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

• Published in: Diabetologia Vol. 52; no. 9; pp. 1842 - 1845
• Main Authors: Alemu, S, Dessie, A, Seid, E, Bard, E, Lee, P. T, Trimble, E. R, Phillips, D. I. W, Parry, E. H. O
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01.09.2009; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Adults; Age groups; Aged; Biological and medical sciences; Body Mass Index; Child; Chronic illnesses; Diabetes; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Diabetes Mellitus, Type 1 - classification; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - etiology; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Ethiopia - epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Hospitals; Human Physiology; Humans; Incidence; Insulin; Internal Medicine; Male; Malnutrition; Malnutrition - complications; Malnutrition - epidemiology; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Rural areas; Rural Population - statistics & numerical data; Sexes; Short Communication; Surveillance; Urban areas; Urban Population - statistics & numerical data; Womens health; Young Adult; Ethiopia; United Kingdom > UK; Africa; Diabetes; Malnutrition; Ethiopia; Insulin-dependent diabetes; Incidence; Endocrinopathy; Immunopathology; Pancreatic hormone; Type 1 diabetes; Nutrition disorder; Autoimmune disease; Insulin
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-009-1433-5

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.