CHAPTER FIVE
5.8 RECOMMENDATIONS
1. Further studies are needed to determine factors responsible for the poor treatment outcome in these patients for both DM and hypertension
2. Non-communicable diseases need to be given public health priority in Nigeria with enhanced health education and active routine screening of DM among all adults in Nigeria from 45 years of age particularly those with history of risk factors which include obesity, first degree relatives with DM, and previous impaired glucose homeostasis.
3. Every diabetic should have the blood pressure checked at all clinic visits and the BMI should be monitored, and maintained at optimal value.
4. Aggressive health promoting lifestyle modifications are recommended for all diabetics especially those who are prehypertensive, overweight or have a positive family history of hypertension or DM even in the face of good glycaemic control.
5. Establishment of diabetic clinic (unit) with register of all diabetic patients at Federal Medical Centre, Owerri and at other health facilities where such does not exist. This will easily give updates on basic statistics for DM, ensure closer interaction between the patients and care givers, enhance monitoring of
patients’ progress, and provide a framework for community based studies on DM.
6. Management of DM should be made comprehensive and team work should be the key. Family Physicians should take particular interest in DM and hypertension. Presently, much of the management and issues concerning these diseases are left for Internists, thus, it is easy to
understand why treatment modality often employed is only hospital based. Little comment is made about patients’ input and motivation, home care and family support which are invaluable in ensuring good control.
7. There is a need for provision of more facilities in our health establishments for early detection and early treatment of DM, hypertension and their associated complications.
8. Considering that the country grapples with limited facilities and financial resources, it is imperative that measures are taken at an early stage to prevent the development of hypertension in diabetics. Government and other agencies in the health sector should provide adequate and regular funding for epidemiological surveys on the burden of NCDs in the country, and in addition, ensure that the care of patients with NCDs such as DM and hypertension is fully covered by the National Health Insurance Scheme (NHIS).
9. Concerted efforts and plans should be made to ensure that drugs used in the treatment of DM and hypertension are more affordable and accessible to the population.
REFERENCES
1. Baniga AF. Addressing the emerging pandemic of diabetes and cardiovascular disease in Sub-Saharan Africa-report of a workshop held in Nairobi. Kenya 2001 April, 16-19.
(http://www.en.wikipedia.org/wiki/Diabetes) retrieved on 07 June 2007 via the internet.
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of Diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care, 2004(5). 27:5.
3. International Diabetes Federation. Facts and Figures 2004 (http://www.idf.org/home) retrieved on 07 June 2007.
4. Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin BO, Kadiri S. The prevalence of hypertension in seven populations of West African Origin Am J Public Health 1997;
87:160-168
5. Kearney PM, Whelton M, Reynolds K. Global burden of Hypertension: analysis of worldwide data. Lancet 2005; 365:217-223
6. Ofoegbu EN. Post-prandial Hyperglycaemia and Diabetic Complications Regional Workshop in Diabetes Mellitus, Enugu, 2003.
7. Claude J, Mbanya N. The Challenges of diabetes in the developing world. In: Pickup JC, Williams G. (eds). Textbook of diabetes. London. MA Blackwell Publishing Company, 2003:1-14.
8. National Expert Committee on Non-Communicable Diseases in Nigeria-Final report of a national survey, Federal Ministry of Health and Social Services 1997.
9. Ahmed AM. History of diabetes mellitus: Saudi Med J. 2002; 23(4):373-8.
10. Canadian Diabetes Association. History of Diabetes
(http://www.chinese-school.netfirms.com/diabetes-history.html) retrieved on 07 June 2007.
11. Wikipedia encyclopedia. Diabetes Mellitus
(http://www.en.wikipedia.org/wiki/Diabetes) retrieved on 07 June 2007
12. Ulasi II. Diabetic Nephropathy: A review of the Past, present and future perspectives-Part I. The Nigerian Postgraduate Medical Journal, 2005(9); 12:3
13. Frier BM, Fisher BM. Diabetes Mellitus. In: Haslett C, Chilvers ER, Boon NA, College NR, Hunter JAA (eds). Davidson’s Principles and Practice of Medicine 19th Edition. (c) Elsevier Science Ltd (CHURCHILL LIVINGS TONE). 2002; 15: 641-82
14. Alvin PC: Diabetes Mellitus. In: Braunwald, Fauci, Kasper, Hauser, Longo, Jameson (eds). Harrison’s Principles of Internal Medicine 15th Edition. (c) McGraw Hill. 2001;
333:2109-37
15. Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care. 1999; 22(4):650.
16. World Health Organization: Diabetes Mellitus. Report of a WHO Study. Geneva, World Health Organization 1999.
17. Mike S. Rapid rise in Diabetes cases worrisome. Nigerian Clinical Review. 2006; 10:3.
18. Siminialayi IM, Emem C. Type 2 Diabetes Mellitus: A Review of Pharmacological Treatment. Nigerian Journal of Medicine, 2006; 15:3.
19.Gonzalez-Clemente JM, Galdon G, Mitjavila J. Translation of the recommendations for the diagnosis of diabetes mellitus into daily clinical practice in a primary health care setting. Diabetes Res Clin Pract 2003; 62:123-9
20. Owoaje EE, Rotimi CN, Kaufman JS, Tracy J, Cooper S. Prevalence of adult diabetes in Ibadan, Nigeria. East African Medical Journal 1997; 74(5):299-301.
21.Sidibe EH. Main complications of diabetes mellitus in Africa. Ann Med Interne (Paris) 2000; 151:624-28
22. Olatubosun ST, Ojo PO, Fineberg NS, Bella AF. Prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban adults in Nigeria. Journal of National Medical Association 1998; 90(5):293-301
23. Mbanya JC, Cruickshank JK, Forrester T. Standardized comparison of glucose intolerance in West African origin populations of rural and urban migrants to Britain.
Diabetes Care 1999; 22:434-40
24. WHO Diabetes Mellitus Report of a WHO Study group; Technical Report. World Health Organization, Geneva, 1985. Series 727
25. Kadiki OA, Roseid RB, Bhairi AM, Elamari IM. Incidence of insulin dependent diabetes mellitus in Benghazi, Libya (1991-1995). Diabetes Metab 1998; 24: 424–27.
26. Chuhwak EK, Puepet FH, Malu OA, Ohwovoriole AE. Morbidity and mortality study of diabetic admissions in Jos University Teaching Hospital. Diabetes International 1999;
9(11):3
27. Erasmus RT, Blanco E, Okesina AB, Matsha T, Gpweta Z, Mesa JA. Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa. S Afr Med J 2001; 91(2):157-60
28.Aspray TJ, Mugusi F, Rashid S. Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity, and urban living. Trans R Soc Trop Med Hyg 2000; 94:637-44.
29. Sobngwi E, Mauvais-Jarvis F, Vexian P, Mbanya JC, Gautier JF. Diabetes in Africans Diabetes Metab (Paris) 2001; 27:628-634
30. Osuntokun BO, Akinkugbe FM, Francis TI, Reddy S, Osuntokun O, TaylorGOL.
Diabetes Mellitus in Nigerians: A study of 832 Patients, West African Medical Journal 1971; 20:295-312
31. Oyegbade OO, Abioye –Kuteyi EA, Kolawole BA, Ezeome IT, Bella IS. Screening for diabetes mellitus in a Nigerian Family Practice population. SA Fam Pract 2007; 49(8):15.
32. Ogunkolo OF, Amballi AA. Prevalence of diabetes mellitus in newly admitted undergraduates of Olabisi Onabanjo University, Nigeria. NigerianMedical Practitioner 2005; 47(3):26-8.
33. Nwafor A, Owhoji A. Prevalence of diabetes mellitus among Nigerians in Port Harcourt correlates with socio-economic status.J Appl Sci Environ Mgt 2001; 5(1):75-7 34. Bakari AG, Onyemelukwe GC, Sani BG, Hassan SS, Aliyu TM. Prevalence of diabetes in suburban Northern Nigeria: results of public screening survey, Diabetes International 1999; 9(3):59-60
35. Baumand A, Craig C. Review of the physical activity component of the WHO Global Strategy on Diet, Physical Activity and Health. CDC/WHO partners meetings:
implementation of WHO physical activity strategy 2004.
36. Mairiga BB. The prevalence of hypertension in diabetics in Jos.
A dissertation submitted to the National Postgraduate Medical College of Nigeria, Faculty of General Medicinal Practice 1997
37. Erasmus RT, Blanco EV, Okesina AB, Mesa J. Hypertension, proteinuria and renal insufficiency in Black South Africans with non-insulin- dependent diabetes. Diabetes International 1999; 9(3):57-58
38. Okubadejo NU, Fasanmade OA. Concomitant Hypertension and Type 2 Diabetes mellitus in Nigerians: Prevalence of obesity and its indices compared to Normotensive Diabetics. Nigeria Med J 2004; 459(4):79-83.
39. Adamu B. Physical Exercise and Health: A Review. Nigerian Journal of Medicine,2006;
15:3
40. Ozumba BC, Obi SN, Oli JM. Diabetes mellitus in pregnancy in an African population.
Int Journal of Gynae & Obs 2004; 84(2)114-9
41. Nyenwe EA, Odia OJ, Ihekwaba AE, Ojule A, Babatunde S. Type 2 diabetes in adult Nigerians: A study of its prevalence and risk factors in Port Harcourt, Nigeria. Diabetes Research and Clinical Practice 2003; 62:177-85
42. Annette M, Hatter BC, Hatter JB (2003) Aging and Insulin Secretion
(http://ajpendo.physiology.org/cgi/content/full/284/1/E7?ck=nck).AJP-Endocrinology and Metabolism retrieved on 10 June 2007.
43. Williams JF. Non-Communicable diseases in the developing world Diabetes International 1999; 9:3
44. Ogbera AO. Foot ulceration in Nigerian diabetic patients: a study of risk factors.
Diabetes International 2007; 15(2):15-7
45. Will JC, Galuska DA, Ford ES, Mokdad A, Calle EE. Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Int J
46. Vinik AI, Fishwick DT, Pittenger G. Advances in diabetes for the millennium: toward a cure for diabetes.MedGen Med2004;6:12.PMID15647717.
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abs tract&list_uids=15647717). Retrieved on 11June 2007.
47. Shapiro EL. International Trial of the Edmonton Protocol for Islet Transplantation NEJM 2006. 355:1318-1330.
48. Voltarelli JC, Couri CE, Stracieri AB, Oliveira MC, Moraes DA, Pieroni F. “Autologus nonmyeloablative hematopoietic stem cell transplantation in newly
diagnosedtypeIdiabetesmellitus.(2007).(http://jama.amaassn.org/cgi/content/full/297/1 4/1568)”.JAMA297(14):156876.PMID17426276(http://www.ncbi.nlm.nih.gov/entrez/qu ery.fcgi?Cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17426276.Retrieved on
11 June 2007.
49. Rozita R, Chan Y, Afifyan FN, Liu XJ, Wan X, Yantha J, Tsui H, Tang L et al
“RPVI+Sensory Neurons Control B Cell stress and Islet inflammation in
AutoimmuneDiabetes(2006).(http://www.cell.com/content/article/fulltext?uid=PIIS0092 867406014656)”. CELL 127:1123-1135. Retrieved 11 June 2007
50. Borch-Johnsen K, Joner G, Mandrup-Poulsen T, Christy M, Zachau-Christiansen B, Kastrup K, Nerup J (1984).”Relation between breast-feeding and
incidenceratesofinsulindependentdiabetesmellitus.Ahypothesis”.Lancet2(8411):10836P MID6150150(http://www.ncbi.ncbi.nlm.gov/entre\/query.fcgi?cmd=Retrieve&db=pubm
ed&dopt=Abstract&list_uids= 1650150). Retrieved on 11 June 2007.
51. America Diabetes Association. “Nutrition Recommendations and
InterventionsforDiabetes2006(http://care.diabetesjournals.org/cgi/content/full/29/9/21 40maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1&FIRSTINDEX=0&s
ortspec=relevance Diabetes Care 29:2140-57. Retrieved on 11 June 2007.
52. Knowler W, Barrett-connor E, Fowler S, Hamman R, Lachin J, Walker E, Nathan D.
“Reduction in the incidence of type 2 diabetes with lifestyle
interventionormetformin.”N.EnglJMed2002.346:6;393403.PMID11832527(http://www.n cbi.nlm.nih.gove/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uid
s=11832527). Retrieved on 11 June 2007.
53. Gerstein H, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, Hanefeld M et al
“Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized
controlledtrial”.Lancet2006.368:9541;1096105.PMID16997664(http://www.ncbi.nlm.nih .gove/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=169976
64). Retrieved on 11 June 2007.
54. Kjeldsen SE, Julius S, Mancia G, Mclnnes GT, Hua T, Weber MA, Coca A et al for the VALUE Trial Investigators. “Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial.” J. Hypertens 2006.
24; 7:1405-12. PMID 16794491
(http://www.ncbi.nlm.nih.gove/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
55. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB “Duration of lactation and incidence of type 2 diabetes”. JAMA 2005;
294(20):2601-10.PMID16304074(http://www.ncbi.nlm.nih.gove/entrez/query.fcgi?cmd=Retrieve&db=
pubmed&dopt=Abstract&list_uids=16304074). Retrieved on 11June 2007.
56. Okesina AB, Bojuwoye BJ, Gadzama AA. Ogunriola EO. Prevalence and sex distribution of complications in diabetic patients from llorin. Nigeria. Diabetes
International 1999; 3:63-4.
57. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV. Diabetes and Cardiovascular Disease: A Statement for Health Professionals from the American Heart
Association, 1999 Sept.
58. Busari OA, Opadijo OG. Management of hypertension in diabetes: blood pressure goals and choice of agents. Diabetes International 2007; 15(2):8-10
59. Williams GH. Hypertensive Vascular Disease. In: Braunwald, Fauci, Kasper, Hauser, Longo, Jameson (eds). Harrison’s Principles of Internal Medicine 15th Edition.
(c)McGraw Hill. 2001; 246:1414-30
60. Hajjar I, Kotcher JM, Kotchen TA. Hypertension: Trends in prevalence, Incidence and Control Annual Review of Public Health 2006; 27:490
61.Boon NA, Fox KAA, Bloomfield P, Bradbury A: Cardiovascular Disease. In: Haslett C, Chilvers ER, Boon NA, College NR, Hunter JAA. Davidson’s Principles and Practice of
Medicine 19th Edition. © Elsevier Science Ltd (CHURCHILL LIVINGSTONE) 2002;
12:357-481
62. WHO/ISH Writing Group 2003: Statement on management of hypertension. J Hypertens 2003; 21:1983-92
63. Balbisi EA. Management of hypertension: An overview of JNC 7; Pharmacy Times Nov 2004.© 2005-2007 Ascend Media
64. Kukkonen-Harjula K, Vuori I. Physical activity in the prevention, treatment and rehabilitation of disease. In: cochrane Evidence based Guidelines © 2005 Duodecin
Medical Publications Ltd.
65. American Diabetes Association: Treatment of hypertension in adults with diabetes.
Diabetes Care 2003; 26(suppl I):S80-S82
66. Omotoso ABO, Opadijo OG, Araoye MA. Diabetes mellitus and hypertension in Nigerians: a review of 572 diabetic patients. Nigerian J Med 1999; 8:108-9.
67. Sowers JR, Reed J. Advisory treatment of hypertension and diabetes. J Clin Hypertens 2000; 2:132-3
68. Ikem RT, Akinola N0, Balogun MO, Ohwovoriole AE, Akinsola A. What does the presence of hypertension portend in the Nigerian with Non insulin dependent diabetes
mellitus. West African J Med. 2001; 20(2):127-30
69. Wokoma FS. Hypertension in non-insulin-dependent diabetic Nigerians: a comparative analysis of normotensive and hypertensive subgroups Diabetes
International 1999; 9(3): 57-8.
70. Benowitz NL. Anti-hypertensive Agents. In: Katzung BG (ed) Basic and Clinical Pharmacology 9th Ed (c) McGraw Hill companies, 2004; 11:178.
71. Idogun ES, Unuigbe EI, Famodu AA, Akinola OT. Body Mass Index in Type 2 Diabetes Mellitus and Diabetic Nephropathy. Nigerian Postgraduate Medical Journal,
2006; 13(1):17-9.
72. Okey A. Epidemiological Research, A practical approach for the medical and nursing sciences. Published by the Faculty of Business Administration, University of Nigeria, Enugu Campus 1994; 57-65
73. Prevention and management of the global epidemic of obesity. Report of the WHO Consultation on Obesity, Geneva (WHO/NUT/NCD/98.1): 1998
74. www.math.yorku.ca/WHO/Faculty/Monet. Retrieved via internet on April 20, 2006.
75. Chinenye S, Unachukwu CN, Hart A. Diet and diabetes mellitus-Guidelines for healthcare providers in the tropics. 2005; 47(6):113-6
76. Abioye-Kuteyi EA, Ojofeitimi EO, Ijadunola KT, Fasanu AO. Assessment of dietary knowledge, practices and control in type 2 diabetes in a Nigerian Teaching hospital.
Nigerian Journal of Medicine 2005; 14(1):58-64
77. Adetunji AA, Ladipo MMA, Irabor AE, Adeleye JO. Perceived family support and blood glucose control in type 2 diabetes. Diabetes International 2007; 15(2):18-9