Tight blood pressure control in type 2 diabetes.

Abstract Background Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa. Method A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I2 statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger’s test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Results Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes. Conclusion The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting. KEY MESSAGES There was a high prevalence of overweight and obesity among the type 2 diabetes patients. Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients. Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.

Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

Suboptimal blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is a paucity of evidence on the prevalence and associated factors of suboptimal blood pressure control in SSA. Therefore, this review aimed to estimate its pooled prevalence and associated factors among people living with DM in SSA. METHODS: We systematically searched PubMed, African Journals OnLine, HINARI, ScienceDirect, Google Scholar, and direct Google to access observational studies conducted in SSA. Microsoft Excel spreadsheet was used to extract the data, which was exported into STATA/MP version 16.0 for further analyses. Heterogeneity across studies was checked using Cochran's Q test statistics and I2 test, and small study effect was checked using Funnel plot symmetry and Egger's statistical test at a 5% significant level. A random-effects model was used to estimate the pooled prevalence and associated factors of suboptimal blood pressure control at a 95% confidence interval (CI) and significance level of p < 0.05.Of the 7329 articles retrieved, 21 articles were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of suboptimal blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03-2.80, I2 = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57-3.68, I2 = 0.00%, p = 0.47) were significantly associated with suboptimal blood pressure control.The prevalence of suboptimal blood pressure control among diabetic patients in SSA was high, and poor adherence to antihypertensive treatment and overweight were significantly associated with suboptimal blood pressure control. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors.PROSPERO CRD42020187901. 

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Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

Context: An upper gastrointestinal endoscopy (UGIE) is now a routine procedure and is a guide to the prevalence and nature of gastrointestinal tract diseases in an area. Aim: To report indications and findings for UGIE in a tertiary hospital in Kaduna, Nigeria, and compare with past reports in the region and from the rest of Nigeria and Africa. Settings and Design: A retrospective review of endoscopy records (2014–2021) of consecutive patients referred to the endoscopy unit of Barau Dikko Teaching Hospital, Kaduna, Nigeria. Statistical Analysis: The data were analyzed using IBM SPSS version 22. Results: Over seven years, 1,525 patients had diagnostic UGIE: mean age = 44.8 years (range 8–100), 61% ≥ 40 years, and 55.7% females. Dyspepsia (70%) and hematemesis/melena (14%) were the most common indications. Superficial gastritis (60%) was the most common endoscopic finding. Peptic ulcer disease (PUD) was diagnosed in 9.6% of patients: Gastric ulcer (6.6%) was more common than duodenal ulcer (3.6%) and more frequent in males than females (9.5% vs. 4.3%, P = 0.000) and in those ≥ 40 years compared with < 40 years (7.8% vs 5%, P = 0.032). Duodenal ulcer was also more common in males (6% vs 1.8%, P = 0.000). Erosive gastritis (20.5%), hiatus hernia (14.4%), esophagitis (13.7%), atrophic gastritis (8.3%), nodular gastritis (6.6%), esophageal varices (6.1%), and gastric carcinoma (1.2%) were other findings. There was no abnormality detected in 6% of patients. Conclusion: We reported a marked change in the pattern of some gastroduodenal diseases in our region. The patients are older and predominantly female. The prevalence of PUD has markedly declined with gastric ulcer now almost twice as common as duodenal ulcer.

Diagnostic upper gastrointestinal endoscopy in Kaduna, Northwest Nigeria: Indications and findings

Background: Endoscopy has a great role in the diagnosis, surveillance, and management of various gastrointestinal (GI) ailments. Aims: This study aimed to evaluate the spectrum of upper GI (UGI) symptoms and correlate them with the findings on UGI endoscopic examination. Patients and Methods: This observational cross-sectional study was carried out from August 2019 to December 2020 in the adult patients presenting with UGI complaints. The patients underwent UGI endoscopy at Yenepoya Medical College Hospital, Mangalore, a tertiary care centre in southern Indian state of Karnataka. Endoscopies were performed as per the standard protocol with diagnosis based on accepted criteria. Results: A total of 450 subjects (mean age: 49.14 ± 13.9; range, 19–89; 322 [71.5%] men) were included. Among the diagnostic indications, dyspeptic symptom seen in 176 (39.1%) patients was the most frequent indication in this study cohort, followed by reflux in 73 (16.2%) patients, UGI bleeding in 69 (15.34%) patients (portal hypertensive bleeding was found to be more common than nonvariceal bleed (49:20). Antral gastritis was seen in 112 (24.9%) patients. Ninety (20%) patients were found to have esophageal varices and 47 (10.4%) had esophagitis. Biopsy showed 25.3% to be positive for Helicobacter pylori. Forty-seven (10.45%) patients with a mean age 32 ± 6.8 years with dyspeptic symptoms but no alarming symptoms had normal endoscopic examination. Conclusion: Antral gastritis was the most common endoscopic finding in patients with dyspeptic symptoms. Portal hypertension was a more common cause of UGI bleeding compared to duodenal ulcers. While the majority of the patients presenting with heartburn had esophagitis, nonerosive esophagitis was observed in 3.2% of patients.

The Spectrum of Upper Gastrointestinal Endoscopic Findings and Therapeutic Interventions in Patients Presenting with Upper Gastrointestinal Complaints: A Tertiary Care Study

Objectives : To describe the prevalence, treatment and control of hypertension among type 2 diabetic patients at Moi Teaching and Referral Hospital (MTRH) and to determine predictors of blood pressure (BP) control. Design : A cross-sectional study. Setting : Diabetic Outpatient Clinic at MTRH, Eldoret, Kenya Subjects : Type 2 diabetic patients Interventions : The study collected socio-demographic (age, gender, employment status, monthly income, education level, marital status, cigarette smoking and alcohol use), clinical (BP, weight, height and waist circumference) and laboratory (serum fasting lipids and creatinine, urine proteins) data from type 2 diabetic patients. Good BP control was defined as 1 anti-hypertensive agent prescribed. Good BP control was associated with compliance to anti-hypertensives (OR= 0.342, 95% CI: 0.105- 1.432) and having HDL at goal (OR = 0.247, 95% CI: 0.126-0.845). Poor BP control was associated with a higher number of prescribed anti-hypertensive agents (OR=1.377, 95% CI: 1.112- 2.302). Conclusion : Prevalence of hypertension among type 2 diabetic patients in MTRH is high and BP control is poor despite anti-hypertensive treatment. Significant predictors of BP control include compliance to anti-hypertensives and control of HDL.

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Prevalence, treatment and control of hypertension among type 2 diabetic patients at moi teaching and referral hospital, eldoret, kenya.

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Prevalence, treatment and control of hypertension among type 2 diabetic patients at moi teaching and referral hospital, eldoret, kenya.