Abstract
BackgroundExisting prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers.MethodsA cross-sectional, clinic-based study was conducted in which individuals with diabetes mellitus were consecutively recruited from April 2015 to April 2016. Demographic and clinical data were collected from patient interviews, medical files and physical examinations. Chi-square tests and T-tests were used to compare proportions and means between rural and urban residents.ResultsA total of 472 participants were recruited (mean age 40.2 ± 19.1 years), including 295 women and 315 rural residents. Compared to urban residents, rural residents had lower levels of education, were more likely to be employed in low-income work and to have limited access to running water and electricity. Diabetes was diagnosed at a younger age in rural residents (mean ± SD 32 ± 18 vs 41 ± 17 years; p < 0.001). Physical inactivity, family history of diabetes and obesity were significantly less prevalent in rural than in urban individuals (44% vs 66, 14.9% vs 28.7 and 27.6% vs 54.1%, respectively; p < 0.001). The frequency of fruit and vegetable consumption was lower in rural than in urban participants. High waist circumference was more prevalent in urban than in rural women and men (75.3% vs 45.5 and 30% vs 6%, respectively; p < 0.001). History of childhood under-nutrition was more frequent in rural than in urban individuals (22.5% vs 6.4%; p < 0.001).ConclusionsCharacteristics of people with diabetes in rural Rwanda appear to differ from those of individuals with diabetes in urban settings, suggesting that sub-types of diabetes exist in Rwanda. Generic guidelines for diabetes prevention and management may not be appropriate in different populations.
Highlights
Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist
In our recent systematic review describing atypical forms of diabetes mellitus in non-European populations in low- and middle-income countries (LMICs), we found evidence of malnutrition-related diabetes mellitus (MRDM) characterized by a type 1 diabetes-like phenotype, a history of childhood malnutrition, underweight at diagnosis, male predominance, young age at diagnosis, and severe symptoms with high blood glucose without ketosis [6]
Two women who had diabetes diagnosis in the third trimester of pregnancy and one men with acromegaly were excluded from the study
Summary
Existing prevention and treatment strategies target the classic types of diabetes yet this approach might not always be appropriate in some settings where atypical phenotypes exist. This study aims to assess the socio-demographic and clinical characteristics of people with diabetes in rural Rwanda compared to those of urban dwellers. Age-specific prevalence appears to be higher in men than in women in many countries, and the incidence increases with age; type 2 diabetes mellitus is most commonly found in persons over the age of 65 years. There is a strong association with obesity in western countries and urban areas in LMICs, diabetes is not uncommon among young and lean people in rural areas in LMICs [2,3,4]. There is limited information on socio-demographic, etiopathological and clinical profile of diabetes to support development of context specific guidelines for prevention, diagnosis, classification and management of potential atypical sub-types of diabetes mellitus in sub-Saharan Africa and other LMICs [6,7,8]
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