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P30 Facteurs de risque et complications obstétricales pour un diagnostic de rattrapage du diabète gestationnel à l'accouchement
DIABETES RESEARCH A N D CLINICAL PRACTICE
onset diabetes and having a first degree relative with diabetes (OR 3.92; P<0.007) and having two relatives with diabetes (OR 5.11; P<0.017). Conclusion: There is a high proportion of early onset type 2 diabetes in this study population which was associated with having a family history of diabetes, a first degree relative with diabetes and more than one diabetic relative.
P29 Severe renal failure in a diabetic patient with urinary tract infection: The kidney may be in bubbles! F. Ngeugoue Tchokouaha, M. Etoa, G. Ashuntantang. Department of Internal Medicine & Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon Introduction: Kidney disease frequently complicates diabetic mellitus. While diabetic nephropathy accounts for most of the cases of kidney disease, other consequences of diabetes mellitus such as immune depression may provide an enabling environment for infection-related kidney disease in this population. We report a case of emphysematous pyelonephritis in a 61 years old diabetic lady with severe renal failure. Case report: Ms N. is a 61 yrs. old retired nurse with 10 years of diabetes, hypertension and dyslipidemia referred for renal impairment. She had received 04 days of ofloxacine for E. coli urinary tract infection prior to presentation. Persistence of fever, the development of bilateral loin pains and the finding of a raised serum creatinine (75.6 mg/l, urea 3.74 g/l), prompted her referral to nephrology. Past history revealed no relevant chronic complications of diabetes, had normal values of creatinine 2 yrs ago (no recent values prior to admission). Her current therapy included insulin, atenolol and irbersantan. On arrival she was acutely ill looking, dehydrated, pale, BP 160/102 mmHg, febrile 38.5 C, pulse 98 bpm, with laboratory evidence of sepsis and urinary tract infection. CT scan of the kidneys was compatible with emphysematous pyelonephritis. Irbersatan was withheld, patient was rehydrated and received 5 doses of neltimicine on alternate days, intravenous metronidazole for 14 days, and carbapenem/cilastin for 21 days. Clinical outcome was good with a decrease in serum creatinine to 33.18 mg/l and a normal CT scan after 3 months. Conclusion: It is possible that this was a case of an acute on chronic kidney disease. Although irbersartan may have contributed to the acute renal injury of this patient, acute renal failure can occur with emphysematous pyelonephritis. Early diagnosis and appropriate management are crucial for good patient and renal survival.
P30 Facteurs de risque et complications obstétricales pour un diagnostic de rattrapage du diabète gestationnel à l’accouchement B. Tandu-Umba, A. Mbangama Muela. Département de Gynécologie et Obstétrique/Cliniques Universitaires de Kinshasa Introduction : Le diagnostic du diabète gestationnel doit s’effectuer suffisamment tôt (avant la 32ème semaine de gestation) pour pouvoir profiter à la grossesse en cours. Mais face au retard de fréquentation des consultations prénatales, nous avons cherché à déterminer parmi les accouchées récentes un groupe à risque de diabète gestationnel en vue d’une surveillance appropriée lors des grossesses futures et/ou le reste de la vie. Méthodes : Nous avons recherché les facteurs de risque et les complications obstétricales du diabète gestationnel parmi 183 accouchées à terme des Cliniques universitaires de Kinshasa durant la période allant du 1er mai au 31 octobre 2013. L’association entre les complications obstétricales rencontrées et les facteurs
103S (2014) S 1–S61
S41
de risque du diabète gestationnel a été évaluée par le calcul des Odds ratio. Résultats : Les complications obstétricales rencontrées ont montré une association significative (Odds ratio) avec 1. l’âge maternel ≥35 ans (OR 7,071, p 0,000, IC 3,388–14,760 pour la césarienne, OR 3,618, p 0,004, IC 1,535–8,527 pour l’Apgar 1’ <7, OR 4,365, p 0,006, IC 1,524–12,496 pour la macrosomie, OR 5,906, p 0,000, IC 2,427–14,372 pour le FPN) ; 2. l’antécédent de macrosomie fœtale (OR 82,5, p 0,000, IC 15,008–453,512 pour la macrosomie) ; 3. l’antécédent familial de diabète (OR 18,222, p 0,001, IC 3,651– 90,944 pour la macrosomie, OR 13,680, p 0,024, IC 2,118–88,354 pour la mort in utero, OR 43,250, p 0,001, IC 6,584–284,129 pour la malformation congénitale) ; 4. l’antécédent maternel de diabète gestationnel (OR 10,636, p 0,019, IC 1,682–67,243 pour le FPN) ; 5. l’antécédent de mort in utero (OR 6,696, p 0,038, IC 1,274– 35,186 pour l’Apgar 1’ <7, OR 14,857, p 0,003, IC 2,563–86,137 pour le FPN). Conclusion : A défaut de diagnostiquer le diabète gestationnel à temps au cours de la grossesse, sa reconnaissance à l’accouchement demeure utile pour déterminer le groupe à surveiller pour risque de diabète à plus ou moins longue échéance.
P31 Starting a hospital-based diabetes management program in a semi-urban setting: from community action to implementation J.C. Katte a , G. Fetse a , C. Kouam Kouam a , M. Dehayem b , E. Sobngwi b . a Bafoussam Regional Hospital; b Yaoundé Central Hospital Objective: Organise diabetes care is crucial for effective follow up and control of diabetes and its complications. The purpose of this project was to organise and implement a system of primary care for people with type 2 diabetes in a hospital setting devoid of diabetes care. Methods: Free screening campaign for diabetes and hypertension was organised, followed by consultation with a nurse and nutritionist. Fasting capillary blood glucose and blood pressure were measured using a glucose meter and a calibrated electronic blood pressure machine respectively in subjects who responded via radio invitation. Anthropometric parameters were also measured and all the values were recorded in an already established questionnaire. A 6 km city wide walk was organised to raise awareness on diabetes. Those with elevated blood pressure values and/or glycaemic values were invited to the hospital for confirmation and eventual follow up. Results: A total of 255 persons took part in the diabetes awareness city wide walk while 1711 adults (973 women) participated in the screening campaign. Among them, 103 (6.0%) had diabetes and were aware, 99 (6.2%) participants were diagnosed having diabetes while 146 (9.1%) had Impaired Fasting Glucose. 66 (66.7%) participants of those newly diagnosed with diabetes were females and 54 (54.4%) were older than 45 years. Finally, a total of 348 participants were enrolled to start routine diet and primary diabetes care in the hospital. Conclusion: Creation of a successful system of care for patients with diabetes in a hospital setting is possible through innovative collaboration and community action.
P32 Benefits of using PMWC with bariatric surgery in morbidly obese patients L. Shchukina. Limo House Hospital, Rift Valley, Kenya Introduction: This presentation was designed to demonstrate a
onset diabetes and having a first degree relative with diabetes (OR 3.92; P<0.007) and having two relatives with diabetes (OR 5.11; P<0.017). Conclusion: There is a high proportion of early onset type 2 diabetes in this study population which was associated with having a family history of diabetes, a first degree relative with diabetes and more than one diabetic relative.
P29 Severe renal failure in a diabetic patient with urinary tract infection: The kidney may be in bubbles! F. Ngeugoue Tchokouaha, M. Etoa, G. Ashuntantang. Department of Internal Medicine & Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon Introduction: Kidney disease frequently complicates diabetic mellitus. While diabetic nephropathy accounts for most of the cases of kidney disease, other consequences of diabetes mellitus such as immune depression may provide an enabling environment for infection-related kidney disease in this population. We report a case of emphysematous pyelonephritis in a 61 years old diabetic lady with severe renal failure. Case report: Ms N. is a 61 yrs. old retired nurse with 10 years of diabetes, hypertension and dyslipidemia referred for renal impairment. She had received 04 days of ofloxacine for E. coli urinary tract infection prior to presentation. Persistence of fever, the development of bilateral loin pains and the finding of a raised serum creatinine (75.6 mg/l, urea 3.74 g/l), prompted her referral to nephrology. Past history revealed no relevant chronic complications of diabetes, had normal values of creatinine 2 yrs ago (no recent values prior to admission). Her current therapy included insulin, atenolol and irbersantan. On arrival she was acutely ill looking, dehydrated, pale, BP 160/102 mmHg, febrile 38.5 C, pulse 98 bpm, with laboratory evidence of sepsis and urinary tract infection. CT scan of the kidneys was compatible with emphysematous pyelonephritis. Irbersatan was withheld, patient was rehydrated and received 5 doses of neltimicine on alternate days, intravenous metronidazole for 14 days, and carbapenem/cilastin for 21 days. Clinical outcome was good with a decrease in serum creatinine to 33.18 mg/l and a normal CT scan after 3 months. Conclusion: It is possible that this was a case of an acute on chronic kidney disease. Although irbersartan may have contributed to the acute renal injury of this patient, acute renal failure can occur with emphysematous pyelonephritis. Early diagnosis and appropriate management are crucial for good patient and renal survival.
P30 Facteurs de risque et complications obstétricales pour un diagnostic de rattrapage du diabète gestationnel à l’accouchement B. Tandu-Umba, A. Mbangama Muela. Département de Gynécologie et Obstétrique/Cliniques Universitaires de Kinshasa Introduction : Le diagnostic du diabète gestationnel doit s’effectuer suffisamment tôt (avant la 32ème semaine de gestation) pour pouvoir profiter à la grossesse en cours. Mais face au retard de fréquentation des consultations prénatales, nous avons cherché à déterminer parmi les accouchées récentes un groupe à risque de diabète gestationnel en vue d’une surveillance appropriée lors des grossesses futures et/ou le reste de la vie. Méthodes : Nous avons recherché les facteurs de risque et les complications obstétricales du diabète gestationnel parmi 183 accouchées à terme des Cliniques universitaires de Kinshasa durant la période allant du 1er mai au 31 octobre 2013. L’association entre les complications obstétricales rencontrées et les facteurs
103S (2014) S 1–S61
S41
de risque du diabète gestationnel a été évaluée par le calcul des Odds ratio. Résultats : Les complications obstétricales rencontrées ont montré une association significative (Odds ratio) avec 1. l’âge maternel ≥35 ans (OR 7,071, p 0,000, IC 3,388–14,760 pour la césarienne, OR 3,618, p 0,004, IC 1,535–8,527 pour l’Apgar 1’ <7, OR 4,365, p 0,006, IC 1,524–12,496 pour la macrosomie, OR 5,906, p 0,000, IC 2,427–14,372 pour le FPN) ; 2. l’antécédent de macrosomie fœtale (OR 82,5, p 0,000, IC 15,008–453,512 pour la macrosomie) ; 3. l’antécédent familial de diabète (OR 18,222, p 0,001, IC 3,651– 90,944 pour la macrosomie, OR 13,680, p 0,024, IC 2,118–88,354 pour la mort in utero, OR 43,250, p 0,001, IC 6,584–284,129 pour la malformation congénitale) ; 4. l’antécédent maternel de diabète gestationnel (OR 10,636, p 0,019, IC 1,682–67,243 pour le FPN) ; 5. l’antécédent de mort in utero (OR 6,696, p 0,038, IC 1,274– 35,186 pour l’Apgar 1’ <7, OR 14,857, p 0,003, IC 2,563–86,137 pour le FPN). Conclusion : A défaut de diagnostiquer le diabète gestationnel à temps au cours de la grossesse, sa reconnaissance à l’accouchement demeure utile pour déterminer le groupe à surveiller pour risque de diabète à plus ou moins longue échéance.
P31 Starting a hospital-based diabetes management program in a semi-urban setting: from community action to implementation J.C. Katte a , G. Fetse a , C. Kouam Kouam a , M. Dehayem b , E. Sobngwi b . a Bafoussam Regional Hospital; b Yaoundé Central Hospital Objective: Organise diabetes care is crucial for effective follow up and control of diabetes and its complications. The purpose of this project was to organise and implement a system of primary care for people with type 2 diabetes in a hospital setting devoid of diabetes care. Methods: Free screening campaign for diabetes and hypertension was organised, followed by consultation with a nurse and nutritionist. Fasting capillary blood glucose and blood pressure were measured using a glucose meter and a calibrated electronic blood pressure machine respectively in subjects who responded via radio invitation. Anthropometric parameters were also measured and all the values were recorded in an already established questionnaire. A 6 km city wide walk was organised to raise awareness on diabetes. Those with elevated blood pressure values and/or glycaemic values were invited to the hospital for confirmation and eventual follow up. Results: A total of 255 persons took part in the diabetes awareness city wide walk while 1711 adults (973 women) participated in the screening campaign. Among them, 103 (6.0%) had diabetes and were aware, 99 (6.2%) participants were diagnosed having diabetes while 146 (9.1%) had Impaired Fasting Glucose. 66 (66.7%) participants of those newly diagnosed with diabetes were females and 54 (54.4%) were older than 45 years. Finally, a total of 348 participants were enrolled to start routine diet and primary diabetes care in the hospital. Conclusion: Creation of a successful system of care for patients with diabetes in a hospital setting is possible through innovative collaboration and community action.
P32 Benefits of using PMWC with bariatric surgery in morbidly obese patients L. Shchukina. Limo House Hospital, Rift Valley, Kenya Introduction: This presentation was designed to demonstrate a