Characteristics of insulin requiring diabetes in rural Northern Ethiopia -A possible link with malnutrition?

We have examined 100 consecutive insulin-treated diabetic patients from the Diabetic Clinic at Mekelle Hospital in Tigray, Northern Ethiopia; an area of low socio-economic status recently affected by severe famine. The study was conducted otter a six month period (1997). Mean age of onset of diabete s tvas 27 +/- 10y (SD) and there was a male excess (3.1:1.0). Body Mass ind ex (BMI) at diagnosis was very low at 15.8 +/- 2.8. Because of erratic insu lin supply 48 (48%) had interrupted insulin treatment in the past for a mea n duration of 9 +/- 12 weeks (range 1-78). Despite this, only 2 (4%) develo ped ketoacidosis (DKA). The patients thus have features suggestive of malnu trition-related diabetes mellitus (MRDM) possibly of the "malnutrition-modu lated" (MMDM) type in view of the apparent absence of overt exocrine pancre atic disease. The famine in this area 10 years previously may be of relevan ce to the aetiology of diabetes in these patients.