Clinical classification of diabetes in tropical west Africa

Fibrocalculous pancreatic diabetes (FCPD)

Fibrocalculous pancreatic diabetes (FCPD) is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis, in the absence of alcohol abuse. The disease is restricted to tropical regions of the world, and southern India has the highest known prevalence of FCPD. The typical patient with FCPD is a lean adolescent or young adult of either sex, presenting with history of recurrent bouts of abdominal pain and steatorrhea. Demonstration of large, discrete pancreatic calculi by plain radiographs or ultrasonography of the abdomen is diagnostic. While the exact etiology of FCPD is unknown, genetic, nutritional and inflammatory factors have been hypothesized to play a role. Diabetes in FCPD is often brittle and difficult to control; most patients require multiple doses of insulin for control of glycemia. However, in spite of high blood glucose levels, patients rarely develop ketosis. Malabsorption responds to pancreatic enzyme supplementation. Surgical removal of stones is indicated for symptomatic relief of intractable pain. While patients with FCPD develop microvascular complications as frequently as those with type 2 diabetes, macrovascular disease is uncommon. Development of pancreatic malignancy is the most dreaded complication and should be suspected in any patient who complains of weight loss, back pain or jaundice.

Prevalence of Type 2 diabetes and central adiposity in La Reunion Island, the REDIA Study

La Reunion Island, a French overseas department in the Indian Ocean provides an example of rapid urbanisation and drastic changes in the way of life--from traditional to "westernized" lifestyle--over a few decades. To study the impact of this epidemiologic transition, a diabetes prevalence study was performed in 1999-2001. Fasting capillary blood glucose (cBG) and glycated hemoglobin (HbA1c) were systematically measured in a random sample of 3600 subjects aged 30-69 years. Weight, height, waist and hip circumferences were also measured to assess body mass index and waist-hip ratio. Diagnosis was assessed using an oral glucose tolerance test according to the World Health Organization recommendations in 363 subjects who had a cBG value > or =6.1 mmol/l, and/or a HbA1c value > or =6%. The overall diabetes prevalence rate was 17.7% for men and 17.3% for women, and the standardized diabetes prevalence rate was 20.1% (95% confidence interval: 18.7-21.4%). The most important morphological factor linked to Type 2 diabetes mellitus was waist-hip ratio, a marker of central adiposity, especially in women. This study confirms that Type 2 diabetes is increasing dramatically in societies in epidemiologic transition and is strongly linked to nutritional status.

Gestational diabetes mellitus and fetal death in Mozambique: an incident case-referent study

BACKGROUND

Third trimester fetal death is a common problem in Mozambique, occurring in approximately 5% of parturient women.

OBJECTIVE

To elucidate the magnitude of the gestational diabetes mellitus problem, and to estimate its prevalence in a group of women with unexplained late fetal deaths and in women with live fetuses (referents).

METHODS

An incident case-referent study of 109 pregnant Mozambican women with fetal deaths and 110 women delivering liveborns, regarding fasting B-glucose, oral glucose tolerance test and glycosylated hemoglobin.

RESULT

The difference in gestational diabetes mellitus prevalence in the two groups is not significant. The prevalence of gestational diabetes mellitus was high in both groups: 11% and 7%, respectively.

Basal and postglucagon C-peptide levels in Ethiopians with diabetes

OBJECTIVE

To study basal C-peptide (BCP) and postglucagon C-peptide (PGCP) levels in Ethiopians with diabetes.

RESEARCH DESIGN AND METHODS

A total of 56 subjects with type 1 diabetes, 97 subjects with type 2 diabetes, and 50 control subjects were recruited from a hospital in Ethiopia. BCP was determined in all subjects and PGCP in 86 subjects.

RESULTS

Mean (+/- SEM) BCP, PGCP, and the increment after glucagon in type 1 diabetic subjects (0.14 +/- 0.04, 0.22 +/- 0.11, and 0.08 +/- 0.05 nmol/l, respectively) were lower (P < 0.001) than those in type 2 diabetic subjects (0.66 +/- 0.04, 1.25 +/- 0.10, and 0.56 +/- 0.06 nmol/l, respectively) or control subjects (0.54 +/- 0.04, 1.52 +/- 0.26, and 1.11 +/- 0.24 nmol/l, respectively). The mean BCP level was higher in type 2 diabetic subjects than control subjects (P=0.015), whereas the mean increment was lower (P=0.005). Insulin-treated type 2 diabetic subjects, compared with non-insulin-treated type 2 diabetic subjects, had lower mean BCP (0.55 +/- 0.08 nmol/l [n=37] vs. 0.73 +/- 0.04 [n=60], P=0.001), lower PGCP (0.97 +/- 0.20 nmol/l [n=18] vs. 1.40 +/- 0.11 [n=35], P=0.010), and a lower C-peptide increment (0.34 +/- 0.06 [n=18] vs. 0.67 +/- 0.07 nmol/l [n=35], P=0.003). In both the type 1 and type 2 diabetic groups, those with BCP levels <0.2 nmol/l had lower BMI than those with higher BCP levels (P=0.023 and P < 0.001, respectively).

CONCLUSIONS

Combined with clinical criteria, C-peptide levels are good discriminators between type 1 and type 2 diabetes in Ethiopians and may also be useful in identifying subjects with type 2 diabetes who require insulin therapy. There is a subgroup of type 2 diabetic subjects with features of type 1 diabetes.