Publications by authors named "Albert G B Amoah"

25 Publications

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Associations between macrovascular and renal microvascular dysfunction in type 2 diabetes and non-diabetes: the HELIUS study.

Microvasc Res 2021 Jul 9;136:104162. Epub 2021 Mar 9.

Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.

Background: Although the associations between measures of macrovascular and microvascular dysfunctions are well characterized in diabetes, there is limited data on these associations in individuals without diabetes. We compared the associations between macrovascular dysfunction and renal microvascular dysfunction in individuals with type 2 diabetes (T2D) and without diabetes.

Methods: Cross-sectional analyses of baseline data from the multiethnic Healthy Life in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands), including 986 participants with T2D and 7680 participants without diabetes were done. Logistic regression analyses were used to examine the associations between macrovascular dysfunction [aortic stiffness, coronary artery disease (CAD), peripheral artery disease (PAD), and stroke] and renal microvascular dysfunction [albuminuria] with adjustments for age, sex, ethnicity, waist-to-hip ratio, systolic blood pressure, LDL-cholesterol, and smoking (and HbA1c and diabetes duration for the T2D group).

Results: In the fully adjusted models, aortic stiffness was associated with albuminuria in individuals with T2D [OR 2.55; 95% CI,1.30-4.98], but not without diabetes [0.96; 0.63-1.45]; stroke was associated with albuminuria in T2D [2.40;1.10-5.25], but not in non-diabetes [1.39;0.83-2.33]. In age-sex adjusted models, CAD was associated with albuminuria in T2D [1.65;1.09-2.50] and in non-diabetes [1.56;1.13-2.15]; the associations were no longer significant in the fully adjusted model. There were no associations between PAD and albuminuria in T2D and non-diabetes.

Conclusions: Our study shows important differences in the associations between measures of macrovascular and renal microvascular dysfunction in T2D and non-diabetes. These findings provide opportunities for future research aimed at prevention and treatment strategies for individuals with vascular dysfunction.
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http://dx.doi.org/10.1016/j.mvr.2021.104162DOI Listing
July 2021

Psychosocial distress, clinical variables and self-management activities associated with type 2 diabetes: a study in Ghana.

Clin Diabetes Endocrinol 2020 14;6:14. Epub 2020 Jul 14.

Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.

Aim: Psychosocial distress can act as a barrier to diabetes self-care management and thus compromise diabetes control. Yet in Ghana, healthcare centres mainly focus on the medical aspect of diabetes to the neglect of psychosocial care. This study determined the relationship amongst psychosocial distress, clinical variables, and self-management activities associated with type 2 diabetes management.

Method: Questionnaires were administered to 162 patients from four hospitals in Accra, Ghana, to assess psychosocial distress (e.g. diabetes distress), clinical variables (e.g. glycaemic control), and self- management activities (e.g. medication intake) related to diabetes. In assessing diabetes distress, the use of the PAID allowed evaluation of broader range of emotional concerns (diabetes-related emotional distress), while the DDS allowed evaluation of factors more closely related to diabetes self-management (diabetes distress).

Results: Diabetes-related emotional distress, diabetes distress and depressive symptoms were reciprocally positively correlated, while non-supportive family behaviour correlated negatively with these psychological variables. Diabetes-related emotional distress correlated positively with systolic and diastolic blood pressure, and correlated negatively with exercise regimen. On the other hand, diabetes distress correlated negatively with dietary and exercise regimen and correlated positively with glycaemic levels, while depressive symptoms correlated positively with glycaemic levels, diabetes complication and systolic blood pressure. Contrary to the literature, non-supportive family behaviour correlated positively with diet, exercise and medication regimen.

Conclusion: The positive association of psychological variables with glycaemic levels and blood pressure levels, and the positive association of non-supportive family behaviour with self-management activities suggests the need for psychosocial care to be incorporate in the management of type 2 diabetes in Ghana. Patients can be screened for diabetes-related distress and symptoms of depression and provided psychosocial care where necessary.
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http://dx.doi.org/10.1186/s40842-020-00102-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362489PMC
July 2020

Association between C reactive protein and microvascular and macrovascular dysfunction in sub-Saharan Africans with and without diabetes: the RODAM study.

BMJ Open Diabetes Res Care 2020 07;8(1)

Public Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands.

Introduction: Although inflammation assessed by elevated C reactive protein (CRP) concentration is known to be associated with risk of cardiovascular disease, its association with microvascular and macrovascular dysfunction in diabetes and non-diabetes remains unclear. We examined the association between CRP and diabetes and associated microvascular and macrovascular dysfunction in sub-Saharan Africans with and without diabetes.

Research Design And Methods: Cross-sectional analyses of baseline data from the multicenter RODAM study (Research on Obesity and Diabetes among African Migrants) including 5248 Ghanaians (583 with diabetes, 4665 without diabetes) aged 25-70 years were done. Logistic regression analyses were used to examine the associations between CRP Z-scores and diabetes and microvascular (nephropathy) and macrovascular (peripheral artery disease (PAD)) dysfunction, with adjustments for age, sex, site of residence, smoking, body mass index, systolic blood pressure, and low-density lipoprotein cholesterol.

Results: In the fully adjusted models, higher CRP concentration was significantly associated with diabetes (adjusted OR 1.13; 95% CI 1.05 to 1.21, p=0.002). In participants with diabetes, higher CRP concentration was associated with PAD (1.19; 1.03 to 1.41, p=0.046) but not nephropathy (1.13; 0.97 to 1.31, p=0.120). Among participants without diabetes, higher CRP concentration was associated with higher odds of PAD (1.10; 1.01 to 1.21, p=0.029) and nephropathy (1.12; 1.04 to 1.22, p=0.004).

Conclusions: In this study, higher CRP concentration was associated with higher odds of diabetes in sub-Saharan Africans. Also, higher CRP concentration was associated with higher odds of nephropathy and PAD in non-diabetes and higher odds of PAD in diabetes. CRP may be an important marker for assessment of risk of diabetes and risk for PAD and nephropathy in sub-Saharan Africans with and without diabetes.
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http://dx.doi.org/10.1136/bmjdrc-2020-001235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365428PMC
July 2020

Higher prevalence of peripheral arterial disease in Ghana compared to Ghanaian migrants in Europe: The RODAM study.

Int J Cardiol 2020 04 14;305:127-134. Epub 2019 Dec 14.

Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.

Background: Evidence suggests that the burden of peripheral artery disease (PAD) is rising more rapidly than other forms of cardiovascular diseases in sub-Saharan Africa, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of PAD among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries.

Methods: Cross-sectional analyses of baseline data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were done. Data from 5516 participants living in Europe (1487 Amsterdam, 546 Berlin, 1047 London) and Ghana [1419 urban and 1017 rural] aged 25-70years were included. PAD was defined as ankle brachial index≤0.90. Comparisons among sites were made using logistic regression analysis.

Results: The age-standardized prevalence of PAD was higher in Ghanaians living in rural [7.52%, 95% CI = 5.87-9.51] and urban [8.93%, 7.44-10.64] Ghana than for their compatriots living in Europe [5.70%, 4.35-7.35 for London; 3.94%, 2.96-5.14 for Amsterdam; and 0.44%, 0.05-1.58 for Berlin]. The differences persisted even after adjustment for age, sex, education and the conventional cardiovascular risk factors [adjusted odds ratio = 3.16, 95% CI = 2.16-4.61, p < .001 for rural-Ghana; and 2.93, 1.87-4.58, p < .00 for urban-Ghana, compared with Ghanaian migrants in Europe].

Conclusions: Our study shows that Ghanaians living in Ghana have higher prevalence of PAD than their migrant compatriots. Further work is needed to identify potential factors driving the high prevalence of PAD among non-migrant Ghanaians to assist interventions aimed at reducing PAD burden.
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http://dx.doi.org/10.1016/j.ijcard.2019.12.028DOI Listing
April 2020

Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study.

J Diabetes Complications 2019 08 10;33(8):572-578. Epub 2019 May 10.

Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands.

Aims: To compare microvascular and macrovascular complication rates among Ghanaians with type 2 diabetes (T2D) living in Ghana and in three European cities (Amsterdam, London and Berlin).

Methods: Data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were analyzed. 650 Ghanaian participants with T2D (206 non-migrant and 444 migrants) were included. Logistic regression analyses were used to determine the association between migrant status and microvascular (nephropathy and retinopathy) and macrovascular (coronary artery disease (CAD), peripheral artery disease (PAD) and stroke) complications with adjustment for age, gender, socioeconomic status, alcohol, smoking, physical activity, hypertension, BMI, total-cholesterol, and HbA1c.

Results: Microvascular and macrovascular complications rates were higher in non-migrant Ghanaians than in migrant Ghanaians (nephropathy 32.0% vs. 19.8%; PAD 11.2% vs. 3.4%; CAD 18.4% vs. 8.3%; and stroke 14.5% vs. 5.6%), except for self-reported retinopathy (11.0% vs. 21.6%). Except nephropathy and stroke, the differences persisted after adjustment for the above-mentioned covariates: PAD (OR 7.48; 95% CI, 2.16-25.90); CAD (2.32; 1.09-4.93); and retinopathy (0.23; 0.07-0.75).

Conclusions: Except retinopathy, the rates of microvascular and macrovascular complications were higher in non-migrant than in migrant Ghanaians with T2D. Conventional cardiovascular risk factors did not explain the differences except for nephropathy and stroke.
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http://dx.doi.org/10.1016/j.jdiacomp.2019.04.016DOI Listing
August 2019

A Novel Gametocyte Biomarker for Superior Molecular Detection of the Plasmodium falciparum Infectious Reservoirs.

J Infect Dis 2017 12;216(10):1264-1272

Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases.

Background: Complete malaria eradication and optimal use of transmission-reducing interventions require knowledge of submicroscopic infectious reservoirs among asymptomatic individuals. Even submicroscopic levels of Plasmodium falciparum gametocytes can infect mosquitoes and promote onward transmission. Most efforts to identify gametocyte carriers use polymerase chain reaction amplification of the gametocyte-specific transcript Pfs25.

Methods: To expand the repertoire of biomarkers available for superior gametocyte detection, we compared the gene expression profiles of gametocytes and asynchronous blood-stage P. falciparum parasites by microarray technology. This allowed the identification of 56 molecules abundantly expressed in the gametocyte stage of the parasite. The analytical sensitivity for gametocyte detection was evaluated for 25 genes with the highest expression levels.

Results: One candidate, Pfg17, exhibited superior analytical sensitivity against a panel of gametocyte-spiked whole blood, detecting 10 gametocytes/mL; in comparison, Pfs25 detected only 25.3 gametocytes/mL. Pfg17 also exhibited superior clinical sensitivity, identifying 19.1% more samples from blood-film microscopy-negative Ghanaian children and 40% more samples from asymptomatic adults as gametocyte positive.

Conclusions: Cumulatively, our results suggest Pfg17 is an excellent biomarker for detecting asymptomatic infectious reservoirs otherwise missed by the most sensitive molecular method available. Our study has also improved the repertoire of transmission-stage antigens available for evaluation as candidate vaccines.
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http://dx.doi.org/10.1093/infdis/jix442DOI Listing
December 2017

Predictors of quality of life in patients with diabetes mellitus in two tertiary health institutions in Ghana and Nigeria.

Niger Postgrad Med J 2017 Jan-Mar;24(1):48-55

School of Medicine, New York state University, USA.

Background: Patients with chronic diseases such as Type 2 diabetes mellitus (DM) usually have a relatively poor quality of life (QoL), because the cost of care (living expenses and health) or diet restrictions are heavily felt by these patients, and this is of a public health concern. However, limited data on DM QoL exist in Ghana and Nigeria. This makes it imperative for data to be collated in that regard.

Materials And Methods: We adopted the Strengthening The reporting of observational studies in epidemiology (STROBE) consensus checklist to survey the patients with DM seen at the diabetic clinic at the Department of Medicine of the Korle-Bu Teaching Hospital and University College Hospital, Ibadan, Nigeria. Patients with Type 2 DM aged 40 years and older were recruited by using systematic random sampling method. The World Health Organization Quality of Life-BREF, diabetes empowerment scale, and DM knowledge scale were used to assess QoL, patient empowerment, and knowledge of DM, respectively. The predictors of QoL were determined using multiple linear regression analyses.

Results: A total of 198 patients in Ghana and 203 patients in Nigeria completed the survey, with female-to-male ratio being 3:1 and 2:1, respectively. The overall QoL in both countries was relatively low: 56.19 ± 8.23 in Ghana and 64.34 ± 7.34 in Nigeria. In Ghana, significant correlates of higher scores on the QoL scale were medication adherence (P = 0.02) and employment status (P = 0.02). Among patients in Nigeria, employment status (P = 0.02) and DM empowerment (0.03) were significant predictors of QoL in patients with DM.

Conclusion: Our study revealed an association between a number of psychosocial factors and QoL among patients with DM in Ghana and Nigeria.
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http://dx.doi.org/10.4103/npmj.npmj_3_17DOI Listing
April 2019

Circulating angiogenic factors in diabetes patients in a tertiary hospital in Ghana.

J Diabetes Metab Disord 2016 10;15:44. Epub 2016 Oct 10.

Department of Medicine & Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana ; National Diabetes Management & Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana.

Background: Impaired angiogenesis is amongst the underlining mechanisms of organ damage in diabetes and hypertensive patients. In diabetes and hypertensive patients without proteinuria and overt CVDs, we studied the levels of angiogenic growth factors, angiopoietin (Ang)-1, Ang-2 and vascular endothelial growth factor (VEGF), and the relationship between these angiogenic growth factors and renal function, measured as estimated glomerular filtration rate (eGFR).

Method: In a case control design, 107 type 2 diabetes (T2DM) patients and 93 non-diabetes controls were recruited into the study. Levels of plasma glucose, lipids, creatinine and angiogenic growth factors; Ang-1, Ang-2 and VEGF measured from fasting blood samples. Estimated glomerular filtration rate (eGFR) was computed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) algorithm and eGFR < 60 ml/min/1.73 m was considered to be low. Multivariable logistic regression was used to assess the odds of change in angiogenic growth factors among patients with diabetes and hypertension, and patients with low eGFR, compared to those without these conditions.

Results: In a total of 200 participants with 49 % females and mean age of 54.1 ± 10.2 years, 22.7 % of T2DM patients and 13.3 % of non-diabetes participant had low eGFR. The levels of Ang-1 and Ang-2 were highest in hypertensive T2DM patients, followed by patients with either T2DM or hypertension alone, with the controls having the lowest levels. The odds of change in circulating Ang-2 levels increased in patients with both diabetes and hypertension [11.76 (7.97-16.63),  < 0.01] compared to patients with either diabetes [5.45 (3.31-9.71),  = 0.02] or hypertension [5.45 (3.31-9.71),  = 0.02] alone. Compared to those with normal eGFR, the odds of change in serum Ang-2 levels were increased in patients with low eGFR in both the crude [1.26 (1.08-2.110),  = 0.023] and adjusted [1.14 (1.03-2.34),  = 0.043] regression models.

Conclusion: In our study population, having diabetes and hypertension increased the levels of Ang-1 and Ang-2. Also, low eGFR status was associated with increased levels of Ang-2 after adjustment for other risk factors.
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http://dx.doi.org/10.1186/s40200-016-0267-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057505PMC
October 2016

Arterial stiffness in hypertensive and type 2 diabetes patients in Ghana: comparison of the cardio-ankle vascular index and central aortic techniques.

BMC Endocr Disord 2016 Sep 29;16(1):53. Epub 2016 Sep 29.

Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.

Background: Diabetes and hypertension increase arterial stiffness and cardiovascular events in all societies studied so far; sub-Saharan African studies are sparse. We investigated factors affecting arterial function in Ghanaians with diabetes, hypertension, both or neither.

Method: Testing the hypothesis that arterial stiffness would progressively increase from controls to multiply affected patients, 270 participants were stratified into those with diabetes or hypertension only, with both, or without either. Cardio-ankle vascular index (CAVI), heart-ankle pulse wave velocity (haPWV), aortic PWV (PWVao) by Arteriograph, aortic and brachial blood pressures (BP), were measured.

Results: In patients with both diabetes and hypertension compared with either alone, values were higher of CAVI (mean ± SD, 8.3 ± 1.2 vs 7.5 ± 1.1 and 7.4 ± 1.1 units; p < 0.05), PWVao (9.1 ± 1.4 vs 8.7 ± 1.9 and 8.1 ± 0.9 m/s; p < 0.05) and haPWV (8.5 ± 1 vs 7.9 ± 1 and 7.2 ± 0.7 m/s; p < 0.05) respectively. In multivariate analysis, age, having diabetes or hypertension and BMI were independently associated with CAVI in all participants (β = 0.49, 0.2, 0.17 and -0.2 units; p < 0.01, respectively). Independent determinants of PWVao were heart rate, systolic BP and age (β = 0.42, 0.27 and 0.22; p < 0.01), and for haPWV were systolic BP, age, BMI, diabetes and hypertension status (β = 0.46, 0.32, -0.2, 0.2 and 0.11; p < 0.01).

Conclusion: In this sub-Saharan setting with lesser atherosclerosis than the western world, arterial stiffness is significantly greater in patients with coexistent diabetes and hypertension but did not differ between those with either diabetes or hypertension only. Simple, reproducibly measured PWV/CAVI may offer effective and efficient targets for intervention.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041289PMC
http://dx.doi.org/10.1186/s12902-016-0135-5DOI Listing
September 2016

Peripheral sensory neuropathy in type 2 diabetes patients: A case control study in Accra, Ghana.

J Clin Transl Endocrinol 2016 Sep 20;5:26-31. Epub 2016 Jul 20.

Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana.

Objective: Peripheral sensory neuropathy (PSN) is a common cause of ulceration and amputation in diabetes (DM) patients. The prevalence of PSN in DM patients is largely undetermined in sub-Saharan African population. We studied the burden of PSN in DM patients using a validated questionnaire and quantitative sensory test.

Methods: In a case-control design, PSN was measured in 491 DM patients and 330 non-DM controls using Michigan neuropathy screening instrument (MNSI) and vibration perception threshold (VPT). PSN was defined as MNSI symptom score ≥7, MNSI examination score ≥2 or VPT ≥25V.

Results: The prevalence of PSN screened by MNSI symptom score, MNSI examination score and VPT was 7.1%, 51.5% and 24.5% in DM patients; and 1.5%, 24.5% and 8.5% in non-DM participants respectively. The major determinants of PSN screened by MNSI examination score were diabetes status [OR (95% CI): 4.31 (2.94-6.31), p < 0.001], age [1.03 (1.01-1.05), p < 0.001], previous [4.55 (2.11-9.82), p < 0.001] and current [8.16 (3.77-17.68), p < 0.001] smoking status. The major determinants of PSN screened by VPT were diabetes status [1.04 (1.02-1.06), p < 0.001], age [1.02 (1.01-1.03), p = 0.047], heart rate [1.78 (1.08-2.92), p = 0.023], second-hand smoking [3.66 (2.26-5.95), p < 0.001] and body height [3.28 (1.65-8.42), p = 0.015].

Conclusion: Our study has shown high burden of PSN in DM patients in Ghana using simple, accurate, and non-invasive screening tools like MNSI and neurothesiometer.
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http://dx.doi.org/10.1016/j.jcte.2016.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644439PMC
September 2016

Body composition and ankle-brachial index in Ghanaians with asymptomatic peripheral arterial disease in a tertiary hospital.

BMC Obes 2016 13;3:27. Epub 2016 May 13.

Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana ; National Diabetes Management & Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana.

Background: Ankle-brachial index (ABI) and indices of obesity are both use to indicate cardiovascular risk. However, association between body composition indices and ABI, a measure of peripheral arterial disease, is inconsistent in various study reports. In this study, we investigated the relationship between ABI and general and central indices of obesity in Ghanaians without history of cardiovascular diseases.

Method: In a case-control design, ABI was measured in a total of 623 subjects and categorised into PAD (ABI ≤ 0.9, n = 261) and non-PAD (ABI > 0.9, n = 362) groups. Anthropometric indices, BMI, waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) were also measured.

Results: PAD subjects had higher mean BMI (29.8 ± 8.7 vs. 26.5 ± 7.6 kg/m(2), p = 0.043) and waist circumference (95 ± 15 vs. 92 ± 24 cm, p = 0.034) than non-PAD subjects. In multivariable logistic regression models, having BMI ≥ 30 kg/m(2) increased the odds of both unilateral [OR (95 % CI): 2 (1.14-3.51), p < 0.01] and overall PAD [2 (1.22-3.27), p < 0.01].

Conclusion: In indigenous Ghanaians in our study, PAD participants had higher BMI and waist circumference than non-PAD participants. Also, halving BMI ≥ 30 kg/m(2) was associated with twofold increase in the odds of PAD.
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http://dx.doi.org/10.1186/s40608-016-0107-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866025PMC
May 2016

Peripheral artery disease and exertional leg symptoms in diabetes patients in Ghana.

BMC Cardiovasc Disord 2016 Apr 19;16:68. Epub 2016 Apr 19.

Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana.

Background: Peripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined. We studied the prevalence of PAD and exertional leg symptoms in diabetes (DM) patients in a tertiary hospital in Ghana.

Methods: In a case control study design, 485 DM and 330 non-diabetes participants were recruited. PAD was diagnosed as Ankle Brachial Index (ABI) < 0.9. Edinburgh Claudication Questionnaire (ECQ) was used to assess exertional leg symptoms.

Results: The overall prevalence of classical intermittent claudication was 10.3 % and ABI-diagnosed PAD was 26.7 %, with 3.5 % of the participants having both classic intermittent claudication and ABI-diagnosed PAD. The prevalence of exertional leg symptoms were similar in diabetes patients with and without PAD. In non-diabetes participants, intermittent claudication and rest pain were higher in PAD patients than in non-PAD participants. In multivariable logistic regression, intermittent claudication [OR (95 % CI), 3.39 (1.14 - 8.1), p < 0.05] and rest pain [4.3 (1.58 - 9.67), p < 0.001] were independently associated with PAD in non-diabetes group, and rest pain [1.71 (1.13 - 2.17), p < 0.05] was associated with PAD in all participants.

Conclusions: There is high burden of PAD and exertional leg pains in DM patients in Ghana. PAD is expressed as intermittent claudication and rest pain in non-diabetes individuals.
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http://dx.doi.org/10.1186/s12872-016-0247-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837554PMC
April 2016

Reference intervals for common biochemical analytes in serum and plasma of a random adult population in the Greater Accra Region of Ghana.

Clin Lab 2012 ;58(7-8):687-93

Chemical Pathology Unit, Dept. of Med Lab. Sc., School of AlliedHealth Sciences, College of Health Sciences, University of Ghana, P.O. Box KB 143, Korle Bu, Accra, Ghana.

Background: The reference interval (RI) is arguably the most widely used decision making tool in clinical practice. Using the manufacturer's reference values may not be appropriate for other ethnic populations.

Objective: The objective was to determine the reference intervals (RI) of Ghanaians and compare them to that provided in kits.

Methods: 6300 adults, 25-65 years were selected by cluster sampling from three communities in the Greater Accra Region, Ghana. A total of 4733 (male/female ratio = 1:1.5) participated. Fasting Blood Glucose (FF), 2-hour post-glucose plasma glucose (2HPP), total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), uric acid (UA), urea (U), albumin (ALB), alkaline phosphatase (ALP) were measured.

Results: Male and female mean ages were 44.9 +/-14.7 and 44.0 +/-14.6 years, respectively. Most assays had mean values between the 25th and 75th percentile apart from HDL-C whose mean values fell within the 50th percentile. Thus half of the manufacturers RI (MRI) represented <25 percentile for FF, 2HPP, LDL-C, ALB and ALP. The MRI for Urea was < 25th - > 97.5th.

Conclusions: Mean values of most of the parameters determined represented the 25th - 75th and not the 95th or 97.5th percentile.
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http://dx.doi.org/10.7754/clin.lab.2011.110DOI Listing
October 2012

Body size and blood pressure: an analysis of Africans and the African diaspora.

Epidemiology 2008 Jan;19(1):38-46

Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK.

Background: Blood pressure is directly and causally associated with body mass index (BMI) in populations worldwide. However, the relationship may vary across BMI in populations of African origin.

Methods: We compared the relationship between blood pressure and BMI in populations of African origin, using 13 samples from Africa, the Caribbean, the United Kingdom and the United States. We had access to data from individual participants for age, height, weight, blood pressure, and treatment of hypertension. Analysis was restricted to 18,072 participants (age 35-64 years; 44% men). We carried out multivariate regression analysis to estimate the relationship between blood pressure and BMI by country and by sex. The use of antihypertensive treatment was taken into account by exclusion and by sensitivity analysis.

Results: There was a positive relationship between both systolic and diastolic blood pressure and BMI. In men the slopes for systolic blood pressure varied from 0.27 mm Hg per kg/m (95% confidence interval = -0.01 to 0.56) in the United States to 1.72 mm Hg per kg/m (95% confidence interval = 0.92 to 2.53) in Ghana (Kumasi). In women, the slopes varied from 0.08 (-0.54 to 0.72) in South Africa to 1.32 (0.98 to 1.66) in the Republic of Congo. Similar variation in trends was seen for diastolic blood pressure. The higher the BMI, the shallower the slopes [-0.10 (-0.15 to -0.06) for systolic, -0.09 (-0.12 to -0.06) for diastolic]. No differences were seen after excluding persons who were being treated for hypertension.

Conclusions: Blood pressure and BMI levels vary among populations of the African diaspora. The effect of BMI on blood pressure levels diminishes as BMI increases. These results suggest a complex relationship among excess body weight, adiposity, and energy expenditure.
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http://dx.doi.org/10.1097/EDE.0b013e31815c4d2cDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830114PMC
January 2008

The changing patterns of hypertension in Ghana: a study of four rural communities in the Ga District.

Ethn Dis 2006 ;16(4):894-9

National Diabetes Management and Research Centre, Korle Bu Teaching Hospital, Korle Bu, Ghana.

Objective: To determine the prevalence, distribution and risk factors of hypertension among rural residents in Ghana.

Design And Setting: Cross sectional study in four rural communities in the Ga District of Ghana.

Subjects And Methods: All adults aged > or = 18 years in four rural communities were asked to participate. The average of two blood pressure readings taken with a mercury sphygmomanometer after 10 minutes of rest was used in the analysis. Hypertension was defined as blood pressure > or = 140/90 mm Hg.

Results: 362 subjects with a mean age of 42.4 +/- 18.6 years participated in the study. The prevalence of hypertension was 25.4%. Of those with hypertension, only 32.3% (n-30) had prior knowledge of their condition, and less than half of these (n=12) were on treatment. Of those on treatment 16.7% were well controlled (blood pressure < or = 140/90 mm Hg). The adjusted odds ratios for developing hypertension for overweight or obesity were 5.8 (95% confidence interval 1.4-24.3) and 6.9 (95% confidence interval 1.7-28.2), respectively. The adjusted odds ratio for hypertension for age groups 45-54, 55-64, and > or = 65 years were 31.9 (95% confidence interval 1.88-539.11), 31.8 (95% confidence interval 1.6-624.2), and 58.8 (95% confidence interval 2.9-1168.7), respectively. The adjusted odds ratio for hypertension with respect to smoking, alcohol consumption, job-related physical activity, family history, education, occupation, and diabetes status did not attain statistical significance.

Conclusion: Hypertension is now of public health significance in rural Ga District of Ghana. The high rate of hypertension was associated with low levels of awareness, drug treatment, and blood pressure control. Overweight and obesity are modifiable risk factors for hypertension that can be addressed through lifestyle interventions. Additionally, integrating hypertension care into primary care in rural health facilities may prove beneficial.
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July 2007

Cardiovascular complications of diabetes mellitus in sub-Saharan Africa.

Circulation 2005 Dec;112(23):3592-601

Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, BP 8046 Yaoundé, Cameroon.

Background: Cardiovascular disease, the major cause of mortality and morbidity in modern societies, is set to overtake infectious diseases in the developing world as the most common cause of death. The increasing prevalence of major and emerging cardiovascular risk factors accounts for the growing burden of cardiovascular disease in the world. Diabetes in all its forms is one of the main cardiovascular risk factors. Two of 3 diabetic patients will die as a result of cardiovascular complications, and approximately 30% of patients treated in cardiovascular intensive care units have diabetes.

Methods And Results: This review on the cardiovascular complications of diabetes in sub-Saharan Africa is a bibliographical MEDLINE search of published data over the past 2 decades. Diabetes-related cardiovascular disease complications are considered to be rare in Africa but are on the rise and are regularly associated with classic cardiovascular risk factors. Coronary heart disease may affect 5% to 8% of type 2 diabetic patients and cardiomyopathy, up to 50% of all patients. Close to 15% of patients with stroke have diabetes, and up to 5% of diabetic patients present with cerebrovascular accidents at diagnosis. Peripheral vascular disease prevalence varies across sites from 4% to 28%.

Conclusions: It is obvious that diabetes mellitus and related cardiovascular complications are gaining more importance in sub-Saharan Africa. The relative contribution of putative risk factors is not well defined, and further research is therefore needed.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.105.544312DOI Listing
December 2005

A novel I247T missense mutation in the haptoglobin 2 beta-chain decreases the expression of the protein and is associated with ahaptoglobinemia.

Hum Genet 2004 Apr 4;114(5):499-502. Epub 2004 Mar 4.

Division of Human Genetics, Department of Forensic Medicine, Kurume University School of Medicine, 830-0011 Kurume, Japan.

We have identified a novel base substitution at codon 247 in the beta-chain of the haptoglobin 2 ( Hp(2)) allele in a Ghanaian with the Hp0 (ahaptoglobinemic) phenotype. The heterozygous T-->C substitution caused reduced expression of the protein when the mutant was transfected into COS7 cells. The base substitution resulted in a missense change of the non-polar amino acid isoleucine to the polar amino acid threonine at a position in the beta-chain that is highly conserved among several species. We had previously identified a mutation in the Hp gene promoter region for the same individual, which gives her genotype as -61C Hp(2)/-61C Hp(2)(I247T). Since the -61C mutation also leads to low Hp expression, the genotype represents the first and most definitive ahaptoglobinemic case reported in Africa.
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http://dx.doi.org/10.1007/s00439-004-1098-6DOI Listing
April 2004

Sociodemographic variations in obesity among Ghanaian adults.

Authors:
Albert G B Amoah

Public Health Nutr 2003 Dec;6(8):751-7

National Diabetes Management and Research Centre, Korle Bu Teaching Hospital, Accra, Ghana.

Objectives: To determine the sociodemographic associations of obesity in Ghana.

Design: A cross-sectional descriptive study was conducted on a sample of 6300 adults aged 25 years and over who were selected by random cluster sampling.

Setting: Two urban (high-class and low-class suburbs) and a rural community in Accra, Ghana.

Subjects And Methods: In total, 4731 (1857 males, 2874 females) subjects participated. Demographic data were obtained by a questionnaire and height and weight were determined with subjects in light clothing and without shoes.

Results: The overall crude prevalence of overweight and obesity was 23.4 and 14.1%, respectively. The rates of overweight (27.1 vs. 17.5%) and obesity (20.2 vs. 4.6%) were higher in females than males. Obesity increased with age up to 64 years. There were more overweight and obesity in the urban high-class residents compared with the low-class residents and in urban than rural subjects. Overweight and obesity were highest among the Akan and Ga tribes and relatively low among Ewes. Subjects with tertiary education had the highest prevalence of obesity (18.8%) compared with less literate and illiterate subjects (12.5-13.8%). Subjects whose jobs were of a sedentary nature had higher levels of obesity (15%) than subjects whose jobs involved heavy physical activity (10%). Subjects who did not engage in leisure-time physical activity were more obese than those who had three or more sessions of leisure-time physical activity per week (15.3 vs. 13.5%).

Conclusions: Overweight and obesity are common among residents in the Accra area. Older age, female gender, urban, high-class residence, sedentary occupation and tertiary education were associated with higher levels of obesity. Policies and programmes that promote healthy lifestyles may prove beneficial.
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http://dx.doi.org/10.1079/phn2003506DOI Listing
December 2003

Obesity in adult residents of Accra, Ghana.

Authors:
Albert G B Amoah

Ethn Dis 2003 ;13(2 Suppl 2):S97-101

Department of Medicine and Therapeutics, University of Ghana Medical School, and the National Diabetes Management and Research Center, Korle Bu Teaching Hospital, Accra, Ghana.

Objectives: To determine the prevalence of obesity in Ghanaian adults.

Design: 6300 adults, aged 25 years and older, were selected by random cluster sampling using electoral enumeration areas and listings of adults.

Setting: Two urban and one rural community in the Greater Accra region of Ghana.

Subjects And Methods: 4733 (males=1860, females=2873) adult Ghanaians participated. Height and weight were determined for subjects wearing light clothing and without shoes.

Results: The mean age and BMI were 44.3 years and 24.4 kg/m2, respectively. Women, though younger, had higher BMI values compared to males (25.6 vs 22.6 kg/m2, respectively; P<.001). The overall crude prevalence of overweight (25.0-29.9 kg/m2) and obesity (> or = 30 kg/m2) were 23.4% and 14.1% for females and males, respectively. The rates of overweight (27.1% vs 17.5%) and obesity (20.2% vs 4.6%) were both higher in women than men. The age-standardized prevalence of obesity in Ghanaians was 13.6%. Obesity increased with age, peaking in the 55-64-year age group. The first to fourth BMI quartiles were: < or = 20.6, 20.7-23.3, 23.4-27.2, and > or = 27.3 kg/m2, respectively. At all ages, more females (32.9%) than males (12%) were placed within the 4th BMI quartile. Residents from the high-class residential area had higher BMI, compared to subjects from the lower class suburb. Also, urban residents had higher BMI compared to rural subjects.

Conclusion: Overweight and obesity are common in Ghanaians, particularly among females, the elderly, and urban dwellers. Further work is needed to ascertain the determinants of overweight and obesity in Ghanaians.
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February 2004

High blood pressure: the foundation for epidemic cardiovascular disease in African populations.

Ethn Dis 2003 ;13(2 Suppl 2):S48-52

Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, Illinois 60153, USA.

High-blood pressure is a powerful independent risk factor for death from heart disease and stroke. It is also a common clinical condition affecting more than 600 million persons worldwide and seen in nearly all populations. Although reliable, large-scale, population-based data on high blood pressure in sub-Saharan Africa (SSA) are limited, recent studies provide important and worrisome findings in both epidemiology and clinical outcomes. Although overall hypertension prevalence is between 10%-15%, prevalence rates as high as 30%-32% have been reported in middle-income urban and some rural areas. Importantly, hypertension awareness, treatment, and control rates as low as 20%, 10%, and 1%, respectively have also been found. Stroke has been by far the most common clinical sequela. In most SSA settings, hypertension control assumes a relatively low priority and little experience exists in implementing sustainable and successful programs for drug treatment. Rapid urbanization and transition from agrarian life to the wage-earning economy of city life continue to fuel increases in average blood pressure levels and prevalence of hypertension. Although the true burden of high blood pressure in sub-Saharan Africa remains largely unmeasured, compelling preliminary evidence suggests that it is the foundation for epidemic cardiovascular disease in Africa and already contributes substantively to death and disability from stroke, heart failure, and kidney failure in this region. Success in limiting this epidemic in SSA will depend heavily on the implementation of sustainable and aggressive population-based programs for high blood pressure awareness, prevention, treatment, and control. It will be critical to obtain investments in improved surveillance and program-relevant research to provide the evidence base for policy development and effective hypertension prevention and control.
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February 2004

Hypertension in Ghana: a cross-sectional community prevalence study in greater Accra.

Authors:
Albert G B Amoah

Ethn Dis 2003 ;13(3):310-5

Department of Medicine and Therapeutics, University of Ghana Medical School, National Diabetes Management and Research Centre, Korle Bu Teaching Hospital, Accra, Ghana.

Objectives: To determine the prevalence of hypertension, and the extent to which it is treated and controlled, among adult Ghanaians.

Design: 6300 adults, aged 25 years and older, were selected by random cluster sampling, using electoral enumeration areas and listings of adults.

Setting: Three communities in the greater Accra region of Ghana.

Subjects And Methods: A total of 4733 subjects (male to female ratio = 1:1.5) participated, representing a response rate of 75%. The analysis used the mean of 2 blood pressure readings, taken with a mercury sphygmomanometer after a 10-minute rest. Hypertension was defined as having blood pressure > or = 140/90 mm Hg, or currently undergoing anti-hypertensive treatment.

Results: The mean ages for males and females were 44.9 +/- 14.7 years, and 44.0 +/- 14.6 years, respectively. The crude prevalence of hypertension was 28.3%. The age-standardized prevalence, to the new standard world population, was 28.4%. Mean systolic and diastolic blood pressures increased with age. Of 1337 subjects with hypertension, 34% were aware of their condition, 18% were treated, and 4% were controlled (blood pressure < 140/90 mm Hg).

Conclusion: Hypertension is a major public health problem, and is associated with relatively low levels of awareness, drug treatment, and blood pressure control. Population-based prevention strategies, such as reduction in salt intake and integration of hypertension care into primary care, may prove beneficial; however, the determinants of hypertension remain to be ascertained.
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November 2003

Diabetes in Africa. Pathogenesis of type 1 and type 2 diabetes mellitus in sub-Saharan Africa: implications for transitional populations.

J Cardiovasc Risk 2003 Apr;10(2):85-96

The Ohio State University College of Medicine and Public Health, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Ohio, USA.

The increasing prevalence and incidence of diabetes and its long-term complications in sub-Saharan Africa (SSA) could have devastating human and economic toll if the trends remain unabated in the future. Approximately 90% or majority of patients with diabetes belongs to the adult onset, type 2 diabetes category while 10% have type 1 diabetes in SSA. However, because of the paucity of metabolic and clinical data, a clear understanding of the natural history of both diseases and the classification of diabetes subtypes has been hampered. Nevertheless, we have attempted to provide a concise review of the pathophysiology of both type 1 and type 2 diabetes as well as phenotypic and clinical variations in patients residing in SSA. The limited metabolic data, (albeit increasing), from high-risk and diabetic individuals in the SSA, have contributed significantly to the understanding of the pathogenetic mechanisms of diabetes and the variations in the presentation of the disease. Sub-Saharan African patients with type 1 diabetes have essentially absolute insulin deficiency. In addition, patients with type 2 diabetes in SSA region also manifest severe insulin deficiency with varying degrees of insulin resistance. Although the exact genetic markers of both diseases are unknown, we believe studies in patients of SSA origin who reside in diverse geographic environments (African diaspora) could potentially contribute to our understanding of the genetic and environmental mediators of both diseases. However, many intrinsic, individual and societal obstacles such as poor education and illiteracy, low socio-economic status and lack of access to health care make uncertain the translation of diabetes research in SSA. In this regard, effective management and/or prevention of diabetes in SSA individuals should adopt multidisciplinary approaches. Finally, innovative health care delivery and educational models will be needed to manage diabetes and its long-term complications in SSA.
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http://dx.doi.org/10.1097/01.hjr.0000060841.48106.a3DOI Listing
April 2003

Insulin resistance, beta cell function and cardiovascular risk factors in Ghanaians with varying degrees of glucose tolerance.

Ethn Dis 2002 ;12(4):S3-10-7

Diabetes Research Laboratory, Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana.

Objective: Type 2 diabetes is characterized by beta cell dysfunction and insulin resistance (IR). The disease is associated with high rates of cardiovascular mortality and morbidity. Recently, the American Diabetes Association Expert Committee recommended the measurement of fasting glucose as a tool for screening and diagnosing diabetes, in order to identify patients with a mild form of the disease as well as to enhance the detection of undiagnosed type 2 diabetes. The significance of these criteria with respect to cardiovascular risk factors in native Ghanaians is unknown. The objectives of the present study were to examine the cardiovascular risk factors in a sample of native Ghanaians with varying degrees of glucose intolerance as defined by fasting glucose levels as specified by the ADA criteria.

Research And Methods: The population consisted of 200 indigenous Ghanaian subjects, age range 25-74 years, residing in the Accra metropolitan areas. Subjects were categorized using the fasting plasma glucose (FPG) alone as normal fasting glucose (NFG, FPG < 110 mg/ dL), impaired fasting glucose (IFG, 11 < FPG 126 mg/dL), and diabetic (DM, FPG > 126 mg/ dL). Anthropometric parameters (blood pressure, waist circumference and waist-hip circumference ratios) were measured in each subject. Levels of serum glucose, c-peptides and insulin were measured at baseline and after 2 hours of oral glucose challenge. Insulin resistance (HOMA-IR) and beta cell function (HOMA-%B) were assessed by homeostasis model assessment (HOMA). Levels of fasting serum cholesterol, high-density lipoprotein cholesterol (HDL-C), cholesterol, and triglycerides were measured in each subject.

Results: There were 181 subjects in the NFG category, 11 in the IFG category, and 8 newly diagnosed type 2 diabetic subjects. The mean age, BMI, waist circumference (WC), and WHR did not differ between the 3 groups. The mean fasting glucose and the corresponding 2-hour glucose levels rose with the worsening of glucose tolerance. Similarly, the means for serum fasting, post-challenge serum insulin, and c-peptide levels were significantly greater in the IFG and DM groups. Fasting serum cholesterol and high density lipoproteins did not differ statistically between the 3 groups, However, the means for serum triglycerides were greater in the IFG and DM groups when compared to the NFG group. The insulin resistance (IR) as assessed by HOMA was 2x and 4x greater in the IFG (3.76) and DM (6.12) groups when compared with the NFG (1.82, P < .05).

Conclusions: We have characterized the metabolic and anthropometric risk factors for CVD in native Ghanaians with varying degrees of glucose tolerance, as defined by the ADA criteria. We found that both IFG and DM were associated with beta cell dysfunction, insulin resistance, and elevated serum triglycerides. However, the well established cardiovascular risk factors, such as body mass index, body fat distribution, and blood pressure did not track with the increasing glucose intolerance in the native Ghanaians. We conclude that the Ghanaian patients with IFG and type 2 diabetes were non-obese and exhibited severe beta cell dysfunction, insulin resistance, and elevated triglycerides, but none of the other conventional risk factors, at the time of diagnosis. Future research should focus on the sequential changes in risk factors during development of cardiovascular diseases in native Ghanaians with varying degrees of glucose tolerance.
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March 2003

Pathogenic mechanism of type 2 diabetes in Ghanaians--the importance of beta cell secretion, insulin sensitivity and glucose effectiveness.

S Afr Med J 2002 May;92(5):377-84

Endocrine and Metabolic Laboratory, Department of Medicine and Therapeutics, University of Ghana.

Objective: To assess insulin sensitivity and beta cell secretion in indigenous Ghanaian subjects with a spectrum of glucose intolerance.

Research And Methods: We evaluated beta cell secretion, insulin sensitivity (Si) and glucose effectiveness (Sg) in three groups: group 1, 15 healthy control subjects without family history of type 2 diabetes; group 2, 11 healthy non-diabetic first-degree relatives of Ghanaian patients with type 2 diabetes; and group 3, 10 patients with type 2 diabetes living in Accra, Ghana, West Africa. A standard oral glucose tolerance test (OGTT) and frequently sampled intravenous glucose tolerance (FSIGT) test were performed for each subject. Si and Sg were measured using Bergman's minimal model method.

Results: The mean body mass index (BMI) and lean body mass were not different among the three groups. However, the waist-to-hip circumference ratio, total body fat as well as triceps and biceps skinfolds were significantly greater in group 3 (diabetic patients) than in group 2 (relatives) and group 1 (healthy controls). Mean fasting and postprandial serum glucose levels were not significantly different between the relatives and healthy controls during oral glucose challenge. The mean fasting and postprandial serum glucose levels were significantly higher in the group 3 diabetic patients than in the non-diabetic groups. Mean fasting serum insulin and C-peptide levels tended to be higher in group 3 than in groups 1 and 2. However, mean serum insulin and C-peptide responses after oral glucose load were significantly greater in group 2 than in the group 1 healthy controls. The insulin responses in the two non-diabetic groups after oral glucose challenge were significantly greater than in the diabetic patients. During the FSIGT, the mean serum glucose responses were similar in the two non-diabetic groups (groups 1 and 2). The serum glucose responses were significantly greater in group 3 than in the non-diabetic groups. Mean total and acute first and second phases of insulin and C-peptide responses were greater in group 2 than group 1. However, acute phases of insulin secretion were severely blunted in group 3 when compared with groups 1 and 2 during FSIGT in our Ghanaians. We found that the mean Si was slightly lower in group 2 (1.72 +/- 0.32) than in the healthy controls in group 1 (1.9 +/- 0.55, P = NS). Mean Si was remarkably lower in the diabetic patients in group 3 (1.30 +/- 0.35 x 10(-4)/min (microU/ml)) when compared with the relatives and healthy controls, but the differences were not statistically significant. Mean glucose effectiveness at basal insulin level (Sg) was not significantly different among the relatives in group 2 (2.38 +/- 0.50), the healthy controls in group 1 (2.66 +/- 0.38) and the diabetic patients in group 3 (2.27 +/- 0.49 x 10(-2)/min).

Conclusions: We conclude that (i) the pathogenetic mechanisms of type 2 diabetes in indigenous Ghanaians are characterised by severe beta cell dysfunction and moderate reduction in Si. Although the healthy relatives manifest insulin resistance with compensatory hyperinsulinaemia, our study suggests that the conversion of such subjects to type 2 diabetes is determined by deterioration in beta cell function and perhaps Si but not tissue Sg in Ghanaians. Prospective studies are needed to examine the sequential changes that lead to the development of type 2 diabetes in indigenous Ghanaians.
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May 2002

Diabetes in Ghana: a community based prevalence study in Greater Accra.

Diabetes Res Clin Pract 2002 Jun;56(3):197-205

Department of Medicine and Therapeutics, Diabetes Research Laboratory, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana.

Data on the prevalence of diabetes in Ghana is scanty and unreliable. In the present study we have ascertained the prevalence of diabetes, impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT) in a random cluster sample of Ghanaians aged 25 years and above from the Greater Accra area of Ghana. Diabetes, IFG and IGT were defined by criteria of the American Diabetes Association and World Health Organization. The mean age of the 4733 subjects involved in the study was 44.3+/-14.7 years, and participation rate was 75%. The crude prevalence of diabetes was 6.3%. Out of 300 subjects with diabetes, 209 (69.7%) had no prior history of the disease. Diabetes, IGT and combined IFG and IGT increased with age. The oldest age group (64+ years) had the highest diabetes prevalence (13.6%). The age-adjusted prevalence of diabetes, IFG and IGT, were 6.4, 6.0 and 10.7%, respectively. Diabetes was more common in males than females (7.7 vs. 5.5%) [P<0.05]. Worsening glycaemic status tended to be associated with increase in age, body mass index, systolic and diastolic blood pressures. Ascertainment of predictors for diabetes in Ghanaians and the significance of the relatively high rates of and IFG and IGT however, remain to be determined.
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http://dx.doi.org/10.1016/s0168-8227(01)00374-6DOI Listing
June 2002