Publication:

Diabetes Mellitus in adult Nigerians: patients’ characteristics, laboratory profile, practices and management outcome

Background Type 2 diabetes constitutes more than 90% of cases seen in Nigeria. Previous reports had shown that patients were poorly controlled and failed to meet management target across a broad range of parameters. Objectives of this study evaluated the characteristics and practices of patients attending the outpatient diabetes clinic. The study also examined to what extent they achieved management goals and what practices by the patients impacted negatively on treatment outcome.

Methods This was a cross sectional descriptive study. All patients were eligible. Consecutive patients attending the Diabetes Clinic were evaluated. Their demographic, behavioural, social, clinical and laboratory data were obtained. Data analysis was done with SPSS V 21.

Results There were 193 subjects, 78 males and 115 females aged 35-82(59.8± 9.1) years.  T2DM was diagnosed in 93.4%.  Hypertension was coexistent in 74%. Present or past foot ulcer was recorded in 11.9%. Only 37% of the subjects had an exercise program, 35% did the daily foot exam, and 45% had ophthalmology consult. Skipping medication was widespread (64%), mainly due to self-titration of medications (44%) and cost (23%). Fear of hypoglycemia (83%) and hypotension (79%) was prevalent. Their body mass index was 18.2-41.2(27.6±4.8) kg/m2. Subjects were prescribed a total of 2-14 medications (5.5±1.6). Metformin was the most commonly used glucose lowering medication (88.6%), followed by sulfonylureas (64%) and insulin (27.5%). HbA1c ranged from 5.3-16; 9.0±2.4%(33-151; 75±2.7 mmol/mol).

Conclusion Glycaemic control was poor in the study population. Intermittent medication to avoid hypoglycemia played a major role. The patients lacked competence to manage their diabetes from day to day. Diabetes Self-Management Education and Support (DSMES) and early use of insulin are recommended.