High Prevalence of Autoimmune Diabetes and Poor Glycaemic Control among Adults in Madagascar: A Brief Report from a Humanitarian Health Campaign in Ambanja

Abstract

Madagascar is a geographically isolated country considered a biodiversity hotspot with unique genomics. Both the low-income and the geographical isolation represent risk factors for the development of diabetes. During a humanitarian health campaign conducted in Ambanja, a rural city in the northern part of Madagascar, we identified 42 adult subjects with diabetes and compared their features to 24 randomly enrolled healthy controls. 42.9% (n = 18) of diabetic subjects showed HbA1c values ≥ 9.0%. Unexpectedly, waist circumference and BMI were similar in people with diabetes and controls. Different from the healthy controls, diabetic subjects showed a low prevalence of obesity (5.7% versus 30%, p = 0.02). Accordingly, we found a high prevalence of autoimmune diabetes as 12% of people with diabetes showed positivity for the autoantibody against glutamic acid decarboxylase. Diabetic subjects with positive autoantibody had higher HbA1c values (11.3 ± 4.1% versus 8.3 ± 2.6%, p = 0.03) compared to diabetic subjects with negative autoantibody. In conclusion, here we describe the presence of diabetes and its features in a rural area of Northern Madagascar, documenting poor glycaemic control and a high prevalence of autoimmune diabetes. These data highlight that the diabetes epidemic involves every corner of the world possibly with different patterns and features.

Identification of a distinct phenotype of elderly latent autoimmune diabetes in adults: LADA China Study 8

“…Patients with LADA are at high risk of progression to insulin dependency . LADA accounts for 2.6% to 12% of all patients with diabetes, which differs significantly in different ethnic groups . Our previous study has shown that around 5.9% of diabetic patients were classified as LADA in China .…”

“…2 LADA accounts for 2.6% to 12% of all patients with diabetes, which differs significantly in different ethnic groups. [3][4][5][6] Our previous study has shown that around 5.9% of diabetic patients were classified as LADA in China. 7 According to the population epidemiological survey, it can be speculated that China has the largest number of LADA patients, which are more than 6 million.…”

Risk of cardiac autonomic neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes: A cross‐sectional study

“…Diabetes mellitus is a heterogeneous disorder consisting of several disease subgroups showing different behaviours and outcomes. 1,2 While the great majority of cases are type 2 diabetes, a proportion varying from 2% to 12% of people with adult-onset diabetes are affected by latent autoimmune diabetes in adults (LADA), 3,4 a slowly progressive form of autoimmune diabetes with similarities and differences from both type 1 and type 2 diabetes. 5 The comparative evaluation of complications between different forms of diabetes is an open research area, with possible implications for the comprehension of complications' pathogenesis, risk stratification and individualized medicine.…”

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

“…It is also uncertain whether CV risk factors for macrovascular complications contribute equally in T1D and T2D . Autoantibodies (AAb) to islet‐cell cytoplasm (ICA), to glutamic acid decarboxylase (GADA) or to islet antigen‐2/2ß (IA‐2A) are detectable in up to 12% of adults with a clinical diagnosis of T2D . The presence of these AAbs identifies a subset of patients who have latent autoimmune diabetes in adults (LADA).…”

“…3 Autoantibodies (AAb) to islet-cell cytoplasm (ICA), to glutamic acid decarboxylase (GADA) or to islet antigen-2/2ß (IA-2A) are detectable in up to 12% of adults with a clinical diagnosis of T2D. 4,5 The presence of these AAbs identifies a subset of patients who have latent autoimmune diabetes in adults (LADA). LADA patients tend to be leaner and younger and to have a healthier CV risk profile than individuals without LADA.…”