A Survey of the Management, Control, and Complications of Diabetes Mellitus in Patients Attending a Diabetes Clinic in Blantyre, Malawi, an Area of High HIV Prevalence

Abstract

Abstract. The aim of this study was to describe the current status of diabetes care in an urban diabetes clinic in Malawi and the prevalence of human immunodeficiency virus (HIV) in this population, investigating possible associations between HIV and diabetes. A systematic prospective survey of patients attending the diabetes clinic at a teaching hospital in Blantyre, Malawi was conducted. Six hundred twenty patients were assessed. Seventy-four percent had glycosylated hemoglobin (HbA1C) > 7.5%. Systolic blood pressure was > 140 mm Hg in 52% of patients. Hypertension was more common in patients with raised creatinine ( P < 0.003), retinopathy ( P = 0.01), and stroke ( P < 0.0002). Microvascular complication rates were high, specifically nephropathy (34.7%), retinopathy (34.7%), and neuropathy (46.4%). HIV seroprevalence was 13.7%. HIV-positive subjects had a lower body mass index (BMI) and lower fasting blood sugar, and they were more likely to have albuminuria (48.0% versus 33.3%; P < 0.05). Control of glycemia and hypertension were poor, and microvascular complications were common. Nephropathy in diabetic patients may be affected by HIV status.

Prevalence of diabetic retinopathy, cataract and visual impairment in patients with diabetes in sub-Saharan Africa

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Diabetes Mellitus Type 2 and Abnormal Glucose Metabolism in the Setting of Human Immunodeficiency Virus

“…al. (33) analyzed 620 patients, separating outcomes between HIV infected and non-infected patients. HIV diabetes patients had similar poor control to their non-infected counterparts, with an average HbA1c of 9.0% vs. 9.5% respectively.…”

First Prospective Cohort Study of Diabetic Retinopathy from Sub-Saharan Africa

“…The World Health Organization (WHO) Malawi national STEPwise survey estimated a prevalence of diabetes of 5.6% in adults aged 25 to 64 years, with a similar prevalence in rural and urban areas 11 . In 2007, our group performed a cross-sectional study using clinical ocular examination to assess grades of retinopathy in patients attending the diabetes clinic at Queen Elizabeth Central Hospital (QECH), Blantyre 12, 13. We reported a high prevalence of sight-threatening and proliferative retinopathy: 19.6% and 5.7%, respectively.…”