Health-related quality of life in insulin-treated diabetic patients in the Sudan.

To determine health-related quality of life (HRQL) in people with insulin-treated diabetes mellitus in Sudan, a total of 89 patients aged 25-55 years and with > or = 5 years diabetes duration was studied. HRQL was measured with a 68-item questionnaire from the Medical Outcomes Study. Late diabetic complications were assessed, and haemoglobin A1c (HbA1c) was measured to assess the metabolic control. Of the patients (m = 36; f = 53), only 13.5%, had good metabolic control ((HbA1c) < 7.5%). These patients rated their HRQL as worse than patients with poor metabolic control ((HbA1c) > 10%). However, the latter were significantly younger, had shorter diabetes duration, and were free from late complications. Overall, 49.4% of the patients had one or more of the late diabetic complications. These patients rated their HRQL significantly lower when compared with patients without complications. Older age and the presence of late diabetic complications were the most important predictors for HRQL. It is concluded that self-rated HRQL in this group of patients is generally low. Improving diabetes knowledge and the metabolic control since early in the course of the disease, will not only retard the development of late complications, but will certainly improve the HRQL of these patients.

A high prevalence of diabetes mellitus and impaired glucose tolerance in the Danagla community in northern Sudan.

The prevalence and associated factors of diabetes mellitus (DM) and impaired glucose tolerance (IGT) were studied in a tribal community with an apparently high diabetes prevalence. A sample of 724 subjects aged > or = 25 years was selected using a multi-stage cluster method and underwent a 75 g oral glucose tolerance test. The crude prevalence of DM and IGT were 8.3% (men 9.9%; women 7.5%) and 7.9% (men 4.1%; women 9.7%), respectively. Age-adjusted prevalence rates, according to the standard population of Segi, were 10.4% (95% CI 7.7-13.2) and 9.8% (95% CI 7.2-12.5) for DM and IGT, respectively. No urban/rural differences were found in the prevalence rates of DM and IGT. New cases (5.1%) were almost twice as common as previously known cases (3.2%). Family history of diabetes, obesity, and advanced age were associated with higher rates of diabetes. The results confirmed that diabetes is common in the Danagla community compared to other communities of northern Sudan. Varying environmental, nutritional, and genetic factors may contribute to this high prevalence. These findings will have profound impact on the health services for this community and the Sudan as a whole.

Classification of newly-onset IDDIM and NIDDIM in subjects aged 25-45 years in Sudan.

OBJECTIVES: To investigate the ability of classifying diabetes mellitus with clinical and biochemical characteristics at diagnosis in 25-45 years old patients. DESIGN: We determined age, body mass index (BMI), ICA, fasting C-peptide and HbA1c at diagnosis, and after 4-27 months follow up, these variables were related to the type of treatment. SETTING: Omdurman Teaching Hospital, Sudan. SUBJECTS: Eighty-six consecutive newly diagnosed diabetic patients, according to WHO criteria, were included. RESULTS: At diagnosis, 27 patients (31.4%) were treated with insulin and 59 (68.6%) with diet and/or oral hypoglycaemic agents (OHA). Insulin-treated patients at diagnosis were younger, had lower BMI and higher HbA1c. In the non-insulin treated group at diagnosis, ICA-negative patients (n = 54) had higher fasting C-peptide (P < 0.05) than ICA-positive. The treatment was changed from insulin to diet and/or OHA in 17 patients, and to insulin in six patients. Patients who discontinued insulin had already at diagnosis higher BMI and higher fasting C-peptide concentration (P < 0.005 and P < 0.05, respectively) than patients remained on insulin. The positive predictive values for insulin treatment of ICA positivity, low fasting C- peptide, and low BMI were 90, 78 and 73%, respectively. The sensitivity, specificity and positive predictive values for these variables in concurrence were, respectively, 85, 92 and 69%. CONCLUSION: The clinical classification of newly- diagnosed young Sudanese patients was satisfactory. With regular follow up and early commencement of appropriate treatment, good glycaemic control is certainly attainable. BMI is potentially valuable for the clinical classification in such patients. ICA and fasting serum C-peptide facilitate the choice of insulin treatment, but cost is a limit to large-scale use of these tests.

A population-based study of the prevalence of diabetes and impaired glucose tolerance in adults in northern Sudan.

OBJECTIVE: To study the prevalence of glucose intolerance in adult urban and rural populations in the northern parts of Sudan. RESEARCH DESIGN AND METHODS: A sample of 1,284 subjects aged > or = 25 years was selected using a multistage cluster method and underwent a 75-g oral glucose tolerance test. RESULTS: The crude prevalence was 3.4% (men, 3.5%; women, 3.4%) for diabetes and 2.9% (men, 2.2%; women, 3.3%) for impaired glucose tolerance (IGT). The highest crude prevalence was in the northern parts of Sudan (5.5%) and the lowest in the western desert-like parts (0.9%). Diabetes and IGT rates were not different between the urban and rural populations. New cases (2.2%) were almost twice as prevalent as previously known cases (1.3%). Family history of diabetes, obesity, and advanced age were associated with higher rates of diabetes. CONCLUSION: The results showed a high prevalence of diabetes in the adult population of Sudan, with a wide difference among the different areas. The high ratio of newly discovered to previously known diabetic cases may reflect poor public awareness and medical services. These findings will certainly have far-reaching implications for diabetes care delivery in this country.

Pattern of long-term complications in Sudanese insulin-treated diabetic patients.

The prevalence of long-term micro- and macrovascular complications was studied in 128 (M/F; 62:66) Sudanese insulin-treated diabetic patients aged 15-75 years and with > or = 1 year duration. Patients were recruited from the out-patient clinics of the general hospitals in three States in Sudan. Haemoglobin A1c (HbA1c) was measured to assess the degree of metabolic control. The prevalence of microvascular complications was, retinopathy 43%, nephropathy 22% and neuropathy 37%. For macrovascular complications the prevalence was, cardiovascular disease 28%, peripheral vascular disease 10% and cerebrovascular accidents 5.5%. The overall prevalence of long-term complications was 67%. Patients with these complications were significantly older (P < 0.005), had longer disease duration (P < 0.001), and had higher serum cholesterol and triglyceride concentration (P < 0.001 and P < 0.05, respectively). The glycaemic control was adequate in only 12.5% of the patients, and was not related to the prevalence of complications. Sudanese diabetic patients are more prone to both microvascular and macrovascular complications than previously reported. More attention from the patients and clinicians is required and all efforts should be made to reduce the incidence of these complications.

Glycaemic control of insulin-dependent diabetes mellitus in Sudan: influence of insulin shortage.

Insulin availability and routine diabetes care were cross-sectionally investigated in 122 (M/F; 59/63) insulin-dependent diabetic patients aged 6-60 years with > or = 1 year duration using a structured questionnaire interview followed by a free conversation. Haemoglobin A1c, blood glucose, and serum lipids were measured in the fasting state to assess the metabolic control. Only 12% of the patients had acceptable glycaemic control (HbA1c < 7.5%). Increased age, shorter diabetes duration, and higher body mass index were associated with better metabolic control. Omission or reduction of the insulin dose was experienced by 51% of the patients due to insulin shortage. The interview data consistently indicated that insulin non-availability had induced poor compliance to therapy regimens and lack of motivation for optimum glycaemic control. Due to limited resources, most of the patients received insufficient diabetes care and education, leading to lower rates of clinic attendance (55%), and dietary non-compliance (78.5%). Elevated haemoglobin A1c was associated with higher fasting blood glucose levels (P < 0.001), serum triglycerides (P < 0.05), and urinary glucose (P < 0.001). Measurable fasting C-peptide was observed in 52.5% of the patients and was related to the age at diagnosis, and body mass index (P < 0.001 for both). There is a considerable potential to improve diabetes care and education practice, and if accessibility to insulin is simultaneously facilitated, the glycaemic control in Sudanese diabetic patients will improve.