Diabetes in urban Guinea-Bissau; patient characteristics, mortality and prevalence of undiagnosed dysglycemia
Stine Byberg, Camilla Bundesen, Frauke Rudolf, Thorny Linda Haraldsdottir, Lamine Indjai, Rui Barai, Henning Beck-Nielsen, Morten Sodemann, Dorte Møller Jensen, Morten Bjerregaard-Andersen, Stine Byberg, Camilla Bundesen, Frauke Rudolf, Thorny Linda Haraldsdottir, Lamine Indjai, Rui Barai, Henning Beck-Nielsen, Morten Sodemann, Dorte Møller Jensen, Morten Bjerregaard-Andersen
Abstract
Background: The burden of diabetes mellitus in Sub-Saharan Africa is growing rapidly, and yet the prevalence and patient characteristics are still largely unknown.
Objectives: We analyzed clinical and demographic characteristics of Type 2 diabetes (T2DM) patients attending a diabetes clinic in Guinea-Bissau from February 2008 to April 2014, and estimated the prevalence and risk factors of unknown-impaired fasting plasma glucose (FPG) and diabetes, as well as excess mortality associated with T2DM.
Methods: We characterized T2DM patients attending the national diabetes clinic in Bissau. Diabetes was diagnosed based on FPG. We matched T2DM patients 1:1 with non-diabetes community controls on age and sex to determine relevant risk factors for T2DM using logistic regression. Furthermore, we matched patients 1:6 with community controls to assess long-term survival (until February 2019) in a Cox regression using calendar time as the underlying timescale. Verbal autopsies determined the cause of death among T2DM patients and controls.
Results: The mean age among T2DM was 50.6 (SD 11.1), and the mean FPG at first consultation was high (13.2 mmol/L (SD 5.1)). Ethnicity, family history of diabetes, hypertension, and anthropometrics differed among T2DM patients, community controls with impaired FPG, and healthy controls. Family history of diabetes (OR = 5.65, 95% CI: 3.10-10.3) and elevated waist circumference (2.33, 1.26-4.29) were significant risk factors for T2DM. 20.4% (59/289) of community controls had abnormal FPG. T2DM patients had an excess mortality hazard ratio of 3.53 (95%CI: 1.92-6.52). Deaths caused by bacterial infections, including foot ulcers, were more common among T2DM patients, compared with community controls (54% (7/13) vs. 19% (5/27) (P = 0.02)).
Conclusion: Several risk factors including were associated with T2DM in Guinea-Bissau. We found a high prevalence of elevated FPG among randomly selected community controls. In combination with higher mortality among T2DM patients, an urgent need for better treatment options and increased awareness.
Keywords: Africa; Guinea-Bissau; Type 2 diabetes mellitus; community burden; mortality; risk factors.
Conflict of interest statement
No potential conflict of interest was reported by the authors.
Figures
References
- Mbanya JC, Motala AA, Sobngwi E, et al. Diabetes in sub-Saharan Africa. Lancet. 2010;375:2254–10.
- Pastakia SD, Pekny CR, Manyara SM, et al. Diabetes in sub-Saharan Africa - from policy to practice to progress: targeting the existing gaps for future care for diabetes. Diabetes Metab Syndr Obes. 2017;10:247–263.
- International Diabetes Federation . IDF diabetes atlas, ninth edition 2019. 2019. .
- Duboz P, Chapuis-Lucciani N, Boetsch G, et al. Prevalence of diabetes and associated risk factors in a Senegalese urban (Dakar) population. Diabetes Metab. 2012;38:332–336.
- Duboz P, Boetsch G, Gueye L, et al. Type 2 diabetes in a Senegalese rural area. World J Diabetes. 2017;8:351–357.
- Sundufu AJ, Bockarie CN, Jacobsen KH.. The prevalence of type 2 diabetes in urban Bo, Sierra Leone, and in the 16 countries of the West Africa region. Diabetes Metab Res Rev. 2017;33:e2904.
- Millogo T, Bicaba BW, Soubeiga JK, et al. Diabetes and abnormal glucose regulation in the adult population of Burkina Faso: prevalence and predictors. BMC Public Health. 2018;18:350.
- Meiloud G, Arfa I, Kefi R, et al. Type 2 diabetes in Mauritania: prevalence of the undiagnosed diabetes, influence of family history and maternal effect. Prim Care Diabetes. 2013;7:19–24.
- Steiniche D, Jespersen S, Erikstrup C, et al. Diabetes mellitus and impaired fasting glucose in ART-naive patients with HIV-1, HIV-2 and HIV-1/2 dual infection in Guinea-Bissau: a cross-sectional study. Trans R Soc Trop Med Hyg. 2016;110:219–227.
- Haraldsdottir TL, Rudolf F, Bjerregaard-Andersen M, et al. Diabetes mellitus prevalence in tuberculosis patients and the background population in Guinea-Bissau: a disease burden study from the capital Bissau. Trans R Soc Trop Med Hyg. 2015;109:400–407.
- Bjerregaard-Andersen M, Hansen L, da Silva LI, et al. Risk of metabolic syndrome and diabetes among young twins and singletons in Guinea-Bissau. Diabetes Care. 2013;36:3549–3556.
- Hennild DE, Bjerregaard-Andersen M, Joaquim LC, et al. Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau. BMC Endocr Disord. 2016;16:46.
- Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–553.
- Mbanya JC, Assah FK, Saji J, et al. Obesity and type 2 diabetes in Sub-Sahara Africa. Curr Diab Rep. 2014;14:501.
- Peer N, Kengne AP, Motala AA, et al. Diabetes in the Africa Region: an update. Diabetes Res Clin Pract. 2014;103:197–205.
- Sobngwi E, Ndour-Mbaye M, Boateng KA, et al. Type 2 diabetes control and complications in specialised diabetes care centres of six sub-Saharan African countries: the Diabcare Africa study. Diabetes Res Clin Pract. 2012;95:30–36.
- Motala AA, Esterhuizen T, Pirie FJ, et al. The prevalence of metabolic syndrome and determination of the optimal waist circumference cutoff points in a rural South african community. Diabetes Care. 2011;34:1032–1037.
- Porskrog A, Bjerregaard-Andersen M, Oliveira I, et al. Enhanced tuberculosis identification through 1-month follow-up of smear-negative tuberculosis suspects. Int J Tuberculosis Lung Dis. 2011;15:459–464.
- Lindman J, Ström K, Da Silva Z, et al. group AtSC: diabetes and pre-diabetes among police officers in Guinea-Bissau. AfrJ Diabetes Med. 2017;25:19–20.
- Carvalho ACCNN, Santos G. A Prevalência da Diabetes Mellitus e Obesidade na População Adulta da Guiné-Bissau: um Estudo Piloto. Revista Portuguesa De Endocrinologia, Diabetes E Metabolismo. 2018;13:2–6.
- Frank LK, Heraclides A, Danquah I, et al. Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population. Trop Med Int Health. 2013;18:141–151.
- Steyn NP, Mann J, Bennett PH, et al. Diet, nutrition and the prevention of type 2 diabetes. Public Health Nutr. 2004;7:147–165.
- Adeloye D, Ige JO, Aderemi AV, et al. Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in Nigeria: a systematic review and meta-analysis. BMJ Open. 2017;7:e015424.
- Foryoung JB, Ditah C, Nde Fon P, et al. Long-term mortality in outpatients with type 2 diabetes in a reference hospital in Cameroon: a retrospective cohort study. BMJ Open. 2018;8:e019086.
- Correia JC, Lopes A, Iala CB, et al. Diabetes management in Guinea Bissau: a situational analysis. Pan Afr Med J. 2019;34:10.
- Krug EG. Trends in diabetes: sounding the alarm. Lancet. 2016;387:1485–1486.
- International Expert C . International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–1334.
- World Health Organization. Verbal autopsy standards: ascertaining and attributing causes of death. 2018. .
Source: PubMed