Diabetes and intermediate hyperglycaemia in Kisantu, DR Congo: a cross-sectional prevalence study.

OBJECTIVES: To study the prevalence and risk markers of diabetes mellitus and intermediate hyperglycaemia (IH) in Kisantu, a semirural town in Bas-Congo province, The Democratic Republic of Congo. DESIGN: A cross-sectional population-based survey. SETTINGS: A modified WHO STEPwise strategy was used. Capillary glycaemia was measured for fasting plasma glucose and 2-h-postload glucose. Both WHO/IDF (International Diabetes Federation) 2006 and American Diabetes Association (ADA) 2003 diagnostic criteria for diabetes and IH were used. PARTICIPANTS: 1898 subjects aged ≥ 20 years. RESULTS: Response rate was 93.7%. Complete data were available for 1759 subjects (86.9%). Crude and standardised (for Doll and UN population) prevalence of diabetes were 4.8% and 4.0-4.2%. Crude IH prevalence was 5.8% (WHO/IDF) and 14.2% (ADA). Independent risk markers for diabetes (p<0.01) were male (OR 2.5), age 50-69 years (OR 2.6), family history (OR 3.5), waist (OR 4.1) and alcohol consumption (OR 0.36). In receiver operating characteristic (ROC) analysis, prediction of diabetes was slightly better by waist than body mass index (BMI). IH defined according to WHO/IDF was associated with BMI (OR 2.6, p<0.001). IH defined according to ADA was associated (p<0.05) with waist (OR 1.4), education level (OR 1.6), BMI (OR 2.4) and physical activity (OR 0.7). CONCLUSIONS: Current prevalence of diabetes in DR Congo exceeds IDF projections for 2030. The lower glucose threshold used by ADA almost triples impaired fasting glucose prevalence compared to WHO/IDF criteria. The high proportion of disorders of glycaemia made up by IH suggests the early stages of a diabetes epidemic.

Estimating prevalence of diabetes in a Congolese town was feasible.

OBJECTIVES: To study prevalence, determinants, and complications at diagnosis of diabetes and intermediate hyperglycemia (IH) in Kisantu, a semirural town in Bas-Congo province, Democratic Republic of Congo. STUDY DESIGN AND SETTING: A large-scale analytical cross-sectional population-based survey was performed in 2007 in Kisantu. After extensive sensitization, the study sample was collected using a modified World Health Organization (WHO) STEPwise strategy, taking subsequently a random sample of streets, households within streets, and inhabitants aged 20 years and older within households. After informed consent, subjects were invited to fixed sites for interview, anthropometry, clinical examination (blood pressure, monofilament, and ophthalmology), and biochemical tests (fasting capillary glucose, serum creatinine, and albuminuria). Fasting glycemia was repeated or 2-hour postload glycemia was measured the next day in subjects with an initial glycemia of 126-199 mg/dL (7.0-11.1 mmol/L) or 100-125 mg/dL (5.6-6.9 mmol/L), respectively. Hence, prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance according to both 2006 WHO/International Diabetes Federation and 2003 American Diabetes Association criteria could be evaluated. Bivariate and multivariate analyses were used for statistical analyses. RESULTS: Response rate was 93.7% (1,898 of 2,025). Complete data were available in 1,866 (92.1%) subjects. CONCLUSION: Estimating the prevalence of diabetes and IH in a small Congolese town was proven to be feasible.

[Albuminuria during the screening for diabetes in a semi-rural area (Kisantu City, DR Congo)]. / Albuminurie pathologique lors du dépistage du diabète en milieu semi-rural (cité de Kisantu en RD Congo).

OBJECTIVES: To determine the prevalence of microalbuminuria, macroalbuminuria and renal insufficiency at the time of screening for diabetes and impaired fasting glucose in the semi-rural area of Kisantu/DR Congo, and to identify determinants of pathological urinary albumin excretion (UAE). METHODS: Step 1: diabetes (81 cases) and impaired fasting glucose (148 cases) tracking in the population (1898 subjects selected by a systematic survey). Step 2: urinary albumin and serum creatinine were measured and glomerular filtration rate was estimated (modification of the diet in renal disease [MDRD] equation). The determinants of pathological UAE were assessed by logistic regression. RESULTS: The prevalence of macroalbuminuria and microalbuminuria in diabetes was 12.0 and 45.2% respectively versus 0 and 13.7% in impaired fasting glucose. Determinants of pathological UAE were: diabetes (adjusted OR [aOR]: 7.01; 95% CI: 3.48-14.11), central obesity (aOR: 2.36 [1.16-4.80]), age less that 60 years (aOR: 2.12 [1.05-4.40]), hypertension [aOR: 3.30 (1.39-7.82)] and diabetic retinopathy (aOR: 3.12 [1.54-6.26]). Renal insufficiency (MDRD<60ml/min/1.73m(2)) prevalence was 21.4% in diabetes and 3.8% in impaired fasting glucose. CONCLUSION: Microalbuminuria and macroalbuminuria are frequently detected during screening for diabetes and impaired fasting glucose in a semi-rural area in DR Congo. They are especially associated with age above 60 years, central obesity and hypertension. Early and integrated management of diabetes is essential to prevent renal failure in the population.