National Obesity Center Research Articles

Diagnostic performance of D-dimers in predicting cardiovascular events in type 2 diabetic subjects monitored at the National Obesity Center of Yaounde Central Hospital

Diagnostic performance of D-dimers in predicting cardiovascular events in type 2 diabetic subjects monitored at the National Obesity Center of Yaounde Central Hospital

Logics of Actors in the Resilience Trajectory of People Living with HIV/Type 2 Diabetes Comorbidity

The person living with HIV/diabetes a type 2 comorbidity (PLHIV/DT2) faces adversities from the moment the diagnosis is announced, such as uncertainty about the course of the pathology, chronicity and the management of complex recommendations. Different professional and social actors intervene in his different environments to support him. In spite of this, PLWHIV/AIDS oscillate between improvement and relapse, acceptance and denial, stability and instability, autonomy and dependence. This reflects a fluctuating trajectory of resilience. The aim of this article is to analyse the logics of the actors in the trajectory of resilience of PLWHA/DT2. In order to answer this question, we have opted for a phenomenological qualitative research. The biographical writings of 05 PLWHA/DT2, who attend the National Obesity Centre and the Cameroonian Association of Diabetics, and in-depth interviews with 20 social and professional actors were carried out and were the subject of a content analysis. The results showed that the characteristics of the actors are diversified and their action strategies are complex. The logics of positioning (power games, confrontation of scientific and secular knowledge), standardisation (respect for deontology, ethics and institutional culture) and complementarities (négociations, intégration, interactions) were identified. Interdisciplinarity is suggested.

Anthroposocial-Medical-Educational Approach and Educational Diagnosis of People Living with Type 2 Diabetes: Case of the National Obesity Centre in Cameroon

Therapeutic patient education is an approach that is increasingly used in the management of chronic diseases. It has a structure, the first essential component of which is the educational diagnosis. However, empirical findings show that this first link is often forgotten or poorly negotiated in the implementation of therapeutic patient education. This situation reveals a difficulty in contextualising the proposed models. Hence our objective, which was to describe the process of integrating the anthroposocial-medical approach into the construction of an educational diagnosis for people living with type 2 diabetes. We conducted a descriptive qualitative study in the National Obesity Centre of the Yaoundé Central Hospital. People living with type 2 diabetes and health professionals constituted our target population and our sample size reached saturation with 16 participants (10 patients and 6 professionals). Semi-structured interviews using interview guides were conducted with the participants. The results revealed that in order to integrate the anthropological dimension in the construction of the educational diagnosis, firstly, the health professional must become acquainted with the patient's culture, his or her eating habits, find out about his or her dietary difficulties and investigate his or her behaviour in the usual environment. Secondly, the health professional must get the patient to verbalise his or her representation of the disease, his or her practices and therapeutic remedies. Thirdly, the health professional must get the patient to narrate his or her therapeutic itinerary. In order to integrate the social dimension into the construction of the educational diagnosis, the professional must firstly find out about the patient's economic situation. Secondly, he/she must find out about the patient's profession, his/her plans, find out about his/her professional interactions and assess his/her physical activity. Thirdly, he/she has to find out about his/her interactions with his/her family. Finally, in order to integrate the medical dimension into the construction of the educational diagnosis, the health professional must collect the patient's biomedical data and assess the patient's knowledge of his or her illness. In conclusion, the anthroposocialmedical approach can be considered as a contextual guide in the process of constructing an educational diagnosis which constitutes the foundation for the development of a therapeutic education programme.

Frequency of B and C Hepatitis Viruses, and Metabolic Profile in Type 2 Diabetics: A Case of the Yaoundé Central Hospital, Cameroon

Poorly controlled type 2 diabetes alters the immune system, increasing the risk of susceptibility to viral infections such as hepatitis B and C infections. This study aimed to determine the frequency of hepatitis B and C and metabolic profiles in type 2 diabetics. This was a cross-sectional study conducted over six months. It was conducted at the National Obesity Center (NOC) of the Yaoundé Central Hospital (YCH), Cameroon. 100 diabetic patients, with a mean age of 58.41 ± 10.74 years were enrolled in the study. The socio-demographic characteristics of the study population and the risk factors for virus transmission were recorded using a pre-established questionnaire. HBsAg and anti-HCV antibodies were revealed by a rapid diagnostic test. Liver function markers’ activities were determined. Commercial kits were used to evaluate the patient’s serum lipid profile, serum fasting glucose level, urea, creatinine, and albumin. With a sex ratio of 3:1, women outnumbered men. Risk factors for HCV and HBV infections evocated by the population were dental care (50%), followed by alcohol consumption (41%). HBsAg and anti-HCV antibodies frequency was 3% and 8% respectively. No cases of coinfection were found. In general, hypertriglyceridemia with a mean of 1.61 ± 0.46 g/L and hyperglycemia of 1.35 ± 0.45 g/L were noted. A significant difference (p = 0.028) was found in HDL-cholesterol values between non-co-affected diabetics and HCV+ diabetics. The effect of the duration of diabetes on biochemical parameters revealed that albumin was the only significant decrease over time (p = 0.013). Based on these results, the metabolic profile of patients was altered. It is important to take note of the prevalence of hepatitis seen in type 2 diabetes mellitus since it demonstrates the potential link between both illnesses. Thus, early detection could prevent complications related to B and C hepatitis infections in type 2 diabetics.

Cystatin C and Chronic Complications of Diabetes Mellitus in a Subsaharian Population

Background: Type 2 diabetes (T2D) is a chronic and progressive condition whose early management is crucial in preventing the occurrence of its chronic degenerative complications. Cystatin C (CysC) is a biomarker that may have a beneficial interest in the early detection of microvascular and macrovascular complications of T2D. Methods: We carried out a cross-sectional analytic study at the National Obesity Center of the Yaounde Central Hospital. We recruited 135 patients with T2D and performed a neurologic physical exam using the Toronto clinical score, a fundoscopy, ECG, ABI, and the following paraclinicals: dosage of serum levels of Cystatin C, lipid profile (with determination of Atherogenic indexes), Creatinine (with calculation of glomerular filtration rate using CKD-EPI formula) and hs-CRP. Results: Prevalences of diabetic retinopathy, nephropathy, neuropathy and PAD were 3.0%, 8.9%, 38.5%, 28.1% respectively. Electrocardiographic signs of myocardial ischemia were present in 5.9 % of the participants. We found 0.3[0.5-0.3] mg/l as median levels of the HDL-cholesterol and 0.9[1.2-0.7] mg/l for LDL-cholesterol. The median value of GFR was 105.7[119,0-85.7] ml/min/1.73m². The median serum CysC level was 0.8[0.9-0.6]mg/l and varied with age (p=0.01), A1C (p=0.016) and high blood pressure (HBP) (p=0.006). There was a relationship between serum CysC and diabetic nephropathy (p=0.01) and neuropathy (p=0.025). There was no significant relationship with diabetic retinopathy (p=0.225), PAD (p=0.169) and ECG signs of myocardial ischemia (p=0.669). Conclusion: Chronic microvascular and macrovascular complications of type 2 diabetes are common and in our study are predominantly represented by diabetic neuropathy and PAD. Serum CysC can be useful in the diagnosis of chronic complications of T2D.

Prevalence and determinants of silent myocardial ischemia in patients with type 2 diabetes in Cameroon: a cross-sectional study.

Introductiondiabetes mellitus is a major health problem worldwide. It is associated with high cardiovascular morbi-mortality especially coronary artery disease. Myocardial ischemia is often asymptomatic (silent myocardial ischemia) in people with type 2 diabetes mellitus thus making early diagnosis difficult. Silent myocardial ischemia is defined as the objective evidence of myocardial ischemia in the absence of chest discomfort or other angina equivalents. This study aimed to determine the prevalence and determinants of silent myocardial ischemia in a population of people with type 2 diabetes using exercise stress electrocardiography.Methodswe carried out a cross-sectional study between January and April 2019 at the National Obesity Centre of the Yaounde Central Hospital. Patients with type 2 diabetes underwent a complete clinical evaluation, blood test, resting electrocardiogram (ECG), and exercise stress ECG according to the Bruce protocol. A positive stress test was defined as horizontal or down-sloping ST depression ≥ 1mm or upsloping ST depression of 2 mm or more 0.06 to 0.08 seconds after the J point.Resultsa total of 112 patients with diabetes (63 males and 49 females) were screened. The median age was 58 (IQR: 51 - 64) years. The median time from diabetes diagnosis was 8 (IQR: 5 - 12) years. Fifty-seven (50.4%) had hypertension, 78 (69.0%) had dyslipidemia, 66 (58.4%) were obese, 70 (61.9%) had poor glycemic control, and 23 (20.2%) were smokers. Sixty-five (58%) patients had a positive exercise stress ECG test. Factors independently associated with a positive stress test were abdominal obesity (aOR: 4.2, [95% CI: 1.4 - 12.8]) and Female sex (aOR: 2.5, [95% CI: 1.1 - 5.7]).Conclusionthe prevalence of silent myocardial ischemia was high in a population of asymptomatic patients. This was independently associated with abdominal obesity and female sex.

Spirometric restrictive ventilatory pattern and type 2 diabetes mellitus in a tertiary hospital in Cameroon: A comparative study

BackgroundThe objective of this study was to assess the association between spirometric restrictive ventilatory pattern (sRVP) and type 2 diabetes mellitus (T2DM) and investigate factors associated with sRVP in subjects with T2DM. Materials and methodsIn this comparative cross-sectional study, subjects with T2DM (diabetes group) were compared to a group of subjects without diabetes (non-diabetes group) from December 2018 to March 2019 (4months) at the National Obesity Center of the Yaoundé Central Hospital. sRVP was defined as the ratio of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) above the lower limit of normal, and FVC<80% of predicted values. Logistic regression was used to identify factors associated with sRVP. ResultsOverall 277 subjects were included in each group. The prevalence [95% confidence interval (95% CI)] of sRVP in the diabetes and non-diabetes groups was 39.4 (33.6–45.1) % and 34.3 (28.9–40.1) %, P=0.218. After multivariate analysis, we did not find an independent association between s sRVP and T2DM [odds ratio (95% CI): 1.13 (0.79–1.63), P=0.418]. The only independent factor associated with sRVP in subjects with T2DM was the presence of chronic vascular complications [odds ratio (95% CI): 1.99 (1.11–3.55), P=0.019]. ConclusionOne-third of patients with type 2 diabetes mellitus have sRVP. There is no independent association between sRVP and T2DM. The presence of chronic vascular complications is associated with sRVP in T2DM. Diagnosis of sRVP in subjects with T2DM presenting chronic vascular complications would help to provide a holistic management.

Prevalence and determinants of masked hypertension among obese individuals at the Yaoundé Central Hospital: a cross-sectional study in sub-Saharan Africa.

The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaounde. We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaounde Central Hospital. Masked hypertension was defined when the mean 24 h SBP was greater than or equal to 130 mmHg and/or the mean 24 h DBP was greater than or equal to 80 mmHg with normal office blood pressure (SBP/DBP) <140/90 mmHg. Logistic regression was used to examine the relationship of masked hypertension with associated factors. Among the 90 participants included, 67.8% were females. The mean age (±SD) was 46 (±8) years. The mean clinical measurements were 120 ± 9.4 mmHg and 75.5 ± 7.9 mmHg, respectively, for the SBP and the DBP. On 24 h ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mmHg, respectively, for the SBP/DBP. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) = 2.90, P = 0.02] and to dyslipidemia (OR = 3.60, P = 0.01), but not to the male sex, diabetes, physical activity, and tobacco/alcohol. Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure or dyslipidemia.

Impact of rest on office blood pressure in patients with hypertension and diabetes at the national obesity centre of Yaounde: a cross-sectional study in Sub-Saharan Africa

Background: Hypertension is the most important cardiovascular risk factor. Enhancing the accuracy of blood pressure (BP) measurement would be helpful for controlling hypertension. The importance of rest before measuring BP in the office is known, but the magnitude of the change in BP with the duration of rest is not known. We aim to evaluate the magnitude of the fall in BP after a prolonged rest in diabetic and hypertensive patients and identify the associated factors. Methods: We carried out a cross-sectional study between January and February 2016 at the National Obesity Centre of Yaounde. Were included all consenting patients with diabetes and hypertension, of both sexes, aged ≥18 years. Sitting BP was measured after resting for 15 minutes (BP15), 30 minutes (BP30), and 45 minutes (BP45). All the BP were measured by the same investigator using an electronic BP device. BP Results: We included 80 (53 women) participants with mean age of 62.4±8.4 years. Mean BP15 was 152.3±26.3 for systolic BP (SBP) and 88.5±15.1 mmHg for diastolic BP (DBP). Compared to BP15, there was a significant reduction of 8.3 (−6.5%) mmHg (P Conclusions: Resting for 45 minutes rather than the recommended 5 to 10 minutes reduce SBP/DBP of 8.3/3.1 mmHg at 30 and 13.5/5.5 mmHg at 45 minutes and may improve the reliability of the office blood pressure values.

Short Term Use of Empagliflozin Does Not Improve Left Ventricular Function in Non-Diabetic Hypertensive Patients: Results from a Non-Randomised Controlled Trial

Background: A selective inhibitor of sodium-glucose cotransporter 2 (SGLT2), empagliflozin, has demonstrated its effects in reducing cardiovascular mortality and hospitalization rates for heart failure in type 2 diabetes patients. However, the cardiac-intrinsic mechanism for this cardiovascular benefit has not been sufficiently studied. We therefore aimed to investigate the effect of empagliflozin on left ventricular function in a group of patients with grade I hypertension. Methods: We carried out a single-arm non-randomized clinical trial at the National Obesity Centre in Yaounde over a period of 8 months (October 2016 to May 2017), where patients were assigned to receive 25 mg of empagliflozin once daily. Cardiac ultrasound, 24-hour ambulatory blood pressure measurement, resting electrocardiography and biological assessment were carried out at baseline and at the end of a 6-week treatment period with empagliflozin. The primary outcome was the improvement of the left ventricular relaxation evaluation criteria. Ethical approval was obtained from the Centre Regional Ethics Committee in Yaounde, Cameroon. Results: A total of 11 patients were treated (median observation time, 6 weeks). We noted a non-significant improvement in the early lateral annular velocity from 9.7 [9.2 - 11.4] cm/s to 9.1 [8.8 - 10.2] cm/s, p =0.21. We also noted a non-significant improvement of the mitral profile (E/A) from 0.71 [0.63 - 0.78] cm/s to 0.81 [0.58 - 0.88] cm/s, p = 0.08. There were no differences in E/E’ ratio, 5.0 [4.1 - 6.3] vs 5.6 [4.9 - 7.4], p = 0.07. There was a non-significant drop in both systolic (p = 0.06) and diastolic (p = 0.09) blood pressure. We also observed on ECG a drop of the PR interval from 200 [157 - 200] ms to 160 [143 - 186] ms, p = 0.04. Conclusion: Short-term treatment with empagliflozin does not show an improvement of the left ventricular function in grade I hypertensive patients with diastolic dysfunction. Trial registration: This study was retrospectively registered on Clinical Trial Registry with ClinicalTrials.gov Identifier: NCT04203914.

Prevalence and determinants of Masked Hypertension among obese individuals at the Yaoundé Central Hospital: A cross-sectional study in sub-Saharan Africa

Several studies on the prognosis of masked hypertension suggest that it portends risks for cardiovascular morbidity and mortality that are comparable to the risks of sustained hypertension. obese individuals could have an increased risk of developing masked hypertension, data on the topic are scarce in our context. The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaoundé. We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaoundé Central Hospital. Masked hypertension was defined when the mean 24-hour Systolic Blood Pressure was greater than or equal to 130 mmHg and/or the mean 24 hour Diastolic Blood Pressure was greater than or equal to 80 mmHg with normal office blood pressure. Logistic regression was used to examine the relationship of masked hypertension with associated factors. Among the 90 participants included, 67.8% were females. Mean age (± SD) was 46 (± 8) years. The mean clinical measurements were 120 ± 9.4 mm Hg and 75.5 ± 7.9 mm Hg respectively for the systolic and the diastolic blood pressure. On 24-hour Ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mm Hg respectively for the systolic/diastolic blood pressure. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) =2.90, P = 0.02] and to dyslipidemia [OR = 3.60, P = 0.01], but not to male sex, diabetes, physical activity, tobacco/alcohol. Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure and/or dyslipidemia.

Evaluation of the Therapeutic Approach and Outcome of Type 2 Diabetes Mellitus Management Strategies in Cameroon

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic syndrome that is characterized by chronic hyperglycaemia, and can lead to chronic long-term complications. The prevalence of diabetes mellitus in Cameroon has been reported at 5.9% in 2017. Studies conducted in 2011, showed that only 41% of patients had a good glycaemic control which was, HbA1c &lt; 6.5.&#x0D; The aim of this study was therefore to evaluate the treatment intensification with time in T2DM patients in the Yaoundé diabetic Centre in Cameroon.&#x0D; Methods: The study was a cross-sectional analytical study. In a group of T2DM patients followed up at the National Obesity Centre (NOC) with poorly controlled blood sugar (HbA1c ≥ 7%). The treatment intensification and outcome were evaluated between the periods January 2016 to April 2018. The data was collected from patients’ medical booklet and through a face-to-face interviewer-administered questionnaire.&#x0D; Results: One hundred and eleven patients (31 males, 27.9% and 80 females, 72.1%) were recruited. The mean age was between 59 ± 10 years and the mean duration of diabetes 8.6 ± 7.0 years. The patients’ treatment consisted: 1) oral anti-diabetic (OAD) agents, monotherapy (24.3%), bitherapy (28.8%), tritherapy 2.7%, 2) insulin only, 19.8% and 3) insulin mixture, 24.3%. The mean baseline HbA1c was 9.3 ± 2.0%. Within the given follow-up time of 16 [11-21] months, only 40 out of the 111 patients had their treatment intensified and 71 had no intensification (therapeutic inertia) despite poor HbA1c levels. Among the 40 with intensification, 5 had immediate intensification and the proportions according to intensification delay ≤3 months, 3-6 months, 6-12 months and &gt;12 months .&#x0D; Conclusion: Therapeutic inertia affected two third of our population. Despite the high level of inertia, both patients with intensified treatment and non-intensified treatment reached treatment targets.

Nutritional status and oral health of elderly patients with diabetes

Introduction : oral health is a prerequisite for a good chewing function, which may have an impact on food choices and nutritional well-being. Thus this study was carried out to evaluate the association between oral health and the nutritional studies of elderly patients with diabetes in the Yaounde Central Hospital. Methods : we carried out a cross-sectional descriptive and analytical study at the National Obesity Centre of the Yaounde Central hospital. We included consecutively 90 elderly patients with diabetes (60 years and above). We assessed their oral health by carrying out a complete oral examination and a subjective oral health assessment of the participants was also carried out. We then assessed the nutritional status of participants using anthropometric parameters, Mini nutritional assessment (MNA) and fasting serum albumin concentrations. Results : ninety participants (60 females and 30 males) aged 66.9 ± 6.1 years were included in our study. With 37% of our participants haven been known diabetic for more than 10 years. Severe and moderate periodontitis was observed in 56(62.2%) and 29(32.2%) of our participants respectively. At least a decay tooth was present in the mouth of 70(77.8%) of our participants. Half 45((50.0%) of our participants declared to be unsatisfied with their oral health, 52(57.8%) limit their food choice because of their oral health. Using the percentage total body fat, 19(63.3%) men and 11(36.7%) women were underweight. The mean BMI of the study population was 27.6 ± 5.26. Seventeen (18.9%) of our participants were malnourished, 70(77.8%) at risk of malnutrition. Mean serum albumin concentration was 29.4 ± 2.2g/l. There was a statistical significance between CPI severity and serum albumin levels of our participants (P value = 0.02) and also between remaining natural teeth and MNA score (P value = 0.001). Conclusion : oral health problems were frequent in our study population, all our participants had moderate to severe periodontitis with some to the extent of edentulism. We found a strong relation between the severity of periodontitis, number of remaining natural teeth and the nutritional status of our study participants.

Use of capillary ketones monitoring in treatment of mild ketotic crisis in adults with ketosis prone atypical diabetes

Introduction : the utility of capillary ketones monitoring is known in the management of type 1 diabetes and severe diabetic ketoacidosis, but not in adults with ketosis-prone atypical diabetes (KPD) or mild ketosis. The objective was to assess the potential reduction in duration of intensive diabetic ketoacidosis treatment in adults with KPD when using capillary versus urinary ketones. Methods : from February to end March 2015, a total of 20 (9/20 newly diagnosed) patients, aged 46 ±12 years and classified as KPD presented at the National Obesity Center of the Yaounde Central Hospital with marked hyperglycemia and significant ketosis (ketonuria ≥ ++) requiring intensive insulin treatment. The mean plasma glucose and urinary ketones levelon admission was 22.8±5mmol/L and 2.9± 2.7 mmol/L respectively. No patient had severe acidosis (HCO3 Results : the time-to-normalization of ketonuria ranged between 2 and 14 hours, and that of ketonemia between 1 and 10 hours. The mean time-to-disappearance of ketonuria was 6.3 ± 3.6 hours with a median time of 5 hours, while the mean time-to-normalization of capillary β-hydroxybutyrate was 4.2± 2.7 hours with the median of 4 hours (p = 0.0002). The absolute difference in time-to-normalization of ketonuria versus ketonemia was 2[1-3] hours (median [interquartile difference]) and relative time reduction of treatment to 32.5±18.0%. Conclusion : the use of capillary ketones versus ketonuria would allow a significant reduction in duration of intensive insulin treatment by one third in adults with ketosis prone diabetes and therefore reduce admission rates and costs.

Pituitary macroadenoma with secondary adrenal insufficiency in a 29 year-old black African lady

Introduction : pituitary adenomas are usually benign tumors. The most common symptoms on presentation are those related to endocrine dysfunction such as irregular menses and those pertaining to mass effects such as headaches, blurring of vision to complete loss of vision. We present the case of a 29 year-old lady with a pituitary macroadenoma with secondary adrenal insufficiency who presented with chronic headaches, blurred vision, galactorrhea and amenorrhea for 3 years. The objective was to present this case in view of the complex relationship between macroadenomas and their inhibiting action on the other cells of the pituitary gland. Methods : this was a case review and report after clinical consultation at the National Obesity Center of the Yaounde Central Hospital. Results : a 29 year old married lady who looks anxious and tired. She has no family history of amenorrhea or other endocrine pathology. On examination, she looks anxious and tired. Blood pressure of 110/70 mmHg, pulse rate of 80 bpm, respiratory rate of 20 cpm, weight of 107 kg and temperature of 36°C. The rest of physical examination was uneventful. Hormone profile showed: prolactine 9048 ng/mL, cortisol 3.21 ug/L, ACTH 15.22 pg/mL, FSH 3.17 IU/L, LH 4.94 IU/L, tyroxine 59.10 ng/mL. Abdominal ultrasound showed a non-gravid uterus with a regular contour measuring 53.3 x 39 mm with hypotrophic ovaries. Brain CT scan revealed an infiltrative mass of the pituitary lobe, in favor of a pituitary macroadenoma measuring 21 x 17 x 17 mm. She was treated with cabergoline, hydrocortisone and analgesics pending transphenoidal surgery. Conclusion : this case sparks an interesting discussion on the varied clinical presentation of pituitary tumors. It also highlights the importance of the use of a high clinical index of suspicion and radiological findings in diagnosis.

Insulin Sensitivity and Gynaecological Features of Infertile Cameroonian Females with Polycystic Ovary Syndrome: A Cross-Sectional Study

Background: Polycystic ovary syndrome (PCOS), characterized by ovulatory dysfunction, polycystic ovary(PCO),hyperandrogenism and insulin resistance is the commonest endocrine disorder in women of reproductive age. It is an intriguing pathology that involves the perpetuation of a vicious circle with reproductive, endocrine and metabolic components. We aimed to assess the reproductive features and insulin sensitivity (IS) in infertile women with or without PCOS. Materials and Methods: We carried out a cross-sectional analytic study at the outpatient Obstetrics and Gynaecology Department of the Yaounde Gyneco-obstetric and Pediatrics Hospital, Cameroon from September 1st 2012 to March 31st 2013 giving total study duration of 07 months. Laboratory analyses were carried out at the National Obesity Centre(NOC)of the Yaounde Central Hospital, Cameroon. Results: Overall, 36 infertile females were enrolled, which included 15 diagnosed cases of PCOS according to Rotterdam consensus meeting of 2003 and 21 non PCOS subjects as control. PCOS women were younger than non PCOS women (28.8 ± 5.5 vs. 35.0 ± 4.2 years; p = 0.0004). The majority of the women in the PCOS group were spaniomenorrheic (11/15), and ultrasonographic findings were typical of PCOS. Hirsutism score was higher in the PCOS group with a median of 9 (7 - 13). Insulin sensitivity was impaired in two-thirds of the study population, with 12 women found to be insulin resistant(6 PCOS, 6 non PCOS), 12 patients had intermediate insulin sensitivity(2 PCOS, 10 non PCOS)and 12 insulin sensitive(7 PCOS, 5 non PCOS). Apart from blood glucose levels (p = 0.007), all other anthropometric and biological parameters were not significant. Spearman’s correlation identified fasting plasma glucose and total cholesterol as factors associated with insulin sensitivity in females with PCOS. Impaired fasting glucose was observed in 13 patients with 08 from the PCOS group. Conclusion: We conclude that young age, spaniomenorrhea and hirsutism are common findings in PCOS. Furthermore, our findings suggest that PCOS may be more of systemic metabolic disease than solely a purely gynecologic disorder as described hitherto. Despite normal fasting plasma glucose levels, a good proportion of these women has impaired insulin sensitivity and it is associated with a metabolic syndrome.

Exercise-induced albuminuria vs circadian variations in blood pressure in type 1 diabetes.

AIMTo investigated the relationship between exercise-induced ambulatory blood pressure measurement (ABPM) abnormalities in type 1 diabetes mellitus (T1DM) adolescents.METHODSWe conducted a case-control at the National Obesity Center of the Yaoundé Central Hospital, Cameroon. We compared 24 h ABPM and urinary albumin-to-creatinine ratio (ACR) at rest and after a standardized treadmill exercise between 20 Cameroonian T1DM patients and 20 matched controls. T1DM adolescents were aged 12-18 years, with diabetes for at least one year, without proteinuria, with normal office blood pressure (BP) and renal function according to the general reference population. Non-diabetic controls were adolescents of general population matched for sex, age and BMI.RESULTSMean duration of diabetes was 4.2 ± 2.8 years. The mean 24 h systolic blood pressure (SBP) and diastolic blood pressure (DBP) were respectively 116 ± 9 mmHg in the diabetic group vs 111 ± 8 mmHg in the non-diabetic (P = 0.06), and 69 ± 7 mm Hg vs 66 ± 5 mm Hg (P = 0.19). There was no difference in the diurnal pattern of BP in diabetes patients and non-diabetic controls (SBP: 118 ± 10 mmHg vs 114 ± 10 mmHg, P = 0.11; DBP: 71 ± 7 mmHg vs 68 ± 6 mmHg, P = 0.22). Nighttime BP was higher in the diabetic group with respect to SBP (112 ± 11 mmHg vs 106 ± 7 mmHg, P = 0.06) and to the mean arterial pressure (MAP) (89 ± 9 mmHg vs 81 ± 6 mmHg, P = 0.06). ACR at rest was similar in both groups (5.5 mg/g vs 5.5 mg/g, P = 0.74), but significantly higher in diabetes patients after exercise (10.5 mg/g vs 5.5 mg/g, P = 0.03). SBP was higher in patients having exercise-induced albuminuria (116 ± 10 mmHg vs 108 ± 10 mmHg, P = 0.09).CONCLUSIONExercise-induced albuminuria could be useful for early diagnosis of kidney damage in adolescents with T1DM.

Impact of a 12-week aerobic exercise training program on anthropometric and metabolic parameters of a group of type 2 diabetes Cameroonian women aged ≥50 years.

We examined whether aerobic exercise could have an impact on anthropometric and metabolic parameters of type 2 diabetes mellitus (T2DM) Cameroonian women aged ≥50 years. We enrolled 23 T2DM Cameroonian women aged ≥50 years regularly followed at the National Obesity Center of Yaounde, Cameroon, in a 12-week aerobic exercise program monitored by a pedometer. Exercise intensity was progressively set between 55% and 75% of maximum heart rate. We measured weight, body mass index (BMI), fat, lean mass, visceral fat, maximum oxygen uptake, glycaemia and insulin tolerance index at baseline, after six and twelve weeks. A mixed ANOVA model was used to evaluate changes of outcome measures over time. Total body weight was significantly reduced after 12 weeks (P<0.05), waist circumference after 6 and 12 weeks (P<0.05). There was an increase of the lean mass from 6 weeks (P<0.001) and a reduction of the mean visceral fat at 12 weeks (P<0.001). At the end of the program, the mean glycaemia was significantly decreased (P<0.05), and the maximum oxygen uptake was enhanced (P<0.05). The 12-week aerobic exercise program improved the anthropometric and metabolic parameters as well as the aerobic capacity of T2DM Cameroonian women aged ≥50 years.

Cardiovascular risk profile, diabetes specific factors, and prevalent microvascular eye complications in sub-Saharan Africans with type 2 diabetes

The aim of this study is to examine the association between cardiovascular risk profile, diabetes-specific factors, and prevalent retinopathy in sub-Saharan Africans with type 2 diabetes. We enrolled 213 (41 % women) diabetic adults from the Cameroon National Obesity Center in 2008. Prevalent retinopathy was based on history and digital mydriatic retinal photography. Cardiovascular risk profile was assessed, and global absolute coronary risk was estimated with the UK Prospective Diabetes Study (UKPDS) and Framingham coronary risk equations. Logistic regressions were used to relate risk factors to prevalent retinopathy and discrimination and calibration assessed. Fifty-four patients (25.4 %) had prevalent of retinopathy. Patients with retinopathy had more often hypertension (88 vs 43 %, p = 0.003), and age at diagnosis, known duration of diabetes, blood glucose, and systolic blood pressure were associated with retinopathy. Estimated 10-year coronary risks by the Framingham and UKPDS had low discrimination for retinopathy, with C-statistic (95 % confidence interval) of 0.593 (0.504–0.682) and 0.603 (0.518–0.688), respectively. New equations developed from this sample had better discrimination and calibration, with a maximum C-statistic of 0.881 (0.828–0.933). Cardiovascular risk profile was poorly correlated with prevalent retinopathy in this population. Strategies based upon routinely assessed diabetes-related factors can improve the selection of patients at high risk of retinopathy for costly confirmatory investigations.

OP23 Epidemiologic characteristics of ketosis prone type 2 diabetic patients at the National Obesity Centre in Yaounde

OP23 Epidemiologic characteristics of ketosis prone type 2 diabetic patients at the National Obesity Centre in Yaounde