprotein cholesterol (HDL-C) (< 1.0 mmol/l in men and less than 1.3 mmol/l in women), and 37.4% (95% CI: 32.2-42.9) for high triglycerides (TG) (≥ 1.7 mmol/l). Subgroup analysis based on gender indicated a notably higher prevalence of dyslipidemia among females compared to males. Conclusion Dyslipidemia is prevalent among persons with T2D in Africa. This highlights the need for early screening, diagnosis, and management of dyslipidemia to mitigate the risk of cardiovascular complications in this population.
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Affiliation(s)
- Emmanuel Ekpor
- School of Nursing and Midwifery, University of Ghana, Legon
- Christian Health Association of Ghana, Accra, Ghana
| | - Dorothy Addo-Mensah
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Foluke Bosun-Arije S, Chibuzor Nwakasi C, Ekpenyong M, Serrant L, Esther Sunday-Abel T, Ling J. A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings. J Res Nurs 2021; 26:763-778. [PMID: 35251284 PMCID: PMC8894752 DOI: 10.1177/17449871211021137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Mandu Ekpenyong
- Research Fellow, Department of Nursing, Manchester Metropolitan University, UK
| | - Laura Serrant
- Professor, Department of Nursing, Manchester Metropolitan University, UK
| | | | - Jonathan Ling
- Professor, Faculty of Health Sciences and Wellbeing, University of Sunderland, UK
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Abstract
BACKGROUND Diabetes is a noncommunicable disease that has attained great significance in the sub-Saharan region, with Nigeria being the most affected. Many persons with the condition suffer a reduced life expectancy and quality of life. Diabetes places an extra burden on the individuals and families affected, especially for the majority of patients unable to access quality health care. OBJECTIVE To describe the elements of diabetes management in Nigeria, areas for improvement, and proposed strategies to optimize care. METHODS A systematic literature search was performed on diabetes in Nigeria. Local and nonindexed literature, PubMed, and Google Scholar were used to source information on the subject. FINDINGS Diabetes-related morbidity and mortality continue to increase due to population expansion, urban migration, declining physical activity, and dietary factors. The organization of diabetes care is poorly coordinated, especially at the primary and secondary tiers of the public health care system, with consequent poor outcomes. Thus life expectancy (just about 50 years), which is low in the region, is further reduced by the double jeopardy of communicable (eg, tuberculosis, HIV/AIDS, and malaria) and noncommunicable diseases, such as diabetes and its closely related comorbidity, hypertension. CONCLUSIONS The way forward is to improve maternal and child care, promote screening of at-risk populations, and develop strategies for primary prevention and early intervention to optimize glycemic control. Greater commitment to health care by the government and nongovernmental organizations and greater awareness by Nigerians should facilitate the desired improvements in disease prevention and glycemic control in those who are already affected.
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Affiliation(s)
- Olufemi A Fasanmade
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN
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Huang KC, Li TM, Liu X, Chen JH, Chien WK, Shiao YT, Tsang H, Lin TH, Liao CC, Huang SM, Li JP, Lin CW, Lin JC, Lin CC, Lai CH, Cheng CF, Liang WM, Hung CH, Chen CC, Lin YJ, Tsai FJ. KCNQ1 variants associate with hypertension in type 2 diabetes and affect smooth muscle contractility in vitro. J Cell Physiol 2017; 232:3309-3316. [PMID: 28059450 DOI: 10.1002/jcp.25775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/23/2016] [Accepted: 01/05/2017] [Indexed: 12/19/2022]
Abstract
KCNQ1 encodes a potassium voltage-gated channel and represents a susceptibility locus for type 2 diabetes mellitus (T2DM). Here, we explored the association between KCNQ1 polymorphisms and hypertension risk in individuals with T2DM, as well as the role of KCNQ1 in vascular smooth muscle cell contraction in vitro. To investigate the relationship between KCNQ1 and the risk of developing hypertension in patients with T2DM, we divided the T2DM cohort into hypertension (n = 452) and non-hypertension (n = 541) groups. The Mann-Whitney U test, chi-square test, and multivariate regression analyses were used to assess the clinical characteristics and genotypic frequencies. In vitro studies utilized the rat aortic smooth muscle A10 cell line. Patients in the hypertension group were significantly older at the time of enrollment and had higher levels of body mass index, waist-to-hip ratio, and triglyceride than those in the non-hypertension group. The KCNQ1 rs3864884 and rs12576239 genetic variants were associated with hypertension in T2DM. KCNQ1 expression was lower in the individuals with the CC versus the CT and TT genotypes. Smooth muscle cell contractility was inhibited by treatment with a KCNQ1 inhibitor. These results suggest that KCNQ1 might be associated with hypertension in individuals with T2DM.
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Affiliation(s)
- Kuo-Chin Huang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Integration of Traditional Chinese and Western Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Te-Mao Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Xiang Liu
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jin-Hua Chen
- Biostatistics Center and School of Public Health, China Medical University, Taichung, Taiwan.,Biostatistics Center and School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Wen-Kuei Chien
- National Applied Research Laboratories, National Center for High-Performance Computing, Hsinchu, Taiwan
| | - Yi-Tzone Shiao
- Heart Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsinyi Tsang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ting-Hsu Lin
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Chu Liao
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Mei Huang
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ju-Pi Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Rheumatism Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Wen Lin
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Jung-Chun Lin
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chien Lin
- Department of Cosmetic Science, Providence University, Taichung, Taiwan
| | - Chih-Ho Lai
- Department of Microbiology and Immunology, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Fung Cheng
- Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, School of Public Health, China Medical University, Taichung, Taiwan
| | - Chien-Hui Hung
- Graduate Institute of Clinical Medical Science, Chang-Gung University, Taipei, Taiwan
| | - Ching-Chu Chen
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ying-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Asia University, Taichung, Taiwan
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