Quality of Diabetes Annual Management in the Internal Medicine Department in Yalgado Ouédraogo Teaching Hospital, Ouagadougou

Introduction: The periodic management of diabetes improves disease’s prognosis. We aimed to evaluate the quality of diabetes annual management and the effectiveness of its treatment in Ouagadougou. Material and Method: It was a cross-sectional and descriptive study, from retrospective records in the internal medicine department, Yalgado Ouédraogo Teaching Hospital (CHU-YO). Diabetic patient’s (15 years old and more) files that were registered between January, 2012 and December, 2016 have been analyzed. Files containing less than 80% data were excluded. Data relating to the baseline characteristics of the patients, the therapeutic education dispensation, the clinical and paraclinical assessment of the initial and annual visits at the first year of patient’s follow-up have been collected. The 2007 diabetes management standards of the French “Haute Autorité de Santé” as well as the biological standards of the same instance have been used. The quantitative variables were expressed as means and standard deviations and qualitative variables were expressed as absolute and relative frequencies. Results: 317 patients, including 218 women (68.77%) were studied. The mean age of women was 51.67 ± 12.46 years, and that of men 55.71 ± 10.63. Diabetes was type 2 in 302 (95.26%) patients. The mean duration since the diagnosis of diabetes was 2.9 years. The completeness rate of therapeutic education at the annual visit was 10.46%. That of the clinical examinations was at best 38.17% and 44.23% for the measurement of weight and blood pressure;otherwise it was less than 5%. About the paraclinical data, apart from the measurement of the fasting blood glucose which completeness rate was 71.61%, that of the others exams were less than 10%. At the annual visit, the mean value of HbA1C was 7.5%, and the target for HbA1C was achieved in 47.90% patients. Conclusion: The quality of diabetes annual management is unsatisfying. A structural improvement and the adaptation of guidelines are needed.

Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)

Background: Achieving and maintaining glycemic targets are a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. Methodology: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. Results: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];p < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];p = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];p = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];p < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];p < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];p < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. Conclusion: The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improving their management.

Trends of Kalemia at Diagnosis of Acidosis versus Non-Acidosis Diabetic Ketosis Décompensations in Ouagadougou (Burkina Faso)

Introduction: Electrolyte’s profile in non-acidosis diabetic ketosis is poorly specified. We aimed to determine the nature of diabetic ketosis decompensations as well as the profile of kalemia and factors associated with its disorders at diagnosis of acidosis compared to non-acidosis diabetic ketosis. Methods: The study was retrospective from 1 January 2010 to 31 December 2011 in Yalgado Ouédraogo teaching hospital. Diabetic in-patients suffering from simple ketosis, keto-acidosis or mixed decompensation, who achieved blood electrolytes assessment before intensive insulin therapy were included. Results: Sixty two patients were studied. The sex ratio was 0.7 and the mean age was 41.7 years. Keto-acidosis, simple ketosis and mixed decompensation were diagnosed respectively in 18 (29%), 32 (51.6%) and 12 (19.4%) patients. Kalemia was normal in 42 (67.7%), while hypokalemia and hyperkalemia were reported respectively in 11 (17.8%) and 9 (14.5%) patients. Kalemia was often normal in all types of ketosis decompensation and disorders of kalemia occurred more in patients with keto-acidosis (50%) than those with simple ketosis (21.9%);p = 0.04. Renal failure was diagnosed in 10 patients (50%) with and 2 (4.8%) without kalemia’s disorders;p = 0.0001. Seven patients (35%) with and 4 (9.5%) without kalemia’s disorders suffered from unconsciousness;p = 0.02. It happens more in hyperkalemia (44.4%) than in normal kalemia condition (9.5%);p = 0.02. Conclusion: If kalemia is often normal in all types of diabetic ketosis emergencies, hypokalemia is the most initial frequent potassium disorder.

Performance of the Finnish Diabetes Risk Score (FINDRISC) in the Identification of Dysglycemia in an Urban Population in Ouagadougou (Burkina Faso)

Background: Diabetes mellitus is a real public health problem worldwide and is growing in developing countries. Our aim was to determine the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) and to evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) questionnaire to identify type 2 diabetics in the urban population of Ouagadougou, Burkina Faso. Methodology: This was a cross-sectional study among volunteers aged 18 years and older recruited systematically from November 11 to 16, 2019, in the city of Ouagadougou, Burkina Faso, FINDRISC score was used. Analysis of the Receiver Operating Characteristic (ROC) curve was used to study the diagnostic performance of FINDRISC for the identification of type 2 diabetics. The optimal threshold was determined by the sum of the highest sensitivity and specificity. Multivariate logistic regression was used to analyze the association of each variable used in the calculation of the FINDRISC score. Results: A total of 1276 individuals were included in the analyses, of which 667 (52.27%) were women. The average age was 34.16 years (SD: ±12.42). The prevalence of T2DM was 10.74%. The mean FINDRISC score was 5.85 (SD: ±4.31). The majority (58.54%) of individuals had a low risk of diabetes according to the FINDRISC score 0 - 7, while 3.61% had a score ≥ 15. The FINDRISC score showed good performance (AUC = 0.70) in identifying undiagnosed type 2 diabetics. However, the variables in the score that best predicted the likelihood of being diabetic were age (p < 0.001), daily physical activity (p = 0.004), use of antihypertensive medication (p = 0.007) and waist circumference (p < 0.001). The optimal cut-off score ≥ 7 was the best predictor of the likelihood of having T2DM. Conclusion: The Finnish Risk Score (FINDRISC) is a good predictor of the risk of dysglycemia in Burkina Faso. It is a score to be promoted in daily clinical practice because it is easy to use, affordable and non-invasive. Further studies are needed to make modifications to the FINDRISC questionnaire in case it is applied to other ethnic groups.

Spectrum of Hypertriglyceridemia at the Onset of Type 2 Diabetes in Ouagadougou

Introduction: Hypertriglyceridemia is a frequent dyslipidemia in type 2 diabetes. We aimed to determine its prevalence, its typology, and its associated factors in newly type 2 diabetes patients in Ouagadougou. Material and Method: This cross-sectional, descriptive and analytic study has been performed from May 2015 to June 2016 in the Internal medicine department in Yalgado Ouédraogo teaching hospital, Ouagadougou. An accidental sample of newly type 2 diabetes outpatients, na?ve of antidiabetics therapy was studied. A 12-hour fasting triglyceridemia was performed;hypertriglyceridemia was defined for triglyceridemia > 1.5 g/L (1.7 mmol/L). Data were analyzed with Epi info 7.1.5.0. Proportions and means were compared respectively with Khi2 or Fisher’s test and Student’s test with a significance of p Results: One hundred and three patients, i.e. 35 (34%) men and 68 (66%) women were included. The sex ratio was 0.51 and the mean age 49.3 ± 10.1 years [limits: 24 and 70]. The mean value of triglyceridemia was 1.8 ± 1.7 mmol/L [limits: 0.5 and 14.9]. Hypertriglyceridemia was reported in 32 patients (31.1%): minor (11.30 mmol/L) in one (3.1%) patients. Hypertriglyceridemia’s phenotype was commonly integrated into a mixed dyslipidemia;it was often combined with a total cholesterolemia increase and a HDL cholesterolemia decrease. In bivariate analysis, hyperglycemia was associated with severe hyperglycemia (p = 0.006) and renal failure (p = 0.03). Conclusion: Hypertriglyceridemia in type 2 diabetes is frequent and often combined with other lipids disorders. It may need an optimal care.