Heterogeneity of diabetes Mellitus in Kenya- KNH experience, - - PowerPoint PPT Presentation

Heterogeneity of diabetes Mellitus in Kenya- KNH experience, implication on aetiology

Presenter: C.F. Otieno Dept of Clinical Medicine& Therapeutics Authors: Huho A.N, C.F. Otieno, Amayo AA, Njagi E

INTRODUCTION

• Type 1&2 diabetes suffer beta cell failure, by

apoptosis

• Type 1 diabetes, beta cell mass loss of 70-80%,

by “insulitis”

• Type 2 diabetes, beta cell mass loss by 25-50%
• r more at diagnosis.

Risk Factors of Diabetes

• Genetics
• Environmental factors e.g. diet
• Obesity

Objective of Study

• To determine the aetiological types of clinically

classified ambulatory patients with diabetes mellitus

Patients and Methods

• Patients with clinical type 1 & 2 diabetes
• Serum assay of: Fasting C-Peptide; GAD auto-

antibody titres and other biochemical tests.

Results

• 184 subjects enrolled;

60 subjects with type 1 diabetes 64 subjects with overweight type 2DM 60 subjects with non-obese type 2DM

• Socio-demographic characteristics of study

subjects

General Characteristics of patients by clinical category

Female% 51.6% 46.6% 54.6% Age (yr) Mean (SD) 16.7 (4.7) 47.2(13.2) 47.6(10.5) Age at Diagnosis (yrs) Mean (SD) 13.5(4.6) 45.1(13.2) 45.1(10.3) Duration in months since diagnosis Mean (SD) 33.43(19.8) 25.04(21.7) 29.63(19.9) BMI Kg/m2 Mean (SD) 19.44(3.0) 22.45(2.4) 29.83(3.4) Fasting Blood glucose mmol/l Mean (SD) 11.52(5.4) 8.09(4.4) 8.17(4.8) Current therapy % Insulin Insulin+OHA OHA Diet 90% 6.7% 3.3% 41.7% 10% 38.3% 10% 25.4% 14.3% 54% 6.3% Positive Family History of diabetes 1st Degree relatives % 2nd Degree relatives % 13.3% 28.3% 43.3% 8.3% 40.6% 6.3%

Type 1 Non Obese Type 2 Obese Type 2

BMI Patterns

Clinical Types

BMI Kg/m2 * Type 1 N(%) Type 2 BMI≤ 25 N(%) BMI > 25 N(%) Total n(%) <18.5 18.5-24.9 25-29.9 >40 Total 13(22%) 44(73%) 3(5%) 60(100%) 2(3.3% 58(96.6%) 60(100%) 36(56%) 27(42%) 1(2%) 64(100%) 154(8%) 102(55%) 39(21%) 27(15%) 1(0.5%) 184(100%)

GADA STATUS

10 20 30 40 50 60 70 80 90 GADA + VE GADA -VE

GADA

CHARACTERISTICS OF GADA POSITIVE AND GADA NEGATIVE SUBJECTS

GADA POSITIVE N=36 GADA NEGATIVE N=148 P Values Mean age (yr) 27.6 39.6 <0.001 Mean HBAIC % 9.6 9.05 <0.001 Mean duration in months since diagnosis 28.5 30.14 0.32 Mean BMI 20.7 24.7 <0.001 Mean fasting blood Glucose mmol/l 11.8 8.62 <0.001

Aetiological classification

Type 1A Type 1B LADA Type 2 “classical” Total Clinical Type 1 a (n=60) 25 41.66% 33 55% 2 3.3% 100% Clinical Type 2 BMI ≤ 25b (n=60) 4 6.66% 13 21.66% 4 6.66% 39 65% 100% Clinical Type 2 BMI >25b ((n=64) 0% 2 3.12% 3 4.69% 59 92.18% 100%

Summary

• The patients with DM attending the clinic are

heterogeneous: Type 1A & B Type LADA Type 2 – “Classical” “youth”

• Diverse aetiological background- environmental,

genetic, obesity

Conclusion

• Aetiological background of diabetes similar to

findings of other regions in the world

• However proportions of the various types may

be different

• The heterogeneity of clinical diabetes has

implications on therapeutic choices

• Further studies need to be done locally to

elucidate unique factors that precipitate diabetes locally