Age and living in an urban environment are major determinants of diabetes among South Kivu Congolese adults

Prevalence and Associated Factors of Diabetes Mellitus Among Newly Enrolled Tuberculosis Patients in Lubumbashi (DRC)

Background

Tuberculosis and diabetes mellitus are major public health challenges worldwide. The two scourges have bidirectional relationship with high morbidity and mortality.

Objective

The present study was conducted to determine the prevalence of diabetes mellitus and identify related factors in patients with tuberculosis.

Methods

A cross-sectional study was conducted in 11 tuberculosis screening and treatment centers in Lubumbashi (DRC) from September to December 2022. Adult patient with a positive smear for tuberculosis were systematically screened for diabetes mellitus. Demographic characteristics, history and symptomatology were the variables of interest. Data was entered using Microsoft Excel software. STATA 16 software was used for analysis.

Results

A total of 255 tuberculosis patients were recruited and the prevalence of diabetes mellitus among these patients was 11.4% (ie, 29 out of 255). After uni and multivariate logistic regression, a BMI ≤ 18.5 Kg/m2, lack of employment, polyuria and intense thirst were the factors associated with diabetes mellitus in tuberculosis patients.

Conclusion

The prevalence of diabetes mellitus in smear positive tuberculosis patients in the present study was higher than the one observed in Central Africa.

Consensus on potential interventions for improving glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a Delphi study

BACKGROUND

Poor glycaemic control is a multifactorial and complex problem with dire clinical and economic implications. In the Democratic Republic of the Congo, recent studies have shown alarming poor control rates. There is no policy framework to guide corrective actions.

OBJECTIVES

To build a consensus on interventions to improve glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo.

METHODS

This was a two-round electronic Delphi study involving 31 local and 5 international experts. The experts rated proposed interventions from previous studies on glycaemic control in sub-Saharan Africa and Kinshasa on a 4-Likert scale questionnaire. Additionally, the experts were asked to suggest other recommendations useful for the purpose. The mode, mean and standard deviation of each statement were calculated for each round.

RESULTS

Participants reached consensus in five domains that included 39 statements on how to improve glycaemic control in Kinshasa: strengthening the health system, enhancing the awareness of diabetes, alleviating the financial burden of diabetes, enhancing the adoption of lifestyle modifications, and reducing the proportion of undiagnosed diabetes.

CONCLUSIONS

Improved glycaemic control needs to be considered within the broader framework of managing noncommunicable diseases in a more integrated, coordinated and better financed healthcare system. Further studies are needed to operationalise the interventions identified for successful implementation.

[Mauvais contrôle des facteurs de risque cardiovasculaire modifiables chez les patients congolais en phase aiguë et séquellaire d'un accident vasculaire cérébral : Une étude transversale]

PURPOSE

To assess the level of the control of the cardiovascular risk factors in patients with a history of stroke in the Democratic Republic of the Congo.

METHODS

The level of the control of arterial hypertension, diabetes mellitus, and dyslipidemias was analyzed in two hundred and seventy-four (274) patients followed for stroke.

RESULTS

Among 188 patients with a prior diagnosis of arterial hypertension, only 100 (53.2%) were treated, 27 (27.0%) had their blood pressure well controlled [12.3% in acute stroke vs. 46.5% in sequelae phase; p = 0.0002].  Among 42 (71.2%) diabetics treated, 23 (63.9%) had glycaemia levels > 200 mg/dl, 60.0% in acute phase and 83.3% in sequelae phase (p = 0.28). Finally, 87.0% of the patients had a non-HDL-C > 85 mg/dl.

CONCLUSIONS

This study shows a poor control of modifiable cardiovascular risk factors in patients with very high cardiovascular risk due to stroke. There is a need for an effective program to combat non-communicable diseases in our environment.

Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo

Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33-61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73-10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41-10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71-9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16-6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17-2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care.

Health Care Providers' Knowledge of Tuberculosis and Diabetes Mellitus Comorbidity in Lubumbashi, Democratic Republic of the Congo (DRC)

Background

Tuberculosis-Diabetes mellitus (TB-DM) co-morbidity is a growing scourge in the world. The new approaches and interventions for TB control implemented by the Tuberculosis National Control Program (TNCP) in DRC require the involvement of health care providers for their success.

Objective

The objective of this study is to assess the knowledge of health care provider on different aspects of the management of TB-DM co-morbidity and to compare this knowledge according to the health care system, the type of providers and the number of years of experience.

Methods

Cross-sectional and analytic study was conducted in 11 health care facilities in the Lubumbashi Health District, selected by reasoned choice, and an electronic questionnaire was administered to health care providers. These providers were interviewed on the different aspects of the management of the TB-DM comorbidity. The data were presented and compared in relation to knowledge about TB, DM, and TB-DM comorbidity.

Results

A total of 113 providers were interviewed, predominantly males and physicians. Questions related to knowledge about DM were better answered. Doctors compared to paramedics; tertiary-level providers compared to secondary-level providers had better responses to the different questions. There is a statistically significant correlation between the level of knowledge of TB, DM and the type of health care provider, the number of years of experience.

Conclusion

The present study shows that there are gaps in the knowledge of our health care providers and community members on the recommendations of the DRC TB guidelines (Programme AntiTuberculeux Intégré 5: PATI 5) in general and on the management of TB-DM. It is therefore important and necessary to put in place strategies to improve this level of knowledge, which will focus on the extension of the guidelines, the awareness and the training of the stakeholders involved in the control.

[Influence of arterial hypertension on the clinical profile and prognosis of patients hospitalized for COVID-19 in the city of Bukavu, in the Democratic Republic of Congo : Prospective cohort study]

PROBLEM

There are no studies on the association between high blood pressure and COVID-19 in South Kivu.

OBJECTIVE

to determine the influence of arterial hypertension on the clinical characteristics and prognosis of COVID-19 patients hospitalized in the city of Bukavu.

METHODOLOGY

Between June 2020 and June 2022, an open cohort of hypertensive and non-hypertensive COVID-19 patients admitted to two clinics in the city of Bukavu was formed. The primary endpoint was the occurrence of death. Thus, a prospective modeling of mortality by the Kaplan-Meier estimator was carried out.

RESULTS

Among the 178 admissions for COVID-19, 68 (38.2%) patients were hypertensive. Compared to non-hypertensives, hypertensive patients were significantly older [61.0 (56.0-71.0) vs. 48.0 (32.7-64.0); p < 0,0001). During the observation period of 1059 patient-days, the incidence of death (3.2/100 patient-days) was non-significantly higher in hypertensive patients (4.3/100 patient-days) (p = 0.06). On the other hand, the independent predictors of death were Sepsis [adjusted HR = 3.7 (1.5-8.7)], CRP > 100 mg/L [adjusted HR = 3.0 (1.2-7, 0)] and SaO₂ < 90 % [adjusted HR = 3.9 (1.3-11.8)].

CONCLUSION

This study shows that hypertension was very common in patients admitted for COVID-19 in the city of Bukavu but did not influence the vital prognosis of the latter, thus confirming the finds of most authors who have addressed the question.

Diabetes prevalence and risk factors, underestimated without oral glucose tolerance test, in rural Gombe-Matadi Adults, Democratic Republic of Congo, 2019

An increase in the diabetes prevalence is reported worldwide. We aimed to determine the diabetes prevalence and its risk factors among adults in a rural area of the Democratic Republic of Congo. A cross-sectional study was conducted in 1531 inhabitants, selected by five stages, in the Health Zone of Gombe-Matadi. Diabetes was defined according to the American Diabetes Association and the International Diabetes Federation. Fasting glycemia and/or an oral glucose tolerance test were collected. We measured body mass index, waist circumference and blood pressure. Mann Whitney's and chi-square tests compared respondents with non-respondents. Multivariable logistic regression measured associations between diabetes and its risk factors. Crude and standardized prevalence of diabetes were 6.7% and 5.3%, respectively. Undiagnosed diabetes accounted for 58.8%. The oral glucose tolerance test alone diagnosed 2.6% of cases. Diabetes was more frequent in males, unemployed, obese and hypertensive (p < 0.05). Risk factors for diabetes were being male, aged ≥ 40 years, general and abdominal obesity associated with elderly, family history of diabetes, and hypertension. Diabetes in rural areas of the Democratic Republic of Congo appears to be underdiagnosed. The oral glucose tolerance test provides an opportunity to screen individuals for diabetes in this setting.

High prevalence of diabetes in elderly of Iran: an urgent public health issue

Purpose

To determine the distribution of blood glucose and prevalence of diabetes in people above 60 years living in Tehran and their relationship with some variables.

Methods

In this cross-sectional population-based study, multistage cluster sampling was performed in the over 60-year-old population of Tehran. Blood samples were collected from all participants and the data of the history of diabetes and the use of blood glucose lowering agents or other drugs were collected using interviews.

Results

Of 3791 selected subjects, 3310 participated in the study (response rate = 87.3%). The mean blood Sugar (BS) and hemoglobin A1c (HbA1c) of the patients was 118.11(95% CI: 115.34 -120.88) and 6.12(95% CI: 6.05-6.2) respectively. The prevalence of diabetes was 29.03%(95% CI: 27.12-30.94) in all subjects, 26.83%(95% CI: 24.58-29.07) in men, and 31.2%(95% CI: 28.24-34.16) in women. Odds of diabetes was significantly worse in women. systolic blood pressure, diasstolic blood pressure, height, weight, waist circumference, wrist circumference, hip circumference, neck circumference and body mass Index were significantly higher in diabetic after adjusting for the effect of sex and age. The odds of blindness was 2.69 (95% CI: 1.10-6.59) times higher in diabetic than in non-diabetics.

Conclusions

On average, one in every three persons above 60 years of age was diabetic. Therefore, attention should be paid to this age group, especially women, due the higher prevalence of diabetes. All anthropometric measurements except height had a strong correlation with diabetes. Blindness was significantly more in diabetics.

Are people most in need utilising health facilities in post-conflict settings? A cross-sectional study from South Kivu, eastern DR Congo

Background: The disruptive effect of protracted socio-political instability and conflict on the health systems is likely to exacerbate inequities in health service utilisation in conflict-recovering contexts.Objective: To examine whether the level of healthcare need is associated with health facility utilisation in post-conflict settings.Methods: We conducted a cross-sectional study among adults with diabetes, hypertension, mothers of infants with acute malnutrition, informal caregivers (of participants with diabetes and hypertension) and helpers of mothers of children acutely malnourished, and randomly selected neighbours in South Kivu province, eastern DR Congo. Healthcare need levels were derived from a combination, summary and categorisation of the World Health Organisation Disability Assessment Schedule 2.0. Health facility utilisation was defined as having utilised in the first resort a health post, a health centre or a hospital as opposed to self-medication, traditional herbs or prayer homes during illness in the past 30 days. We used mixed-effects Poisson regression models with robust variance to identify the factors associated with health facility utilisation.Results: Overall, 82% (n = 413) of the participants (N = 504) utilised modern health facilities. Health facility utilisation likelihood was higher by 27% [adjusted prevalence ratio (aPR): 1.27; 95% CI: 1.13-1.43; p < 0.001] and 18% (aPR: 1.18; 95% CI: 1.06-1.30; p = 0.002) among participants with middle and higher health needs, respectively, compared to those with low healthcare needs. Using the lowest health need cluster as a reference, participants in the middle healthcare need cluster tended to have a higher hospital utilisation level.Conclusion: Greater reported healthcare need was significantly associated with health facility utilisation. Primary healthcare facilities were the first resort for a vast majority of respondents. Improving the availability and quality of health service packages at the primary healthcare level is necessary to ensure the universal health coverage goal advocating quality health for all can be achieved in post-conflict settings.

Comparison of prostate size and anthropometric parameters between diabetic and non-diabetic Congolese patients who underwent transurethral prostate resection in the Democratic Republic of Congo

Background

Benign prostate hyperplasia (BPH) and type 2 diabetes mellitus are prevalent in older men, and both represent a challenge to public health. Prior studies reported a correlation between BPH and (hyper)glycaemia, a component of the metabolic syndrome, which is on the increase in sub-Saharan Africa (SSA) due to rapid modernization. This study was designed to evaluate the association of prostate volume and anthropometric parameters among diabetic and non-diabetic patients who had transurethral resection of the prostate (TURP) for BPH.

Results

We analyzed data of 159 selected patients who had TURP over a three-year period (February 2014–January 2017) for histologically confirmed BPH. Mean age in the entire cohort was 68 ± 8.5 years. Out of the 159 patients, 94 (59.1%) were non-diabetics and 65 (40.9%) were diabetics. International Prostate Symptom Score (IPSS) and fasting blood glucose were significantly higher in diabetic than in non-diabetic group (28.6 ± 4.3 vs 25.6 ± 6.4, and p 0.005; 121.7 ± 45.7 vs 85.4 ± 11.7 mg/dl, and p < 0.001, respectively). BMI and waist circumference were statistically greater in non-diabetics than in diabetics (25.1 ± 3.3 kg/m2 vs 23.6 ± 3.5 kg/m2, and p 0.008; 94.6 cm ± 10.3 vs 90.6 ± 10.4 cm, and p 0.018). Diabetic patients had larger prostate volume than non-diabetic in the working age subgroup only (< 65 years of age); beyond 65 years, this difference was not consistent (62.6 ± 23.1 cc vs 50.1 ± 20.7 cc, and p 0.027; 56.2 ± 23.7 cc vs 49 ± 20.2 cc, and p 0.15, respectively). Prostate size was significantly associated with fasting blood glucose (p = 0.002) and PSA (p = 0.027). However, prostate size was not related to age, presence of diabetes, BMI, waist circumference, IPSS, quality of life score, and duration of symptoms.

Conclusion

Prostate volume is not correlated with anthropometric parameters in diabetic and non-diabetic Congolese patients who had TURP in South Kivu. Diabetics were not obese and yet had larger prostate volume than non-diabetics < 65 years of age. It is hoped that these results would form groundwork for further studies on this topic in SSA region.

Diabetes and complications of the heart in Sub-Saharan Africa: An urgent need for improved awareness, diagnostics and management

Type 2 diabetes mellitus is no longer a disease of high income countries but a global health pandemic. With the continued and rapid increase in its prevalence worldwide it is forecasted that diabetes will be a leading cause of morbidity and mortality. A major concern stems from its role in development and progression of cardiovascular disease, including cardiac dysfunction and heart failure. Within low- and middle-income areas such as Sub-Saharan Africa the burden of diabetes is already significant driven by many factors, including, socioeconomic (urbanisation), nutritional (high-calorie "western-diet", obesity) and lifestyle (physical inactivity) changes. Insufficient economic and community resources, poor health care system development and chronic disease management, poor education, and a lack of preventative and diagnostic measures further aggravate the severity of the diabetes problem. This review outlines the burden of type 2 diabetes mellitus in Sub-Saharan Africa and highlights the need for improved community health care and regulations to reduce its epidemiological spread and devastating impact on health.

Built environmental characteristics and diabetes: a systematic review and meta-analysis

BACKGROUND

The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide.

METHODS

We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663).

RESULTS

From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I² = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I² = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I² = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence.

CONCLUSIONS

An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.

Prevalence of obesity, diabetes mellitus, hypertension and associated risk factors in a mining workforce, Democratic Republic of Congo

Introduction

The burden of non-communicable diseases (NCDs) is increasing in low and middle-income countries (LMIC). According to the World Health Organization (WHO) the largest increase occurs in Africa. Obesity, diabetes mellitus and hypertension (ODH) are major risk factors for cardiovascular diseases, causing nearly 18 million deaths worldwide. Various risks associated with mining as an occupational activity are implicated in NCDs' occurrence. This study describes the baseline prevalence of ODH and associated risk factors in the workforce of Tenke Fungurume Mining (TFM), in southern Democratic Republic of Congo.

Methods

A cross-sectional study was conducted on a sample of 2,749 employees' and contractor's occupational health examination files for 2010. Socio-demographic, occupational, medical, anthropometric and behavioral characteristics were collected and assessed. Disease status regards ODH was based on WHO criteria. A multivariate logistic regression model was used.

Results

Overall prevalence of ODH was 4.5%, 11.7%, and 18.2% respectively. Proportions of pre-ODH individuals were 19.7%, 16.5%, and 47.8% respectively. Prevalence of ODH increased with age, professional grade, nature of work, gender and reported alcohol use. Smoking 10 or more cigarettes per day increased risk of diabetes and hypertension, while decreasing obesity.

Conclusion

Rates of ODH and associated risk factors are higher in the TFM workforce, than in the general DRC population. This is likely reflective of other mining sites in the country and region. It is evident that ODH are associated with various socio-demographic, occupational, anthropometric, biomedical and behavioral risk factors. A NCD prevention program and close monitoring of disease and risk factors trends are needed in this population.

Glucose homeostasis abnormalities among Cameroon patients with newly diagnosed hypertension

The authors assessed the frequency of glucose homeostasis abnormalities among 839 Cameroonians with newly diagnosed hypertension (mean age: 50.8±11 years; 49.9% female) in a cross-sectional survey conducted at the Douala General Hospital, Douala, Cameroon. In all participants, blood pressure, fasting plasma glucose (FPG), and lipids were recorded. Impaired fasting glycemia was described as an FPG level between 100 and 125 mg/dL and provisional diabetes as an FPG level ≥126 mg/dL. The FPG was 101±30 mg/dL. The overall proportion of abnormal glucose homeostasis was 38.3%, while 7.7% of patients (n=65) had known diabetes. A total of 23.7% (n=199) had impaired fasting glycemia and 6.8% (n=57) had provisional diabetes. Multivariable logistic regression revealed that male sex (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.15-2.06), age older than 55 years (OR, 1.55; 95% CI, 1.15-2.09), and low-density lipoprotein cholesterol >1 g/L (OR, 1.34; 95% CI, 1.00-1.82) were independently associated with abnormal glucose homeostasis (all P<.05). Glucose homeostasis abnormalities are highly prevalent among Cameroonian patients with newly diagnosed hypertension.

Prevalence of cardiovascular risk factors among workers at a private tertiary center in Angola

Background

The burden of cardiovascular diseases (CVD) is increasing in most countries of sub-Saharan Africa. However, as there is a scarcity of data, little is known about CVD in Angola. This study aimed to determine the prevalence of prehypertension, hypertension, prediabetes, diabetes, overweight, and obesity among workers at a private tertiary center in Angola.

Methods

A cross-sectional study was conducted among 781 workers of Clínica Girassol, a tertiary health care center in Angola, during the month of November 2013. Demographic, anthropometric, and clinical variables were analyzed.

Results

Of the 781 participants studied, 50.44% were males and 78.11% were under 40 years old. The prevalence of hypertension and prehypertension was 17.93% (95% confidence interval [CI]: 15.24%–20.74%) and 54.03% (95% CI: 50.58%–57.62%), respectively. Among hypertensive subjects, 83.57% (117) were unaware of the diagnosis. Hypertension was associated with age (≥40 years) (odds ratio [OR]: 6.21; 95% CI: 4.18–9.24; P<0.001) and with overweight and obesity (OR: 2.32; 95% CI: 1.56–3.44; P<0.001). The prevalence of diabetes and prediabetes was 2.69% (95% CI: 1.54%–3.97%) and 7.94% (95% CI: 6.02%–9.99%), respectively. The prevalence of overweight was 34.44% (95% CI: 31.11%–37.90%) and 19.85% (95% CI: 17.03%–22.79%) for obesity. There was an association between overweight and obesity and the female sex (OR: 1.71; 95% CI: 1.29–2.28; P<0.001). The prevalence of family history of CVD, smoking, and alcoholism was 52.24%, 4.87%, and 45.33%, respectively.

Conclusion

There was a high prevalence of cardiovascular risk factors in apparently healthy workers at the private tertiary center in Angola.

Obesity and diabetes mellitus association in rural community of Katana, South Kivu, in Eastern Democratic Republic of Congo: Bukavu Observ Cohort Study Results

BACKGROUND

Factual data exploring the relationship between obesity and diabetes mellitus prevalence from rural areas of sub-Saharan Africa remain scattered and are unreliable. To address this scarceness, this work reports population study data describing the relationship between the obesity and the diabetes mellitus in the general population of the rural area of Katana (South Kivu in the Democratic Republic of the Congo).

METHODS

A cohort of three thousand, nine hundred, and sixty-two (3962) adults (>15 years old) were followed between 2012 and 2015 (or 4105 person-years during the observation period), and data were collected using the locally adjusted World Health Organization's (WHO) STEPwise approach to Surveillance (STEPS) methodology. The hazard ratio for progression of obesity was calculated. The association between diabetes mellitus and obesity was analyzed with logistic regression.

RESULTS

The diabetes mellitus prevalence was 2.8 % versus 3.5 % for obese participants and 7.2 % for those with metabolic syndrome, respectively. Within the diabetes group, 26.9 % had above-normal waist circumference and only 9.8 % were obese. During the median follow-up period of 2 years, the incidence of obesity was 535/100,000 person-years. During the follow-up, the prevalence of abdominal obesity significantly increased by 23 % (p <0.0001), whereas the increased prevalence of general obesity (7.8 %) was not significant (p = 0.53). Finally, diabetes mellitus was independently associated with age, waist circumference, and blood pressure but not body mass index.

CONCLUSION

This study confirms an association between diabetes mellitus and abdominal obesity but not with general obesity. On the other hand, the rapid increase in abdominal obesity prevalence in this rural area population within the follow-up period calls for the urgent promoting of preventive lifestyle measures.

Childhood diabetes in Africa

PURPOSE OF REVIEW

This review summarizes the current state of diabetes in African children.

RECENT FINDINGS

Type 1 diabetes is the most common form of pediatric diabetes in Africa. Significant improvements have been achieved over the last 6 years, including the training of more than 60 pediatric endocrinologists who are now practicing in 14 African nations, greater training of other healthcare providers, increased availability of insulin through the efforts of philanthropic organizations and industry, modestly better availability of testing supplies, and the introduction of patient education materials in native languages. However, there is still a long way to go before the standard-of-care available to children in resource-rich nations is available to children with diabetes in Africa.

SUMMARY

Here, we review the known epidemiology, pathophysiology, complications, and treatment of diabetes in children in Africa.

The prevalence of type 2 diabetes among older people in Africa: a systematic review

Little information is available on the prevalence of diabetes in people aged 55 years or older living on the African continent. We did a systematic review of the prevalence of type 2 diabetes in studies reported from Jan 1, 2000, to June 30, 2015, to provide accurate data for monitoring future trends. We did a comprehensive literature search using an African search filter and extracted and synthesised data from full papers. Among 1473 identified citations, 41 studies providing 49 separate data contributions involving 16 086 individuals met the inclusion criteria. The overall prevalence of diabetes was 13·7% (95% CI 11·3-16·3) and was higher in studies based on the oral glucose tolerance test (23·9%, 17·7-30·7, 12 contributions with 3415 participants) than fasting blood glucose criteria (10·9%, 8·9-13·0, 37 contributions with 12 671 participants; p<0·001). Prevalence was also higher in non-STEPS than in STEPS studies (17·1%, 95% CI 13·6-20·9) vs 9·6%, 6·6-13·0, p=0·003) and in urban than in rural settings (19·7%, 15·0-24·9 vs 7·9%, 4·6-12·0, p=0·0002), but did not differ significantly across age groups, sex, sample size, year of publication, region, or population coverage. These data highlight the need to reduce diabetes risk factors and implement adequate management strategies. In addition, they suggest that uniform diagnostic methods should be used across African countries and elsewhere to enable assessment of trends in diabetes prevalence and the success of diabetes prevention strategies. A collaborative initiative is required between key international and national diabetes and geriatric organisations to improve diabetes care for the older population in Africa and worldwide.

Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012

Diabetes represents a challenging global health issue in the 21st century. Data from sub-Saharan African populations are scarce and are usually restricted to urban settings. The objective of this study was to compare prevalence and risk factors of diabetes in rural and urban areas in Senegal. Methods. In a community-based survey between January and May 2012, we included 1027 adults aged ≥18 years living in northern Senegal. Sociodemographic, clinical, and biological data were collected during household visits. Multivariate logistic regression was performed to identify factors associated with diabetes. Results. Mean age of participants was 48.0 ± 16.9 years and 65.7% were female. Participants from urban area represented 55.7%. The age-standardized prevalence of diabetes was 7.6% (6.0% in men versus 9.0% in women). Prevalence of diabetes was higher in urban areas (8.1%) compared to rural areas (4.6%). Disease awareness rate was 43%. After multivariate analysis, age (OR = 1.63, p = 0.001), familial history of diabetes (OR = 1.42, p = 0.001), and abdominal obesity (OR = 1.17, p = 0.05) were associated with diabetes. Conclusion. Diabetes is frequent in urban and rural areas in Senegal. Awareness rate is very low among populations. Age, family history of diabetes, and abdominal obesity are the main risk factors identified.

Per capita sugar consumption and prevalence of diabetes mellitus--global and regional associations

Background

Diabetes mellitus (DM) is a rampant epidemic worldwide. Causative factors and predisposition is postulated to be multi-factorial in origin and include changing life styles and diet. This paper examines the relationship between per capita sugar consumption and diabetes prevalence worldwide and with regard to territorial, economic and geographical regions.

Methods

Data from 165 countries were extracted for analysis. Associations between the population prevalence of diabetes mellitus and per capita sugar consumption (PCSC) were examined using Pearson’s correlation coefficient (PCC) and multivariate linear regression analysis with, infant mortality rates (IMR, as an general index maternal and child care), low birth weight (LBW, as an index of biological programming) and obesity prevalence included in the model as confounders.

Results

Despite the estimates for PCSC being relatively crude, a strong positive correlation coefficient (0.599 with p < 0.001) was observed between prevalence of diabetes mellitus and per capita sugar consumption using data from all 165 countries. Asia had the highest correlation coefficient with a PCC of 0.660 (p < 0.001) with strongest correlation noted in Central (PCC = 0.968; p < 0.001), South (PCC = 0.684; p = 0.050) and South East Asia (PCC = 0.916; p < 0.001). Per capita sugar consumption (p < 0.001; Beta = 0.360) remained significant at the last stage as associations of DM prevalence (R² = 0.458) in the multivariate backward linear regression model. The linear regression model was repeated with the data grouped according to the continent. Sugar was noted to be an independent association with DM only with regard to Asia (p < 0.001 Beta = 0.707) and South America (p = 0.010 Beta 0.550). When countries were categorized based on income PCS and DM demonstrated significant association only for upper middle income countries (p < 0.001 Beta 0.656).

Conclusions

These results indicate independent associations between DM prevalence rates and per capita sugar consumption both worldwide and with special regard to the Asian region. Prospective cohort studies are proposed to explore these associations further.

Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review

BACKGROUND

Hypertension and obesity are known to contribute, directly or indirectly, to the development of long-term complications of type 2 diabetes mellitus (T2DM). Knowing the prevalence of these comorbidities is important for determining the size of the population that may benefit from strategies that reduce blood pressure and weight while controlling blood glucose.

METHODS

In this systematic literature review, electronic searches of PubMed, Embase, and the Cochrane Library were conducted to identify observational studies of hypertension and/or obesity prevalence in patients with T2DM throughout the world. The searches were limited to studies reported in English from January 1, 2001 to February 16, 2012.

RESULTS

From a total of 2,688 studies, 92 observational studies provided prevalence rates for hypertension and/or obesity specifically in adults with T2DM. Fifteen studies of specific subtypes of hypertension or subpopulations with T2DM were subsequently excluded, leaving 78 studies (in 77 articles) for inclusion in this article. Of these, 61studies reported hypertension prevalence, 44 reported obesity prevalence, and 12 reported the prevalence of hypertension with obesity. Most studies had a low risk of bias regarding diagnosis of T2DM (70/78), hypertension (59/69), or obesity (45/47). The continental regions with the most observational studies of hypertension or obesity prevalence were Europe (n = 30) and Asia (n = 26). Hypertension rates typically were high in all regions; most studies presented rates above 50%, and many presented rates above 75%. Obesity rates exceeded 30% in 38 of 44 studies and 50% in 14 of 44 studies, especially those assessing central obesity (based on waist circumference). Among obese adults, hypertension rates were at or above 70% in Asia and above 80% in Europe; rates were lower in North and South America but still above 30%.

CONCLUSION

Around the world, hypertension and obesity, separately or together, are common comorbidities in adults with T2DM.

New insights on diabetes mellitus and obesity in Africa-part 1: prevalence, pathogenesis and comorbidities

Evidence continues to accumulate on the rising burden of diabetes mellitus at a higher pace in Africa. In a series of two papers, we sought to summarise recent evidence on diabetes and obesity in Africa based on a systematic review of studies published between January 2002 and October 2012. This first paper on the prevalence, pathogenesis and comorbidities shows that the increase in diabetes prevalence has paralleled that of obesity in Africa. Recent surveys on diabetes and obesity have been largely suboptimal. Hence, the need for more representative and robust continent-wide prevalence figures, which may be somehow achieved through pooling of existing data. Prospective studies linking environmental risk factors to disease occurrence and outcomes remain scarce, and genetic factors for diabetes or obesity have not been extensively assessed. The health consequences of diabetes are manifold, and include a complex interaction with other conditions like HIV infection and sickle cell disease/trait.

Ferroportin Q248H mutation, hyperferritinemia and atypical type 2 diabetes mellitus in South Kivu

BACKGROUND

The ferroportin Q248H mutation is relatively common in sub-Saharan Africa. No previous study examined its relationship with atypical diabetes mellitus (DM) in this area.

OBJECTIVE

To determine the potential interactions between ferroportin Q248H mutation, hyperferritinemia and DM in South Kivu (RDC).

METHODOLOGY

Presence of ferroportin Q248H mutation and iron status were investigated in diabetic patients (n=179, age (mean) 57.7 years, CRP (median) 0.16 mg/L) and non-diabetic subjects (n=86, age 44.5 years, CRP 0.07 mg/L) living in the city of Bukavu. Hyperferritinemia was considered for values greater than 200 and 300 μg/L in women and in men, respectively.

RESULTS

The prevalence of ferroportin Q248H mutation [12.1%] was non-significantly higher in diabetics than non-diabetics [14.0% vs. 8.1%, p=0.17]. Similarly, hyperferritinemia frequency was higher in diabetic patients with Q248H mutation [44.0% vs. 14.3%, p=0.16] and in mutation carriers [37.0% vs 16.5%, p=0.001] than in the control groups, respectively. The association between Q248H mutation and DM was nevertheless not significant [adjusted OR 1.70 (95% CI: 0.52-5.58), p=0.37], whereas hyperferritinemia [OR 2.72 (1.24-5.98), p=0.01] showed an independent effect after adjustment for age and metabolic syndrome.

CONCLUSIONS

The present work suggests a potential association between abnormal iron metabolism, ferroportin Q248H mutation and atypical DM in Africans, which may be modulated by environmental factors.

Diabetes and intermediate hyperglycaemia in Kisantu, DR Congo: a cross-sectional prevalence study

OBJECTIVES

To study the prevalence and risk markers of diabetes mellitus and intermediate hyperglycaemia (IH) in Kisantu, a semirural town in Bas-Congo province, The Democratic Republic of Congo.

DESIGN

A cross-sectional population-based survey.

SETTINGS

A modified WHO STEPwise strategy was used. Capillary glycaemia was measured for fasting plasma glucose and 2-h-postload glucose. Both WHO/IDF (International Diabetes Federation) 2006 and American Diabetes Association (ADA) 2003 diagnostic criteria for diabetes and IH were used.

PARTICIPANTS

1898 subjects aged ≥ 20 years.

RESULTS

Response rate was 93.7%. Complete data were available for 1759 subjects (86.9%). Crude and standardised (for Doll and UN population) prevalence of diabetes were 4.8% and 4.0-4.2%. Crude IH prevalence was 5.8% (WHO/IDF) and 14.2% (ADA). Independent risk markers for diabetes (p<0.01) were male (OR 2.5), age 50-69 years (OR 2.6), family history (OR 3.5), waist (OR 4.1) and alcohol consumption (OR 0.36). In receiver operating characteristic (ROC) analysis, prediction of diabetes was slightly better by waist than body mass index (BMI). IH defined according to WHO/IDF was associated with BMI (OR 2.6, p<0.001). IH defined according to ADA was associated (p<0.05) with waist (OR 1.4), education level (OR 1.6), BMI (OR 2.4) and physical activity (OR 0.7).

CONCLUSIONS

Current prevalence of diabetes in DR Congo exceeds IDF projections for 2030. The lower glucose threshold used by ADA almost triples impaired fasting glucose prevalence compared to WHO/IDF criteria. The high proportion of disorders of glycaemia made up by IH suggests the early stages of a diabetes epidemic.