Immunological and C-peptide studies of patients with diabetes in northern Ethiopia: existence of an unusual subgroup possibly related to malnutrition

Abstract

Aims/hypothesis Surveys in northern Ethiopia have demonstrated that apparent type 1 diabetes occurs more frequently than elsewhere in Africa and, indeed, in other parts of the world. We therefore investigated in detail a cohort of diabetic patients from this region to clarify the nature of this type of diabetes. Methods All patients attending the diabetic clinic at Mekelle Hospital in the Tigray region of northern Ethiopia were investigated over a 6 week period. Clinical, demographic and anthropometric data were collected, as well as measurements of HbA 1c , fasting lipid profile, fasting serum Cpeptide and serum markers of beta cell autoimmunity, i.e. islet antigen-2 and GAD antibodies (GADA). Results Of 105 patients seen, 69 (66%) were on insulin treatment and had been from or close to diagnosis. Their median age and diabetes duration were 30 and 5 years, respectively, with a male excess of 2:1. Median BMI was 20.6 kg/m 2 . Despite these clinical characteristics suggestive of type 1 diabetes, only 42 of 69 (61%) patients were Cpeptide-negative and 35% GADA-positive. Overall, 38 (36%) of the total group (n=105) had immunological or C-peptide characteristics inconsistent with typical type 1 or type 2 diabetes. The clinical characteristics, local prevalence of undernutrition, and GADA and C-peptide heterogeneity suggest a malnutrition-related form of diabetes. Conclusions/interpretation Not all patients in northern Ethiopia with apparent type 1 diabetes appear to have the form of disease seen in Europids; their disease may, in fact, be related to malnutrition.

Islet cell-associated autoantibodies in Ethiopians with diabetes mellitus

“…In Caucasian population, the prevalence of islet cell-associated antibodies in recently diagnosed subjects with T1DM ranged from 80% to 97% (Diabetes Prevention Trial -Type 1 Diabetes Study Group, 2002;Landin-Olsson et al, 1992;Notkins & Lernmark, 2001). The prevalence in our study was comparable to that of Asians (Lee, Ng, Thai, Lui, & Loke, 2001;Todd, Ng, Lui, & Thai, 2004;Zimmet et al, 1993) where it was reported at 5-40% and Africans (Hawa et al, 2005;Lutale et al, 2007;Oli et al, 1981;Panz et al, 2000) which ranged 7-44%, including what was reported in Ethiopia in the 1980s and in 2011 (Gill et al, 2011;Peters et al, 1986). We think that part of the reason why the antibody positivity in our T1DM patients was relatively lower is the fact that most of our T1DM patients were not newly diagnosed as indicated by the mean duration of diabetes.…”

“…Most studies dealing with the relationship between types of diabetes and autoimmunity were done in European or American populations (Atkinson & Maclaren, 1994). Despite some emerging literature in Africa dealing with autoimmunity and diabetes, our understanding still remains limited and incomplete (Elkadhi et al, 2002;Gill, Tekle, & Reja, 2011;Hawa et al, 2005; (IAA) have been well studied as alternatives to ICA (Bonifacio & Bingley, 1997;Winter & Schatz, 2011). Furthermore, combi-assays for GADA and IA-2A have been shown to be as reliable but more convenient than single assays (Dittler, Seidel, Schenker, & Ziegler, 1998;Siraj, Rogers, Gupta, & Reddy, 2012;Wiest-Ladenburger et al, 1997).…”

High rates of ocular complications in a cohort of Haitian children and adolescents with diabetes

“…This same study also showed that only 38.5% of the 91 Haitian children were positive for ≥1 of 3 pancreatic autoantibody, compared to 89.6% in a predominantly Caucasian cohort of children with type 1 DM . These data are similar to previous reports showing lower than usual rates of negative C‐peptide and pancreatic autoantibody positivity in African populations . There is insufficient data to classify with certainty this type of diabetes seen in the Haitian and African populations.…”

Clinical and biological characteristics of diabetic patients under age 40 in Cameroon: Relation to autoantibody status and comparison with Belgian patients

“…These variant disease phenotypes are characterized by mixed features of both type 1 and type 2 diabetes, thus complicating disease classification on clinical grounds [3]. This challenge may lead to the irrational use of insulin therapy in economically disadvantaged SSA [4], and to inadequate disease management with the risk of a future upsurge of diabetes complications. In addition to the increasing burden of diabetes [1,5], the need for the implementation of additional measures for disease classification has never been more relevant.…”