Background: Endocrine action is integrative and an endocrine dysfunction of one gland is known to affect other endocrine glands. Parathyroid glands are associated with the beta cell function. Thus, insulin resistance observed in type 2 diabetes mellitus (T2DM) may be associated with alterations of parathyroid hormones and their metabolic pathways. These have been reported to have a genetic root, postulated to be aberrant haemoglobin gene resulting in haemoglobin variants. This has not been fully explored in sub-Saharan Africa, which has significant population of haemoglobin variants. Aim: The aim of this study was to evaluate the status of parathyroid dysfunction and its association with haemoglobinopathies among Sub-Saharan Africans with type 2 diabetes mellitus. Method: A total of 204 individuals aged 25 – 80 years which comprised 100 T2DM and 104 Controls without T2DM were enrolled from a tertiary hospital, in Ibadan, Nigeria and environs.10mL intravenous blood was obtained from each participant. Parathyroid Hormone (PTH) was measured using enzyme linked immunosorbent assay (ELISA). Calcium, Phosphate, Albumin and Fasting Plasma Glucose (FPG) were analysed spectrophotometrically. Haemoglobin A2 (HbA2), Haemoglobin A (HbA), Haemoglobin C (HbC) and Haemoglobin S (HbS) and Glycated haemoglobin (HbA1c) were determined by High Performance Liquid Chromatography (HPLC) method using Variant Haemoglobin Testing System (Bio-Rad Variant II). Data analysed using appropriate statistical analysis were significant at p<0.05. Results: Normal parathyroid function, hyperparathyroidism and hypoparathyroidism were present in 93% vs 96%, 3% vs 0.96% and 4% vs 6.73% in T2DM and controls respectively. T2DM and controls with AA and Non AA had 62% vs 31% normoparathyroidism, 3% vs 0% hyperparathyroidism and 2% vs 2% hypoparathyroidism respectively. The association between parathyroid gland disorder in T2DM and controls with the various haemoglobin variants was not significant (p>0.05) but the difference between parathyroid function in the control group with and without Beta Thalassaemia Trait was significant (p<0.05). Conclusion: Hypoparathyroidism and hyperparathyroidism were revealed in Type 2 Diabetes Mellitus and control individuals with haemoglobin genotype AA (HbAA). Hypoparathyroidism was also found among controls with Beta Thalassaemia Trait. Timely identification of these disorders may be helpful in appropriate therapeutic regimen to facilitate bone growth, prevent fractures and complications of parathyroid gland in these individuals. KEYWORDS: Haemoglobin Variants, Parathyroid Dysfunction, Type 2 Diabetes Mellitus (T2DM).

Diabetes mellitus is a chronic metabolic disease characterized by persistent hyperglycemia resulting from absolute or relative deficiencies in insulin secretion and/or action. Diabetes and its complications cause substantial morbidity, disability and premature mortality. There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even further. In view of the increasing burden of diabetes in Nigeria, there is an urgent need to develop and implement an effective and sustainable policy for its prevention and management in the country. If diabetes is not given the attention it deserves now, it could impose an even greater toll on health and socio-economic development in Nigeria and overwhelm an already resource constrained health care system. The time for action is now. Suggested approaches to address the burden of diabetes in Nigeriaare discussed in this commentary. Key words: Diabetes, Burden, Nigeria, Action

Coronavirus disease-2019(COVID-19) is an emerging viral infection of public importance and it is caused by a beta coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). So far, it has affected about 15 million individuals and over 600 000 patients have died from it. The virus is novel and there is no approved specific therapy for the infection. This has led to the trial of different drugs to reduce the morbidity and mortality of the infection. Statins are primarily used to lower cholesterol. They also have other pleiotropic effects such as anti-inflammatory, anti-thrombotic, immunomodulatory and antiviral effects. Coincidentally, the processes that statins antagonize are the mechanisms underlying the pathogenesis of COVID-19. Therefore, it has been suggested that statins should be considered as an adjunct in the treatment of COVID-19. In the new era of evidence-based medicine, there is a need to examine the level of evidence available to support the clinically beneficial effect of statins in COVID-19 treatment. This literature review explores the strength and volume of evidence for the usage of statins in COVID-19. However, as at the time of writing this review, the evidence base is very scanty. The most quoted evidence available is a retrospective study which is a low level of evidence. Therefore, it can be concluded that there are various mechanisms identified by which statins could be useful in the treatment of COVID-19. However, the evidence for their recommendation as adjuncts for COVID-19 treatment is very weak.

Background and Objectives: Graves’ disease is the commonest cause of thyrotoxicosis and it is much less common in males. Also, there is scanty information about the clinical characteristics of males with Graves’ disease. The objectives of the study were to determine the frequency of males with Graves’ disease seen by the Endocrinology unit of a tertiary hospital and describe their clinical characteristics. Subjects, Materials and Methods: Clinical data was retrieved from the case records of patients with thyroid disease seen between January, 2016 and January, 2018 and analyzed using descriptive and inferential statistics. Results: 61 patients with Graves’ disease were seen out of which 6 cases were males giving a frequency of 10.9%. The male-to-female ratio was 1:9. The mean age at diagnosis of the male cases was 45 ± 16 years. All the patients had goitre and weight loss. 50% had heat intolerance, excessive sweating, palpitation, hyperdefaecation and hand tremors. Thyroid eye disease and thyrotoxic heart disease were found in 50% of the cases respectively. There was no statistically significant difference in the initial free thyroxine between males and females (p=0.18). There was no statistically significant association between initial free thyroxine and thyroid eye disease (p=0.39). Conclusion: Graves’ disease is 9 times commoner in females compared to males in our centre. The clinical features in males are similar to reported features in females except thyroid eye disease which appears commoner in males

Background: Anemia is reportedly common in type 2 diabetes mellitus (T2DM), and it is often unrecognized or overlooked, despite its contribution to the morbidity and mortality. With the growing burden of diabetes in sub-Saharan Africa, the occurrence of anemia among T2DM patients needs to be adequately characterized. Objective: We aimed to determine the prevalence and correlates of anemia among Nigerian patients with T2DM attending a tertiary outpatient clinic. Materials and Methods: It was a cross-sectional study involving 155 patients with T2DM and 78 controls without diabetes. Full blood count, serum creatinine, fasting plasma glucose, glycosylated hemoglobin (HbA1c), and spot urinary albumin–creatinine ratio were determined in the patients. The frequency and determinants of anemia among the participants were determined. Results: Anemia was found in 45.2% of the T2DM patients, compared to 28.2% of the controls (P = 0.012). The T2DM patients were twice as likely to have anemia as the controls. Among the T2DM patients with anemia, majority (68.6%) had a normocytic anemia, while 25.7% and 5.7% had microcytic and macrocytic anemia, respectively. The independent predictors of anemia were longer duration of diabetes and lower estimated glomerular filtration rate (eGFR) with odds ratio of 2.1 and 4.7, respectively. Conclusion: Anemia is common in T2DM patients including those with normal eGFR. Longer duration of diabetes and declining eGFR were the major factors associated with anemia. Screening for anemia is recommended for patients with T2DM as part of their routine annual evaluation, especially in those with longer disease duration and eGFR <60 ml/min.

BACKGROUND: Excess weight gain is common in people with type 2 diabetes mellitus (DM) but little is known about its ethno-geographic variation among the Nigerian populace. We aimed to report the prevalence and regional variation of overweight/obesity among subjects with type 2 DM in all the six geo-political regions of Nigeria. METHOD: Basic demographic and anthropometric data were consecutively collected from patients with type 2 DM attending out-patient clinics of seven designated teaching hospitals in the six geographic regions of the country using a pre-agreed method of measurement of anthropometry including waist circumference. The study was hospital-based descriptive cross-sectional in design. Body Mass Index (BMI) was categorised using the WHO criteria. Based on recommendations of the International Diabetes Federation (IDF) cut-off values for waist circumference, values> 94 cm and > 80 cm were taken as abnormal for men and women respectively. RESULTS: A total of 709 subjects with DM comprising 378 (53.3%) females and 331 (46.7%) males (female: male ratio 1:1.14)with an overall mean age (SD) of 51.9 (13.9) years were evaluated. The prevalence of excess body weight among Nigeriansubjects with type 2 DM was: peripheral (417 or 58.8%) and abdominal obesity (449 or 63.3%). Also, there was a significantwide variation in excess weight gain (both peripheral and central) across ethno-geographic regions (p=0.001) and between both sexes (p=0.001). In both peripheral and abdominal obesities, whether intra or inter centres, the female subjects with type 2 DM demonstrated relatively higher proportions of anthropometric measures. Generally, subjects from south-south and south-east Nigeria had higher BMI and abdominal obesity compared to those from south-west who had the lowest. The female subjects with type 2 DM were heavier peripherally and centrally compared to their male counterparts. CONCLUSION: The prevalence of peripheral and central obesity among Nigerians living with type 2 DM (especially the female subjects) is unacceptably high. Additionally, there is a wide variation in the proportion and absolute values of both peripheral and central obesity across different parts of Nigeria.

BACKGROUND: Diabetes is a complex, chronic illness which requires continuous medical care. Requests for specialist consultation is a regular occurrence, and the referral process is most commonly initiated by a referral letter. The ability to effectively formulate an appropriate management plan for a patient at the time of specialist consultation largely depends on the quality of clinical information provided in the referral letter. AIM: The aim of the study was to assess the information provided in referral letters to the specialist diabetes clinic in tertiary hospital in Nigeria. METHODS: This was a cross-sectional study conducted between August and December 2017. All referral letters presented to the diabetes clinic on selected clinic days were evaluated using a data extraction tool designed by the investigators. RESULTS: The majority of referral letters provided information on patient identifiers. However, the provision of clinical information deemed vital for effective patient triage and good quality review in the specialist diabetes clinic was generally unsatisfactory. Less than a quarter of the referral letters provided information on key parameters such as physical examination findings, patients medication and glycated hemoglobin (HbA1c) level. Short term measures of glycemic control, blood pressure status, serum creatinine and serum lipid profiles were reported in just 51.3%, 35%, 6.7% and 2.5% of referral letters respectively. CONCLUSION: We have observed that referral letters to our specialist diabetes clinic often do not contain adequate information considered essential for a good quality consultation. Identifying the root causes of the inadequacies observed and the institution of intervention measures to address the problems identified could help improve the delivery of specialist review services for patients with diabetes. Interventions such as the use of standardized formats for referral letters, provision of referral guidelines and physician education programmes might help improve the quality of information provided at the time of referral.

Background: Beta thalassaemia trait (BTT), a beta globin gene disorder share insulin resistance with Type 2 Diabetes Mellitus (T2DM). BTT may therefore be a risk factor for T2DM. We hypothesise that undiagnosed BTT could be a risk factor for T2DM. Methods: BTT was compared between 99 individuals with T2DM and 105 apparently healthy individuals in an unmatched case-control study. Red cell indices and haemoglobin fractions were analysed using an electronic cell counter and HPLC respectively. Findings: T2DM individuals were a decade older than controls, 59.6 years vs. 46 years (p=0.001), more likely to be women. T2DM had a lower mean haematocrit, 37.3% vs. 40.6% (p=0.001). Though the mean HbA2 was higher in T2DM (2.6% vs. 2.4% (p=0.03)) the prevalence of BTT was twice as high in the control 8% vs. 4%. More T2DM had the Sickle Cell Trait (SCT) 27.3% (27/99) vs. 15.2% (16/105); p=0.035. The mean HbA2 for individuals with SCT was higher than for individuals without the trait (3.1% vs. 2.4%; p=0.001). All T2DM with BTT had the SCT while six of the eight controls with BTT had SCT. T2DM with BTT were older, more likely to be women and had a lower haematocrit, red cell indices than controls with BTT but both had similar RDW and HbA2. Conclusion: The higher HbA2 in SCT, T2DM and a higher prevalence of SCT in T2DM may be linked to the presence of BTT. Apparent protection of T2DM by BTT may be because of early deaths of T2DM with BTT. T2DM may therefore differ between those with BTT and those without.

Objective: The study aims to assess the quality of care provided at a diabetes outpatient clinic of a tertiary hospital in Nigeria using quality indicators approved by the National Diabetes Quality Improvement Alliance (NDQIA).Materials and Methods: The medical records of patients who had visited the clinic at least two times within a 12 months period preceding the index visit were reviewed during a 5 month period. Process measure indicators, approved by the NDQIA (evaluating the functioning of the clinic) and outcome measures, published by the American Diabetes Association, (evaluating the health status of the attending patients) were retrieved from the medical records.Results: The 332 records reviewed showed that the most consistently performed process measures were blood pressure and weight measurement (>90%). Foot examination was done infrequently (10.5%). Less than 50% had at least an annual low-density lipoprotein cholesterol (LDL-C) and hemoglobin A1c testing done. The mean (standard deviation) HbA1C (%), LDL-C (mg/dL) systolic blood pressure (SBP) (mmHg), and diastolic blood pressure (DBP) (mmHg) were 7.6 (2.0), 107.3 (31.5), 134.3 (20.8), 79.5 (11.0), respectively. HbA1C > 8.0%, LDL-C > 130 mg/dL, SBP > 130 mmHg, and DBP > 90 mmHg) were observed in 34.8%, 21.1%, 40.4%, and 23.8%, respectively.Conclusion: Although the organization of the outpatient services allowed for good performance with regards to "free" services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that required payment were consistently underperformed. Regular assessment of the quality of care may help in the identification of opportunities for improvement in the organization and delivery of care.

BACKGROUND:Autoimmune diseases including thyroid. disorders, type 1 diabetes and celiac disease are commoner in persons with Down's syndrome compared with the general population. Coexistent type 1 diabetes and hyperthyroidism in Down's syndrome is however not commonly reported in literature.OBJECTIVE:To report a case of a lady presenting with Graves' disease and type 1 diabetes at the same time.CLINICAL PRESENTATION:We report the case of a 22- year-old lady with Down's syndrome who presented with weight loss, polyuria and polydipsia. Physical examination revealed typical dysmorphicfacies of Down's syndrome and a goitre. Laboratory data revealed hyperglycaemia (random plasma glucose-331 mg/dl). She also had biochemical evidence in keeping with hyperthyroidism and markedly elevated thyroid peroxidase antibodies (>1087.0 IU/ml). She improved after rehydration, insulin therapy and antithyroid drugs.CONCLUSION:Coexisting autoimmune diseases may present in patients with Down's syndrome. We advocate for routine screening for diabetes and thyroid dysfunction in ersons with Down's syndrome.

A number of complexities surround the health and well-being of patients with type 2 diabetes.These difficulties relate to self-care efforts and outcomes, and several other factors play regulatory functions.This study was carried out to investigate the inter-relationship among physical activity, quality of life, and clinical and sociodemographic factors in a group of Nigerian patients with type 2 diabetes.The study was conducted at the outpatient clinics of two major healthcare facilities in Ibadan, Southwest Nigeria.Physical activity was assessed using the International Physical Activity Questionnaire, and quality of life was assessed using the Diabetes Quality of Life Brief Clinical Inventory.Clinical and sociodemographic characteristics were also documented.A total of 227 patients with type 2 diabetes with a mean age of 55.83 ± 13.76 years took part in the study.A total of 156 (68.7%) of the participants, had low level of physical activity, while 81 (35.7%) reported quality of life scores below the intermediate score and hypertension was the mo 63 (27.8%) of the participants.Being 50 years and older (OR = 2.5; 95% CI = 1.21-3.67)increased the odds of having lower quality of life, while physical activity of moderate-to-high intensity reduced the odds (OR = 0.4; 95% CI = 0.2-0.8).A substantial proportion of patients with type 2 diabetes had below intermediate level quality of life, and most of them were physically inactive.Lower quality of life was also linked with sociodemographic and clinical variables but patients with moderate-to-high physical activity were likely to reduce by half the risk of poor quality of life.

BACKGROUND:Diabetes-specific emotional distress is common among people with type 2 diabetes due to the complexities associated with care and maintenance of wellness among the patients. Unlike the focus on glycaemic control, literature appears unavailable about how physical activity may help in the control of diabetes-specific emotional distress. This study was conducted to investigate the link between diabetes- specific emotional distress and physical activity.METHODOLOGY:Type 2 diabetes patients (n = 206) were enrolled into this study from two major health care facilities in Ibadan, Southwestern Nigeria. Physical activity was assessed using the International Physical Activity Questionnaire while diabetes-specific emotional distress was assessed using the Problem Areas in Diabetes Questionnaire. Data were analysed using descriptive and inferential statistics at ± 0.05.RESULTS:The participants' mean age was 58.6 12.7 years with 109 (52.9%) reporting low physical activity levels and 182 (88.3%) reporting varying degrees of diabetes- specific emotional distress. Compared to participants with low physical activity, those who reported moderate-to- vigorous physical activity reported a reduced risk of diabetes-specific emotional distress (OR = 0.53; 95% CI = 0.26-0.82). Age, sex and level of education were not associated with the distress.CONCLUSIONS:A substantial proportion of patients with type 2 diabetes reported low physical activity levels and much more reported diabetes-specific emotional distress. Those who reported moderate-to-vigorous physical activity reported a significantly lower risk of diabetes-specific emotional distress. Reduction in. the risk of diabetes-specific emotional distress may be yet another strong point in advocacy for physical activity among patients with type 2 diabetes.

Background: Persons with type 2 DM have a cardiovascular risk 2-4 times that of the normal population. Co-occurrence of metabolic syndrome (MS) with type 2 DM is associated with an increased risk of development of cardiovascular disease. The aim of this study was to determine the prevalence of the MS in patients with type 2 diabetes mellitus and to compare absolute cardiovascular risk in type 2 DM Patients with MS with those without MS.Methods: Anthropometric measurements and Blood Pressure of 340 eligible patients with type 2 DM recruited into the study were taken. Participants' FPG, FLP and glycated haemoglobin were also estimated. Cardiovascular risk score was calculated using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Diagnosis of the MS was the International Diabetes Federation Criteria (IDF).Results: Over 66% participants had MS. The absolute cardiovascular risk score was found to be similar in persons with type 2 DM whether they fulfilled the criteria for diagnosis metabolic syndrome or not.Conclusion: The absolute cardiovascular risk score was similar in type 2 DM patients with or without the metabolic syndrome. (C) 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Background : Most diabetes patients in Nigeria either do not exercise at all or do not exercise appropriately and this is thought to be due partly to an inadequate exercise education. Objectives: To investigate the impact of a type 2 diabetes-oriented exercise education curriculum (T2DEEC) on exercise performance and adiposity of type 2 diabetes patients. Materials and Methods: The patients (n=86) were randomized into either the T2DEEC or the control groups. The T2DEEC was administered to patients in the T2DEEC group while the controls were encouraged to exercise but did not go through the T2DEEC. The participants continued exercises at home for 12 weeks. Outcomes were amount of time and days spent on each of aerobic, resistance, joint mobilization and foot care exercises per week; waist circumference, body mass index, and percent body fat. Results: By the 12 th week, the T2DEEC participants increased their exercise days from 1.2 to 3.8 days and increased aerobic, resistance, joint mobilization and foot care exercise times by 56.5, 42.3, 39.8 and 28.1 minutes respectively (p<0.05). The controls only increased their aerobic exercise time by 5.1 minutes (p=0.141) and maintained zero exercise times for resistance, joint mobilization and foot care exercises. Also the T2DEEC group but not the controls recorded significant improvements (p<0.05) in adiposity variables. Conclusions : The participants who were taught with the T2DEEC unlike those who received verbal encouragement to exercise improved their exercise performance and adiposity parameters significantly. The T2DEEC is recommended for exercise education of type 2 diabetes patients. Keywords : Type 2 diabetes, exercise education, joint mobilization, aerobic activities, curriculum

BACKGROUND:Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan.MATERIALS AND METHODS:It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique.RESULTS:The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist.CONCLUSION:Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.