Browsing by Author "Bahendeka, Silver"

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Consensus Recommendations on Sulfonylurea and Sulfonylurea Combinations in the Management of Type 2 Diabetes Mellitus – International Task Force
(Indian Journal of Endocrinology and Metabolism, 2018) Kalra, Sanjay; Bahendeka, Silver; Sahay, Rakesh; Ghosh, Sujoy; Md, Fariduddin; Orab, Abbas; Ramaiya, Kaushik; Shammari, Sameer Al; Shrestha, Dina; Shaikh, Khalid; Abhayaratna, Sachitha; Shrestha K, Pradeep; Mahalingam, Aravinthan; Askheta, Mazen; Rahim, Aly Ahmed A; Eliana, Fatimah; Shrestha, Hari K.; Chaudhary, Sandeep; Ngugi, Nancy; Mbanya, Jean Claude; Aye, Than Than; Latt, Tint Swe; Akanov, Zhanay A.; Syed, Abbas Raza; Tandon, Nikhil; Unnikrishnan, A. G.; Madhu, S. V.; Jawa, Ali; Chowdhury, Subhankar; Bajaj, Sarita; Das, Ashok Kumar
For decades, sulfonylureas(SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose‑lowering drugs.
EADSG Guidelines: Insulin Storage and Optimisation of Injection Technique in Diabetes Management
(PMC, 2019-02-27) Bahendeka, Silver; Kaushik, Ramaiya; Babu Swai, Andrew; Otieno, Fredrick; Bajaj, Sarita; Kalra, Sanjay; Bavuma, Charlotte M; Karigire, Claudine
To date, insulin therapy remains the cornerstone of diabetes management; but the art of injecting insulin is still poorly understood in many health facilities. To address this gap, the Forum for Injection Technique and Therapy Expert Recommendations (FITTER) published recommendations on injection technique after a workshop held in Rome, Italy in 2015. These recommendations are generally applicable to the majority of patients on insulin therapy, athough they do not explore alternative details that may be suitable for low- and middle-income countries. The East Africa Diabetes Study Group sought to address this gap, and furthermore to seek consensus on some of the contextual issues pertaining to insulin therapy within the East African region, specifically focusing on scarcity of resources and its adverse effect on the quality of care. A meeting of health care professionals, experts in diabetes management and patients using insulin, wasconvened in Kigali, Rwanda on 11 March 2018, and the following recommendations were made: (1) insulin should be transported safely, without undue shaking and exposure to high ([32 C) temperature environments. (2) Insulin should not be transported below 0 C. (3) If insulin is to be stored at home for over 2 months, it should be stored at the recommended temperature of 2–8 C. (4) Appropriate instructions should be given to patients while dispensing insulin. (5) Insulin in use should be kept at room temperature and should never be kept immersed under water. Immersing insulin under water after the vial has been pierced carries a high risk of contamination, leading to loss of potency and likelihood of causing injection abscesses. (6) The shortest available needles (4 mm for pen and 6 mm for insulin syringe) should be preferred for all patients. (7) In routine care, intramuscular injections should be avoided, especially with long-acting insulins, as it may result in severe hypoglycaemia. (8) The practice of slanting the needle excessively should be avoided as it results in sub-epidermal injection of insulin which leads to poor absorption and may cause ‘‘tattooing’’ of the skin and scarring. (9) In patients presenting in a wasted state, with ‘‘paperlike skin’’, injections should, if possible, be initiated with pen injection devices, so as to utilise the 4-mm needle without lifting a skin fold (pinching the skin); otherwise lifting of a skin fold is required, if longer needles are utilised. (10) Reuse of needles and syringes is not recommended. However, as the reuse of syringes and needles is practiced for various reasons, and by many patients, individuals should not be given alarming messages; and usage should be limited to discarding when injections become more painful; but at any rate not to exceed reusing a needle more than 5 times.
Euthymia in Diabetes
(Springer Nature, 2019-04-22) Kalra, Sanjay; Das, A.K; Baruah, M. P.; Unnikrishnan, A. G.; Dasgupta, Arundhati; Shah, Parag; Sahay, Rakesh; Shukla, Rishi; Das, Sambit; Tiwaskar, Mangesh; Vijayakumar, G.; Chawla, Manoj; Eliana, Fatimah; Suastika, Ketut; Orabi, Abbas; Abdul Rahim, Aly Ahmed; Uloko, Andrew; Lamptey, Roberta; Ngugi, Nancy; Bahendeka, Silver; Abdela, Abdurezak Ahmed; Mohammed, Fariduddin; Pathan, Mohammed Faruque; Rahman, Muhammed Hafizur; Afsana, Faria; Selim, Shajada; Moosa, Muaz; Murad, Moosa; Shreshtha, Pradeep Krishna; Shreshtha, Dina; Giri, Mimi; Hussain, Wiam; Al-Ani, Ahmed; Ramaiya, Kaushik; Singh, Surender; Raza, Syed Abbas; Aye, Than Than; Garusinghe, Chaminda; Muthukuda, Dimuthu; Weerakkody, Muditha; Kahandawa, Shyaminda; Bavuma, Charlotte; Ruder, Sundeep; Vanny, Koy; Khanolkar, Manish; Czupryniak, Leszek
Aim: To develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management. Background: Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient–provider communication to aid enhancement of coping skills. Results: After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care. Conclusions: Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and wellbeing of affected individuals.
Obesity and type 2 diabetes in sub-Saharan Africans – Is the burden in today’s Africa similar to African migrants in Europe? The RODAM study
(BMC, 2016-10-21) Agyemang, Charles; Meeks, Karlijn; Beune, Erik; Dabo, Ellis Owusu; Mockenhaupt, Frank P; Addo, Juliet; Aikins, Ama de Graf; Bahendeka, Silver; Danquah, Ina; Schulze, Matthias B; Spranger, Joachim; Burr, Tom; Baffour, Peter Agyei; Amoah, Stephen K; Galbete, Cecilia; Henneman, Peter; Grobusch, Kerstin Klipstein; Nicolaou, Mary; Adeyemo, Adebowale; Straalen, Jan van; Smeeth, Liam; Stronks, Karien
Background: Rising rates of obesity and type 2 diabetes (T2D) are impending major threats to the health of African populations, 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 obesity and T2D among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in different European countries. Methods: A multi-centre cross-sectional study was conducted among Ghanaian adults (n = 5659) aged 25–70 years residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin). Comparisons between groups were made using prevalence ratios (PRs) with adjustments for age and education. Results: In rural Ghana, the prevalence of obesity was 1.3 % in men and 8.3 % in women. The prevalence was considerably higher in urban Ghana (men, 6.9 %; PR: 5.26, 95 % CI, 2.04–13.57; women, 33.9 %; PR: 4.11, 3.13–5.40) and even more so in Europe, especially in London (men, 21.4 %; PR: 15.04, 5.98–37.84; women, 54.2 %; PR: 6.63, 5.04–8.72). The prevalence of T2D was low at 3.6 % and 5.5 % in rural Ghanaian men and women, and increased in urban Ghanaians (men, 10.3 %; PR: 3.06; 1.73–5.40; women, 9.2 %; PR: 1.81, 1.25–2.64) and highest in Berlin (men, 15.3 %; PR: 4.47; 2.50–7.98; women, 10.2 %; PR: 2.21, 1.30–3.75). Impaired fasting glycaemia prevalence was comparatively higher only in Amsterdam, and in London, men compared with rural Ghana. Conclusion: Our study shows high risks of obesity and T2D among sub-Saharan African populations living in Europe. In Ghana, similarly high prevalence rates were seen in an urban environment, whereas in rural areas, the prevalence of obesity among women is already remarkable. Similar processes underlying the high burden of obesity and T2D following migration may also be at play in sub-Saharan Africa as a consequence of urbanisation.
Prevalence of hyperglycaemia frst detected during pregnancy and subsequent obstetric outcomes at St. Francis Hospital Nsambya
(BMC, 2017-05-02) Nakabuye, Betty; Bahendeka, Silver; Byaruhanga, Romano
Background: Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Data on hyperglycaemia in pregnancy in sub-Saharan Africa is scanty and varied depending on the populations studied and the methodologies used to defne hyperglycaemia in pregnancy. With the recent 2013 World Health Organisation (WHO) diagnostic criteria and classifcation, there is yet no sufcient data on the prevalence of hyperglycaemia in sub-Saharan Africa. The objective was to determine the prevalence of Hyperglycaemia frst detected during pregnancy and subsequent obstetric outcomes among patients attending antenatal care (ANC) at St. Francis Hospital Nsambya. Methods: A prospective cohort study. All women with no history of diabetes mellitus attending at or after 24 weeks gestation were eligible to participate in the study. Participants underwent a standard 75 g oral glucose tolerance test (OGTT) after an informed written consent. The primary outcome was diagnosis of hyperglycaemia. Enrolled participants were followed up to delivery to assess obstetric outcomes (secondary outcomes were birth weight, neonatal admission, maternal genital trauma, delivery mode, neonatal and maternal status at discharge). Results: 251 women were screened between December 2013 and February 2014. The prevalence of hyperglycaemia frst detected in pregnancy was 31.9%. We found 23.8 % of women with hyperglycaemia had no known risk factor. Macrosomia was the only obstetric outcome that was signifcantly associated with hyperglycaemia. Conclusion: The prevalence of hyperglycaemia frst detected in pregnancy was high in the studied population. Clinicians, therefore, should become more vigilant to screen for the condition. Selective screening may miss 23.8% of pregnant women with hyperglycaemia. However the cost/beneft implications of screening strategy and the recent 2013 WHO diagnostic criteria need to be studied in our setting.