Obesity is increasing in Africa, but the underlying genetic background largely remains unknown. We assessed existing evidence on genetic determinants of obesity among populations within Africa. ...MEDLINE and EMBASE were searched and the bibliographies of retrieved articles were examined. Included studies had to report on the association of a genetic marker with obesity indices and the presence/occurrence of obesity/obesity trait. Data were extracted on study design and characteristics, genetic determinants and effect estimates of associations with obesity indices. According to this data, over 300 polymorphisms in 42 genes have been studied in various population groups within Africa mostly through the candidate gene approach. Polymorphisms in genes such as ACE, ADIPOQ, ADRB2, AGRP, AR, CAPN10, CD36, C7orf31, DRD4, FTO, MC3R, MC4R, SGIP1 and LEP were found to be associated with various measures of obesity. Of the 36 polymorphisms previously validated by genome‐wide association studies (GWAS) elsewhere, only FTO and MC4R polymorphisms showed significant associations with obesity in black South Africans, Nigerians and Ghanaians. However, these data are insufficient to establish the true nature of genetic susceptibility to obesity in populations within Africa. There has been recent progress in describing the genetic architecture of obesity among populations within Africa. This effort needs to be sustained via GWAS studies.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Aim
It is unclear whether ketosis‐prone diabetes is a specific type or a subtype of Type 2 diabetes. We aimed to describe the clinical and metabolic features of ketosis‐prone diabetes in a ...sub‐Saharan population.
Methods
We consecutively enrolled and characterized 173 people with non‐autoimmune diabetes admitted for hyperglycaemic crisis at the Yaoundé Central Hospital, Cameroon. Blood samples were collected for fasting glucose, HbA1c, lipid profile and C‐peptide assays with insulin resistance and secretion estimation by homeostasis model assessment. People were classified as having Type 2 diabetes (n = 124) or ketosis‐prone diabetes (n = 49). Ketosis‐prone diabetes was sub‐classified as new‐onset ketotic phase (n = 34) or non‐ketotic phase (n = 15).
Results
Ketosis‐prone diabetes was found in 28.3% of the hyperglycaemic crises. Age at diabetes diagnosis was comparable in Type 2 and ketosis‐prone diabetes 48 ± 14 vs 47 ± 11 years; P = 0.13 with a similar sex distribution. Overall BMI was 27.7 ± 13.4 kg/m2 and was ≥ 25 kg/m2 in 55.8% of those taking part, however, 73.5% of those with ketosis‐prone diabetes reported weight loss of > 5% at diagnosis. Blood pressure and lipid profile were comparable in both types. Ketosis‐prone diabetes in the ketotic phase was characterized by lower insulin secretion and higher serum triglycerides compared with non‐ketotic ketosis prone and Type 2 diabetes. Type 2 and ketosis prone diabetes in the non‐ketotic phase were comparable in terms of lipid profile, blood pressure, waist‐to‐hip ratio, BMI and fat mass, insulin secretion and insulin resistance indices.
Conclusions
Ketosis‐prone diabetes is likely to be a subtype of Type 2 diabetes with the potential to develop acute insulinopenic episodes.
What's new?
Although ketosis‐prone diabetes has been described in many populations, there are few reports in sub‐Saharan populations living in Africa. This article presents some epidemiological, clinical and metabolic features of ketosis‐prone diabetes in Cameroon.
Ketosis‐prone diabetes may be more frequent than expected in sub‐Saharan Africa and is comparable with Type 2 diabetes, with the exception of acute ketotic onset and relapses and transient lower insulin secretion. Ketosis‐prone diabetes is likely to be a subtype of Type 2 diabetes with the potential to develop acute insulinopenic phases at diagnosis or during unexplained ketotic relapses.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Summary
In first‐degree relatives of type 1 diabetic patients, we investigated whether diabetes risk assessment solely based on insulinoma antigen 2 (IA‐2) and zinc transporter 8 (ZnT8) antibody ...status (IA‐2A, respectively, ZnT8A) is as effective as screening for three or four autoantibodies antibodies against insulin (IAA), glutamate decarboxylase 65 kDa (GAD) glutamate decarboxylase autoantibodies (GADA) and IA‐2A with or without ZnT8A in identifying children, adolescents and adults who progress rapidly to diabetes (within 5 years). Antibodies were determined by radiobinding assays during follow‐up of 6444 siblings and offspring aged 0–39 years at inclusion and recruited consecutively by the Belgian Diabetes Registry. We identified 394 persistently IAA+, GADA+, IA‐2A+ and/or ZnT8A+ relatives (6·1%). After a median follow‐up time of 52 months, 132 relatives developed type 1 diabetes. In each age category tested (0–9, 10–19 and 20–39 years) progression to diabetes was significantly quicker in the presence of IA‐2A and/or ZnT8A than in their joint absence (P < 0·001). Progression rate was age‐independent in IA‐2A+ and/or ZnT8A+ relatives but decreased with age if only GADA and/or IAA were present (P = 0·008). In the age group mainly considered for immune interventions until now (10–39 years), screening for IA‐2A and ZnT8A alone identified 78% of the rapid progressors (versus 75% if positive for ≥ 2 antibodies among IAA, GADA, IA‐2A and ZnT8A or versus 62% without testing for ZnT8A). Screening for IA‐2A and ZnT8A alone allows identification of the majority of rapidly progressing prediabetic siblings and offspring regardless of age and is more cost‐effective to select participants for intervention trials than conventional screening.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Aim
We evaluated the performance of the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) and Cockcroft–Gault (CG) equations against creatinine ...clearance (CrCl) to estimate glomerular filtration rate (GFR) in 51 patients with Type 2 diabetes.
Methods
The CrCl value was obtained from the average of two consecutive 24‐h urine samples. Results were adjusted for body surface area using the Dubois formula. Serum creatinine was measured using the kinetic Jaffe method and was calibrated to standardized levels. Bland–Altman analysis and kappa statistic were used to examine agreement between measured and estimated GFR.
Results
Estimates of GFR from the CrCl, MDRD, CKD‐EPI and CG equations were similar (overall P = 0.298), and MDRD (r = 0.58; 95% CI: 0.36–0.74), CKD‐EPI (r = 0.55; 95% CI: 0.33–0.72) and CG (r = 0.61; 95% CI: 0.39–0.75) showed modest correlation with CrCl (all P < 0.001). Bias was −0.3 for MDRD, 1.7 for CKD‐EPI and −5.4 for CG. All three equations showed fair‐to‐moderate agreement with CrCl (kappa: 0.38–0.51). The c‐statistic for all three equations ranged between 0.75 and 0.77 with no significant difference (P = 0.639 for c‐statistic comparison).
Conclusions
The MDRD equation seems to have a modest advantage over CKD‐EPI and CG in estimating GFR and detecting impaired renal function in sub‐Saharan African patients with Type 2 diabetes. The overall relatively modest correlation with CrCl, however, suggests the need for context‐specific estimators of GFR or context adaptation of existing estimators.
What's new?
Glomerular filtration rate (GFR) equations for estimating kidney function are routinely used in sub‐Saharan Africa. There is, however, a paucity of data on the performance of these equations in patients with diabetes mellitus who are, for the most part, undiagnosed and unaware of their condition.
We investigated the performance of the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) and Cockcroft–Gault (CG) equations in patients with Type 2 diabetes.
Our results suggest that the lowest bias is observed with the MDRD formula compared with the CKD‐EPI and CG equations. However, all three equations performed similarly in predicting altered kidney function based on low GFR.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Haemodialysis improves uraemia-induced insulin sensitivity and is therefore likely to induce significant changes in circulating glucose concentrations in end-stage renal disease (ESRD). We ...aimed to assess clinically relevant circulating glucose changes in patients undergoing chronic maintenance haemodialysis using continuous interstitial monitoring. We investigated 14 non-diabetic ESRD subjects aged 40.6 ± 2.4 years. Participants were examined 24-h day pre-dialysis, during the index dialysis session and 24-h post-dialysis with simultaneous measurement of capillary blood glucose and continuous interstitial glucose (CGMS). Participants performed five capillary blood glucose measurements the day before dialysis, and 10 during and after dialysis. Mean capillary blood glucose was 128 ± 20 mg/dl the day before, 93 ± 8 mg/dl during haemodialysis, and 105 ± 13 mg/dl after haemodialysis. There was a significant trend towards lower blood glucose during the session from 105 ± 16 mg/dl to a 3rd hour nadir of 83 ± 15 mg/dl (Anova F = 2.89, p = 0.029). No hypoglycaemia was recorded. Interstitial glucose profile was comparable to capillary glucose profile. Glucose concentrations varied significantly from 126 ± 13 mg/dl before to 112 ± 12 mg/dl after haemodialysis respectively ( p = 0.006). This study provides evidence for the use of CGMS in ESRD and haemodialysis, and demonstrates significant changes in glucose concentrations during and after haemodialysis that would guide treatment monitoring and adjustments.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background Management of hyperglycaemic crises requires expensive and labour-intensive procedures that are not achievable in all clinical settings. Intramuscular (IM) insulin therapy is a ...more feasible alternative, but remains insufficiently evaluated. We report here on an audit of clinical outcomes of a simple management protocol that involves IM insulin therapy, careful rehydration and inexpensive monitoring in a resource-limited setting. Methods In June 2006, we began the routine use of a protocol based on IM insulin administration, careful rehydration and affordable monitoring for the management of hyperglycaemic crises in Yaoundé Central Hospital. Clinical records of patients admitted for hyperglycaemic crises 6 months before and 6 months after introduction of the protocol were independently coded and compared for clinical outcomes, including the 48-hour death rate as a primary endpoint. Secondary endpoints were blood glucose (BG) normalization and duration of hospital stay. Results A total of 112 patients’ files fulfilled the inclusion criteria, including 57 before and 55 after the introduction of the IM protocol (intervention). Patients of the pre-intervention group were aged 56.4 ± 2.1 years versus 53.9 ± 2.3 years in the intervention group (p = 0.41), with 23% versus 40%, respectively, with newly diagnosed diabetes ( p = 0.05), and 45% versus 41%, respectively, with significant ketosis on admission ( p = 0.84). As for the primary endpoint, 15.8% of the pre-intervention group died within 48 hours of admission versus 3.6% in the intervention group ( p = 0.03). BG was normalized within 24 hours of admission in 28.1% patients of the pre-intervention group versus 90.9% of the intervention group ( p < 0.001). However, the overall duration of hospitalization was similar in both groups. Septic shock, ketosis and high serum creatinine on admission were associated with poor outcomes in both groups. Conclusion The proposed protocol using IM insulin can be safely used to treat hyperglycaemic crises, with mortality rates comparable to those in specialized centres in developed countries.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary
Obesity is increasing in
A
frica, but the underlying genetic background largely remains unknown. We assessed existing evidence on genetic determinants of obesity among populations within
A
...frica.
MEDLINE
and
EMBASE
were searched and the bibliographies of retrieved articles were examined. Included studies had to report on the association of a genetic marker with obesity indices and the presence/occurrence of obesity/obesity trait. Data were extracted on study design and characteristics, genetic determinants and effect estimates of associations with obesity indices. According to this data, over 300 polymorphisms in 42 genes have been studied in various population groups within
A
frica mostly through the candidate gene approach. Polymorphisms in genes such as
ACE
,
ADIPOQ
,
ADRB
2
,
AGRP
,
AR
,
CAPN
10
,
CD
36
,
C
7orf31
,
DRD
4
,
FTO
,
MC3R
,
MC4R
,
SGIP1
and
LEP
were found to be associated with various measures of obesity. Of the 36 polymorphisms previously validated by genome‐wide association studies (
GWAS
) elsewhere, only
FTO
and
MC4R
polymorphisms showed significant associations with obesity in black
S
outh
A
fricans,
N
igerians and
G
hanaians. However, these data are insufficient to establish the true nature of genetic susceptibility to obesity in populations within
A
frica. There has been recent progress in describing the genetic architecture of obesity among populations within
A
frica. This effort needs to be sustained via
GWAS
studies.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Experimental studies suggest that pretreatment with β-agonists might prevent acute lung injury (ALI).
To determine if in adult patients undergoing elective esophagectomy, perioperative treatment with ...inhaled β-agonists effects the development of early ALI.
We conducted a randomized placebo-controlled trial in 12 UK centers (2008-2011). Adult patients undergoing elective esophagectomy were allocated to prerandomized, sequentially numbered treatment packs containing inhaled salmeterol (100 μg twice daily) or a matching placebo. Patients, clinicians, and researchers were masked to treatment allocation. The primary outcome was development of ALI within 72 hours of surgery. Secondary outcomes were ALI within 28 days, organ failure, adverse events, survival, and health-related quality of life. An exploratory substudy measured biomarkers of alveolar-capillary inflammation and injury.
A total of 179 patients were randomized to salmeterol and 183 to placebo. Baseline characteristics were similar. Treatment with salmeterol did not prevent early lung injury (32 19.2% of 168 vs. 27 16.0% of 170; odds ratio OR, 1.25; 95% confidence interval CI, 0.71-2.22). There was no difference in organ failure, survival, or health-related quality of life. Adverse events were less frequent in the salmeterol group (55 vs. 70; OR, 0.63; 95% CI, 0.39-0.99), predominantly because of a lower number of pneumonia (7 vs. 17; OR, 0.39; 95% CI, 0.16-0.96). Salmeterol reduced some biomarkers of alveolar inflammation and epithelial injury.
Perioperative treatment with inhaled salmeterol was well tolerated but did not prevent ALI. Clinical trial registered with International Standard Randomized Controlled Trial Register (ISRCTN47481946) and European Union database of randomized Controlled Trials (EudraCT 2007-004096-19).
The inconclusiveness of previous research on the association between gender diverse boards (GDB) and corporate social performance (CSP) has led us to revisit the question in light of stakeholder ...management and institutional theories. Given that corporate social responsibility (CSR) is a multidimensional concept, we test the influence of GDB on various groups of stakeholders. By considering the interaction between stakeholders' power and directors' personal motivations toward the prioritization of stakeholders' claims, we find that GDB are positively related to CSR dimensions that are related to less powerful stakeholders such as the environment, contractors, and the community. However, GDB do not appear to have a significant impact on CSR dimensions that are associated with stakeholders who benefit from more institutionalized power, such as employees and customers.
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