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Insulin-requiring diabetes in rural Ethiopia: should we reopen the case for malnutrition-related diabetes?

Insulin-requiring diabetes in rural Ethiopia: should we reopen the case for malnutrition-related diabetes?
Insulin-requiring diabetes in rural Ethiopia: should we reopen the case for malnutrition-related diabetes?
AIMS/HYPOTHESIS: We evaluated the incidence of insulin-requiring diabetes in a rural area of sub-Saharan Africa. METHODS: Health surveillance data from a chronic disease programme in two zones of Ethiopia, Gondar and Jimma, were studied. The two zones have a population of more than 5,000,000 people. RESULTS: In Gondar Zone (1995-2008) and Jimma Zone (2002-2008) 2,280 patients presented with diabetes, of whom 1,029 (45%) required insulin for glycaemic control at diagnosis. The annual incidence of insulin-requiring diabetes was 2.1 (95% CI 2.0-2.2) per 100,000 and was twice as high in men (2.9 per 100,000) as in women (1.4 per 100,000). In both sexes incidence rates peaked at the age of 25 to 29 years. Incidence rates in the urban areas of Gondar and Jimma were five times higher than in the surrounding rural areas. Patients with insulin-requiring diabetes from rural and urban areas had a very low BMI and most were subsistence farmers or unemployed. CONCLUSIONS/INTERPRETATION: The typical patient with diabetes in rural Ethiopia is an impoverished, young adult male with severe symptoms requiring insulin for glycaemic control. The low incidence rates in rural compared with urban areas suggest that many cases of this disease remain undiagnosed. The disease phenotype encountered in this area of Africa is very different from the classical type 1 diabetes seen in the West and most closely resembles previous descriptions of malnutrition-related diabetes, a category not recognised in the current WHO Diabetes Classification. We believe that the case for this condition should be reopened.
0012-186X
1842-1845
Alemu, S.
f5112fb0-ebf9-4306-9aa5-fc413f26b4cf
Dessie, A.
ca73507c-d979-441f-a304-f8d1c8036242
Seid, E.
74406afa-4f01-4061-b8ee-a41282262dbf
Bard, E.
a003f080-1ccc-4f49-b9e5-fbb953e1d848
Lee, P.T.
49ea7373-c39e-4bc6-8a4d-5bee85efcb19
Trimble, E.R.
85363650-46d7-4afe-b981-fd1ad6d99b5a
Phillips, D.I.
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Parry, E.H.
7bddaf95-a266-4379-8a76-bf84fd439139
Alemu, S.
f5112fb0-ebf9-4306-9aa5-fc413f26b4cf
Dessie, A.
ca73507c-d979-441f-a304-f8d1c8036242
Seid, E.
74406afa-4f01-4061-b8ee-a41282262dbf
Bard, E.
a003f080-1ccc-4f49-b9e5-fbb953e1d848
Lee, P.T.
49ea7373-c39e-4bc6-8a4d-5bee85efcb19
Trimble, E.R.
85363650-46d7-4afe-b981-fd1ad6d99b5a
Phillips, D.I.
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Parry, E.H.
7bddaf95-a266-4379-8a76-bf84fd439139

Alemu, S., Dessie, A., Seid, E., Bard, E., Lee, P.T., Trimble, E.R., Phillips, D.I. and Parry, E.H. (2009) Insulin-requiring diabetes in rural Ethiopia: should we reopen the case for malnutrition-related diabetes? Diabetologia, 52 (9), 1842-1845. (doi:10.1007/s00125-009-1433-5).

Record type: Article

Abstract

AIMS/HYPOTHESIS: We evaluated the incidence of insulin-requiring diabetes in a rural area of sub-Saharan Africa. METHODS: Health surveillance data from a chronic disease programme in two zones of Ethiopia, Gondar and Jimma, were studied. The two zones have a population of more than 5,000,000 people. RESULTS: In Gondar Zone (1995-2008) and Jimma Zone (2002-2008) 2,280 patients presented with diabetes, of whom 1,029 (45%) required insulin for glycaemic control at diagnosis. The annual incidence of insulin-requiring diabetes was 2.1 (95% CI 2.0-2.2) per 100,000 and was twice as high in men (2.9 per 100,000) as in women (1.4 per 100,000). In both sexes incidence rates peaked at the age of 25 to 29 years. Incidence rates in the urban areas of Gondar and Jimma were five times higher than in the surrounding rural areas. Patients with insulin-requiring diabetes from rural and urban areas had a very low BMI and most were subsistence farmers or unemployed. CONCLUSIONS/INTERPRETATION: The typical patient with diabetes in rural Ethiopia is an impoverished, young adult male with severe symptoms requiring insulin for glycaemic control. The low incidence rates in rural compared with urban areas suggest that many cases of this disease remain undiagnosed. The disease phenotype encountered in this area of Africa is very different from the classical type 1 diabetes seen in the West and most closely resembles previous descriptions of malnutrition-related diabetes, a category not recognised in the current WHO Diabetes Classification. We believe that the case for this condition should be reopened.

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Submitted date: 2009

Identifiers

Local EPrints ID: 72475
URI: https://eprints.soton.ac.uk/id/eprint/72475
ISSN: 0012-186X
PURE UUID: 469d9e61-a2bb-4d10-99ee-6894fc57d303

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Date deposited: 16 Feb 2010
Last modified: 18 Jul 2017 23:54

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