摘要
This case describes the diagnosis of secondary diabetes mellitus in a patient with chronic heart failure,followed in Bunia since 2022,province of Ituri in the Democratic Republic of Congo,transferred to the Clinique International de Medecine Avancee au Kivu(CIMAK)in eastern Democratic Republic of Congo(DRC).The patient is a 32-year-old nurse born into a non-diabetic sibling group of 5 children,all of whom are still alive.He was transferred to CIMAK from BUNIA for the first time in 2022,diagnosed with heart failure with reduced ejection fraction,with blood sugar levels within the norms,treated as an outpatient,stabilized and then returned to BUNIA with an appointment that was not kept due to a lack of resources,especially air transport.The patient was transferred back to CIMAK on September 23,2024 with 48-hour anuria,congestive signs,NYHA IV dyspnea,and blood pressure 127/83 mmHg,heart rate 112 bpm,oxygen saturation 84%at free air.The patient had prominent and turgid jugular veins;his cardiopulmonary examination was marked by regular tachycardia,protodiastolic gallop,pluriorificial systolic murmur and pulmonary crepitations.His abdomen showed a stasis liver,and his lower limbs were edematous.The workup requested:NT-ProBNP came back elevated at 6535.81 pg/L due to lack of BNP,fasting plasma glucose elevated at 220 mg/dL from 400 mg/dL in Bunia since 48 hours,glycated hemoglobin(HbA1c)8.97%.We believe that diabetes mellitus secondary to heart failure is caused by several mechanisms,notably insulin resistance and pancreatic hypoperfusion.It is crucial to disseminate this diagnosis in order to draw the attention of clinicians in the DRC to patient education and the systematic search for secondary diabetes in heart failure patients,thereby improving the poor prognosis associated with its occurrence in heart failure patients in our resource-limited environment.
