ABSTRACT
AIMS: To determine the characteristics of patients with diabetes who reported food insecurity at three diabetes clinics in western Kenya. METHODS: This study includes routinely collected demographic data at the first presentation of patients with diabetes at clinics in western Kenya from 1 January 2006 to 24 September 2011. A validated questionnaire was used to assess food insecurity with descriptive and comparative statistics being used to analyse the food-secure and food-insecure populations. RESULTS: The number of patients presenting to these clinics who were food-secure and those who were food-insecure was 1179 (68.0%) and 554 (32.0%), respectively. Comparative analysis shows a statistically significant difference in weight, BMI, the presence of a caretaker, and use of insulin between the two groups. These variables were lower in the food-insecure group. The overall assessment of the clinic population revealed an abnormally high mean HbA1c concentration of 81 mmol/mol (9.6%). CONCLUSIONS: Despite the widely recognized contribution of caloric over-nutrition to the development of diabetes, this study highlights the high prevalence of food insecurity amongst patients with diabetes in rural, resource-constrained settings. Other factors, such as the lower prevalence of obesity, poor glucose control, challenges in the use of insulin because of the risk of hypoglycaemia, and varying subtypes of diabetes in this population, point to the need for additional research in understanding the aetiology, pathophysiology and optimum management of this condition, as well as understanding the effects of enhancing food security.
Subject(s)
Diabetes Mellitus/etiology , Diet/adverse effects , Food Supply , Malnutrition/physiopathology , Overnutrition/physiopathology , Rural Health , Body Mass Index , Combined Modality Therapy , Community Health Centers , Diabetes Mellitus/diet therapy , Diabetes Mellitus/drug therapy , Diabetes Mellitus/economics , Diet/economics , Diet/ethnology , Diet/psychology , Diet, Diabetic/adverse effects , Diet, Diabetic/economics , Diet, Diabetic/ethnology , Diet, Diabetic/psychology , Family Characteristics/ethnology , Female , Food Supply/economics , Glycated Hemoglobin/analysis , Humans , Hyperglycemia/epidemiology , Hyperglycemia/prevention & control , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/economics , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/adverse effects , Insulin/economics , Insulin/therapeutic use , Kenya/epidemiology , Male , Malnutrition/economics , Malnutrition/ethnology , Malnutrition/etiology , Middle Aged , Overnutrition/economics , Overnutrition/ethnology , Overnutrition/etiology , Poverty Areas , Rural Health/economics , Rural Health/ethnology , Socioeconomic FactorsABSTRACT
SETTING: Diabetes clinics in three hospitals in Western Kenya: Moi Teaching and Referral Hospital and two associated district hospitals. OBJECTIVE: To determine the proportion of diabetes patients with a history of tuberculosis (ââTB), human immunodeficiency virus (HIVââ) infection and tobacco smoking. DESIGN: A descriptive study using routinely collected data from patient records in the three diabetes clinics. RESULTS: Of 1376 patients analyzed, 750 (55%) were female. The mean age of the patients in the clinics was 53.5 years (95%CI 52.2-54.8), with an average duration of diabetes of 8.1 years (95%CI 7.6-8.7). Of all patients, 5.6% reported a history of TB, similar to the frequency about 20 years earlier (1990) in Tanzania. Only 30% of the patients reported knowing their HIV status; 6% were HIV-positive. A history of tobacco smoking was reported by 3.8% of the patients. CONCLUSION: The HIV epidemic does not seem to have significantly changed the relationship between TB and diabetes mellitus (DM) in this cohort of diabetes patients. The frequency of HIV and TB in this special population was comparable to that in the general population, and only a small proportion of patients reported a history of tobacco smoking.
