Characteristics of subjects with diabetes mellitus diagnosed before 35 years of age presenting to a tertiary diabetes clinic in Durban, South Africa, from 2003 to 2016

Abstract

Background: Most patients diagnosed with diabetes mellitus < 35 years will have type 1 diabetes (T1D). The increase in youthonset type 2 diabetes (T2D) parallels the obesity epidemic and in African subjects ketosis-prone type 2 diabetes (KPD) may occur in this age group. Objectives, setting and subjects: To evaluate the clinical, biochemical and immunologic characteristics of patients diagnosed with diabetes < 35 years presenting to a tertiary diabetes clinic in Durban, South Africa over 13 years. Design: A retrospective chart review of patients < 35 years diagnosed with diabetes was conducted. Data included clinical and laboratory variables, complications and follow-up status. Results: The study included 517 patients of whom 445 (86.1%) were diagnosed with T1D, 27 (5.2%) with T2D, 27 with KPD (5.2%) and 18 (3.5%) with other forms of diabetes. Mean age of the total group was 28 ± 10 years. Subjects with T1D were younger at diagnosis with a lower BMI than both T2D and KPD. HbA1c was higher in subjects with T1D. Overall mortality was low (3.5%) and follow-up was poor in all groups. Conclusion: The majority of young people with diabetes in KwaZulu-Natal, South Africa, have T1D, with small numbers of other types. Glucose control is poor with a high loss to follow-up.

Pattern, Trend and Predictors of Adult-Onset Type 1 Diabetes in Uyo, Nigeria

“…Unlike in type 2 diabetes and before insulin therapy in type 1 diabetes, changes in BMI status have never featured prominently as a characteristic of adult-onset type 1 diabetes. This cardinal feature of type 1 diabetes was observed in the present sample such that the overall cohort had a mean BMI within the normal range (24.27 ± 3.40), consistent with similar findings by Govender and colleagues [17] in South Africa. However, the mean BMI status among the females was significantly high compared to the males and was found to be in the overweight range (26.30 ± 4.25).…”

“…Most of the study cohorts were in their thirties at the time of diagnosis and age ≤30 years was an independent predictor of type 1 diabetes in the present study. This pattern seems to fit into the age description of reported cases of adult-onset type 1 diabetes documented within the African region [16,17]. The majority of the Africans present a decade later, between 22 and 29 years, compared with the European descendants [16,17].…”

“…However, the mean BMI status among the females was significantly high compared to the males and was found to be in the overweight range (26.30 ± 4.25). Evidence suggests that higher BMI may accelerate beta cell destruction which may partly explain the younger age at diagnosis observed among the females in the present study who had higher BMI status than the males [17].…”

“…The majority of the Africans present a decade later, between 22 and 29 years, compared with the European descendants [16,17]. Moreover, Africans have been reported to have a bimodal peak of the age of onset of type 1 diabetes; the first peak occurring between 14 and 17 years, and the second peak occurring around age 30 [16,17].…”