title: Insulin-requiring diabetes in Ethiopia: associations with poverty, early undernutrition and anthropometric disproportion.
abstract: OBJECTIVE
  Most insulin-requiring diabetes patients in Ethiopia have an atypical form of the disease, which resembles previous descriptions of malnutrition-related diabetes. As so little is known about its aetiology, we have carried out a case-control study to evaluate its social and nutritional determinants.
  
  
  METHODS
  Men and women with insulin-requiring diabetes (n=107), aged 18-40 years, were recruited in two centres, Gondar and Jimma, 750 km northwest and 330 km southwest of the capital, Addis Ababa, respectively. Controls of similar age and sex (n=110) were recruited from patients attending other hospital clinics.
  
  
  RESULTS
  Diabetes was strongly associated with subsistence farming, odds ratio=3.5 (95% confidence interval: 1.5-7.8) and illiteracy/low levels of education, odds ratio=4.0 (2.0-8.0). Diabetes was also linked with a history of childhood malnutrition, odds ratio=5.5 (1.0-29.0) the mother's death during childhood, odds ratio=3.9 (1.0-14.8), and markers of poverty including poorer access to sanitation (P=0.004), clean water (P=0.009), greater overcrowding (P=0.04), increased distance from the clinic (P=0.01) and having fewer possessions (P=0.01). Compared with controls, people with diabetes had low mid upper arm circumference, body mass index (BMI) and fat/lean body mass (P<0.01). In addition, men with the disease tended to be shorter, were lighter (P=0.001), with reduced sitting height (P=0.015) and reduced biacromial (P=0.003) and bitrochanteric (P=0.008) diameters.
  
  
  CONCLUSIONS
  Insulin-requiring diabetes in Ethiopia is strongly linked with poor education and markers of poverty. Men with the disease have associated disproportionate skeletal growth. These findings point towards a nutritional aetiology for this condition although the nature of the nutritional deficiency and its timing during growth and development remains obscure.
authors.affiliation: Chronic Disease Programme, Jimma University Hospital, Jimma, Ethiopia.
authors.forename: S
authors.initials: S
authors.lastname: Fekadu
authors.forename: M
authors.initials: M
authors.lastname: Yigzaw
authors.forename: S
authors.initials: S
authors.lastname: Alemu
authors.forename: A
authors.initials: A
authors.lastname: Dessie
authors.forename: H
authors.initials: H
authors.lastname: Fieldhouse
authors.forename: T
authors.initials: T
authors.lastname: Girma
authors.forename: E R
authors.initials: ER
authors.lastname: Trimble
authors.forename: D I W
authors.initials: DI
authors.lastname: Phillips
authors.forename: E H O
authors.initials: EH
authors.lastname: Parry
mesh_terms: D000293:Adolescent; D000328:Adult; D001837:Body Weights and Measures; D001846:Bone Development; D016022:Case-Control Studies; D002648:Child; D002657:Child Development / Q000502:physiology*; D015362:Child Nutrition Disorders; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D011204:Poverty Areas; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D007328:Insulin