Asymptomatic Plasmodium infection and glycemic control in adults: Results from a population-based survey in south-central Côte d’Ivoire

• Published in: Diabetes research and clinical practice Vol. 156; p. 107845
• Main Authors: Eze, Ikenna C., Essé, Clémence, Bassa, Fidèle K., Koné, Siaka, Acka, Félix, Schindler, Christian, Imboden, Medea, Laubhouet-Koffi, Véronique, Kouassi, Dinard, N'Goran, Eliézer K., Utzinger, Jürg, Bonfoh, Bassirou, Probst-Hensch, Nicole
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2019
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cote d'Ivoire; Cross-Sectional Studies; Côte d’Ivoire; Diabetes mellitus; Fasting glucose; Female; Glucose - metabolism; Glycated hemoglobin; Humans; Malaria; Malaria - complications; Male; Middle Aged; Plasmodium; Prevalence; Risk Factors; Surveys and Questionnaires; Young Adult; Cote d'Ivoire; Plasmodium; Glycated hemoglobin; Malaria; Diabetes mellitus; Fasting glucose; Côte d’Ivoire
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2019.107845

•We studied the association between Plasmodium infection (PI) and glycemic control.•Glycemic control markers were fasting glucose (FG) and glycated hemoglobin (HbA1c).•FG-based prediabetes and diabetes were higher than HbA1c-based diagnoses.•Asymptomatic PI was independently associated with FG, but not with HbA1c.•FG-based diabetes diagnosis in a background of PI may overestimate diabetes burden. We investigated the cross-sectional associations of Plasmodium infection (PI) with fasting glucose (FG) and glycated hemoglobin (HbA1c) in malaria-endemic south-central Côte d’Ivoire. We studied 979 participants (non-pregnant; no treated diabetes; 51% males; 18–87 years) of the Côte d’Ivoire Dual Burden of Disease study. Fasting venous blood was obtained for PI, FG, and HbA1c assessment. We defined PI as a positive malaria rapid diagnostic test (RDT) or microscopic identification of Plasmodium species. We applied multivariable linear regressions to assess beta coefficients (β) and 95% confidence intervals (CIs) of PI positivity for FG and HbA1c independent of diabetes risk factors. Prevalence of PI was 10.1% (5.5% microscopy; 9.7% RDT) without clinical fever. Prevalence of FG-based prediabetes (45.8%) and diabetes (3.6%) were considerably higher than HbA1c-based values (2.7% and 0.7%, respectively). PI was independently associated with FG among participants with higher body temperature (β 0.34, 95% CI 0.06–0.63, pheterogeneity = 0.028), or family history of diabetes (β 0.88, 95% CI 0.28–1.47, pheterogeneity = 0.009). Similar patterns observed with HbA1c were obliterated on accounting for FG. We also observed consistent associations with parasite density. FG-based diabetes diagnosis in the presence of asymptomatic PI may misclassify or overestimate diabetes burden in malaria-endemic settings. Longitudinal studies are needed to confirm these findings and determine the risk for diabetes.