The diabetes epidemic in Sri Lanka - a growing problem.

Diabetes mellitus, which was once considered a disease of the developed world, has become a worldwide pandemic, with two thirds of the global diabetic population living in the developing countries. Local studies show a definite upward trend in the prevalence of diabetes mellitus. The earliest available study on a rural community in 1990 reported a prevalence of 2.5%. The largest-ever study on the diabetes prevalence in Sri Lanka was published in 2005. It showed a prevalence of 14.2% among males and 13.5% among females. The World Health Organisation and the International Diabetic Federation estimates and forecasts are much lower than the available local prevalence rates, and what may be predicted from the prevalence rates in South India. Further research is necessary to investigate the exact underlying mechanisms for the South Asian epidemic. Wider preventive programmes need to be urgently implemented to stem the tide.

Antibodies to hepatitis C virus in patients who have had multiple transfusions in Sri Lanka.

OBJECTIVE: To determine the prevalence of antibodies to hepatitis C virus (HCV) in patients who have had multiple transfusions in Sri Lanka. SETTING: University Medical Unit at the National Hospital, Colombo, the Cancer Institute, Maharagama, and the Lady Ridgeway Children's Hospital, Colombo. PATIENTS: One to 5 ml of blood for serology was collected from 200 multiply transfused patients (those who have received five or more blood transfusions). METHOD: The sera were tested for HCV specific antibodies using a third generation anti-HCV enzyme immuno-assay (EIA) kit. All sera giving positive or intermediate EIA results were re-tested by a commercial HCV Western blot confirmatory test. RESULTS: Of the 200 patients, 10 (5%) were repeatedly positive and confirmed by the Western blot. 33% (7/21) of haemophiliacs and 10% (3/31) of thalassaemics were positive for antibodies to HCV. Antibodies were not detected in other groups of multiply transfused patients (haemolytic disease, aplastic anemias, chronic renal failure, haematological and other malignancies). Of the 200 patients, those who have had more than 80 blood transfusions had a significantly higher prevalence of antibodies to HCV. The frequency of HCV infection was also higher among those who had received factor concentrates. CONCLUSION: 33% of haemophiliacs and 10% of thalassaemics who have received multiple transfusions were infected with HCV. These findings warrant a larger study among blood donors, and justify screening and decontamination of blood and blood products given to haemophiliacs and thalassaemics in Sri Lanka.

Patient mixed biphasic insulin in a diabetic clinic.

INTRODUCTION: Improved glycaemic control is possible with the use of multiple injections of premixed insulin. These are expensive, and not available in state hospitals. OBJECTIVES: To study the cost, patient acceptance and efficacy of a patient mixed and administered combination of soluble and lente (biphasic) insulin administered twice a day. PATIENTS: A cohort of 25 patients with poor glycaemic control on a single dose of 100 units or more of lente insulin. 25 patients matched for age and glycaemic control were used as a control. SETTING: The diabetic clinic of the National Hospital Sri Lanka. METHOD: A prospective study of a cohort of patients. RESULTS: Mean fasting blood glucose decreased from 8.3 mmol/l (SD 3.1) to 6.9 mmol/l (SD 2.3, p < 0.01) and mean blood glucose levels declined from 12.3 mmol/l (SD 4.1) to 10.1 mmol/l (SD 4.7, p < 0.01) in the biphasic group. Total mean insulin dose fell from 80 units (SD 12) to 61 units (SD 11) in the biphasic group, but increased in the control group from 82 units (SD 16) to 91 units (SD 13.1). The diabetes well-being score in the biphasic group was 91.5 (SD 35.3), while the control group had a score of 63.7 (SD 21.3 p < 0.01). Mean glycosylated haemoglobin (HbA1c %) was 8.1 (SD 2.7) in the biphasic group compared to 9.2 (SD 3.3) in the control group. CONCLUSION: Patient mixed and administered biphasic insulin on a twice daily basis is feasible, acceptable to patients, results in better glycaemic control and affords better patient satisfaction.

Macrovascular disease in Sri Lankan kidney transplant recipients.

INTRODUCTION: Macrovascular diseases such as angina, myocardial infarction, stroke and peripheral occlusive arterial disease are common causes of mortality and morbidity in transplant patients. OBJECTIVES: To study the frequency and determinants if vascular disease in Sri Lankan patients with renal transplants. PATIENTS: A cohort of 237 renal transplant recipients (163 males (76%), mean age 35.09, SD 11.05 years). SETTING: Patients under follow up at the Faculty of Medicine Transplant program. METHOD: Prospective study of a cohort of patients. RESULTS: Macrovascular diseases developed in 42% of transplant recipients. 5.6% had transient ischaemic attacks, 2.8% strokes, 18.2% angina, 8.4% myocardial infarctions, 2.3% underwent lower extremity amputations because of vascular insufficiency, 7% peripheral vascular occlusive disease and 49.5% were hypertensive. Male sex (odds ratio of 2.87, 95% CI 1.33-6.85, p = 0.006), serum cholesterol greater than 6.2 mmol/l at transplant (odds ratio 8.60, 95% CI 2.53-38.9, p = 0.0001) at 5 years after transplant (odds ratio 10.25, 95% CI 1.22-22.9, p = 0.01) were associated with a higher risk of macrovascular disease. Pre-transplant diabetes was associated with a higher risk of macrovascular disease and lower extremity amputation (odds ratio 4.53, 95% CI 1.32-6.76, p = 0.007). CONCLUSIONS: Strategies to screen for and treat potential risk factors should form an integral part of the follow up for Sri Lankan and Asian kidney transplant recipients.