Abstract
Type 2 diabetes mellitus (DM2) is now a global epidemic which is also ravaging developing countries including Nigeria. Its impact in the country is significant with the disease found to impact on hospital admissions, mortality and life expectancy of patients. Previous investigations done in Nigeria showed that DM2 patients have poor glycaemic controls with resultant high levels of disease morbidity and mortality. This was demonstrated by consistently elevated mean HbA1c levels (> 8.0%) in Nigerian diabetics over a decade of assessment of care of the patients. Similarly the prevalence of diabetic retinopathy rose by more than 200% between 1989 and 2008. Diabetic morbidity which is underpinned by hyperglycaemia is associated with diabetic retinopathy, nephropathy, foot ulcers and other clinical conditions such as hyperlipidaemia, altered sympathetic system, bone disorders, infertility, defective body sodium handling and renal compromise. Some investigators believe that persons of African ancestry are more susceptible to some diseases associated with DM2. This includes documented increased renal glomerular hyperfiltration in patients of African ancestry. The disease complications are linked to metabolic derangements which if properly understood and managed, may help to reduce the impact of the rising prevalence of DM2 in Nigeria. Furthermore, if the Nigerian medical team is aware of the peculiar susceptibility of blacks to DM2 complications, they will be able to apply appropriate treatment for improved care, despite rising disease prevalence.
Highlights
Diabetes mellitus type 2 (DM2) is the commonest form of diabetic disease and it accounts for about 90– 95% of the cases in hospital and community
The essence of this review is to evaluate and identify peculiar issues of DM2 that pertains to persons of African origin
The high prevalence of diabetic complications in Nigerian patients is associated with poor glycaemic control
Summary
Diabetes mellitus type 2 (DM2) is the commonest form of diabetic disease and it accounts for about 90– 95% of the cases in hospital and community. Cardiovascular risk factors including DM, hypertension and hyperlipidaemia are associated with dementia.[81] As the prevalence of DM increases, there is a concomitant rise in the level of dementia[82] and this will have significant implication for developing economies like Nigeria where increase in DM2 prevalence is a cause for concern.[18] The World Alzheimer Report of 2015 states that over 46 million people live with dementia worldwide, and that this number is estimated to increase to 131.5 million by 2050 with most of the increase occurring in low income (264%), middle income (223%) and upper middle income (227%), countries.[83] Population based studies shows that DM2 patients have a twofold increased risk of developing either vascular dementia or Alzheimer’s disease.[84] Another recent population based study concluded that the hyperglycaemia of DM and not its association with hypertension or hyperlipidaemia is the main driver of dementia.[82] The association between DM2 and dementia has been demonstrated in Nigeria.[85,86] Dementia is a common cause of morbidity in late stages of diabetes mellitus and it is one of the commonest and most disabling late life mental disorders.[87] The pathogenic mechanisms linked to dementia in DM2 subjects are hyperinsulinaemia, brain infarcts, white matter disease, advanced glycosylated end products, and lipoprotein related proteins. A more sustainable program for mitigating dementia and other complications of DM2 in developing countries like Nigeria will involve efficient public and clinical management of the disease.[18]
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