CLINICAL CLASSIFICATION OF DIABETES IN TROPICAL WEST-AFRICA

The objective of this work was to classify and describe the different types of diabetic patients detected in West Africa. In four health cen tres (three in Ivory Coast, one in Niger) 310 new cases were detected and followed up over 1 year. Classification was based on age at diagno sis, BMI, ketonuria, basal and stimulated C-peptide levels at inclusio n, and response to antidiabetic therapy. In this population, males wer e predominant (sex ratio = 2.40), and random blood glucose levels very high at screening (mean +/- SE, 18.6 +/- 0.4 mmol/l). Only one case o f fibrocalculous pancreatic diabetes and one possible case of diabetes mellitus related to malnutrition were detected. IDDM was diagnosed in 11.3% of the patients, half of them above 35 years. Leanness was obse rved in 59% of the patients with NIDDM. A dramatic decrease of fasting blood glucose was observed in all groups after 2 months of treatment, especially in NIDDM. As IDDM and non-obese NIDDM presented great simi larities before treatment, even for C-peptide levels, a point score sy stem is proposed to classify these two groups at baseline. In conclusi on, it is confirmed that the form of diabetes previously defined as re lated to malnutrition is a very rare entity in black African populatio ns. In contrast, African diabetes is characterised by the high proport ion of NIDDM patients with low BMI, and reduced P-cen function, rarely associated to ketonuria. This form of diabetes seems to be adequately controlled with oral hypoglycaemic drugs and/or diet in the year foll owing diagnosis. (C) 1998 Elsevier Science Ireland Ltd. All rights res erved.