Diabetic polyneuropathy with/out neuropathic pain in Mali: A cross-sectional study in two reference diabetes treatment centers in Bamako (Mali), Western Africa

The diabetic foot: progress in Sub-Saharan Africa

In Sub-Saharan Africa (SSA), the number of people with diabetes mellitus is increasing along with the number of complications linked to the condition. Among all complications, diabetes-related foot complications (DRFC) have the greatest rates of morbidity and mortality, and their incidence will increase in tandem with it.Over the past two decades, the magnitude of DRFC has underscored the challenges within SSA's healthcare systems, including limited access to diagnostics, specialized healthcare providers, and treatment options. Education and prevention have proven critical in addressing these challenges, as evidenced by programs like 'Step by Step' and 'Train the Foot Healthcare Professional'. These initiatives not only focus on prevention but also equip healthcare providers with skills in identification, diagnosis, treatment, and holistic management of DRFC, significantly reducing severe complications and improving outcomes. The integration of digital health technologies, including telemedicine and mobile health tools, offers innovative solutions for enhancing access to care, particularly in underserved areas. Governments have a pivotal role in recognizing and addressing the burden of DRFC through policy initiatives, surveillance systems, and public health campaigns. Bridging these gaps requires a coordinated approach, leveraging education, technology, and collaboration to build resilient healthcare systems and improve the management of DRFC in SSA.

Assessing Autonomic Dysfunction in Diabetes: A Hospital-based Study in a Developing Country

BACKGROUND

Autonomic nervous system (ANS) dysfunction is a common complication in patients with diabetes mellitus, potentially affecting the various organ systems leading to significant morbidity. This study aimed to evaluate ANS dysfunction in diabetic patients attending Wad Madani Teaching Hospital, Sudan.

MATERIALS AND METHODS

A cross-sectional and hospital-based study was conducted on a sample of 100 patients in Wad Madani Teaching Hospital in Sudan. For each participant, a data collection form was utilized to record the sociodemographic details, previous medical history, and patient assessment results including heart rate (HR), blood pressure (BP), weight, and height. Patients were assessed for the signs of autonomic dysfunction using the clinical examinations and standardized autonomic function tests. HR variability (HRV), BP response to standing, and deep breathing tests were the primary methods used to assess ANS function. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. 0.

RESULTS

The mean age of the participants was 63.4 ± 9.9 years, with males comprising 75% of the sample. Of the participants, 48% were overweight and 22% were obese, with 77% demonstrating poor glycemic control (hemoglobin A1c ≥ 7.0%). Only 11% of participants had normal HRV during deep breathing, while 56% showed abnormal values. For the HR response to standing, 27% of participants had abnormal results. Regarding BP response to standing, 19% had abnormal readings. Autonomic dysfunction was prevalent, with 89% of participants exhibiting some degree of dysfunction, including early parasympathetic (16%) and combined parasympathetic and sympathetic dysfunction (19%).

CONCLUSION

Autonomic dysfunction is highly prevalent among diabetic patients in Wad Madani, with most exhibiting parasympathetic and sympathetic dysfunctions. This underscores the need for the early diagnosis and management of autonomic complications in diabetic patients to improve the outcomes and quality of life.

Prevalence and risk factors of painful diabetic neuropathy: A systematic review and meta-analysis

Painful diabetes-related peripheral neuropathy (PDPN) is a common and debilitating complication of diabetes, contributing significantly to morbidity and healthcare costs. This systematic review and meta-analysis aim to determine the global prevalence of PDPN among individuals with diabetic peripheral neuropathy (DPN) and to identify associated risk factors. A comprehensive search of four English and three Chinese databases was conducted for observational studies on PDPN prevalence up to June 22, 2024. Of the 41 studies included, the pooled global prevalence of PDPN was 46.7 % (95 % CI, 41.8-51.7). In subgroup analysis, significant statistical differences were observed in prevalence estimates between different diagnostic methods for neuropathic pain, with neuropathic-specific pain scales indicating higher rates (P = 0.03). Studies with mean diabetes duration of less than 10 years or more than 15 years reported higher prevalence (P < 0.01). Significant risk factors for PDPN included older age (OR = 1.02, 95 % CI, 1.01-1.04), female gender (OR = 1.58, 95 % CI, 1.19-2.11), BMI ≥ 30 kg/m2 (OR = 1.62, 95 % CI, 1.43-1.83), longer diabetes duration (OR = 1.05, 95 % CI, 1.01-1.08), and nephropathy (OR = 1.32, 95 % CI, 1.24-1.40). Targeted screening and standardized diagnostic tools are urgently needed to enhance PDPN management and mitigate its burden globally.

Assessing traditional medicine in the treatment of neurological disorders in Mali: prelude to efficient collaboration

INTRODUCTION

Neurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND.

METHODS

We conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments.

RESULTS

3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25-0.35, p < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively). We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly "sometimes" (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor "take into account" our existence.

CONCLUSION

Our work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients.

Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The disorder is common in type 2 diabetics (T2D) and is linked with T2D comorbidities, particularly cardiovascular disease. Dyslipidemia in T2D is typically characterized by elevated plasma triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels. There is a significant gap in the literature regarding dyslipidemia in rural parts of Africa, where lipid profiles may not be captured through routine surveillance. This study aimed to characterize the prevalence and demo-graphic profile of dyslipidemia in T2D in the rural community of Ganadougou, Mali. We performed a cross-sectional study of 104 subjects with T2D in Ganadougou between November 2021 and March 2022. Demographic and lipid profiles were collected through cross-sectional surveys and serological analyses. The overall prevalence of dyslipidemia in T2D patients was 87.5% (91/104), which did not differ by sex (P = .368). High low-density lipoprotein cholesterol (LDL-C) was the most common lipid abnormality (78.9%, [82/104]). Dyslipidemia was associated with age and hypertension status (P = .013 and.036, respectively). High total and high LDL-C parameters were significantly associated with hypertension (P = .029 and .006, respectively). In low-resource settings such as rural Mali, there is a critical need to improve infrastructure for routine dyslipidemia screening to guide its prevention and intervention approaches. The high rates of dyslipidemia observed in Gandadougou, consistent with concomitant increases in cardiovascular diseases in Africa suggest that lipid profile assessments should be incorporated into routine medical care for T2D patients in African rural settings.

Diabetic foot ulcer disease in African continent: 'From clinical care to implementation' - Review of diabetic foot in last 60 years - 1960 to 2020

The prevalence of diabetes mellitus is increasing globally and the greatest potential increases in diabetes will occur in Africa. Data suggest that these increases is associated with rapid demographic, sociocultural and economic transitions. There will be a parallel increase in the complications of diabetes and among the various complications those related to diabetic foot disease are associated with the highest morbidity and mortality. Diabetic Peripheral neuropathy (DPN) is the most common cause of diabetic foot complications in African countries; however, peripheral arterial disease (PAD) appears to increase, possibly a result of rising urbanization. Search done for the past six decades (1960 to 2020) on all foot complications. Rates of complications of diabetic foot in last six decades varied by country as follow: DPN: 4-90%; PAD: 0-77%; foot ulcers: 4-61%; amputation rates: 3-61% and high mortality rates reaching to 55%, patients who presented late with infection and gangrene. Educational and prevention programmes are required to curb the growing complications of diabetic foot ulcers in Africa among patients and health care workers. Secondly, it is imperative that governments across the African continent recognise the clinical and public health implications of diabetic foot disease in persons with diabetes.

Diabetic peripheral neuropathy in diabetic patients attending an urban health and training centre

Introduction

Diabetic neuropathy is a complication affecting almost 50% of the diabetic patients. Diabetic Peripheral Neuropathy (DPN) predominantly affects the hands and lower limbs. It leads to loss of protective sensation resulting in continuous injury to insensitive feet. The early detection of DPN using an objective screening test followed by its appropriate management is important as up to 50% of the patients may be asymptomatic.

Objectives

To screen Diabetic patients attending an Urban Health and Training Centre of a medical college in Tamilnadu for Diabetic Peripheral Neuropathy. To assess the association between DPN and selected variables such as socio-demographic factors, glycaemic control, duration of diabetes, physical activity, body mass index, smoking and consumption of alcohol.

Methods

The study was conducted among 204 diabetic patients attending an Urban Health and Training Centre. Participants were assessed using Michigan Neuropathy Screening Instrument (MNSI), which involves using a questionnaire followed by a physical examination.

Results

Of the 204 patients, 58.8% were male. The mean age was 54.8 years (SD = 8.8 years). About 79.9% were employed of which 29.4% were skilled labourers. Mean duration of diabetes was 6.2 years (SD = 5.3 years). The proportion of diabetics who screened positive for Peripheral Neuropathy was 23% and 45.6% using MNSI questionnaire and examination, respectively. An age of 60 years and above was significantly associated with DPN (OR = 2.505, P value = 0.003). A duration of more than 4 years of diabetes was also significantly associated with DPN (OR = 1.872, P value = 0.02820).

Conclusion

A high proportion of diabetics with peripheral neuropathy did not express symptoms specific for diabetics. Thus, a simple tool like MNSI would be useful in primary care settings to screen for peripheral neuropathy, and hence prevent disability".

Status of Analgesic Drugs and Quality of Life Results for Diabetic Peripheral Neuropathy in China

OBJECTIVE

The purpose of this study is to describe the current clinical situation of patients with painful diabetic peripheral neuropathy (DPN) and related anxiety, depression, and the quality of life of patients in mainland China, and to report the current status of the use of analgesics.

METHODS

Between June 15, 2021, and October 15, 2021, a total of 401 participants participated in the study. Recruitment was carried out using a multi-level sampling method. Participants' demographics, medical history, analgesic use, Michigan Symptom Score (MNSI), Numerical Rating Scale (NRS) pain score, Patient Health Questionnaire 9 (PHQ-9) score, Generalized Anxiety Disorder 7 (GAD) -7) Score, quality of life score (SF-12) and diabetes treatment status were collected.

RESULTS

Among the participants, there were 236 male patients and female patients. Participants were 322 patients over 40 years old. Regarding the use of analgesics: 132 patients reported using analgesics, 221 patients reported not using analgesics, and 48 patients reported having used analgesics. The results of the scale showed that the scores of NRS, GAD-7, PHQ-9 and SF-12 were 5.12 ± 2.15, 6.33 ± 3.67, 8.46 ± 4.07 and 47.84 ± 19.92 for patients who used analgesics, Compared with patients who did not use analgesics (NRS: 1.99 ± 1.7, GAD-7: 1.81 ± 2.81, PHQ-9: 3.13 ± 4.10, SF-12: 78.34 ± 21.66) there are significant differences (p< 0.001). In addition, patients' NRS scores are also closely related to GAD-7, PHQ-9 and SF-12 scores.

CONCLUSION

The severity of symptoms, mental status and quality of life of patients who used analgesics were more severe than those of patients who did not use analgesics. Pregabalin is still the preferred analgesic for patients with painful DPN, and the use of opioids in my country is extremely low, which is consistent with current international guidelines. Age, diabetic duration, DPN duration, PHQ-9 score, GAD-7 score and SF-12 scores are closely related to NRS pain scores. In addition, there are still a considerable number of patients who have not used analgesics due to financial burdens and other reasons, suggesting that China still has insufficient pain management in DPN patients.