Differences in demographic and clinical variables among some African ethnic groups with T2DM

Abstract

Background: Diabetes mellitus, the commonest endocrine disease is approaching epidemic proportion worldwide driven by age, nutrition, genetic admixture, socio-economy and ethnicity.

Objective: To determine differences in demographic and clinical outcome of two ethnic African populations with type 2 diabetes.

Methodology: A cross sectional study of 240 type 2 diabetic persons (in two groups of 120 each) diagnosed using WHO criteria recruited from diabetes out-patient clinics of tertiary health facilities in Nigeria, West Africa and Lesotho, Southern Africa. They had no apparent diabetic complication(s). Information on age, sex, blood pressure, body mass index (BMI) and glycosylated haemoglobin determined by standard procedure were obtained from hospital records and analyzed using Statistical Package for Social Sciences (SPSS) version 20.

Results: Participants age ranged 32-82 years with mean of 52.4(±13.9) years. Nigerians were significantly older than Basotho (57.40±10.72 vs 47.40±14.94; p=0.0001). There were no significant differences in gender and mean BMI (p=0.267; p=0.264 respectively). Basotho had higher proportion of obese diabetics than Nigerians (40 % vs 20%) who were more in the overweight category [45% vs 25%], (p=0.003). Mean HbA1c was higher in Basotho than Nigerians [10.64±3.95 vs 8.27±1.53] (p=0.0001) while mean blood pressure of study participants were within normal though Nigerians had non-significantly higher mean systolic pressure [135.58±20.13 vs 133.33±26.71; p=0.603]. BMI of study participants correlated positively with age, BP and HbA1c irrespective of ethnicity.

Conclusion: There are differences in age, BP, BMI and HbA1c of ethnic African diabetics. Improved education, access to quality health care and social insurance policies should drive preventing DM and improve management outcomes.

Keywords: Ethnicity, clinical outcomes, socio-demography, Type 2 diabetes.

Abstrait
Contexte: Le diabète sucré, la maladie endocrinienne la plus courante, s’approche de la proportion épidémique dans le monde en raison de l’âge, de la nutrition, du mélange génétique, de la socio-économie et de l’ethnicité.

Objectif: Pour déterminer les différences dans les résultats démographiques et cliniques de deux populations ethniques africaines atteintes de diabète de type 2.

Méthodologie: Une étude transversale de 240 personnes diabétiques de type 2 (en deux groupes de 120 chacun) diagnostiquées selon les critères de l’OMS recrutées dans les cliniques externes de diabète des établissements de santé tertiaires au Nigéria, en Afrique de l’Ouest et au Lesotho, en Afrique Australe. Ils n’avaient aucune complication (s) diabétique apparente (s). Les informations sur l’âge, le sexe, la pression artérielle, l’indice de masse corporelle (IMC) et l’ hémoglobine glycosylée déterminées par la procédure standard ont été obtenues à partir des dossiers hospitaliers et analysées à l’aide du progiciel statistique pour les sciences sociales (SPSS) version 20.

Résultats: L’âge des participants variait de 32 à 82 ans avec une moyenne de 52,4 ( ± 13,9 ) ans. Les Nigérians étaient significativement plus âgés que les Basotho (57,40 ± 10,72 vs 47,40 ± 14,94 ; p = 0,0001). Il n’y avait pas de différences significatives dans le sexe et l’IMC moyen ((p = 0,267; p = 0,264 respectivement). Basotho avait une proportion plus élevée de diabétiques obèses que les Nigérians (40% vs 20%) qui étaient plus dans la catégorie du surpoids [45% vs 25 %], (p = 0,003). L’HbA1c moyenne était plus élevée parmi les Basotho que chez les Nigérians [10,64 ± 3,95vs8,27±1,53] (p = 0,0001) alors que la pression artérielle moyenne des participants à l’étude était dans la normale, bien que les Nigérians aient une systolique moyenne non significativement plus élevée pression [135,58 ± 20,13vs133,33 ± 26,71 ; p = 0,603]. L’IMC des participants à l’étude était corrélé positivement avec l’âge, la PA et l’HbA1c indépendamment de l’origine ethnique.

Conclusion: Il existe des différences d’âge, de PA, d’IMC et d’HbA1c des diabétiques ethniques africains. Une éducation améliorée, l’accès à des soins de santé de qualité et des politiques d’assurance sociale devraient favoriser la prévention du diabète et améliorer les résultats de gestion.

Mots clés: Ethnicité, résultats cliniques, socio-démographie, diabète de type 2.

Correspondence: Dr. O. Odusan, Department of Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo Teaching Hospital, Sagamu, Nigeria. E-mail: tunsan2001@yahoo.com

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References

Centers for Disease Control and Prevention: National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; Atlanta: 2014.

Zimmet P Z. Diabetes and its drivers; the largest epidemic in history? Clin Diabetes and Endocrinol 2017; 3:1.

Alberti KG and Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications Part 1: Provisional report of a WHO consultation. Diabet Med 1998; 15 (7): 539-553.

International Diabetes Federation; International Diabetic Federation Atlas; 7th edition, 2015 Executive summary: Diabetes: A global emergency. http;//www.diabetesatlas.org

Pueppet F. H. The prevalence of diabetes mellitus and associated risk factors in adults in Jos; National Postgraduate Medical College of Nigeria. 1996, Part 2 FMCP dissertations

Nyenwe EA, Odia JO, Anele EI and Aarono SB. Type 2 diabetes in adult Nigerians; A study of its prevalence and risk factors in Port Harcourt, Nigeria; Diab Res Clin Prac 2003; 62; 177-185.

International Diabetes Federation; International Diabetic Federation Atlas; 8th edition, 2017. http;//www.diabetesatlas.org.

Walker RJ, Williams JS and Egede LE. Impact of Race/Ethnicity and Social Determinants of Health on Diabetes Outcomes. Am J Med Sci. 2016 April; 351(4): 366–373. doi:10.1016/j.amjms.2016.01.008.

Campbell JA, Walker RJ, Smalls BL and Egede LE. Glucose control in diabetes: the impact of racial differences on monitoring and outcomes. Endocrine. 2012; 42:471–482. [PubMed: 22815042]

Ferreira LT, Saviolli IH, Valenti VE and Abreu LC. Diabetes mellitus: hyperglycemia and its chronic complications. ABCS Health Sciences 2011; 36(3):182-188.

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998; 317:703–713. [PubMed: 9732337]

American Diabetes Association (ADA). Standards of medical care in diabetes-2015. Diabetes Care 2016; 39(Supl.):1-112.

Kurian AK and Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis. 2007; 17:143–152. [PubMed: 17274224]

Solar O and Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). World Health Organization; Geneva: 2010.

Marmot M. Social determinants of health inequities. The Lancet. 2005; 365:1099–1104

Williams DR, Costa MV, Odunlami AO and Mohammed SA. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract. 2008; 14(Suppl):S8–S17. [PubMed: 18843244]

Healthy People. Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020. Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States. Jul 26. 2010 Available from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview .aspx? topicid=39

Marmot M. Fair society, healthy lives (the Marmot review). Department of Health; London: 2010.

World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications; Part 1: Diagnosis and classification of diabetes mellitus. Department of Non-communicable Disease Surveillance, Geneva, 1999.

Gning SB, Thiam M, Fall F, et al. diabetes mellitus in Sub-Saharan Africa epidemiological aspects and management issues. Med Trop (Mars). 2007 Dec; 67 (6): 607-611

Raimi TH, Odusan O and Fasanmade OA. Correlation of Anthropometric Indices and Age with Fasting Plasma Glucose among Inhabitants of Ogun State, South-West Nigeria. 2016. British Journal of Medicine & Medical Research. 2017; 19 (5): 1-11

Odusan O, Amoran OE, Olubodun AB and Salami BA. Type 2 Diabetes Mellitus: Awareness, Knowledge and Associated Risk factors among Commercial Bank workers in Sagamu, Nigeria. Nigerian Medical Practitioner. 2017; vol 71, No 5-6, 81-87.

Shonubi AMO, Odusan O, Oloruntoba DO, Agbahowe SA and Siddique MA; Health for All in a Least-Developed Country. Journal of the National Medical Association. 2005; vol. 97 (7):1020-1026.

American Diabetes Association. Strategies for improving care. Sec.1: In Standards of Medical Care in Diabetes—2015. Diabetes Care. 2015; 38(Suppl. 1):S1–S94.

Lynch CP, Strom Williams JL, Reid J, et al. Racial/Ethnic differences in multiple diabetes outcomes in patients with type 2 diabetes in the southeastern United States. Ethn Dis. 2014; 24(2):189–194. [PubMed: 24804365]

World Health Organization: Obesity;www.who.int/features/factfiles/obesity/facts.

Ali MK, Bullard KM, Saaddine JB, et al. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013; 368(17):1613-1624.

Strenstrom G, Gottsater A. Bakhtadze E, Berger B and Sundkvist G,; Latent autoimmune diabetes of adults; Definition, Prevalence, β cell function and treatment; Diabetes 2006 Dec; 54( supp 2), s68-72. Available from http;//lup.lub.lu.se/record/147737 DOI; 10.2337/diabetes.54 suppl-2.s68

Unadike BC, Eregie A and Ohwovoriole AE. Prevalence of hypertension among persons with diabetes mellitus in Benin City, Nigeria. Niger J Clin Pract 2011; 14 (3): 300-302 doi:10.4103/1119-3077.86772

Liu X and Song P. Is the association of diabetes with uncontrolled blood pressure stronger in Mexican Americans and blacks than in whites among diagnosed hypertensive patients? Am J Hypertension. 2013; 26(11):1328–1334.