Objective : An aging population,a risk factor for diabetes mellitus ,forms different proportion of national population across Africa and the world over. This research seek to answer the question what clinical deduction can be derived from the management (MGT) of diabetics 65 years and above (DM65YRS&A) in African when Ademolus Classification of Hypoglycemia (ACH) is used as a tool in this age bracket?
Methods : This is a retrospective study of 183 documented hypoglycemic episodes occurring in 64 diabetics in Africa over a 13 years period. Randomly selected casenotes of DM65YRS&A with hypoglycemic episodes whether as in or out patients were thoroughly studied. Exclusion criteria include probable hypoglycemia (HG), HG in non diabetics, and HG in diabetics aged below 65years. HG was defined as blood sugar of 70mg/dl or less. CIinical deduction were made using ACH as a tool.
Results : All cases studied were type 2 diabetics. Of the 183 hypoglycemic episodes studied,98 episodes occurred during in patient while 85 episodes occurred during out patient diabetes MGT. Of the 64 diabetics studied, 22 were in patients while 42 were out patients. Age range among in patients was 65 to 95 years while age range among out patients was 65 to 87 years.Severe HG occurred in 15% of DM65YRS&A as in patients while none of the DM65YRS&A managed as out patients had severe HG.
Discussion : The tendency for diabetics to develop HG is more with in patient MGT when blood sugar control is more intensive compared to with out patient MGT.Hence clinicians need to be less aggressive on blood sugar control in DM65YRS&A on admission because the risk of severe hypoglycemia is more than when they are on out patients MGT..Also from this study,it can be deducted that if DM65YRS&A is having life threatening problem with repeated severe hypoglycemia while on insulin and oral hypoglycemic agents (OHA) then consider placing them on OHA alone as this reduces the risk of hypoglycemia from moderate to mild. Similarly, if they are on both insulin and OHA,risk of developing moderate to severe hypoglycaemia is less if they are placed on insulin therapy alone.However the risk of hypoglycemia is much less when switched from the combination to OHA alone than to insulin alone.While grade 1 hypoglycemia is the commonest in 7th 8th and 9th decades of life, grade 2 is in the 10th decades.
Conclusion : Evidence based,clinically relevant practice based guideline and deduction can be made when ACH is used as a tool in management of DM65YRS&A in Africa. What of in other races?How does ACH as a tool affects montreal cognitive assessment,Katz index and the Lawton instrumental activities of daily living in African and the world in geriatrics?
Adegbenga Ademolu– FELLOW IN TRAINING, LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA LAGOS NIGERIA., Lagos, Nigeria
FELLOW IN TRAINING
LAGOS STATE UNIVERSITY TEACHING HOSPITAL IKEJA LAGOS NIGERIA.
Accomplished medical doctor with years of clinical research and managerial experience in both the public and private sector. Multiple papers published in the field of Endocrinology and Metabolism. Regarded as a natural leader and communicator, with experience training 100+ interns, and caring for 75,000+ during course of career.
Received international recognition as speaker and board member of American endocrinology journal.
Invited speaker to the Annual World Congress of Diabetes in 2015, one of two Africans invited.
Reviewed papers written by professors for the Journal of Clinical Endocrinology and Metabolism (JCEM).
Pioneered medical practice in Lagos, and received community service award in 2014 based on efforts.
Scientific Meetings in the United States of America
• American Association of Clinical Endocrinologist Annual Clinical and Scientific meeting, Boston,MA 2018
• International Conference on Diabetes and Diabetes Care, Charlotte, NC 2017
• International Diabetes and Degenerative Disease Conference, San Diego, CA 2017
• Endocrine Society Annual Scientific meeting, Orlando, FL 2017
• Endocrine Society Annual Scientific meeting, Boston, MA 2016
• Endocrine Society Annual Scientific meeting, San Diego, CA 2015
• American Association of Clinical Endocrinologist Annual Clinical and Scientific meeting, Nashville, TN 2015
• American Association of Clinical Endocrinologist Annual Clinical and Scientific meeting, Las Vegas, NV 2014
Reviewer - Journal of Clinical Endocrinology and Metabolism (JCEM) 2014 till date
Reviewer - Medical Research Journal of Medicine and Medical Sciences (MRJMMS) 2016 till date
Reviewer - The Journal of the Endocrine Society (JES) 2017
Editorial Board Member of Open Access Journal of Endocrinology (OAJE) 2017
Editorial Board Member of the journal, Gastroenterology and Liver Clinical and Medicals 2017 Reviewer- Novel Technique in Nutrition and Food Science 2017
National Outstanding Leadership Award 2018