Mortality of young patients with diabetes in Kinshasa, DR Congo

Muyer, Muel Telo; Buntinx, Frank; Mapatano, Mala Ali; Clerck, M. De; Carla, Truyers; Muls, Erik

doi:10.1111/j.1464-5491.2010.02961.x

Cited by 18 publications

(15 citation statements)

References 11 publications

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“…Mortality before diagnosis and/or inclusion in the registry is also a possible limiting factor in this population, which is supported by the low incidence at younger ages ( < 10 years) and the fact that until 2009, most district hospitals did not have a glucose meter. The high mortality in the Democratic Republic of the Congo in the first few years after diagnosis also raises the suspicion of missed cases due to mortality . Cases receiving care from private or foreign providers may also have been missed, although the numbers are likely to be small.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa

et al. 2015

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“…Diabetic ketoacidosis (DKA) is one of the most common complications of type 1 diabetes and is one of the most serious acute medical conditions in the field of endocrinology, imposing substantial healthcare challenges and costs [1]. The in-hospital mortality rate is low (<1%) but overall mortality is increased in people >60 years of age, individuals with comorbidity [1][2][3], socioeconomic and psychosocial burdens [4] and in those from developing areas [5]. DKA and diabetic coma account for the greatest proportion of excess mortality (~25%) in individuals with type 1 diabetes aged <50 years [2,6] and it is likely that a high mortality outside of hospital contributes to this.…”

Section: Introductionmentioning

confidence: 99%

Substrate metabolism, hormone and cytokine levels and adipose tissue signalling in individuals with type 1 diabetes after insulin withdrawal and subsequent insulin therapy to model the initiating steps of ketoacidosis

et al. 2018

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Aims/hypothesis Lack of insulin and infection/inflammation are the two most common causes of diabetic ketoacidosis (DKA). We used insulin withdrawal followed by insulin administration as a clinical model to define effects on substrate metabolism and to test whether increased levels of counter-regulatory hormones and cytokines and altered adipose tissue signalling participate in the early phases of DKA. Methods Nine individuals with type 1 diabetes, without complications, were randomly studied twice, in a crossover design, for 5 h followed by 2.5 h high-dose insulin clamp: (1) insulin-controlled euglycaemia (control) and (2) after 14 h of insulin withdrawal in a university hospital setting. Results Insulin withdrawal increased levels of glucose (6.1 ± 0.5 vs 18.6 ± 0.5 mmol/l), NEFA, 3-OHB (127 ± 18 vs 1837 ± 298 μmol/l), glucagon, cortisol and growth hormone and decreased HCO 3 − and pH, without affecting catecholamine or cytokine levels. Whole-body energy expenditure, endogenous glucose production (1.55 ± 0.13 vs 2.70 ± 0.31 mg kg −1 min −1), glucose turnover, non-oxidative glucose disposal, lipid oxidation, palmitate flux (73 [range 39-104] vs 239 [151-474] μmol/min), protein oxidation and phenylalanine flux all increased, whereas glucose oxidation decreased. In adipose tissue, Ser473 phosphorylation of Akt and mRNA levels of G0S2 decreased, whereas CGI-58 (also known as ABHD5) mRNA increased. Protein levels of adipose triglyceride lipase (ATGL) and hormone-sensitive lipase phosphorylations were unaltered. Insulin therapy decreased plasma glucose concentrations dramatically after insulin withdrawal, without any detectable effect on net forearm glucose uptake. Conclusions/interpretation Release of counter-regulatory hormones and overall increased catabolism, including lipolysis, are prominent features of preacidotic ketosis induced by insulin withdrawal, and dampening of Akt insulin signalling and transcriptional modulation of ATGL activity are involved. The lack of any increase in net forearm glucose uptake during insulin therapy after insulin withdrawal indicates muscle insulin resistance.

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“…In 1994, this problem was termed the 'insulin dilemma' [2] and it has been much discussed and widely accepted [3][4][5][6][7]. More recent surveys have confirmed the breadth of the problem [8,9], and there is no doubt that deaths owing to diabetic ketoacidosis as a result of insulin shortage occur in people with type 1 diabetes living in remote, resource-poor areas [10]. Chronic self-underdosing with insulin also occurs, to economise and to make supplies last longer in case of interruption.…”

Section: Introductionmentioning

confidence: 99%

The insulin dilemma in resource-limited countries. A way forward?

et al. 2010

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The International Insulin Foundation (IIF) has developed and validated a needs-assessment instrument called the Rapid Assessment Protocol for Insulin Access (RAPIA) which has been used in seven countries in four continents to analyse the constraints to delivering effective continuing care for people with diabetes. One major contributor to the difficulties in availability of insulin is a failure to use the least costly sources and types of insulin and other effective drugs for diabetes. The purchase of insulins can consume as much as 10% of government expenditure on drugs, this being highly sensitive to the selection of newer analogue insulins as first-choice options, which cost between three and 13 times more than biosynthetic human insulin. Insulin cartridges for use with injection pens further add to costs. Similar considerations apply to most of the newer treatments for people with type 2 diabetes, which may cost up to 40 times more than metformin and sulfonylureas, still considered first-line drugs by European and US guidelines. Both biosynthetic human insulin and the first-line oral hypoglycaemic drugs are available from generic manufacturers. With the present price differentials, there is thus a growing need for countries involved in tendering for sourcing insulin to be provided with the guarantees of Good Manufacturing Practice, quality and bioequivalence, which would come from a WHO Pre-Qualification Scheme as currently exists for a variety of drugs for chronic diseases, both communicable and non-communicable. The IIF has developed a position statement on the provision and choice of diabetes treatments in resource-limited settings which should be applicable wherever consideration of resources is a component of therapeutic decision making.

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Mortality of young patients with diabetes in Kinshasa, DR Congo

Abstract: One out of six patients died, most within 5 years after diagnosis. Death occurred more frequently at home, in male patients and in subjects aged

Cited by 18 publications

References 11 publications

Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa

Prevalence and incidence of clinically recognized cases of Type 1 diabetes in children and adolescents in Rwanda, Africa

Substrate metabolism, hormone and cytokine levels and adipose tissue signalling in individuals with type 1 diabetes after insulin withdrawal and subsequent insulin therapy to model the initiating steps of ketoacidosis

The insulin dilemma in resource-limited countries. A way forward?

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