Browsing by Subject "diabetes"

Now showing 1 - 6 of 6
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    Open Access
    A retrospective review with prospective follow up of renal function, blood pressure and proteinuria post living donor nephrectomy at Groote Schuur Hospital, Cape Town South Africa
    (2020) Murugan, Ashley; Dave, Nicola
    Introduction: Renal transplantation is the treatment of choice for patients with end stage renal disease [ESRD]. An increased risk of ESRD has been demonstrated when comparing donors to age matched healthy non-donors. There are no outcome data in Africa on long term donor renal function or mortality. Therefore, this study aimed to assess long term health complications in the living donor population and evaluate risk factors associated with poor health outcomes of the donors. Methods: This was a retrospective review with prospective follow up of persons undergoing living related donor nephrectomy for renal transplantation, at Groote Schuur Hospital (GSH) from January 2005 to November 2017. We retrospectively analysed baseline demographics, clinical information including blood pressure and renal function (creatinine, eGFR and proteinuria) and compared them with follow up blood pressure and renal function. Results: The majority of the donors were of mixed ancestry 94/154(61%) and 1st degree relatives 111/154 (72%) of which 63/111 (56.8%) donors were siblings. Hypertension developed in 16/31 (51.6%) donors at follow-up. Those developing hypertension had a higher mean baseline blood pressure (systolic blood pressure 139±11.3 mmHg and diastolic blood pressure 85.5±7.3 mmHg). 21/49(42.9%) developed chronic kidney disease [CKD], of which, 16 donors had an eGFR < 60 ml/min/1.73m2 . In those that developed CKD there was a higher percentage of males (p=0.018) and they were older (p=0.048) at baseline. Baseline systolic and diastolic blood pressures was not statistically different in those that developed CKD. 3/31(9.6%) donors developed diabetes. Conclusions: In South Africa, CKD is on the rise and the need for kidney donors for patients with ESRD is therefore also increasing. This study demonstrates that our living donors are at increased risk of CKD and hypertension and therefore need to be followed up more rigorously.
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    Open Access
    Effects of diabetes mellitus on amyotrophic lateral sclerosis: a systematic review
    (BioMed Central Ltd, 2014) Lekoubou, Alain; Matsha, Tandi; Sobngwi, Eugene; Kengne, Andre
    BACKGROUND:Amyotrophic lateral sclerosis (ALS) is an incurable motor neuron degenerative disease which onset and course may be affected by concurrent diabetes mellitus (DM). We performed a systematic review to assess the effect of DM/dysglycemic states on ALS. METHODS: We searched PubMed MEDLINE, from inception to March 2013 for original articles published in English and in French languages on DM (and related states) and ALS. We made no restriction per study designs. RESULTS: Seven studies/1410 citations (5 case-control and 2 cross-sectional) were included in the final selection. The number of participants with ALS ranged from 18 to 2371. The outcome of interest was ALS and DM/dysglycemic states respectively in three and two case control-studies. DM/impaired glucose tolerance status did not affect disease progression, survival, disease severity and disease duration in ALS participants but ALS participants with DM were found to be older in one study. DM/IGT prevalence was similar in both ALS and non ALS participants. This review was limited by the absence of prospective cohort studies and the heterogeneity in ALS and DM diagnosis criteria. CONCLUSIONS: This systematic review suggests that evidences for the association of ALS and DM are rather limited and derived from cross-sectional studies. Prospective studies supplemented by ALS registries and animal studies are needed to better understand the relationship between both conditions.
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    Factors influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with type 2 diabetes attending a clinic in Cape Town
    (Medical and Pharmaceutical Publications, 2014) Ebrahim, Z; De Villiers, A; Ahmed, T
    Objective: The purpose of this study was to explore the experiences of patients with type 2 diabetes mellitus attending the Groote Schuur Hospital Diabetes Clinic in relation to contextual factors that promote or impede adherence to nutrition care guidelines. Subjects and setting: Eight diabetic patients (four males and four females) attending the Groote Schuur Hospital Diabetes Clinic who were between 40-70 years old. Outcome measures: Qualitative analysis of factors influencing adherence to dietary guidelines. Method: An explorative study, using a qualitative approach with eight semi-structured interviews, was used. Patients were interviewed at the diabetes outpatient clinic in Cape Town. Semi-structured interviews were recorded and transcribed, and thereafter analysed using ATLAS/ti®. Results: Various themes as to what influences adherence to dietary guidelines emerged. An ecological analysis is offered to understand the different levels of influence on participants’ dietary behaviour. The main identified factors at individual level were motivation, individual knowledge, perceptions of moderation, self- responsibility, taste concept or cravings, and temptations. At small group (family and friends) level, family relations with the patients were identified as the main support system used to manage the diabetes. At the organisational or health systems level, long waiting times and the theme of seeing different doctors emerged as problematic factors, but overall, patients were satisfied with the clinic service. At community and policy level, culture and the cost of food were identified as key influential factors with regard to adherence to nutrition care guidelines. Conclusion: This study shows the usefulness of adopting an ecological model in identifying factors that influenced adherence to dietary guidelines by patients with type 2 diabetes. Some factors acted as enablers and others as barriers. These had an impact on patient adherence to nutrition care guidelines. These factors should be considered by diabetes educators, including dietitians and nurses and doctors, when planning treatment modalities for patients with type 2 diabetes mellitus.
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    Fasting insulin sensitivity indices are not better than routine clinical variables at predicting insulin sensitivity among Black Africans: a clamp study in sub-Saharan Africans
    (BioMed Central Ltd, 2014) Sobngwi, Eugene; Kengne, Andre-Pascal; Echouffo-Tcheugui, Justin; Choukem, Simeon; Sobngwi-Tambekou, Joelle; Balti, Eric; Pearce, Mark; Siaha, Valentin; Mamdjokam, Aissa; Effoe, Valery; Lontchi-Yimagou, Eric; Donfack, Oliver; Atogho-Tiedeu, Barbara
    BACKGROUND: We aimed to evaluate the predictive utility of common fasting insulin sensitivity indices, and non-laboratory surrogates [BMI, waist circumference (WC) and waist-to-height ratio (WHtR)] in sub-Saharan Africans without diabetes. METHODS: We measured fasting glucose and insulin, and glucose uptake during 80/mU/m2/min euglycemic clamp in 87 Cameroonians (51 men) aged (SD) 34.6 (11.4) years. We derived insulin sensitivity indices including HOMA-IR, quantitative insulin sensitivity check index (QUICKI), fasting insulin resistance index (FIRI) and glucose-to-insulin ratio (GIR). Indices and clinical predictors were compared to clamp using correlation tests, robust linear regressions and agreement of classification by sex-specific thirds. RESULTS: The mean insulin sensitivity was M =10.5+/-3.2mg/kg/min. Classification across thirds of insulin sensitivity by clamp matched with non-laboratory surrogates in 30-48% of participants, and with fasting indices in 27-51%, with kappa statistics ranging from 0.10 to 0.26. Fasting indices correlated significantly with clamp (/r/=0.23-0.30), with GIR performing less well than fasting insulin and HOMA-IR (both p <0.02). BMI, WC and WHtR were equal or superior to fasting indices (/r/=0.38-0.43). Combinations of fasting indices and clinical predictors explained 25-27% of variation in clamp values. CONCLUSION: Fasting insulin sensitivity indices are modest predictors of insulin sensitivity measured by euglycemic clamp, and do not perform better than clinical surrogates in this population.
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    Obesity phenotypes in urban and rural Cameroonians: a cross-sectional study
    (BioMed Central Ltd, 2015) Mbanya, Vivian; Echouffo-Tcheugui, Justin; Akhtar, Hussain; Mbanya, Jean-Claude; Kengne, Andre
    BACKGROUND: Despite the increasing prevalence of diabetes and other health consequences of obesity, little is known on the metabolic profile across categories of body mass index (BMI) among African populations. We therefore assessed the prevalence and distribution of body size phenotypes among urban and rural Cameroonians. METHODS: Adults (n=1628; 41% rural dwellers) aged 24-74 years in 1994 provided data on BMI and metabolic health, defined on the basis of elevated levels of blood pressure (BP); triglycerides, fasting plasma glucose (FPG), and insulin resistance as assessed with homeostasis model assessment (HOMA). Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Metabolic measures include elevated blood pressure; elevated triglycerides ([greater than or equal to]150 mg/dL or 1.69mmo/L), elevated fasting plasma glucose ([greater than or equal to]100 mg/dl or 5.6 mmol/L or documented use of antidiabetic medications), and elevated homeostasis model assessment of insulin resistance value (HOMA-IR>90th percentile). RESULTS: A total of 25.2% of participants were overweight yet metabolically healthy (<1 abnormality) and 10.1% were obese yet metabolically healthy, whereas 1.4% were normal weight but metabolically abnormal ([greater than or equal to]2 abnormalities). Proportion of rural dwellers with abnormal metabolic phenotype across normal-weight, overweight, obese categories were 2.9%, 0.8% and 0.3%, respectively; and 0 .3%, 2.2% and 2.6% among urban dwellers. Metabolically abnormal participants increased linearly across BMI categories (p<0.001). BMI categories and metabolic status interacted to affect age, gender, BMI, FPG, triglycerides, and BP status distributions (all p<0.04). Metabolic status and residence (rural vs. urban) interacted to influence the distribution across BMI categories of diastolic BP, BMI, waist circumference, fasting and 2-hour glucose, triglycerides, HOMA-IR, and prevalent diabetes (all p<0.005), with differential occurrence of BMI categories and metabolic status among urban and rural participants. CONCLUSIONS: Metabolic healthy obesity and obesity with a favorable cardiometabolic profile are not uncommon among Cameroonians, including among rural dwellers; but the latter group tended to have a better profile.
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    Protocol for the modeling the epidemiologic transition study: a longitudinal observational study of energy balance and change in body weight, diabetes and cardiovascular disease risk
    (BioMed Central Ltd, 2011) Luke, Amy; Bovet, Pascal; Forrester , Terrence; Lambert, Estelle; Plange-Rhule, Jacob; Schoeller, Dale; Dugas, Lara; Durazo-Arvizu, Ramon; Shoham, David; Cooper, Richard; Brage, Soren; Ekelund, Ulf; Steyn, Nelia
    BACKGROUND: The prevalence of obesity has increased in societies of all socio-cultural backgrounds. To date, guidelines set forward to prevent obesity have universally emphasized optimal levels of physical activity. However there are few empirical data to support the assertion that low levels of energy expenditure in activity is a causal factor in the current obesity epidemic are very limited. METHODS/DESIGN: The Modeling the Epidemiologic Transition Study (METS) is a cohort study designed to assess the association between physical activity levels and relative weight, weight gain and diabetes and cardiovascular disease risk in five population-based samples at different stages of economic development. Twenty-five hundred young adults, ages 25-45, were enrolled in the study; 500 from sites in Ghana, South Africa, Seychelles, Jamaica and the United States. At baseline, physical activity levels were assessed using accelerometry and a questionnaire in all participants and by doubly labeled water in a subsample of 75 per site. We assessed dietary intake using two separate 24-hour recalls, body composition using bioelectrical impedance analysis, and health history, social and economic indicators by questionnaire. Blood pressure was measured and blood samples collected for measurement of lipids, glucose, insulin and adipokines. Full examination including physical activity using accelerometry, anthropometric data and fasting glucose will take place at 12 and 24 months. The distribution of the main variables and the associations between physical activity, independent of energy intake, glucose metabolism and anthropometric measures will be assessed using cross-section and longitudinal analysis within and between sites. DISCUSSION: METS will provide insight on the relative contribution of physical activity and diet to excess weight, age-related weight gain and incident glucose impairment in five populations' samples of young adults at different stages of economic development. These data should be useful for the development of empirically-based public health policy aimed at the prevention of obesity and associated chronic diseases.