title: Immunological and C-peptide studies of patients with diabetes in northern Ethiopia: existence of an unusual subgroup possibly related to malnutrition.
abstract: OBJECTIVE
  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 C-peptide 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/m². Despite these clinical characteristics suggestive of type 1 diabetes, only 42 of 69 (61%) patients were C-peptide-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
  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.
authors.affiliation: Department of Tropical Medicine, Liverpool School of Tropical Medicine, UK. g.gill@liv.ac.uk
authors.forename: G V
authors.initials: GV
authors.lastname: Gill
authors.forename: A
authors.initials: A
authors.lastname: Tekle
authors.forename: A
authors.initials: A
authors.lastname: Reja
authors.forename: D
authors.initials: D
authors.lastname: Wile
authors.forename: P J
authors.initials: PJ
authors.lastname: English
authors.forename: M
authors.initials: M
authors.lastname: Diver
authors.forename: A J K
authors.initials: AJ
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Tesfaye
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D002096:C-Peptide / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D005002:Ethiopia; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D044342:Malnutrition / Q000097:blood* / Q000276:immunology*; D008875:Middle Aged
chemical_list: D001323:Autoantibodies; D002096:C-Peptide; D007328:Insulin; D005968:Glutamate Decarboxylase