Clinical and Biological Characterization of Type 2 Diabetic Patients Followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé, Cameroon
Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.
References
[1]
ADA (American Diabetes Association) (2009) Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 32, S62-S67. https://doi.org/10.2337/dc09-s062
[2]
Arner, P. (2003) The Adipocyte in Insulin Resistance: Key Molecules and the Impact of the Thiazolidinediones. Trends in Endocrinology and Metabolism, 14, 137-145. https://doi.org/10.1016/s1043-2760(03)00024-9
[3]
Grundy, S.M. (2004) Obesity, Metabolic Syndrome, and Cardiovascular Disease. The Journal of Clinical Endocrinology & Metabolism, 89, 2595-2600. https://doi.org/10.1210/jc.2004-0372
[4]
Schlienger, J. (2013) Complications du diabète de type 2. La Presse Médicale, 42, 839-848. https://doi.org/10.1016/j.lpm.2013.02.313
[5]
Sdiri, C., Htira, Y., Cheikhrouhou, M., Hentati, N., Hadj Ali, Z., Hedfi, I., et al. (2023) Quel profil lipidique des diabétiques obèses en Tunisie? Annales d’Endocrinologie, 84, 177. https://doi.org/10.1016/j.ando.2022.12.249
[6]
IDF (2021) Diabetes Atlas 10th Edition. Diabetes around the World in 2021. International Diabetes Federation.
[7]
Mbanya, J.C.N., Motala, A.A., Sobngwi, E., Assah, F.K. and Enoru, S.T. (2010) Diabetes in Sub-Saharan Africa. The Lancet, 375, 2254-2266. https://doi.org/10.1016/s0140-6736(10)60550-8
[8]
Jaffiol, C. (2011) The Burden of Diabetes in Africa: A Major Public Health Problem. Bulletin de l’Académie Nationale de Médecine, 195, 1239-1254. https://doi.org/10.1016/s0001-4079(19)31983-1
[9]
Sobngwi, E. (2004) Exposure over the Life Course to an Urban Environment and Its Relation with Obesity, Diabetes, and Hypertension in Rural and Urban Cameroon. International Journal of Epidemiology, 33, 769-776. https://doi.org/10.1093/ije/dyh044
[10]
Fezeu, L., Balkau, B., Sobngwi, E., Kengne, A., Vol, S., Ducimetiere, P., et al. (2010) Waist Circumference and Obesity-Related Abnormalities in French and Cameroonian Adults: The Role of Urbanization and Ethnicity. International Journal of Obesity, 34, 446-453. https://doi.org/10.1038/ijo.2009.256
[11]
Bigna, J.J., Nansseu, J.R., Katte, J. and Noubiap, J.J. (2018) Prevalence of Prediabetes and Diabetes Mellitus among Adults Residing in Cameroon: A Systematic Review and Meta-Analysis. Diabetes Research and Clinical Practice, 137, 109-118. https://doi.org/10.1016/j.diabres.2017.12.005
[12]
Mbanya, J.C.N., Ngogang, J., Salah, J.N., Balkau, B. and Minkoulou, E. (1997) Prevalence of NIDDM and Impaired Glucose Tolerance in a Rural and an Urban Population in Cameroon. Diabetologia, 40, 824-829. https://doi.org/10.1007/s001250050755
[13]
Mbanya, J.C., Cruickshank, J.K., Forrester, T., Balkau, B., Ngogang, J.Y., Riste, L., et al. (1999) Standardized Comparison of Glucose Intolerance in West African-Origin Populations of Rural and Urban Cameroon, Jamaica, and Caribbean Migrants to Britain. Diabetes Care, 22, 434-440. https://doi.org/10.2337/diacare.22.3.434
[14]
Sobngwi, E., Mbanya, J.N., Unwin, N., Kengne, A., Fezeu, L., Minkoulou, E., et al. (2002) Physical Activity and Its Relationship with Obesity, Hypertension and Diabetes in Urban and Rural Cameroon. International Journal of Obesity, 26, 1009-1016. https://doi.org/10.1038/sj.ijo.0802008
[15]
Halle, M.P., Takongue, C., Kengne, A.P., Kaze, F.F. and Ngu, K.B. (2015) Epidemiological Profile of Patients with End Stage Renal Disease in a Referral Hospital in Cameroon. BMC Nephrology, 16, Article No. 59. https://doi.org/10.1186/s12882-015-0044-2
[16]
Lekoubou, A., Clovis, N., Dzudie, A. and Kengne, A.P. (2017) Diagnosed Diabetes Mellitus and In-Hospital Stroke Mortality in a Major Sub-Saharan African Urban Medical Unit. Primary Care Diabetes, 11, 57-62. https://doi.org/10.1016/j.pcd.2016.07.008
[17]
Mirza, S., Hossain, M., Mathews, C., Martinez, P., Pino, P., Gay, J.L., et al. (2012) Type 2-Diabetes Is Associated with Elevated Levels of TNF-α, IL-6 and Adiponectin and Low Levels of Leptin in a Population of Mexican Americans: A Cross-Sectional Study. Cytokine, 57, 136-142. https://doi.org/10.1016/j.cyto.2011.09.029
[18]
Alamri, B.N., Bahabri, A., Aldereihim, A.A., Alabduljabbar, M., Alsubaie, M.M., Al-naqeb, D., Almogbel, E., Metias, N.S., Alotaibi, O.A. and Al-Rubeaan, K. (2019) Hyperglycemia Effect on Red Blood Cells Indices. European Review for Medical and Pharmacological Sciences, 23, 2139-2150. https://doi.org/10.26355/eurrev_201903_17259
[19]
Freemantle, N., Holmes, J., Hockey, A. and Kumar, S. (2008) How Strong Is the Association between Abdominal Obesity and the Incidence of Type 2 Diabetes? International Journal of Clinical Practice, 62, 1391-1396. https://doi.org/10.1111/j.1742-1241.2008.01805.x
[20]
Malomo, K. and Ntlholang, O. (2018) The Evolution of Obesity: From Evolutionary Advantage to a Disease. Biomedical Research and Clinical Practice, 3, 1-5. https://doi.org/10.15761/brcp.1000163
[21]
WHO (1995) Physical Statuts: The Use and Interpretation of Anthropometry. Report of a WHO expert Committee. World Health Organization. https://www.who.int/publications/i/item/9241208546
[22]
Seidell, J.C. and Flegal, K.M. (1997) Assessing Obesity: Classification and Epidemiology. British Medical Bulletin, 53, 238-252. https://doi.org/10.1093/oxfordjournals.bmb.a011611
[23]
Draunet-Busson, C., Barbosa, S.L., Rodien, P., Illouz, F., Rohmer, V. and Bouhanick, B. (2010) Diabète et hypertension artérielle. EMC—Endocrinologie—Nutrition, 7, 1-11. https://doi.org/10.1016/s1155-1941(10)51214-9
[24]
Alidu, H., Dapare, P.P.M., Quaye, L., Amidu, N., Bani, S.B. and Banyeh, M. (2023) Insulin Resistance in Relation to Hypertension and Dyslipidaemia among Men Clinically Diagnosed with Type 2 Diabetes. BioMed Research International, 2023, Article ID: 8873226. https://doi.org/10.1155/2023/8873226
[25]
Diyane, K., Ansari, N.E., Mghari, G.E., Anzid, K. and Cherkaoui, M. (2013) Caractéristiques de l’association diabète type 2 et hypertension artérielle chez le sujet âgé de 65 ans et plus. Pan African Medical Journal, 14, Article 100. https://doi.org/10.11604/pamj.2013.14.100.1880
[26]
Tsalamandris, S., Antonopoulos, A.S., Oikonomou, E., Papamikroulis, G., Vogiatzi, G., Papaioannou, S., et al. (2019) The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. European Cardiology Review, 14, 50-59. https://doi.org/10.15420/ecr.2018.33.1
[27]
Fumeron, F. (2005) De l’obésité au diabète de type 2: Épidémiologie et physiopathologie. Sciences des Aliments, 25, 339-347. https://doi.org/10.3166/sda.25.339-347
[28]
Akhtar Khan, N. (2006) Inflammation et immunité: Implications dans l’obésité et le diabète de type 2. Oléagineux, Corps gras, Lipides, 13, 343-351. https://doi.org/10.1051/ocl.2006.0047
[29]
Dorsemans, A.C. (2018) Diabète Inflammation et stress oxydatif: Impact sur la bar-rière hémato-encéphalique la neurogenèse et la réparation cérébrale. Master’s Thesis, Université de la Réunion.
[30]
Ouhdouch, F., Errajraji, A. and Diouri, A. (2009) P263 Le profil lipidique chez les diabétiques de type 2. Diabetes & Metabolism, 35, A89. https://doi.org/10.1016/s1262-3636(09)72061-0
[31]
Shehri, Z.S.A. (2017) The Relationship between Some Biochemical and Hematological Changes in Type 2 Diabetes Mellitus. Biomedical Research and Therapy, 4, 1760-1774. https://doi.org/10.15419/bmrat.v4i11.382
[32]
Al-Ali, Z.A.J. (2016) Some Hematological and Biochemical Parameters in Type 2 Diabetic Patients Missan/Iraq. International Journal of Advanced Research in Biological Sciences, 3, 30-34. http://s-o-i.org/1.15/ijarbs-2016-3-4-4
[33]
Milosevic, D. and Panin, V.L. (2019) Relationship between Hematological Parameters and Glycemic Control in Type 2 Diabetes Mellitus Patients. Journal of Medical Biochemistry, 38, 164-171. https://doi.org/10.2478/jomb-2018-0021
[34]
Ebrahim, H., Fiseha, T., Ebrahim, Y. and Bisetegn, H. (2022) Comparison of Hematological Parameters between Type 2 Diabetes Mellitus Patients and Healthy Controls at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: Comparative Cross-Sectional Study. PLOS ONE, 17, e0272145. https://doi.org/10.1371/journal.pone.0272145
[35]
Al Salhen, K. and Mahmoud, A. (2017) Hematological Profile of Patients with Type 2 Diabetic Mellitus in El-Beida, Libya. Ibnosina Journal of Medicine and Biomedical Sciences, 9, 76-80. https://doi.org/10.4103/1947-489x.210115
[36]
Friedewald, W.T., Levy, R.I. and Fredrickson, D.S. (1972) Estimation of the Concentration of Low-Density Lipoprotein Cholesterol in Plasma, without Use of the Preparative Ultracentrifuge. Clinical Chemistry, 18, 499-502. https://doi.org/10.1093/clinchem/18.6.499
[37]
Biadgo, B., Melku, M., Mekonnen Abebe, S. and Abebe, M. (2016) Hematological Indices and Their Correlation with Fasting Blood Glucose Level and Anthropometric Measurements in Type 2 Diabetes Mellitus Patients in Gondar, Northwest Ethiopia. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 9, 91-99. https://doi.org/10.2147/dmso.s97563
[38]
Diallo, I.S. (2019) Fréquence de la dyslipidémie chez les diabétiques de type 2 dans le service de médicine Interne du CHU au point G. Master’s Thesis, Université des Sciences. https://www.mcours.net/cours/pdf/hasclic5/hassaaeclic115.pdf
[39]
Fagot, C.A., Romon, T., Fosse. S., Rondier, C. and Roudier, C. (2010) Prévalence et incidence du diabète et mortalité liée au diabète en France synthèse; épidémiologie. Maladies chroniques et traumatisme. Institut de Veille Sanitaire.
[40]
Nnakenyi, I.D., Nnakenyi, E.F., Parker, E.J., Uchendu, N.O., Anaduaka, E.G. and Ezeanyika, L.U. (2022) Relationship between Glycaemic Control and Lipid Profile in Type 2 Diabetes Mellitus Patients in a Low-Resource Setting. Pan African Medical Journal, 41, Article 281. https://doi.org/10.11604/pamj.2022.41.281.33802
[41]
Wautier, J.L. and Wautier, M.P. (2018) Molecular Links between Erythrocyte Adhesion and Vascular Dysfunction in Diabetes Mellitus, Polycythemia Vera, Retinal Vascular Occlusion. Journal of Hematology & Thromboembolic Diseases, 6, Article ID: 1000289. https://doi.org/10.4172/2329-8790.1000289
[42]
Koper-Lenkiewicz, O.M., Kamińska, J., Wilińska, E., Milewska, A., Lewoniewska, S., Tomaszewska, J., et al. (2019) Factors Associated with Erythrocyte Count and Hemoglobin Concentration in Men and Women with Type 2 Diabetes. DiagnostykaLaboratoryjna, 55, 199-208. https://doi.org/10.5604/01.3001.0013.8982
[43]
Adane, T., Asrie, F., Getaneh, Z. and Getawa, S. (2021) White Blood Cells and Platelet Profiles of Diabetic Patients at University of Gondar Specialized Referral Hospital: A Comparative Cross-Sectional Study. Journal of Clinical Laboratory Analysis, 35, e23808. https://doi.org/10.1002/jcla.23808
[44]
Walker, H.K., Hall, W.D. and Hurst, J.W. (1990) Clinical Methods: The History, Physical and Laboratory Examinations. 3rd Edition, Butterworth-Heinemann.
[45]
Hezam, A.A.M., Shaghdar, H.B.M. and Chen, L. (2024) The Connection between Hypertension and Diabetes and Their Role in Heart and Kidney Disease Development. Journal of Research in Medical Sciences, 29, 22. https://doi.org/10.4103/jrms.jrms_470_23
[46]
Phosat, C., Panprathip, P., Chumpathat, N., Prangthip, P., Chantratita, N., Soonthornworasiri, N., et al. (2017) Elevated C-Reactive Protein, Interleukin 6, Tumor Necrosis Factor α and Glycemic Load Associated with Type 2 Diabetes Mellitus in Rural Thais: A Cross-Sectional Study. BMC Endocrine Disorders, 17, Article No. 44. https://doi.org/10.1186/s12902-017-0189-z
[47]
Jun, J.E., Lee, S., Lee, Y., Jee, J.H., Bae, J.C., Jin, S., et al. (2017) Increase in Serum Albumin Concentration Is Associated with Prediabetes Development and Progression to Overt Diabetes Independently of Metabolic Syndrome. PLOS ONE, 12, e0176209. https://doi.org/10.1371/journal.pone.0176209
[48]
Smith, R. (2022) High Levels of Albumin Is a Common Complication of Both Type 1 and Type 2 Diabetes. African Journal of Diabetes Medicine, 30.
[49]
Al Quran, T.M., Bataineh, Z.A., Al-Mistarehi, A., Zein Alaabdin, A.M., Allan, H., Al Qura’an, A., et al. (2022) Prevalence and Pattern of Dyslipidemia and Its Associated Factors among Patients with Type 2 Diabetes Mellitus in Jordan: A Cross-Sectional Study. International Journal of General Medicine, 15, 7669-7683. https://doi.org/10.2147/ijgm.s377463
[50]
Jayakumari, C., Jabbar, P.K., Soumya, S., Jayakumar, R.V., Das, D.V., Girivishnu, G., et al. (2020) Lipid Profile in Indian Patients with Type 2 Diabetes: The Scope for Atherosclerotic Cardiovascular Disease Risk Reduction. Diabetes Spectrum, 33, 299-306. https://doi.org/10.2337/ds19-0046
[51]
Moosazadeh, M., Kheradmand, M., Ranjbaran, H., Alizadeh-Navaei, R. and Yakhkeshi, R. (2021) Association between White Blood Cells Count and Diabetes Mellitus in Tabari Cohort Study: A Case-Control Study. International Journal of Preventive Medicine, 12, 121. https://doi.org/10.4103/ijpvm.ijpvm_336_19
[52]
Guevara Tirado, A. (2023) Hemoglobina como predictor del recuento de hematocrito y hematíes según edad y sexo en una población de Villa El Salvador en Lima-Perú. Horizonte Médico (Lima), 23, e1962. https://doi.org/10.24265/horizmed.2023.v23n2.07
[53]
Lam, C.L.K., Munro, C. and Siu, B.P.C. (1990) A Study of the Correlation between Serum Total Cholesterol and Lowdensity Lipoproteins (LDL) in Chinese. Family Practice, 7, 301-306. https://doi.org/10.1093/fampra/7.4.301
[54]
Damião, C.P., Rodrigues, A.O., Pinheiro, M.F.M.C., Cruz Filho, R.A.d., Cardoso, G.P., Taboada, G.F., et al. (2016) Prevalence of Vitamin B12 Deficiency in Type 2 Diabetic Patients Using Metformin: A Cross-Sectional Study. Sao Paulo Medical Journal, 134, 473-479. https://doi.org/10.1590/1516-3180.2015.01382111