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

Figure 1.
Figure 1.
Study flowchart 2008–2014.
Figure 2.
Figure 2.
Kaplan-Meier survival curve for T2DM patients vs. community controls.
Figure 2.
Figure 2.
Kaplan-Meier survival curve for T2DM patients vs. community controls.

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