Insulin-requiring diabetes in Ethiopia: Associations with poverty, early undernutrition and anthropometric disproportion

Fekadu, S., Yigzaw, M., Alemu, S., Dessie, A., Fieldhouse, H., Girma, T., Trimble, E. R., Phillips, D. I.W. and Parry, E. H.O. (2010) Insulin-requiring diabetes in Ethiopia: Associations with poverty, early undernutrition and anthropometric disproportion. European Journal of Clinical Nutrition, 64 (10), 1192-1198. (doi:10.1038/ejcn.2010.143).

Abstract

Background/Objectives:Most insulin-requiring diabetes patients in Ethiopia have an atypical form of the disease, which resembles previous descriptions of malnutrition-related diabetes. As so little is known about its aetiology, we have carried out a case-control study to evaluate its social and nutritional determinants.

Subjects/Methods:Men and women with insulin-requiring diabetes (n=107), aged 18-40 years, were recruited in two centres, Gondar and Jimma, 750 km northwest and 330 km southwest of the capital, Addis Ababa, respectively. Controls of similar age and sex (n=110) were recruited from patients attending other hospital clinics.

Results:Diabetes was strongly associated with subsistence farming, odds ratio3.5 (95% confidence interval: 1.5-7.8) and illiteracy/low levels of education, odds ratio4.0 (2.0-8.0). Diabetes was also linked with a history of childhood malnutrition, odds ratio=5.5 (1.0-29.0) the mother's death during childhood, odds ratio3.9 (1.0-14.8), and markers of poverty including poorer access to sanitation (P=0.004), clean water (P=0.009), greater overcrowding (P=0.04), increased distance from the clinic (P=0.01) and having fewer possessions (P=0.01). Compared with controls, people with diabetes had low mid upper arm circumference, body mass index (BMI) and fat/lean body mass (P=0.01). In addition, men with the disease tended to be shorter, were lighter (P=0.001), with reduced sitting height (P=0.015) and reduced biacromial (P=0.003) and bitrochanteric (P=0.008) diameters.

Conclusions:Insulin-requiring diabetes in Ethiopia is strongly linked with poor education and markers of poverty. Men with the disease have associated disproportionate skeletal growth. These findings point towards a nutritional aetiology for this condition although the nature of the nutritional deficiency and its timing during growth and development remains obscure.

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