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Objective: The objective is to determine the pattern and prevalence of diabetic retinopathy (DR) among patients living with diabetes mellitus. Methodology: Descriptive cross-sectional study in a tertiary hospital. Questionnaires were used to obtain data from eligible participants. Visual acuity measurement, fundal examination, and photography were performed together with fasting blood glucose and glycated hemoglobin A1c. The Statistical Package for Social Sciences (SPSS) for Windows version 20 was used for data analysis. Results: Overall 200 patients were enrolled of which 75.5% were female. The participant's mean age was 53.8 ± 11.7 years. DR was present in 53/200 (26.5%) of participants, of which 52 (98.1%) had nonproliferative DR (NPDR), and 1 (1.9%) had proliferative DR (PDR). NPDR was mild in 44/53 (83.0%) and moderate in 8/53 (15.1%) patients. Evidence of sight-threatening DR was found in 37/200 (18.5%) of participants (36 had diabetic macular edema and 1 had PDR + DMO). Conclusions: DR was present in 26.5% of the study participants, and 18.5% had sight-threatening DR mainly due to DMO. This finding underscores the need for routine screening of all people living with diabetes to detect early DMO and provide treatment to prevent visual loss.

There has been a rise in burden and risk factors for development and progression of diabetes mellitus in developing countries. The associated multisystemic complications and the burden of care potentially impair mental health status of sufferers. This study was aimed at assessing mental health status among diabetic patients in a developing country setting. Case-control study design was used, and subjects were recruited using random sampling method. Cases were recruited from medical wards and clinics in the University of Calabar Teaching Hospital, Calabar, for 14 weeks beginning mid-April through mid-July 2019. Age- and sex-matched non-diabetic normotensive controls were civil servants. Validated and pretested PHQ-9 instrument was used to assess mental health status, and clinical depression was defined as score > 10. p value was set at 0.05. One hundred and sixty-five diabetic patients and their matched controls were studied, with male/female ratio of 1:0.9. Mean age was 54.9 ± 9.6 years. Prevalence of clinical depression was 17.2% and 23.1% for male and female diabetics, respectively. For both male and female subjects, significantly higher proportion of cases compared with controls had clinical depression (p

Background: Sickle cell disease (SCD) is the commonest genetic disorder worldwide with a global prevalence of 20-25 million. About 12-15 million affected persons are in Sub-Sahara Africa with Nigeria bearing the highest burden of people living with sickle cell disease. SCD is a disease characterized as an autosomal, recessive, heterogeneous, and a monogenetic disorder caused by an A-to-T point mutation in the β-globin gene responsible for the production of abnormal hemoglobin S (HbS), which polymerizes in the deoxygenated state and results in the sickling of erythrocytes. Haemoglobin variants are mutant forms of haemoglobin in a population usually occurring as a result of genetic changes in specific genes, or globins that causes change on alterations in the amino acid. They could affect the structure, behavior, the production rate and the stability of the specific gene. Well-known haemoglobin variants such as sick-cell anaemia are responsible for diseases and are considered haemoglobinopathies. Other variants cause no detectable pathology and are thus considered as non-pathological variants. Aim: The study is aimed at evaluating the burden of sickle cell disease and other haemoglobin variants in Calabar, South-South Nigeria. Methods: This is a retrospective study done at the haematology laboratory of University of Calabar Teaching Hospital, Calabar. Cellulose acetate electrophoresis at alkaline pH was used for the evaluation of haemoglobinopathies. The data were entered into Microsoft Excel 2016 spreadsheet and analysed with the IBM SPSS Version 22. Data were summarized into percentage of different phenotypes. Results: Results of the total 3648 haemoglobin electrophoresis recorded, 1368 (37.50%) were male while the remaining 2280 (62.5%) females given a male to female ratio of 1:1.7. Five haemoglobin phenotypes were identified as HbAA, HbAS, HbAC, HbSC and HbSS. The overall average values of their prevalence were HbAA 64.78%, HbAS 32.62%, HbSS 2.14%, HbAC 0.33%, HbSC 0.14%. Thus, the prevalence of SCD (Prevalence of HbSS+HbSC) was 2.28%. The highest proportion of SCD was observed in 2011 with least in 2016 and 2017 respectively. Conclusion: The prevalence of SCD and other haemoglobin variants in Calabar is similar to that of the national prevalence rate. There is need for continuous enlightenment and premarital counselling on the pattern of inheritance of SCD most especially with the increased burden of sickle traits in the environment has reported in this study.

Background: Sickle cell disease (SCD) is often associated with liver disease. The constant state of haemolysis, multiple blood transfusion, viral hepatitis, hepatic sinusoidal congestion, haemosiderosis and cholestasis, are all conditions which may eventually evolve into liver disease. Sickle cell disease is a heterogeneous group of disorders that is usually associated with an autosomal recessive structural haemoglobin disorder. Biochemical abnormalities have been associated with SCD and it is usually more pronounced in vaso occlusive crises; an acute bone crisis and common painful complication of SCD, than in steady state. Aim: The aim of the study was to assess some biochemical parameters in relation to SCD patients in our environment with a view to improving the monitoring and management of these patients. Methodology: The study was a comparative hospital based research carried out at the University of Calabar Teaching Hospital (UCTH), Calabar, South-South Nigeria. Liver function tests were carried out on 60 SCA both in steady state and in crisis and also on 50 apparently healthy adults. The data collected were analyzed using statistical data for social sciences (SPSS) Version 22 for windows. Pearson linear correlation and simple inferential statistical methods were employed for data analysis, a P ≤ 0.05 was considered to be statistically significant. Result: The serum concentrations of AST, ALT, ALP, LDH, Total and conjugated bilirubin were seen to be elevated in VOC compared to in steady state and with the apparently healthy control group. The AST/ALT ratio was also observed to be elevated in VOC as compared with the steady state and the control. Significant product moment correlation was observed in the biochemical parameters both in steady state and in VOC. Conclusion: The findings of this study revealed marked changes in the biochemical parameters of the liver in VOC than in steady state. It will be recommended that routine evaluation and proper interpretation of liver enzymes is paramount in early detection of liver pathology in SCD.

Henry Ohem Okpa,1,2 Elvis Mbu Bisong,3 Ofem Egbe Enang,2,4 Emmanuel Edet Effa,1,2 Emmanuel Monjok,3,5 Ekere James Essien51Renal Unit, Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria; 2Department of Internal Medicine, University of Calabar, Calabar, Nigeria; 3Department of Family Medicine, University of Calabar, Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria; 4Endocrine and Metabolism Unit, University of Calabar Teaching Hospital, Calabar, Nigeria; 5Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USABackground: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD4 counts and associated with a high rate of morbidity and mortality. The objective of this study is to determine the prevalence and predictors of chronic kidney disease (CKD) amongst HIV patients on highly active antiretroviral therapy (HAART) at the University of Calabar Teaching Hospital, Calabar.Materials and methods: This was a cross-sectional study that was carried out over a 4-month period from May to August 2018. In all, a total of 118 patients with HIV on HAART were recruited into the study in a consecutive manner and their serum creatinine measured with the calculation of estimated glomerular filtration rate (eGFR). Other data collected were sex, age, weight, height, body mass index (BMI), waist hip ratio (WHR), packed cell volume, CD4 count etcetera. Data collected were inputted and analyzed with SPSS version 18, and statistical significance was taken to be p

The International Diabetes Federation estimates that 1.6 million (1 in 53) Nigerian adults have diabetes mellitus while 60.7% (949,900) of Nigerian adults with diabetes are undiagnosed. In spite of these worrying projections, current nationwide data on diabetes prevalence to aid policy formulation in Nigeria is non-existent. This was a cross-sectional observational study that recruited 1200 adults residing in the Southern Cross River State. Glucometers were used to measure the fasting capillary glucose of participants, and those with readings ≥ 7 mmol/l were asked to come back the following day for another fasting blood glucose check for confirmation. Those who had two fasting blood glucose readings consistently ≥ 7 mmol/l were classed as having diabetes mellitus and referred to the nearest hospital for further evaluation and management. Blood pressure and waist circumference were also measured. There were 683 (56.9%) females and the mean age of the participants was 41.3 ± 15.3. Using body mass index (BMI), 159 (13.3%) participants were found to be obese. The prevalence of diabetes mellitus among the tested participants was 6.9%. Univariate analysis was carried out to identify associations with diabetes among the participants. Statistically significant associations were identified between blood pressure > 140/90 mmHg (p = 0.013), local government area (p = 0.001), level of education (p = 0.002), and diabetes. The diabetes mellitus prevalence of 6.9% in this community is much higher than internationally reported estimates for Nigeria and makes a compelling case for further epidemiological studies on diabetes in Nigeria and prioritisation of this disease by health policy makers.

Introduction:among hypertensive patients, the comorbidity of diabetes is not uncommon. Yet, little is known about diabetes prevention among non-diabetic hypertensive patients. This study sought to assess such patients' knowledge about diabetes and its risk factors. Methods:a cross-sectional descriptive study design and random sampling were used to recruit non-diabetic hypertensive patients from University of Calabar Teaching Hospital. A pretested 33-item questionnaire was used to assess various aspects of diabetes knowledge. Participants' alcohol consumption, smoking habits, physical activity, and fresh fruit consumption were also assessed. The p-value was set to 0.05. Results:of 212 respondents with a mean age of 45.5 ± 10.8 years, approximately half (49.1%) had inadequate knowledge of diabetes. Most participants demonstrated poor knowledge of diabetes' clinical features (81.1%) and complications (59.4%), while fewer participants showed poor knowledge of causes and risk factors (24.5%) and diabetes management (40.6%). Older subjects, those in the wards, non-drinkers, physically active people, and those who frequently consumed fresh fruit had a significantly greater understanding of diabetes symptoms and complications (p

Henry Ohem Okpa,1 Elvis Mbu Bisong,2 Ofem Egbe Enang,1 Emmanuel Monjok,2,3 Ekere James Essien3 1Department of Internal Medicine, 2Department of Family Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria; 3Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA Background: The introduction of highly active antiretroviral therapy (HAART) has remarkably improved the prognosis of human immunodeficiency virus (HIV)-infected patients, at the expense of the development of long-term complications such as cardiovascular and renal diseases. Hypertension (HTN) is a major risk factor for cardiovascular diseases and its associated mortality. In this study, we aimed to determine the prevalence of HTN and to identify possible predictors among HIV-infected patients attending the HIV Special Treatment Clinic at the University of Calabar Teaching Hospital, Calabar.Materials and methods: A cross-sectional study was carried out over a 5-month period from February to July 2016. A total of 112 HIV-infected persons were consecutively recruited and their blood pressures were measured in two consecutive clinic visits. They were compared with the HIV-negative control group (n=309). Data collected were analyzed with SPSS 18, and statistical significance was set at P40 years), increased weight and body mass index (BMI), and presence of obesity. Male sex and duration of exposure to HAART and CD4 count levels >200 cells/mm3 were associated with HTN in HIV-infected patients, whereas the absence of family history of HTN was significantly associated with HTN in both groups. However, in a multivariate logistic regression, the predictors of HTN in both groups are absence of family history of HTN and older age in HIV-infected patients and HIV-negative subjects, respectively.Conclusion: Traditional risk factors such as older age, increased BMI, and obesity were linked to HTN in both HIV-infected and HIV-negative subjects, but higher CD4 count level and cumulative HAART exposure were associated with HTN in HIV-positive individuals. In a multivariate logistic regression, the predictors of HTN in both groups are absence of family history of HTN and older age in HIV-infected patients and HIV-negative subjects, respectively. Keywords: hypertension, urban, HIV, population, Calabar, Nigeria

Key Clinical Message While chronic pulmonary aspergillosis (CPA), pulmonary tuberculosis (PTB), and Klebsiella pneumoniae pneumonia co‐infection is rare, we present a 50‐year‐old woman with uncontrolled diabetes who presented with these three diseases. There is considerable overlap in symptoms of PTB and CPA. Treatment with antifungals, anti‐tuberculosis therapy, and antibiotics is beneficial.

Objective: To determine the prevalence and pattern of obesity among health workers in LUTH, Lagos. Nigeria.Methods: A cross-sectional survey was conducted in sample of 200 Nigerian adults in LUTH, Lagos. Bodyweight, height, waist circumference and blood pressure were measured using standard methods. Overweight and obesity were defined according to the World Health Organization classification. Central obesity was defined according to guidelines of the International Diabetes Federation.Results: The mean age of respondents was 33.6 ± 11.2 years. A total of 106 (53.0%) respondents were females while 94 (47.0%) of the respondents were males. The mean BMI and waist circumference were 23.1kg/m2 and 77.2 cm, respectively, for men and 23.5 kg/m2 and 79.6 cm, respectively, for women. The overall prevalence of obesity was 9.0 % and the prevalence was higher in females (15.7%) than in males (4.4%) and the difference was statistically significant (P

BACKGROUND : Excess weight gain is common in people with type 2 diabetes mellitus (DM) but little is known about its ethno-geographic variation among the Nigerian populace. We aimed to report the prevalence and regional variation of overweight/obesity among subjects with type 2 DM in all the six geo-political regions of Nigeria. METHOD : Basic demographic and anthropometric data were consecutively collected from patients with type 2 DM attending out-patient clinics of seven designated teaching hospitals in the six geographic regions of the country using a pre-agreed method of measurement of anthropometry including waist circumference. The study was hospital-based descriptive cross-sectional in design. Body Mass Index (BMI) was categorised using the WHO criteria. Based on recommendations of the International Diabetes Federation (IDF) cut-off values for waist circumference, values >94 cm and > 80 cm were taken as abnormal for men and women respectively. RESULTS : A total of 709 subjects with DM comprising 378 (53.3%) females and 331 (46.7%) males (female: male ratio 1:1.14) with an overall mean age (SD) of 51.9 (13.9) years were evaluated. The prevalence of excess body weight among Nigerian subjects with type 2 DM was: peripheral (417 or 58.8%) and abdominal obesity (449 or 63.3%). Also, there was a significant wide variation in excess weight gain (both peripheral and central) across ethno-geographic regions (p=0.001) and between both sexes (p=0.001). In both peripheral and abdominal obesities, whether intra or inter centres, the female subjects with type 2 DM demonstrated relatively higher proportions of anthropometric measures. Generally, subjects from south-south and south-east Nigeria had higher BMI and abdominal obesity compared to those from south-west who had the lowest. The female subjects with type 2 DM were heavier peripherally and centrally compared to their male counterparts. CONCLUSION : The prevalence of peripheral and central obesity among Nigerians living with type 2 DM (especially the female subjects) is unacceptably high. Additionally, there is a wide variation in the proportion and absolute values of both peripheral and central obesity across different parts of Nigeria. KEY WORDS : Obesity, Prevalence, Ethno-Geographic Variation, Nigerians, Type 2 Diabetes Mellitus

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Introduction: Anaemia is one of the haematological complications of HIV, and most of the studies in Nigeria and outside Nigeria have shown prevalence above 50%. Also, anaemia in HIV patients has been shown to be associated with morbidity and mortality. Our study therefore aimed to determine the prevalence and the likely risk factors associated with the development of anaemia among HIV patients attending the special treatment clinic in the University of Calabar Teaching Hospital, Calabar, Nigeria.Methods: This was a cross – sectional study conducted over a period of 6 months from June to November, 2010. A total of 321 patients were recruited but only 300 met the inclusion criteria, and their haemoglobin levels were measured with the use of Drabkin Cyanide method. Data obtained was analyzed with SPSS version 20 with statistical significance at p < 0.05.Results: There were more females than males in the study (70.0% vs 30.0%). Majority of the participants were in the 30 – 39 years age category (35.0%), closely followed by those in the 40 – 49 years age category (21.0%). The overall prevalence of anaemia was 76%. Female sex, living in an Urban Area and low CD4 cell count are risk factors that were associated with anaemia among HIV patients. However, in a multivariate logistic regression analysis, female sex was the only predictor of anaemia .Conclusion: Anaemia is a common complication seen among HIV patients in view of the prevalence rate of 76% observed in our study. The risk factors associated with anemia were female sex, living in urban area and low CD4 cell count.Keywords: Anaemia, HIV, Prevalence, Risk factors, Nigeria

Background: Chronic lymphocytic leukemia (CLL) is a heterogeneous group of monoclonal forms of lymphoproliferative disorder, which is usually common among older adults. There is an increasing trend in the number of patients presenting with the disease. Aim: This study aims to determine the epidemiology pattern of CLL in Cross River state. Methodology: A retrospective study with 10-years data (2010–2019) obtained from the register of the Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar. The data collected include the date of presentation, the age, gender, location of residence, and occupations of the patients. Results: A total of 47 cases were seen during the 10-year period, with a male: female ratio of 1:1. The mean age at presentation was 59 years. The majority of the patients were in their fifth and sixth decades of life. Most patients (44.68%) practice farming as their profession. Conclusion: The study has reawaken our consciousness on the increasing trend on the epidemiological burden of CLL in our environment and will help to enhance further investigation into the relationship between the rising trend and available possible risk factors in our environment.

A case report of a 56-year-old female patient who was managed for chronic lymphocytic leukemia with intravenous cyclophosphamide regimen who suddenly developed hyperglycemic state with no previous/family history of diabetes or steroid is presented. Laboratory investigation showed glycated hemoglobin of 6.1% and normal electrolyte and liver function. Diagnosis of prediabetic state was made, and the patient was commenced with oral hypoglycemic agent (metformin). Since then, blood glucose has been normalized.

This study aimed to identify the unmet sexual health needs of the patients with diabetes seen in a tertiary healthcare facility in Nigeria.Case-control study design and random sampling method were utilized to recruit type 2 diabetic cases from the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Female Sexual Function Index (FSFI) and International Index for Erectile Function (IIEF) were used to assess sexual function.There were 330 subjects with the mean age of 54.9 years. Among females, the FSFI score was lower among cases compared with controls (18.8 vs. 23.1, P0.05). Except for sexual interest, mean scores for all other domains of sexual function were also lower among cases (P0.05). Among males, there was no significant difference in overall mean IIEF score comparing cases and controls (40.0 vs. 41.7, P0.05). However, mean scores for desire and satisfaction was lower among cases compared with controls (P0.05). Older age, unmarried status, presence and duration of hypertension were associated with sexual dysfunction among females. The use of supplements was associated with sexual dysfunction among males (P0.05).Sexual dysfunction is common among diabetics with variation in affected domains in both genders in the study setting. These unmet sexual health needs focus to be addressed.

Background Diabetes is now a global epidemic, but most cases are now in low- and middle-income countries. Diabetes self-management education (DSME) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications. However, there is limited evidence on the effectiveness of different DSME programmes in resource limited settings. Methods We conducted an unblinded, parallel-group, individually-randomised controlled trial at the University of Calabar Teaching Hospital (Nigeria) to evaluate whether an intensive and systematic DSME programme, using structured guidelines, improved glycaemic control compared to the existing ad hoc patient education (clinical practice was unchanged). Eligible patients (≥18 years, HbA1c > 8.5% and physically able to participate) were randomly allocated by permuted block randomisation to participate for six months in either an intensive or conventional education group. The primary outcome was HbA1c (%) at six-months. Results We randomised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups, respectively. Intensive group participants had a mean six-month HbA1c (%) of 8.4 (95% CI: 8 to 8.9), while participants in the conventional education group had a mean six-month HbA1c (%) of 10.2 (95% CI: 9.8 to 10.7). The difference was statistically (P < 0.0001) and clinically significant, with intensive group participants having HbA1c outcomes on average -1.8 (95% CI: -2.4 to -1.2) percentage points lower than conventional group participants. Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data. Conclusions This study demonstrates the effectiveness of a structured, guideline-based DSME intervention in a LMIC setting versus a pragmatic comparator. The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs, where nurses/diabetes educators can run the programme. Trial Registration Pan African Clinical Trial Registry PACTR20130200047835

Objective: To assess the knowledge, beliefs, and practices among participants with diabetes mellitus (DM) receiving care at a tertiary government hospital in Calabar, Nigeria, on DM and diabetic eye disease. Materials and Methods: A hospital-based, cross-sectional study where serial recruitment of consenting participants was performed. Ethical approval was obtained from the hospitals’ ethics committee. Data were obtained using a structured interviewer-administered questionnaire. Data were collated and analyzed using the SPSS for Windows (version 20; SPSS Inc., Chicago, Illinois, USA). Categorical variables were presented as frequencies and continuous variables as means. Results: Of the 123 study participants, majority 87 (70.7%) were females and 36 (29.3%) were males. Forty-three (35%) had a duration of DM greater than 10 years. A total of 54 (44%) had good knowledge of DM. One hundred and six (86.2%) had the knowledge that regular eye checkups for a diabetic person was important, and 92 (69.9%) knew that DM could affect vision, whereas 84 (68.3%) believed that DM frequently affects vision. Eye-health-seeking behavior was good in 83 (67.5%) of participants, and an ophthalmologist was the medical personnel sought for by most participants. Conclusion: The knowledge of diabetic eye disease as a potential cause of vision loss among study participants was good. However, the knowledge on DM was poor in majority of study participants. The beliefs and practice toward eye-health were also good. Sustained health education including eye health education will most likely improve the knowledge base of DM and encourage early presentation for eye evaluation in patients with DM.

Objective Population data on dysglycemia are scarce in West Africa. This study aimed to determine the pattern of dysglycemia in Calabar city in South East Nigeria. Design This was a cross-sectional observational study. Methods 1134 adults in Calabar were recruited. A multistage sampling method randomly selected 4 out of 22 wards, and 50 households from each ward. All adults within each household were recruited and an oral glucose tolerance test was performed. Dysglycemia was defined as any form of glucose intolerance, including: impaired fasting glucose (blood glucose level 110–125 mg/dL), impaired glucose tolerance (blood glucose level ≥140 mg/dL 2 h after consuming 75 g of glucose), or diabetes mellitus (DM), as defined by fasting glucose level ≥126 mg/dL, or a blood glucose level ≥200 mg/dL, 2 h after a 75 g glucose load. Results Mean values of fasting plasma glucose were 95 mg/dL (95% CI 92.1 to 97.5) for men and 96 mg/dL (95% CI 93.2 to 98.6) for women. The overall prevalence of dysglycemia was 24%. The prevalence of impaired fasting glucose was 9%, the prevalence of impaired glucose tolerance 20%, and the prevalence of undiagnosed DM 7%. All values were a few percentage points higher for men than women. Conclusions The prevalence of undiagnosed DM among residents of Calabar is similar to studies elsewhere in Nigeria but much higher than the previous national prevalence survey, with close to a quarter of the adults having dysglycemia and 7% having undiagnosed DM. This is a serious public health problem requiring a programme of mass education and case identification and management in all health facilities. Trial registration number CRS/MH/CR-HREC/020/Vol.8/43

Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend.