Correlation between insulin-based and C-peptide based homeostatic model assessment of insulin resistance in adults without diabetes in a sub-Saharan African setting: a cross-sectional study

OBJECTIVE

To assess the correlation between the insulin-based and C-peptide based HOMA-IR in the general population without diabetes in sub-Saharan Africa as well as to identify factors associated with IR.

RESULTS

This was a cross-sectional study in urban settings in Yaoundé, Cameroon. We included 84 people with a body mass index (BMI) ≥ 18.5 Kg/m² and without diabetes (females: 72.6%; mean age: 37 years). IR was assessed using the following formulae: HOMA-IR_INS = fasting insulin (mU/ml) x fasting plasma glucose (FPG) (mmol/L)/ 22.5; HOMA-IR_CP1 = fasting C-peptide (mU/ml) x FPG (mmol/L)/ 22.5; and HOMA-IR_CP2 = 1.5 + (FPG (mg/dl) x fasting C-peptide (ng/ml))/ 2800. Correlation (rho) between HOMA-IR_INS and C-peptide based HOMA-IR was investigated using the Spearman rank test. The median (25th -75th percentiles) HOMA-IR_INS, HOMA-IR_CP1, and HOMA-IR_CP2 were: 1.94 (1.36-3.50), 0.18 (0.11-0.27) and 9.91 (6.81-14.52), respectively. There was no correlation between the insulin-based and C-peptide-based HOMA-IR indices: rho = 0.043, p = 0.697. IR (HOMA-IR_INS ≥ 2.8) was associated with obesity: A BMI ≥ 30 Kg/m² (adjusted odds ratio (aOR): 16.9, 95% confidence intervals (CI): 3.1-92.5) and being a student (aOR: 8.9, 95%CI: 2.1-38.2) were associated with IR.

Bacterial profile of diabetic foot infections and antibiotic susceptibility in a specialized diabetes centre in Cameroon

Introduction

bacterial profile of diabetic foot infections and the antibiotic susceptibility are essential in the prescription of empirical antibiotics before the results of cultures of deep wound samples are available. The aim of this study was to determine the microbiological profile and antibiotic susceptibility of bacteria isolated from infected diabetic foot ulcers in patients attending the Yaoundé Central Hospital, Cameroon.

Methods

we retrospectively analyzed the records of patients hospitalized between 2008 and 2013 for diabetic foot infections. The main outcomes were the bacteriological profile and susceptibility patterns of isolates from positive culture of deep wound sample before antibiotherapy, carried out in the national reference laboratory. Eligible clinical records of patients were retrieved from the hospitalization registry.

Results

a total of 101 patient records were analyzed. The mean age of patients was 57.1 ± 9.1 years. There were more males (64.4%), mostly with type 2 diabetes (99%), with a median duration of 9 years (IQR: 4 - 14 years). Their median blood sugar on admission was 246 mg/dL. Five percent of patients died and 23% had a major amputation. Two hundred and twenty-five (225) germs were isolated, with an average of 2.25 germs per patient. Gram-negative bacteria were more frequent (75.2%). These were mainly Morganella morganii (13.8%), Klebsiella pneumonia (12%), Escherichia coli (11.6%), Proteus spp. (10.7%), and Pseudomonas aeruginosa (8.9%). Gram-positive bacteria (24.8%) were mainly Staphylococcus aureus (9.3%), Streptococcus spp. (7.6%), and Enterococcus spp. (7.1%). Gram-negative bacteria showed a high resistance to amoxicillin-clavulanic acid (78%), fluoroquinolones (55%), and gentamycin (50%). They were susceptible to imipenem (95%), amikacin (88%), and show moderate susceptibility to third generation cephalosporins (62%). Gram-positive bacteria were susceptible to vancomycine (94%), and moderately susceptible to pristinamycine (82%) and fusidic acid (67%).

Conclusion

Gram-negative bacteria were more frequently associated with diabetic foot infections, and were frequently resistant to the usually prescribed antibiotics, but remain susceptible to imipenem and amikacin. Our findings should be considered when prescribing empirical anti-biotherapy for diabetic foot infections in our setting.

Unexpected low burden of coronavirus disease 2019 (COVID-19) in sub-Saharan Africa region despite disastrous predictions: reasons and perspectives

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the development of a highly contagious disease called coronavirus disease (COVID-19). Ten months after the onset of the pandemic, America and Europe remain the most affected regions. Initially, experts predicted that Africa, the poorest continent with the most vulnerable population and health system, would be greatly affected by the ongoing outbreak. However, 240days after the first confirmed case, Africa is among the least affected region, with lower than expected incident cases and mortality. In this review, we discuss possible explanations and reasons for this unexpected low burden of COVID-19 in Africa. We focus on the characteristics of the virus, specificities of the sub-Saharan African population and local environment.

Effect of Topical Capsaicin on Painful Sensory Peripheral Neuropathy in Patients with Type 2 Diabetes: A Double-Blind Placebo-Controlled Randomised Clinical Trial

Objective

The aim of this study was to evaluate the efficacy of capsaicin in inducing significant pain relief in a population of sub-Saharan African type 2 diabetic patients with painful peripheral neuropathy.

Design

This was a prospective double-blind placebo-controlled randomised clinical trial.

Setting

A single tertiary-level hospital diabetes center in Yaounde, Cameroon.

Participants

Twenty-two participants with type 2 diabetes mellitus, presenting with painful diabetic neuropathy, aged 18 years and above.

Intervention

Participants were equally randomised to capsaicin or placebo. Each drug was to be applied on the lower limbs thrice daily. Follow-up was done every two weeks for eight weeks. 

Main outcome measure

Reduction in the median pain score from baseline, as assessed by the Visual Analogue Scale. 

Results

Twenty-two participants aged 57.5 (50-60) years with a median pain intensity of 6.8 units in the capsaicin group and 5.8 units in the placebo group were included; at inclusion, there was no significant difference in the two groups (p=0.29). After two weeks, the value of pain intensity was 3.3 [2.5-4.0] vs 5.0 [4.0-7.4] (p=0.003); at week four, 3.0 [2.5-3.3] vs 5.0 [4.2-5.5] (p=0,02); at week six, 3.3 [2.5-4.0] vs 4.8 [4.0-6.0] (p=0.03); and at week eight, 6.6 [6.0-7.0] vs 5.2 [5.0-6.0] (p=0.54) for capsaicin and placebo respectively.

Conclusion

This study, carried out due to a paucity of information on the effect of capsaicin and painful diabetic neuropathy in sub-Saharan African diabetes patients, shows that capsaicin significantly reduces neuropathic pain with worsening after eight weeks of use.

Trial registration number

Pan Africa Trial Registry: PACTR202003714748946.