Papers by ekenechukwu young
Nigerian Journal of Medicine
Review Article IntRoductIon A post glucose challenge state of glucose tolerance, intermediate bet... more Review Article IntRoductIon A post glucose challenge state of glucose tolerance, intermediate between that defined as normal and that classified as diabetes, was described in 1979 and in 1980, respectively, by both the American National Diabetes Working Group and the World Health Organization (WHO) to replace the terms-borderline, chemical, and asymptomatic diabetes mellitus. [1] This apparently new state, which was termed impaired glucose tolerance (IGT) or prediabetes, represented a raised 2 hours plasma glucose level of between 140 and 199 mg/dL (7.8-11.0 mmol/L) in an individual who had normal fasting plasma glucose levels. [1] In addition, individuals in this new category were discovered to have an increased tendency towards developing type 2 diabetes mellitus (T2DM) in future and cardiovascular disease. Close to two decades after the term IGT was adopted, a different but related category of elevated, nondiabetic range of fasting plasma glucose levels which also predicted future diabetes was likewise-reported in some individuals. This was termed impaired fasting glucose (IFG) by the American Diabetes Association (ADA) in 1997 and was subsequently adopted by the WHO in 1999, as impaired fasting glycemia (IFG). [1] Thus, IFG was defined as a fasting plasma glucose value of 110-125 mg/dL (6.1-6.9 mmol/L). [2] However, over time, several research-based data evidence showed that the lower limit of 110 mg/dL for IFG was unconvincing, as it was found to be the exact threshold predictive of future diabetes, in an individual. The sore point Prediabetes-comprising impaired fasting glycaemia (IFG) and/or impaired glucose tolerance (IGT)-is a transitory median interphase between normal blood glucose levels and diagnostic levels of diabetes. The raised blood glucose levels surreptitiously damage the body's organ systems and are often an augury of type 2 diabetes mellitus (T2DM), the two having been found to share similar pathogenesis. Current concepts in the pathogenesis of prediabetes support a pentad of mechanisms responsible for its development. Majority of the countries in Sub-Saharan Africa belong to the low and middle income category, whose population accounts for more than 70% of the 352 million adults (20-79 years) worldwide with IGT (one component of prediabetes), as at 2017. The presence of prediabetes increases health care related expenditure in individuals and takes a toll on the workforce. Nigeria (West Africa) is currently among the top ten countries with the highest number of individuals with IGT as at 2017, and Ethiopia (East Africa) has been projected to join Nigeria in this category by 2045. A PubMed and MEDLINE search was conducted using the keywords prediabetes, Sub-Saharan Africa, prevalence, and pathophysiology. Major studies were identified and reviewed. Numerous large scale studies have revealed that progression from prediabetes to T2DM is not relentless. Structured and intensive lifestyle modifications aimed at modest weight loss, increased physical activity, and healthy dietary habits have shown to halt or slow the progression to T2DM, and in some cases, even reverse prediabetes, with such individuals regaining normal blood glucose levels.
International Journal of Health Services
The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle... more The prevalence of diabetes mellitus and hypertension is increasing yearly in many low- and middle-income countries such as Nigeria. The increasing burden of these noncommunicable diseases has led to an increase in the overall cost of health care. This study aimed at determining the direct and indirect health care costs of diabetes mellitus and hypertension occurring both singly and in co-morbidity. The study was undertaken in the Enugu State University Teaching Hospital (a tertiary hospital) in Enugu State, Southeast Nigeria. Data were collected using a pre-tested questionnaire. Out of 817 patients interviewed, 37% had only diabetes mellitus, 35% had hypertension, and 28% had both diabetes mellitus and hypertension in co-morbidity. Direct costs of treating diabetes mellitus and hypertension in the month before the survey were $28.40 and $19.35, respectively, while the indirect costs of treatment in the month before the study were $7.36 and $5.51, respectively. Direct and indirect co...
Journal of Diabetes Science and Technology
Additional file 1: Supplement 1. Questionnaire to evaluate knowledge and practice of diabetes car... more Additional file 1: Supplement 1. Questionnaire to evaluate knowledge and practice of diabetes care among general practitioners in Southeast Nigeria. This supplementary file contains the questionnaire that was used to evaluate knowledge and practice of diabetes care among general practitioners in Southeast Nigeria.
International Journal of Medicine and Health Development, 2020
Background: Short sleep duration of less than 5.5h a day has been associated with cardiometabolic... more Background: Short sleep duration of less than 5.5h a day has been associated with cardiometabolic risk factors. Epidemiological evidence suggests a rising trend in the prevalence of cardiovascular diseases in Nigeria. Objective: The aim of this study was to determine the relationship between traditional cardiometabolic risk factors, prediabetes, and short sleep duration in a group of rural Nigerian women. Subjects and Methods: Five hundred and thirty-eight women living in Ihuokpara, a rural community in Southeast Nigeria, participated in the study. A structured questionnaire was administered to the participants to obtain demographic information and self-reported nighttime sleep duration. Anthropometric measurements and blood pressure were recorded. Participants underwent a 75 g Oral Glucose Tolerance Test using standard protocols. Prediabetes was defined using the World Health Organization criteria (fasting plasma glucose 110–125 mg/dL or 2h post-glucose 140–199 mg/dL) and hypertension was defined using the Joint National Committee (JNC-7) criteria. Results: The mean age of the subjects was 49.9 ± 16.2 years and 280 (52%) had no formal education. Hypertension was present in 238 (44.2%), prediabetes was present in 120 (22.3%), generalized obesity in 32 (5.9%), and increased waist circumference (>88cm) in 116 (21.6%) women. Average sleep duration of less than 5.5h per night was reported in 182 (33.8%) women. Short sleep duration was significantly associated with prediabetes and hypertension but not obesity or older age in the subjects. Conclusion: More than a third of the women had short sleep duration and this was a significant risk factor for prediabetes and hypertension in them.
Nigerian Journal of Medicine, 2017
Purpose: The purpose of this study was to determine the knowledge and practice of female secondar... more Purpose: The purpose of this study was to determine the knowledge and practice of female secondary school students to sexually transmitted infections in Enugu, South East Nigeria.These could pose as barriers to effective sexual education and impair case management within the community. Methods: This study was cross-sectional and descriptive in design using a self- administered custom designed multiple choice questionnaire with sections on general information on sexually transmitted infections, awareness and perception of such infections. Ethical clearance and informed consent were obtained. Results: There were 183 respondents with a mean age of 15.9 ± 1.3 years, all female.There was a high level of awareness of HIV (97.8%) and STIs (94.5%).While 74.3% had correct knowledge of modes of transmission,60.7% incorrectly identified casual contact as modes of transmission of HIV. Only 59% correctly identified all the HIV prevention methods tested, while 74.9% practiced all modes of prevention. The median aggregate score for knowledge of transmission and prevention was 72.2%, while it was 62.5% for good prevention practice. The older students were more likely to be sexually active. Conclusion: Female secondary school students in Enugu had a high level of awareness for sexually transmitted infections, especially for HIV. However, in-depth knowledge regarding mode of transmission and prevention was sub-optimal.There is a need to strengthen public and school based sexual health education in Nigeria. Keywords: Sexually transmitted infections, knowledge, female students, Nigeria
International Journal of Medicine and Health Development, 2021
Background: Support groups have been advocated in the care of patients with HIV and are integrate... more Background: Support groups have been advocated in the care of patients with HIV and are integrated into HIV care and treatment programs. Objectives: This study aimed to assess in patients living with HIV, their awareness of support groups, knowledge of its benefits, and perceived barriers to their participation. Materials and Methods: A cross-sectional descriptive study was conducted on 430 consenting adult patients being managed for HIV/AIDS at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. Patients were recruited consecutively over 4 weeks, and information on their sociodemographic data, knowledge, and membership of HIV support groups was obtained using a structured interviewer-administered questionnaire. Data were analyzed using Statistical Packages for Social Sciences (SPSS) version 23. The level of significance was < 0.05, and the confidence interval was 95%. Results: The mean age of the participants was 42.8 ± 6.58 years and 70.5% were female. A diagnosis ...
Journal of Pharmaceutical Research International, 2021
Diabetes mellitus has sadly become a pandemic, with chronic and debilitating complications which ... more Diabetes mellitus has sadly become a pandemic, with chronic and debilitating complications which by far are more pronounced in the developing countries of the world. Despite the availability of a wide array of anti-diabetic drugs (both oral and parenteral medications), micro-vascular and macro-vascular diabetes complications are still common. Owing to this sad reality, the place of micronutrients augmentation has come to the frontline of research in diabetes management. Zinc is one of the well-known micro-elements with diverse functions in various physiologic processes in humans. The authors reviewed the role of zinc augmentation in subjects with diabetes generally, both those with complications of diabetes and those without complications. Emphasis was also laid on the modulatory actions of zinc on various diabetes-related processes which include: its anti-oxidant effect; improvement of insulin secretion/sensitivity; increased amylin action; inhibition of gluconeogenesis and atheros...
Journal of Diabetes Mellitus, 2019
Background: Diabetes in Nigeria presents a rising public health challenge and many cases are prob... more Background: Diabetes in Nigeria presents a rising public health challenge and many cases are probably undetected. Poor glycemic control is a risk factor to both micro and macro vascular complications of diabetes and a major factor in the burden of the disease worldwide. The aim of the present study was to determine the pattern of glycemic control among adult diabetes patients attending a medical outpatient clinic in Enugu. Methods: Using a semi-structured questionnaire, we conducted a cross sectional descriptive study of patients with diabetes attending the medical outpatient clinic of one of the tertiary Hospitals in Enugu, Nigeria. Good glycemic control was defined as fasting blood glucose of less than 100 mg/dl. Study duration was 6 months. Statistical analyses were done using SPSS software. Results: A total of 119 participants were recruited for the study: 74 (62.2%) females and 45 males (37.8%) with a mean age of 62.2 (11.7) years. The mean systolic and diastolic blood pressure was 138.4 (24.3) mmHg and 81.2 (12.9) mmHg respectively. Eight (6.7%) had a documented history of diabetes-related coma in the past. The mean fasting blood glucose was 127.9 (22.4) mg/dl. Good, fair and poor glycemic control was achieved in 16.8%, 30.3% and 63% (52.9%) respectively. Correlation statistics showed that low level of adherence and abstaining from alcohol/tobacco are correlated with poor glycemic control. Conclusion: Majority (52.9%) of patients with diabetes attending a tertiary health center in Enugu, Nigeria has poor glycemic control status. Medication adherence and substance use are correlated with poor control.
International Journal of Diabetes in Developing Countries, 2021
The prevalence of diabetes mellitus (DM) is rising in sub-Saharan Africa, including Nigeria. A pr... more The prevalence of diabetes mellitus (DM) is rising in sub-Saharan Africa, including Nigeria. A previous study in Abia State, Nigeria, showed a high prevalence of diabetes, with no significant difference in urban and rural communities. This study aimed at investigating the prevalence and risk factors for impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), which represent reversible and preventable early signs of DM. A cross-sectional comparative study of 2800 adult residents of Abia State, comprising equal number of urban and rural respondents. Interviewer-administered semi-structured questionnaires were used for data collection. Fasting blood glucose was performed for all the respondents, while oral glucose tolerance test (OGTT) was done for 2424 respondents, comprising 1117 urban residents and 1307 rural residents. Data was analyzed using SPSS version 20. Mean age of the respondents was 48.54 ± 13.24 years: rural = 54.23 ± 14.26 years and urban = 42.85 ± 13.24 years, p < 0.001. Male to female ratio was 1:2.5 (p < 0.001). Pre-diabetes (IFG and IGT) was observed in 6.3% of the respondents, comprising 3.9% in urban and 8.7% in rural residents, p < 0.001. The prevalence of IFG and IGT was 4.7% and 12%, respectively, p < 0.001. Independent predictors of pre-diabetes included abnormal waist circumference (WC), hypertension, and daily intake of fruits and vegetables in the urban area, while in the rural area, they included hypertension and abnormal WC. The prevalence of pre-diabetes is high in Abia State, with a higher burden among rural residents. Hypertension and abnormal WC are significant predictors of pre-diabetes in Abia State. Daily consumption of fruits/vegetables in processed forms may be associated with an increased risk of pre-diabetes.
PAMJ Clinical Medicine, 2020
INTRODUCTION: Sickle cell disease is a genetic disorder of haemoglobin characterized by chronic a... more INTRODUCTION: Sickle cell disease is a genetic disorder of haemoglobin characterized by chronic anaemia due to ongoing haemolysis and is frequently associated with recurrent vaso-occlusive crisis (VOC). The affected patients often have impaired immunity and are predisposed to infections. It is known that infections and infestations are important trigger factors towards development of vaso-occlusive crises (VOC) in SCA patients. Aims and objectives: to demonstrate any significant difference in the Haemoglobin levels and frequency of vaso-occlusive crises among children with SCA harbouring intestinal helminthes compared with SCA patients without Intestinal Helminths. METHODS: a hospital based cross sectional study was conducted between August and October 2018 in 120 children aged 2 to 18 years with sickle cell anaemia. Frequency of vaso-occulsive crisis in children with or without intestinal helminths was assessed using a structured questionnaire. Stool and Blood samples were collected and analysed using standard methods. RESULTS: the ages of the children ranged between 2 - 18 yrs, 55.8% were males with a mean age of 8.6(±4.6SD) years. Females had a mean age of 9.1 (±3.9SD) years. Eleven stool samples contained intestinal helminths. The median haemoglobin of the helminth-infected subjects was 6.5g/dl. There was no significant statistical difference in episodes of vaso-occlusive crises in those with or without helminthic infections (p = 0.822) though statistical difference in the haemoglobin levels appeared significant (p-value 0.010). CONCLUSION: haemoglobin levels appeared lower in children with intestinal helminthiasis while the frequency of vaso-occlusive crises did not differ.
Journal of Advances in Medicine and Medical Research, 2020
Introduction: Ethical norms in research promote the aims of research such as knowledge, truth and... more Introduction: Ethical norms in research promote the aims of research such as knowledge, truth and avoidance of error. Observing ethics in clinical research is very important and this should be well known by all health care practitioners. The aim of this study was to determine the knowledge of doctors working in a tertiary hospital about research ethics and the barriers they encounter in the ethical conduct of research. Materials and Methods: A questionnaire-based survey was conducted among 215 doctors in a tertiary hospital in Nigeria to determine their knowledge of the concepts of ethics in research, their research practices and perceived barriers to ethical conduct of research. Data obtained was analysed with SPSS v 20 and reported as Tables and charts. Chi square was used to test for differences between categorical variables and a P value < .05 was regarded as significant. Results: There were 108 consultants, while the rest were medical officers and resident doctors. The consu...
BMC Family Practice, 2020
Background Due to the perennial shortage of diabetes specialists, primary care physicians (PCPs) ... more Background Due to the perennial shortage of diabetes specialists, primary care physicians (PCPs) constitute the largest diabetes care manpower in Nigeria. However, the competence of the PCPs to undertake this task is not known. This study was aimed at evaluating diabetes care knowledge and practice among PCPs in Southeastern part of Nigeria. Methods This was a cross-sectional study among PCPs in Southeastern Nigeria. Diabetes care knowledge and practices were evaluated using a structured self administered questionnaire. Results A total of 64 PCPs with mean duration of practice of 17.3 ± 11.6 years completed the study. 65.6% were in private practice and 50% attended to between 11 and 20 persons living with diabetes (PLWD) weekly. Majority (78.1%) had not participated in any diabetes training since graduation from medical school and 79.9% were not aware of any diabetes clinical practice guideline. The PCPs had adequate knowledge of classical symptoms of diabetes. However, they had ver...
Nigerian Journal of Medicine, 2020
Original Article IntroductIon Diabetes mellitus (DM) is a metabolic disorder characterized by chr... more Original Article IntroductIon Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia from relative insulin deficiency, resistance, or both. [1] The estimated global prevalence of DM among adults aged 20-79 years in 2019 was reported by the International Diabetes Foundation to be 9.3%, affecting 463.0 million adults, and this figure is projected to increase to 578.4 million by 2030 and eventually, to 700.2 million adults, in 2045. [2] A recent systematic review of DM prevalence in Nigeria (2018), revealed a nationwide prevalence of 5.7%, though with marked regional variations in prevalence. [3] Type 2 DM (T2DM) is the most common type of DM and results from a combination of insulin resistance and less severe insulin deficiency. [1] T2DM is also the most commonly seen diabetes presentation in older adults, though in recent times, it has been noted to be increasing in incidence among children, adolescents, and younger adults due to poor diet, obesity, and sedentary lifestyle. DM as a complex chronic disease, requires multifactorial risk-reduction strategies beyond glycemic control. [4] The long-term metabolic derangement in DM leads to the affectation of different organs and systems in the body including the kidneys, nerves, eyes, and cardiovascular system. Insulin is the key hormone required for the storage and controlled release of chemical energy in form of glucose from food in the body [1] Background: The prevalence of diabetes mellitus (DM) has increased globally making it a major public health concern. Serum calcium levels, together with other minerals, play an important role in the regulation of plasma glucose. The aim of this study was to determine the serum calcium levels in individuals with Type 2 DM (T2DM) as well as its relationship with their clinical characteristics and glycemic control. Materials and Methods: This was a cross-sectional study carried out at the University of Nigeria Teaching Hospital, Enugu State. A total of 300 participants were recruited, comprising 150 participants with DM and 150 age-and gender-matched normal participants as control. A questionnaire was administered to obtain clinical characteristics. Serum calcium and glycosylated hemoglobin (HbA1c) were measured. Mean ± standard deviation was calculated, and an independent t-test was used to determine the mean difference. Pearson's correlation was done to establish the correlation between serum calcium and HbA1c. Data were analyzed with SPSS version 23. Results: This study showed that the mean serum calcium level for the T2DM participants was significantly reduced (2.16 ± 0.17) when compared to that of the controls (2.21 ± 0.17) (P = 0.02). Furthermore, individuals with T2DM showed a significant negative correlation between serum calcium levels and HbA1c-a long-term measure of glycemic control (r = 0.273; P = 0.001). Conclusion: Participants with T2DM were found to have a lower mean level of serum calcium. In addition, T2DM participants who had poor glycemic control were more likely to have hypocalcemia.
NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2019
Background: Evaluation of patients who present with diarrhea and constipation requires a good kno... more Background: Evaluation of patients who present with diarrhea and constipation requires a good knowledge of what constitutes normal defecation frequency and stool form. This study was designed to determine the normal defecation frequency and normal stool form in adult rural and urban dwellers in Southeast Nigeria. Materials and Methods: This was an observational, descriptive, cross-sectional, questionnaire-based study of adults in rural and urban settings in Southeast Nigeria. Defecation frequency was recorded as number of bowel motions per week, while stool form was determined with the use of the Bristol stool scale. Variables included in the questionnaire were age, sex, occupation, level of education, use of alcohol, cigarette smoking, use of kolanut, use of coffee, and body mass index. Data were analyzed with SPSS v 23. Results: There were 670 participants (61.6% females and 56.7% rural dwellers). The 25 and 75 percentiles of the stool form were Bristol types 3 and 4, while the 25 and 75 percentiles of defecation frequency were 7 and 14. Defecation frequency was higher in males than females (P = 0.006), while stool form was significantly affected by age (P = 0.001), sex (P = 0.041), and place of abode (P = 0.001). Conclusion: In Southeast Nigeria, normal defecation frequency is between 7 and 14 bowel motions per week, while normal stool forms are Bristol types 3 and 4. Age, sex, and place of abode significantly affect defecation frequency and stool form.
Analytical Cellular Pathology, 2020
Metformin has been used for a long time as an antidiabetic medication for type 2 diabetes. It is ... more Metformin has been used for a long time as an antidiabetic medication for type 2 diabetes. It is used either as a monotherapy or in combination with other antidiabetic medications. The drug came into prominence in diabetes and other conditions with cardiovascular risk after the landmark study of 1995 by the United Kingdom Prospective Diabetes Study which emphasized its importance. However, the drug has been used in experimental trials in various aspects of medicine and pharmacology such as in reproductive medicine, cancer chemotherapy, metabolic diseases, and neurodegenerative diseases. It has been in use in the treatment of polycystic ovarian disease and obesity and is being considered in type 1 diabetes. This study seeks to evaluate the relevance of metformin in cancer management. Different mechanisms have been proposed for its antitumor action which involves the following: (a) the activation of adenosine monophosphate kinase, (b) modulation of adenosine A1 receptor (ADORA), (c) r...
Journal of Diabetes Mellitus, 2018
Background: Despite the rising prevalence of diabetes in Nigeria and sub-Saharan Africa, few stud... more Background: Despite the rising prevalence of diabetes in Nigeria and sub-Saharan Africa, few studies have assessed the prevalence of prediabetes and diabetes in people with low socioeconomic status or urban slums. Methods: Using the WHO STEP-wise approach to surveillance of noncommunicable diseases, we estimated the prevalence of diabetes and prediabetes among adults 20 years and older living in two urban slums in Enugu south east Nigeria. Diabetes was defined as previous history of diabetes, use of hypoglycemic agents and fasting blood glucose within the diabetes range on two occasions during the survey period. Study duration was 5 months. Results: Out of the 811 individuals invited to the clinic, 605 (74.6%) participants had their fasting blood glucose measured based on the study protocol. The prevalence of diabetes and prediabetes in the population was 11.7% (95% CI; 9.2-14.3) and 7.6% (95% CI; 5.0-9.7) respectively. About 54.9% were newly detected and 28.1% of them had normal control. The prevalence of diabetes peaked at 55-64 years. The odds ratio for diabetes was significantly higher in participants ≥ 45 years (1.033, 95% CI; 1.208-3.420), participants with hypertension (0.442, 95% CI; 0.257-0.762) and stroke (1.638, 95% CI; 0.459-5.848). Conclusion: There is a relatively high prevalence of diabetes among adults in two urban slums in Enugu. Public health educational measures promoting prevention and early detection of diabetes should be encouraged. Efforts should be made to educate the populace on the need for early detection and treatment.
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Papers by ekenechukwu young