The variable African diabetic phenotype: tales from the north and the south

RESUMO

Although most African diabetic patients are clearly phenotypically type 1 or 2, some do not easily fit into these categories. Examples are malnutrition-related diabetes mellitus (MRDM) and atypical ketosis-prone type 2 diabetes. To explore this problem we have compared two cohorts of diabetic patients from very different parts of Africa ­ rural KwazuluNatal in South Africa, and Mekelle District in northern Ethiopia. Basic demographic data were collected as well as measurements of blood pressure (BP) and glycated haemoglobin (HbA1c). South African patients were older (56±11 vs 41±16 years, p<0.001) than Ethiopian patients, and more were female (70% vs 30%, p< 0.001). Body mass index (BMI) was higher in South African patients (31.5±6.3 v 20.6±5.4, p<0.001) and 56% were obese (BMI >30.0) compared with 4% in Ethiopia (p<0.001). Hypertension (BP >140/80) affected 80% of South African patients but only 4% of the Ethiopian cohort (p<0.001). Insulin treatment was more common in the Ethiopian patients compared with South Africans (66% vs 25%, p<0.001). Duration of diabetes and HbA1c were similar in both groups. Phenotypically, 96% of the South Africans had typical type 2 diabetes, whereas only 42% of the Ethiopians had such type 2 characteristics (p<0.001). The high occurrence of apparent type 1 diabetes (42%) in the Ethiopian patients, in conjunction with their very low BMI levels and local chronic food shortages, raises the possibility as to whether at least some of this group may have MRDM