Abstract:
Objective-To study the clinical characteristics of
newly diagnosed diabetic patients in tropical Africa.
Design-Prospective study of all newly diagnosed
diabetic patients registered at a major urban hospital
between 1 June 1981 and 31 May 1987.
Setting-Muhimbili Medical Centre, Dar es
Salaam, Tanzania.
Patients- 1250 Patients: 874 men, 376 women.
Results-272 (21-8%) Patients had diabetes
requiring insulin, 825 (66.0%) had diabetes not
requiring insulin, and 153 (12-2%) had diabetes of
uncertain type. Most patients (1103, 88.2%) presented
with the classic symptoms of diabetes. The
peak time of presentation of diabetic patients requiring
insulin was at age 15 to 19 years. Male manual
workers and peasant farmers with diabetes not
requiring insulin presented at a significantly older
age and had a lower body mass index than sedentary
office workers. Forty six (18-1%) of the patients
requiring insulin diabetes and 111 (14.4%) not requiring
insulin had first degree relative with diabetes.
Twenty seven per cent of patients were underweight
(body mass index <20 kg/M2) and 14-6% were obese
(body mass index >30 kg/m2). Hypertension was
diagnosed in 211 (26.7%) of 791 patients not requiring
insulin. Nine (3.3%) of those requiring insulin may
have had the protein deficient type of diabetes
related to malnutrition. The fibrocalculous variety of
diabetes related to malnutrition was not observed.
Conclusions-Newly presenting diabetic patients
in Tanzania with diabetes requiring insulin are older
at presentation than those in Britain; most diabetic
patients present with diabetes not requiring insulin
and a smaller proportion of Tanzanian patients are
obese. Most have a lower socioeconomic state than
diabetic patients in Britain. There are often delays in
diagnosis in Tanzania, and there is a higher incidence
of death shortly after presentation.
