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Htun NSN, Odermatt P, Paboriboune P, Sayasone S, Vongsakid M, Phimolsarn-Nusith V, Tran XD, Ounnavong PS, Andriama-Hefasoa N, Senvanpan ND, Homsana A, Lianosay B, Xayavong D, Robinson DR, Bounsavath P, Prasayasith PP, Syphan SD, Lu YX, Thilakoun K, Xaiyaphet XS, Vongngakesone PT, Eze IC, Imboden M, Sripa B, Reinharz D, Probst-Hensch N. Association between helminth infections and diabetes mellitus in adults from the Lao People's Democratic Republic: a cross-sectional study. Infect Dis Poverty 2018; 7:105. [PMID: 30396368 PMCID: PMC6219195 DOI: 10.1186/s40249-018-0488-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As a result of epidemiological transition, the health systems of low- and middle-income countries are increasingly faced with a dual disease burden of infectious diseases and emerging non-communicable diseases. Little is known about the mutual influence of these two disease groups. The aim of this study was to investigate the co-occurrence of helminth infections and diabetes mellitus in adults in Lao People's Democratic Republic (Lao PDR). METHODS We conducted a cross-sectional study among 1600 randomly selected adults aged 35 and older from four different socio-economical and ecological provinces. Information on socio-demographics, risk factors and health conditions was obtained from personal interviews. Clinical assessments including anthropometry (height, weight, waist and hip circumference) and blood pressure measurements were also conducted. Diabetes was classified based on self-reported diagnoses and a point-of-care glycated haemoglobin (HbA1c) test from finger prick blood samples. Stool samples for helminth diagnosis were examined with formalin-ether concentration technique for intestinal parasitic infections. The independent associations of helminth infections with diabetic status and HbA1c were assessed using multiple regression analyses. RESULTS The prevalence of pre-diabetes and diabetes was 37.3% and 22.8%, respectively. Fifty-six percent of diabetic cases were undiagnosed and 85% of diagnosed diabetic cases had poor glycemic control. Participants from rural areas and from southern parts of the country had higher infection rates, with Opisthorchis viverrini, being the most common helminth infection (30.5%). We found a positive association between Taenia spp. infections and HbA1c (β = 0.117; 95% CI: 0.042-0.200) and diabetes mellitus risk (OR = 2.98; 95% CI: 1.10-8.05). No other helminth species was associated with glycated hemoglobin. CONCLUSIONS Hyperglycaemia and diabetic rates in Lao PDR are alarmingly high, but consistent with other high rates in the region. Given the high rates of under-diagnosis and poorly-controlled glycaemia in diabetes mellitus patients, routine diabetes screening and treatment is essential for the local healthcare system. Large longitudinal cohorts integrating biomarkers are warranted in the search of causal diabetes mellitus risk factors in the region. Common intestinal helminth infections, including O. viverrini, are unlikely to explain the high diabetes mellitus rates observed.
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Affiliation(s)
- Nan Shwe Nwe Htun
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, 4002, 4051 Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Peter Odermatt
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, 4002, 4051 Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Phimpha Paboriboune
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Somphou Sayasone
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, 4002, 4051 Basel, Switzerland
- grid.415768.9Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Malisa Vongsakid
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Vilayouth Phimolsarn-Nusith
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Xuan Duong Tran
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Phoum-Savath Ounnavong
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Navalone Andriama-Hefasoa
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Nilun-Done Senvanpan
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Anousine Homsana
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Baocher Lianosay
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Dalouny Xayavong
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | | | - Phaivanh Bounsavath
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Phoy-Phaylinh Prasayasith
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Seng-Davanh Syphan
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Yi-Xiao Lu
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Kanchana Thilakoun
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Xaipa-Song Xaiyaphet
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Phout-Tasin Vongngakesone
- The Francophone Institute for Tropical Medicine (International Program for Health in the Tropics), Vientiane, Lao PDR
| | - Ikenna C Eze
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, 4002, 4051 Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Medea Imboden
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, 4002, 4051 Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Banchob Sripa
- 0000 0004 0470 0856grid.9786.0Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daniel Reinharz
- 0000 0004 1936 8390grid.23856.3aUniversité Laval, Quebec City, Canada
| | - Nicole Probst-Hensch
- 0000 0004 0587 0574grid.416786.aDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, 4002, 4051 Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
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