Diabetic complications and glycaemic control in remote North Africa.
BACKGROUND
Delivery of diabetes services in resource-poor areas of Africa is difficult. Control is often poor and complications are common. However, adequate robust surveys are uncommon, particularly in remote rural areas. This makes needs assessment difficult and health-care planning impossible.


OBJECTIVE
To accurately assess the glycaemic control and burden of complications in a group of diabetic patients from a remote area of a resource-limited north African country.


METHODS
Prospective cohort study.


METHODS
Over a 6-week period, all patients attending the diabetic clinic at Mekelle Hospital in northern Ethiopia were intensively assessed, using imported western technology as necessary. Glycated haemoglobin (HbA(1c)), lipid profile, serum creatinine and urinary albumin-creatinine ratio were measured. Complications were assessed as accurately as possible, including examination of fundi by an ophthalmic specialist, and biosthesiometry for neuropathy.


RESULTS
There were 105 patients, mean (+/- SD) age 41 +/- 16 years and diabetes duration 7 +/- 6 years. There were 74 (70%) males, and 69 (66%) on insulin. Median body mass index was low at 20.6 kg/m(2), but mean HbA(1c) high at 11.3 +/- 2.8% (68% had an HbA(1c) over 10.0%). Cataract (12%), retinopathy (21%), neuropathy (41%) and microalbuminuria (51%) were common; but nephropathy (2%) was rare, as was large vessel disease (6% had peripheral vascular disease, and none had coronary artery disease or cerebrovascular disease). Risk factors such as hypertension (5%) and smoking (2%) were uncommon, and lipid profiles were generally good.


CONCLUSIONS
We conclude that in this severely resource-limited area of North Africa, glycaemic control amongst diabetic patients is very poor. Neuropathy, retinopathy and microalbuminuria are common; but large vessel disease risk factors are beneficial, and macroangiopathy prevalence is low. Scattered populations, shortage of drugs and insulin and lack of diabetes team care are major factors behind these serious issues of diabetic control and complications.
Gill
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G
Department of Diabetes and Endocrinology, University Hospital Aintree, Liverpool, L9 1AE, UK. g.gill@liv.ac.uk
Gebrekidan
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A
English
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Wile
D
D
Tesfaye
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S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000209:etiology; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D005002:Ethiopia; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose; D007004:Hypoglycemic Agents