Browsing by Author "Lamptey, R."
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Item African Cuisine-Centered Insulin Therapy: Expert Opinion on the Management of Hyperglycaemia in Adult Patients with Type 2 Diabetes Mellitus(Adis, 2021) Mbanya, J.C.; Lamptey, R.; Uloko, A.E.; Ankotche, A.; Moleele, G.; Mohamed, G.A.; Ramracheya, I.; Ramaiya, K.; Ndiweni, M.; Mbaye, M.N.; Bahendeka, S.; Kalra, S.The prevalence of diabetes in sub-Saharan Africa (SSA) is growing rapidly, and a steadily increas ing number of adults are estimated to be living with type 2 diabetes mellitus (T2DM). Insulin therapy is the treatment of choice in patients who present with severe hyperglycaemia and in most of those who do not achieve target goals on oral hypoglycaemic agents. Initiating treat ment with the appropriate type of insulin based on the meal patterns and lifestyle of the indi vidual patient is a strategy that is more likely than others to improve glycaemic control and adherence. African cuisine typically has a high carbohydrate load. Given these predominantly carbohydrate-rich food habits, it is essential to modify this dietary pattern whilst at the same time ensuring that insulin therapy is initiated, titrated and maintained in a timely manner, as needed to suit the patient’s habits. To date, there are no published clinical guidelines to guide practitioners and patients on tailoring insulin to match the high carbohydrate content in African cuisine. To address this gap, we have reviewed current insulin therapy practices and propose a patient-centric guide to insulin therapy based on African cuisine. A literature search was conducted for studies published in English up to November 2019 that focused on the choice of insulin and its dosing in relation to African foods. All articles extracted were reviewed by an expert group. The recommendation of the expert group was that basal-bolus and premix insulin regimens are best suited to manage post-meal glycaemia in African cuisine. The timing and constituents of the meal, portion sizes, glycaemic load and glycaemic index of meals should be considered when choosing the type of insulin and insulin regimen. Assessment of individual preferences and comorbidities should be prioritised and form an integral part of diabetes management.Item Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up(2008-07-11) Adjei, G.O.; Kurtzhals, J.A.L.; Rodrigues, O.P.; Alifrangis, M.; Hoegberg, L.C.G.; Kitcher, E.D.; Badoe, E.V.; Lamptey, R.; Goka, B.Q.Abstract Background Artesunate-amodiaquine (AS+AQ) and artemether-lumefantrine (AM-L) are efficacious artemisinin combination therapy (ACT) regimens that have been widely adopted in sub-Saharan Africa. However, there is little information on the efficacy of these regimens on subsequent episodes beyond 28 days, or on the safety of repeated treatments. Methods Children aged six months to 14 years with uncomplicated malaria were randomly assigned to treatment with AS+AQ (n = 116), or AM-L (n = 111). Recruited subjects were followed-up, initially for 28 days, and then monthly for up to one year. All subsequent attacks of uncomplicated malaria after 28 days were treated with the same regimen as at randomization. Investigations aimed at determining efficacy and side effects were conducted. Results Adequate clinical and parasitological response in subjects with evaluable end-points were, 97.1% (100/103) and 98.2% (107/109) on day 14, and 94.2% (97/103) and 95.3% (102/107) on day 28 in the AM-L and AS+AQ groups, respectively. Similar results were obtained after PCR correction. The incidence of malaria attacks in the year following recruitment was similar between the two treatment groups (p = 0.93). There was a high incidence of potentially AQ-resistant parasites in the study area. The incidence of adverse events, such as pruritus, fatigue and neutropaenia were similar in the two treatment groups. No patient showed signs of hearing impairment, and no abnormal neurological signs were observed during one year of follow-up. Other adverse events were mild in intensity and overlapped with known malaria symptomatology. No adverse event exacerbation was observed in any of the subjects who received multiple treatment courses with these ACT regimens during one year follow-up. Conclusion AS+AQ and AM-L were efficacious for treatment of children with uncomplicated malaria in Ghana and drug-related adverse events were rare in treated subjects during one year of follow-up. The high prevalence of potentially AQ resistant parasites raises questions about the utility of AQ as a partner drug for ACT in Ghana. The efficacy of AS+AQ in Ghana requires, therefore, continuous monitoring and evaluation. Trial registration NCT 00406146 http://www.clinicaltrials.govItem BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion(Diabetes Therapy, 2019-03-19) Lamptey, R.; Bajaj, S.; Das, A.K.; Kalra, S.; Sahay, R.; Saboo, B.; Das, S.; Shunmugavelu, M.; Jacob, J.; Priya, G.; Khandelwal, D.; Dutta, D.; Chawla, M.; Surana, V.; Tiwaskar, M.; Joshi, A.; Shrestha, P.K.; Bhattarai, J.; Bhowmik, B.; Latt, T.S.; Aye, T.T.; Vijayakumar, G.; Baruah, M.; Jawad, F.; Unnikrishnan, A.G.; Chowdhury, S.; Pathan, M.F.; Somasundaram, N.; Sumanathilaka, M.; Raza, A.; Bahendeka, S.K.; Coetzee, A.; Ruder, S.; Ramaiya, K.; Bavuma, C.; Shaikh, K.; Uloko, A.; Chaudhary, S.; Abdela, A.A.; Akanov, Z.; Rodrı`guez-Saldan˜a, J.; Faradji, R.; Tiago, A.; Reja, A.; Czupryniak, L.The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoringItem Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness(BMC Health Services Research, 2023) Lamptey, R.; Amoakoh‑Coleman, M.; Barker, M.M.; et al.Background In high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive. Aim To compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings. Research design and methods. Design Single-blind randomised parallel comparator controlled multi-centre trial. Adults (>18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 1:1 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotment concealed in opaque numbered envelopes. The intervention effect was assessed with linear mixed models. Main outcome: Change in HbA1c after 3-month follow-up. Primary analysis involved all participants. Clinicaltrial.gov identifer:NCT04780425, retrospectively registered on 03/03/2021. Results Recruitment: 22nd until 29th January 2021. We randomised 206 participants (69% female, median age 58 years [IQR: 49–64], baseline HbA1c median 64 mmol/ mol [IQR: 45–88 mmol/mol],7.9%[IQR: 6.4–10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up were death (n=1), stroke(n=1) and unreachable or unavailable (n=47). A reduction in HbA1c was found in both groups; -9 mmol/mol [95% CI: -13 to -5 mmol/mol], -0·9% [95% CI: -1·2% to -0·51%] in the intervention group and -3 mmol/mol [95% CI -6 to 1 mmol/mol], -0·3% [95% CI: -0·6% to 0.0%] in the control group. The intervention efect was 1 mmol/mol [95%CI:-5 TO 8 p=0.726]; 0.1% [95% CI: -0.5, 0.7], p=0·724], adjusted for site, age, and duration of diabetes. No significant harms were observed.Item Diabetes self-management education interventions and self-management in low resource settings; a mixed methods study(PLOS ONE, 2023) Lamptey, R.; Amoakoh-Coleman, M.; Djobala, B.; Grobbee, D.E.; Adjei, G.O.; Klipstein-Grobusch, K.Introduction Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. Aim We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). Research design and methods A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enu meration, consecutive sampling, purposive and judgemental sampling. Multivariable regres sion models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants’ experi ences and context, to complement the quantitative findings. Results In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-manage ment knowledge score was 40% ((IQR 20–60). For every one unit increase in diabetes self management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%- 9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial con straints, conflicting messages, beliefs, and stigma were the themes underpinning self-man agement behaviour. Conclusions The DSME interventions studied were under-resourced, and unstructured. Diabetes self management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incor porate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.Item Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care(Diabetes Therapy, 2019-12) Kalra, S.; Czupryniak, L.; Kilov, G.; Lamptey, R.; Kumar, A.; Unnikrishnan, A.G.; Boudiba, A.; Abid, M.; Akanov, Z.A.; Latheef, A.; Araz, M.; Audehm, R.; Bahendeka, S.Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.Item The impact of the COVID-19 pandemic on diabetes services: planning for a global recovery(Lancet Diabetes Endocrinol, 2022) Khunti, K.; Aroda, V.R.; Aschner, P.; Chan, J.C.N.; Prato, S.D.; Hambling, C.E.; Harris, S.; Lamptey, R.; McKee, M.; Tandon, N.; Valabhji, J.; Seidu, S.The COVID-19 pandemic has disproportionately affected certain groups, such as older people (ie, >65 years), minority ethnic populations, and people with specific chronic conditions including diabetes, cardiovascular disease, kidney disease, and some respiratory diseases. There is now evidence of not only direct but also indirect adverse effects of COVID-19 in people with diabetes. Recurrent lockdowns and public health measures throughout the pandemic have restricted access to routine diabetes care, limiting new diagnoses, and affecting self-management, routine follow-ups, and access to medications, as well as affecting lifestyle behaviours and emotional wellbeing globally. Pre-pandemic studies have shown that short-term delays in delivery of routine care, even by 12 months, are associated with adverse effects on risk factor control and worse microvascular, macrovascular, and mortality outcomes in people with diabetes. Disruptions within the short-to-medium term due to natural disasters also result in worse diabetes outcomes. However, the true magnitude of the indirect effects of the COVID-19 pandemic on long-term outcomes and mortality in people with diabetes is still unclear. Disasters tend to exacerbate existing health disparities; as we recover ambulatory diabetes services in the aftermath of the pandemic, there is an opportunity to prioritise those with the greatest need, and to target resources and interventions aimed at improving outcomes and reducing inequalityItem Plantains: Gluco-friendly usage(Journal Of Pakistan Medical Association, 2019-10) Lamptey, R.; Velayoudom, F.L.; Kake, A.; Uloko, E.A.; Rhedoor, A.J.; Kibirige, D.; Ndour, M.N.M.; Sobgnwi, E.; Kalra, S.Plantains are a staple food for a large proportion of the world's population. Rich sources of carbohydrates, they are considered taboo by most diabetes care providers. For persons living with diabetes, however, they are a preferred food item. This multi country authored article discusses the nutritional and culinary qualities of plantains. It discusses how to consume the fruit in a glucose-safe manner, by reducing the glycaemic load and total caloric load due to a low glycaemic index. Simple ways of modifying plantain preparation and serving are suggested, to help patients take this foodstuff without impacting glucose control.Item Structured diabetes self- management education and glycaemic control in low- and middle- income countries: A systematic review(Wiley, 2022) Lamptey, R.; Robben, M.P.; Amoakoh-Coleman, M.; Boateng, D.; Grobbee, D.E.; Davies, M.J.; Klipstein-Grobusch, K.Aim: To determine the association between structured diabetes self- management education (DSME) and glycaemic control in persons living with diabetes (PLD) in low- and middle- income countries (LMICs).Methods: PubMed, Embase and Cochrane databases were searched up to June 2020 for intervention studies on the effect of structured DSME on glycaemic con-trol in PLD in LMICs (PROSPERO registration CRD42020164857). The primary outcome was reduction in glycated haemoglobin. Included studies were assessed for risk of bias (RoB) with the Cochrane RoB tool for randomised trials. Findings were summarized in a narrative synthesis.Results: Out of 154 abstracts retrieved and screened for eligibility, nine stud-ies with a total of 1389 participants were included in the review. The structured DSME interventions were culturally tailored and were delivered in- person. They were associated with reductions in glycated haemoglobin in all studies: mean/median reduction ranged between 0.5% and 2.6% relative to baseline.Conclusions: There is a dearth of literature on the association between struc-tured DSME and glycaemic control among PLD in LMICs. The evidence available suggests that in LMICs; particularly in sub- Saharan Africa, structured DSME is associated with reduction in glycated haemoglobin. We recommend further in-tervention studies on the effects of structured DSME in LMICs.Item Structured diabetes self-management education and glycaemic control in low-and middle-income countries: A systematic review(Diabetic Medicine, 2022) Lamptey, R.; Robben, M.P.; Amoakoh-Coleman, M.; Boateng, D.; Grobbee, D.E.; Davies, M.J.; Klipstein-Grobusch, K.Aim: To determine the association between structured diabetes self-management education (DSME) and glycaemic control in persons living with diabetes (PLD) in low-and middle-income countries (LMICs). Methods: PubMed, Embase and Cochrane databases were searched up to June 2020 for intervention studies on the effect of structured DSME on glycaemic control in PLD in LMICs (PROSPERO registration CRD42020164857). The primary outcome was reduction in glycated haemoglobin. Included studies were assessed for risk of bias (RoB) with the Cochrane RoB tool for randomised trials. Findings were summarized in a narrative synthesis. Results: Out of 154 abstracts retrieved and screened for eligibility, nine studies with a total of 1389 participants were included in the review. The structured DSME interventions were culturally tailored and were delivered in-person. They were associated with reductions in glycated haemoglobin in all studies: mean/ median reduction ranged between 0.5% and 2.6% relative to baseline. Conclusions: There is a dearth of literature on the association between structured DSME and glycaemic control among PLD in LMICs. The evidence available suggests that in LMICs; particularly in sub-Saharan Africa, structured DSME is associated with reduction in glycated haemoglobin. We recommend further intervention studies on the effects of structured DSME in LMICs.