What characteristics are most important in stratifying patients into groups with different risk of diabetic foot ulceration?

Aims/introduction: This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications.

Materials And Methods: A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two-step cluster analysis technique  was utilised to divide the patients into groups, each with similar characteristics.

Predicting the risk of amputation and death in patients with diabetic foot ulcer. A long-term prospective cohort study of patients in Tanzania.

Introduction: This prospective cohort study aimed to identify the characteristics of patients with diabetic foot ulcer who are at higher risk of amputation and at increased risk of death.

Methods: About 103(M/F:60/43) participants, with active foot ulcer at baseline, participated in this study and followed for 22 years till death or lost to follow-up. Ten clinical measures were collected at baseline.

The Charcot Foot: An Emerging Public Health Problem for African Diabetes Patients.

Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. To characterize the epidemiology and the clinical burden of CN in a large diabetes population in Tanzania, and to evaluate outcomes of persons with the condition. This was a prospective analytic cohort study conducted between January 2013 through December 2015.

Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study.

Background: HIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic.

Integrating HIV, diabetes and hypertension services in Africa: study protocol for a cluster randomised trial in Tanzania and Uganda.

Introduction: HIV programmes in sub-Saharan Africa are well funded but programmes for diabetes and hypertension are weak with only a small proportion of patients in regular care. Healthcare provision is organised from stand-alone clinics. In this cluster randomised trial, we are evaluating a concept of integrated care for people with HIV infection, diabetes or hypertension from a single point of care.

Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania.

Objectives: The aim of this study was to identify the parameters that predict the risk of future foot ulcer occurrence in patients with diabetes.

Research Design And Methods: 1810 (male (M)/female (F): 1012/798) patients, with no foot ulcer at baseline, participated in this study. Data from a set of 28 parameters were collected at baseline.

Rat bite as a cause of diabetic foot ulcer in sub-Saharan Africa.

There have been relatively few reports of foot ulcers in diabetes resulting from rat bite. The findings were derived from people attending a single specialist service in Dar es Salaam for diabetic foot ulcers (DFUs) between 1 January 1999 and 31 December 2016. Details from people presenting for the first time with an ulcer judged to be caused by rat bite were compared with those with from other causes of foot ulcer.

Can a combination of lifestyle and clinical characteristics explain the presence of foot ulcer in patients with diabetes?

Aims: The aim of this study was to identify the biomechanical, neurological and clinical parameters along with other demographics and lifestyle risk factors that could explain the presence of foot ulcer in patients with diabetes in Africa.

Methods: A total of 1270 (M/F:696/574) patients; 77(M/F:53/24) with ulcerated vs 1193 (M/F: 643/550) with non-ulcerated feet; participated in this study. A set of 28 parameters were collected and compared between the participants with and without active foot ulcers.

Prevalence of Depression and Associated Factors among Diabetic Patients in an Outpatient Diabetes Clinic.

Despite adequate treatment for diabetes, it is estimated that 15%- 20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania. The study is aimed at determining the prevalence of depression and associated factors among patients with diabetes.

Adiposity Is a Key Correlate of Circulating Fibroblast Growth Factor-21 Levels in African Males with or without Type 2 Diabetes Mellitus.

Background: Fibroblast growth factor-21 is an endocrine regulator with therapeutic and diagnostic potential. The levels and pattern of circulating FGF-21 have been described mainly in European and Asian populations. Given its strong association with adiposity, and the reported ethnic variabilities in body composition, examining FGF-21 in an African population is crucial.

Albuminuria in patients with chronic obstructive pulmonary disease: a cross-sectional study in an African patient cohort.

Background: Cardiovascular disease (CVD) is remarkably frequent in patients with chronic obstructive pulmonary disease (COPD). Albuminuria is a marker of vascular endothelial dysfunction and predictor of CVD events. Albuminuria is prevalent in patients with COPD as it has been shown in Caucasian and Oriental populations with COPD.

Prevalence of erectile dysfunction and associated factors among diabetic men attending diabetic clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania.

Introduction: There has been an increase in the prevalence of erectile dysfunction (ED) in the general population especially among Diabetic patients. This seems to be neglected problem in low-income countries. This study aims at establishing the prevalence of ED and associated risk factors in diabetic patients attended at Diabetic Clinic at Muhimbili National Hospital.

Oxidative Stress Correlates with Complications Among Diabetic Patients Attending a Diabetic Clinic in Muhimbili National Hospital, Dar es Salaam, Tanzania.

In diabetes, persistent hyperglycemia results in increased production of free radicals especially oxygen free radicals, which can cause cell destruction and tissue injury resulting in cell dysfunction. With the premise that oxidative stress is a major cause of diabetic complications, we conducted a controlled laboratory based investigation on level of lipid peroxide levels in the serum of Type 1 and Type 2 diabetic patients attending Muhimbili National Hospital. From our clinical data it was observed that majority of the patients had higher waist to hip ration and body mass index, which suggests that the patients were either overweight or obese.

Prevalence and covariates of abnormal left ventricular geometry in never-treated hypertensive patients in Tanzania.

AIM. To assess prevalence, type and covariates of abnormal left ventricular (LV) geometry in untreated native Tanzanian patients with hypertension in relation to normotensive controls. METHODS.

Left atrial volume index as a marker of left ventricular diastolic dysfunction in asymptomatic Tanzanian diabetic patients.

Aim: To determine the prevalence of left atrial (LA) enlargement and its relation to left ventricular (LV) diastolic dysfunction among asymptomatic diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods: Echocardiography was performed in 122 type 2 and 58 type 1 diabetic patients. Diastolic dysfunction was defined as peak transmitral blood velocity to medial mitral annulus velocity (E/E') ratio ≥ 15.

Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients.

Objective: To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods: Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height(2.

The utility of Gram stains and culture in the management of limb ulcers in persons with diabetes.

In Tanzania, limited laboratory services often preclude routine identification of microorganisms that cause infections in persons with diabetes. Thus, we carried out this study to determine the utility of a Gram stain alone versus culture in guiding appropriate antimicrobial therapy. During February 2006 to December 2007 (study period), deep tissue biopsies were obtained from persons with diabetes presenting to the Muhimbili National Hospital (MNH) with infected limb ulcers.

The 'Step by Step' Diabetic Foot Project in Tanzania: a model for improving patient outcomes in less-developed countries.

Foot complications cause substantial morbidity in Tanzania, where 70% of leg amputations occur in diabetic patients. The Step by Step Foot Project was initiated to train healthcare personnel in diabetic foot management, facilitate transfer of knowledge and expertise, and improve patient education. The project comprised a 3-day basic course with an interim period 1-year of for screening, followed by an advanced course and evaluation of activities.

Comparison of post amputation outcome in patients with type 2 diabetes from specialized foot care centres in three developing countries.

Objective: To evaluate post amputation outcome and associated complications in type 2 diabetic patients who had undergone major amputations in developing countries.

Patients And Methods: A total of 526 (M:F; 369:157) subjects from three centers [India (IND), n=194, Bangladesh (BAN) n=177 and Tanzania (TAN) n=155 who had undergone amputation and subsequently visited the hospital were included in this analysis. Details on foot problems and associated complications were recorded.

Diabetic foot ulcers and ethnicity in Tanzania: a contrast between African and Asian populations.

To characterise the role of ethnicity in the occurrence of foot ulcer disease in persons with diabetes, we analysed prospectively collected data for persons attending the diabetes clinic at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. A case was defined as any adult presenting to MNH with an ulcer at or below the ankle joint during July 1998-June 2005. We documented clinical and epidemiologic characteristics, progress, interventions and outcome.

Prevalence and covariates of electrocardiographic left ventricular hypertrophy in diabetic patients in Tanzania.

Background: Left ventricular hypertrophy (LVH) has been demonstrated to be a powerful predictor of cardiovascular (CV) morbidity and mortality in diabetic as well as hypertensive patients. However, less is known about the prevalence of electrocardiographic LVH (ECG-LVH) and its relation to other CV risk factors in diabetic patients in sub-Saharan Africa. Therefore, the aim was to assess the prevalence of ECG-LVH in diabetic patients in Dares Salaam, Tanzania, and its relation to other cardiovascular risk factors.

Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents.

Objective: To compare populations with and outcomes of diabetic foot ulcers managed in the U.K., Germany, Tanzania, and Pakistan and to explore the use of a new score of ulcer type in comparing outcomes among different countries.

Comparison of four systems of classification of diabetic foot ulcers in Tanzania.

Aims: The aim was to compare the use of four different systems of foot ulcer classification in a consecutive population with diabetes presenting to a specialist clinic in Dar es Salaam, Tanzania.

Methods: Clinical data were collected prospectively in all patients presenting with foot ulcers between 3 January 2003 and 30 September 2005, and were used retrospectively to classify their ulcers using the Meggitt/Wagner, University of Texas (UT), Size (Area and Depth), Sepsis, Arteriopathy, and Denervation [S(AD)SAD] and Perfusion, Extent/size, Depth/tissue loss, Infection and Sensation (PEDIS) systems. Comparison was made between the strength of the associations between baseline characteristics of each system and outcome determined at 5 December 2005, using linear by linear association.

Islet cell autoantibodies in African patients with Type 1 and Type 2 diabetes in Dar es Salaam Tanzania: a cross sectional study.

Background: The aim of the present study was to assess the occurrence of glutamic acid decarboxylase autoantibodies (GADA) and insulinoma antigen 2 autoantibodies (IA2A) among patients of African origin in Dar es Salaam, Tanzania and to compare the occurrence of autoimmune mediated Type 1 diabetes with findings previously reported from the same place and from other African diabetic populations.

Methods: Two hundred and forty five patients from the diabetic clinic at Muhimbili Hospital were recruited for a cross sectional study. Patients were clinically classified into groups with Type 1 (T1D) and Type 2 diabetes (T2D); there were 94 patients with T1D and 151 with T2D.