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Biomedical subjects

D G McLarty

Publications and source records attributed to D G McLarty.

At least 19 recordsLinked to original sources
PubMed1992

Is diabetes mellitus related to undernutrition in rural Tanzania?

OBJECTIVE: To investigate the relation between undernutrition and diabetes. DESIGN: Survey of glucose tolerance in rural Tanzania. SETTING: Eight villages in three widely separated regions of Tanzania. SUBJECTS: 8581 people aged 15 and above: 3705 men and 4876 women. MAIN OUTCOME MEASURES: Oral glucose tolerance, body mass index, height, and low haemoglobin and cholesterol concentrations. RESULTS: In the eight villages 42.7-56.9% of all men and 30.0-45.2% of all women had a body mass index below 20 kg/m2; the lowest quintile was 18.2 kg/m2 in men and 18.6 kg/m2 in women. The prevalence of diabetes did not change significantly from the lowest to the highest fifths of body mass index in men (lowest 1.6% (95% confidence interval 0.8% to 2.9%) v highest 1.3% (0.7% to 2.5%)) or women (1.1% (0.6% to 2.1%) v 0.5% (0.2% to 1.2%)). In men and in women prevalence of impaired glucose tolerance was greater in the lowest fifths of height (8.2% (6.3% to 10.6%), and 11.1% (9.2% to 13.3%)) respectively and body mass index (9.6% (7.5% to 12.1%), and 8.4% (6.7% to 10.5%)) than in the highest fifths (impaired glucose tolerance 4.7% (3.4% to 6.5%); and 5.1% (3.9% to 6.7%); body mass index 5.1% (3.7% to 7.0%), and 7.7% (6.2% to 9.6%). CONCLUSION: Rates of diabetes were not significantly associated with low body mass index or height, but overall rates were much lower than those in well nourished Western populations. Increased impaired glucose tolerance in the most malnourished people may reflect the larger glucose load per kilogram weight. The role of undernutrition in the aetiology of diabetes must be questioned.

Adolescent↗
PubMed1992

Must diabetes be a fatal disease in Africa? Study of costs of treatment.

OBJECTIVE: To estimate the costs of diagnosis and treatment of diabetes in Tanzania. DESIGN: Costs estimated from the reported and recorded experience of patients with newly presenting diabetes in 1989-90 and of diabetic patients first seen in 1981-2. SETTING: Muhimbili Medical Centre, Dar es Salaam. SUBJECTS: 464 patients (315 men and 149 women). 262 patients diagnosed during 1 September 1989-31 August 1990 (group 1) and 202 during 1 June 1981-31 August 1982 (group 2). RESULTS: The average annual direct cost of diabetes care in 1989-90 was $287 for a patient requiring insulin and $103 for a patient not requiring insulin. Purchase of insulin accounted for 68.2% ($156) of the average annual outpatient costs for patients requiring insulin. For patients not requiring insulin the cost of oral hypoglycaemic drugs and treatment of chronic complications and infections accounted for 42.5% ($29.3) and 48.8% ($33.7) of costs respectively. Cost of outpatient care of diabetic patients for the whole of Tanzania was estimated at $2.7m, *75,128 (32.2%) of which was for insulin. Doctors' and nurses' costs accounted for 0.2% of total costs of outpatient care. The annual direct inpatient care costs were estimated at $1.25m. Around 0.2% of the Tanzanian population aged 15 years and over used the equivalent of 8% of the total government health expenditure, which was $47,4088,382. CONCLUSION: Diabetes places a severe strain on the limited resources of developing countries. If African patients with diabetes have to pay for their treatment most will be unable to do so and will die.

Adolescent↗
PubMed1991

Prevalences of diabetes and cardiovascular disease risk factors in Hindu Indian subcommunities in Tanzania.

OBJECTIVES: To seek differences in the prevalence of diabetes mellitus and other coronary heart disease risk factors, and to identify factors associated with these differences within a Hindu Indian community. DESIGN: Population based cross sectional survey. SETTING: Dar-es-Salaam, Tanzania. SUBJECTS: Of 20 Hindu subcommunities categorised by caste in Dar-es-Salaam, seven were randomly selected. 1147 (76.7%) of 1495 subjects aged 15 or over participated. MAIN OUTCOME MEASURES: Blood glucose concentrations (fasting and two hours after oral glucose loading), serum total cholesterol and serum triglyceride concentrations, blood pressure, and height and weight. RESULTS: The subcommunities differed substantially in socioeconomic characteristics and lifestyle. Overall, 9.8% of subjects (109/1113) had diabetes, 17.0% (189/1113) impaired glucose tolerance, 14.5% (166/1143) hypertension, and 13.3% (151/1138) were obese. The mean fasting blood glucose concentration was 4.9 mmol/l, the blood glucose concentration two hours after oral loading (75 g) 6.0 mmol/l, the total cholesterol concentration 4.9 mmol/l, the serum triglyceride concentration 1.4 mmol/l, and body mass index (weight/height: kg/m2) 24.3. Systolic and diastolic blood pressures were 121 and 77 mm Hg respectively. There were important intercommunity differences even after standardisation for age, sex, and body mass index--for example, in mean fasting blood glucose concentration (range 4.5 (Jains) to 5.9 mmol/l (Patels)), serum total cholesterol concentration (range 4.5 (Jains) to 6.2 mmol/l (Suthars)), systolic blood pressure (range 110 (Limbachias) to 127 mm Hg (Bhatias)), and prevalences of diabetes (range 3.4% (3/87 Limbachias) to 18% (20/111 Navnats)) and hypertension (range 5.7% (5/87 Limbachias) to 19.4% (43/222 Bhatias). Variables which showed significant linear correlation with subcommunity variations were entered into a multiple regression model. Intercommunity variations persisted. The Limbachia and Jain communities had the lowest prevalence of and mean values for coronary heart disease risk factors and the Bhatia and Patel communities had the highest. CONCLUSIONS: In this series intercommunity variations in disease and risk factors might have been related to genetic, dietary, socioeconomic, and lifestyle differences but could not be explained by the characteristics studied. Studies of Indian subcommunities are warranted to confirm and extend these descriptive findings and explore the genetic basis of diabetes. Communities of Indian origin should not be perceived as homogeneous.

Adolescent↗
PubMed1991

No deterioration of oral glucose tolerance during pregnancy in rural Tanzania.

There is still controversy concerning the reference ranges for glucose tolerance tests in pregnancy. The WHO has recommended the universal use of the 75 g oral glucose load with 2-h post-load values of greater than 6.7 mmol l-1 to be considered impaired glucose tolerance (IGT) in the non-pregnant, and equivalent to gestational diabetes in the pregnant. Some data are available for pregnant Caucasians but little information is available for other ethnic groups. Oral glucose tolerance tests (75 g) have therefore been performed in 189 pregnant women in rural Tanzania. Mean fasting blood glucose values were 4.0 mmol l-1 in non-pregnant women, and 3.7, 3.5, and 3.3 mmol l-1 in pregnant women in the first, second, and third trimesters, respectively. Two-hour OGTT values were 4.7 mmol l-1, and 4.6, 4.5, and 4.2 mmol l-1 while the upper limit of normal values (mean + 2SD) were 7.1 mmol l-1, and 6.8, 6.8, and 6.1 mmol l-1. The 2-h glucose levels are therefore close to WHO recommendations but lower than those reported for Caucasians. By contrast with reports for Caucasians, glucose tolerance did not deteriorate during pregnancy. The prevalence of diabetes and IGT was zero in the pregnant group.

Adult↗
PubMed1991

Impaired glucose tolerance and diabetes mellitus in Hindu Indian immigrants in Dar es Salaam.

The prevalence of Impaired Glucose Tolerance (IGT) and diabetes mellitus was studied in a migrant Hindu Indian community in Dar es Salaam, Tanzania. Using 1985 WHO criteria, 75 g oral glucose tolerance tests (OGTT) were performed on 1147 (583 men; 564 women) subjects aged 15 years and over. The age-standardized prevalence of IGT in men and women was 15.2 and 17.2%, and that of diabetes was 9.1% (6.5% known; 2.6% previously undiagnosed) and 9.0% (3.7% known; 5.3% previously undiagnosed), respectively. Diabetes was present in 12.9% of men and 12.8% of women aged 35 years and above. The overall age- and sex-standardized prevalence of IGT was 16.2% and of diabetes 9.1%. The major risk factors associated with diabetes in both men and women were age, family history of diabetes, and physical inactivity, and in women body mass index (BMI). Age and BMI contributed to the higher frequency of IGT in women as compared with men while in men, age was the only contributory factor. Despite overweight and obesity being more frequent in women than men, age-standardized prevalence rates of IGT and diabetes were similar between men and women. The decreased prevalence of diabetes in men and women performing moderate/heavy physical activity was independent of age and BMI.

Adolescent↗
PubMed1991

Outcome of pregnancy in diabetic patients in Dar es Salaam, Tanzania.

Between 1 June 1986 and 31 August 1987 all 47 pregnant diabetic Tanzanian women attending Muhimbili Medical Centre, Dar es Salaam were seen and managed by a small team of interested physicians and obstetricians. Of the 50 pregnancies there were 44 (88%) live births, five (10%) perinatal deaths, and one (2%) spontaneous abortion. One child was born with a serious congenital abnormality. All five perinatal deaths were seen in women who presented late in pregnancy (three) or had poor blood glucose control (two). In 10 (36%) of the 28 pregnancies in the 25 patients with insulin-requiring diabetes, insulin requirements decreased greater than 8 U during the course of pregnancy. The present study suggests that with close supervision of the pregnant diabetic patient in Africa perinatal mortality rates approaching those seen in developed countries can be achieved, despite the lack of home blood glucose monitoring. Rates could be further reduced if medical services were more widely available, and if all patients were educated on the importance of early presentation in pregnancy.

Abortion, Spontaneous↗
PubMed1991

Study in Tanzania of impaired glucose tolerance. Methodological myth?

During a study of diabetes prevalence in six rural Tanzanian communities, a repeat oral glucose tolerance test (OGTT) was carried out in 514 subjects greater than or equal to 15 yr of age within 1 wk of an initial 75-g OGTT. In 498 subjects, blood glucose was measured 2 h after the glucose load on both occasions, and in 175 subjects, fasting blood glucose measurement was also repeated. Of the 498 subjects, 245 had normal glucose tolerance in the first test and were selected at random for further testing; 223 subjects had impaired glucose tolerance (IGT), and 30 had diabetic values. Diabetes and IGT were diagnosed on the basis of the 2-h blood glucose values. In the second test, 241 (98.4%) of the 245 subjects with normal tolerance continued in this category and 4 (1.6%) showed IGT. Of the 223 with IGT in the first test, 171 (76.2%) reverted to normal on the second test, 7 (3.1%) had diabetic values, and 45 (20.2%) persisted with IGT. Of the 30 subjects diagnosed as diabetic in the first test, 8 (26.7%) remained with diabetic values, 11 (36.7%) had IGT, and 11 (36.7%) were normal. Based on the second test, the population-prevalence rates of diabetes and IGT would have been 0.5 and 3.3% vs. 1 and 7.6% based on the first test. There was a significant downward trend in the mean 2-h blood glucose values in all three diagnostic groups. Regression toward the mean could not account for the downward shift in blood glucose values observed on retesting.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Specificity of hypoglycaemia for cerebral malaria in children.

Glycaemic status on hospital admission was compared in 97 children with severe falciparum malaria (36 with cerebral malaria) and 89 children with other serious illnesses (32 in coma; 57 with acute pneumonia, not in coma). The frequency of hypoglycaemia (blood glucose below 2.2 mmol/l) did not differ significantly between malarial and control patients (5.2% vs 11.2%) nor between the comatose (11.1% vs 18.8%) and conscious (1.6% vs 7.0%) malarial and control subgroups. Compared with normoglycaemic patients, hypoglycaemic patients had appropriately low serum insulin (3.0 vs 8.2 mU/l) and C-peptide (0.13 vs 0.42 mmol/l) and high plasma non-esterified fatty acids (1.42 vs 0.83 mmol/l). Hypoglycaemia, the level of consciousness, and death were all significantly associated with the time since the last meal. Hypoglycaemia is not a specific complication of malaria but is found in severely ill fasted children, resulting from glycogen depletion and perhaps impaired hepatic gluconeogenesis. It should be sought in all severely sick children. A single bolus dose of glucose may not be enough to correct it.

Alanine↗
PubMed1990

Diabetes in tropical Africa: a prospective study, 1981-7. I. Characteristics of newly presenting patients in Dar es Salaam, Tanzania, 1981-7.

OBJECTIVE: To study the clinical characteristics of newly diagnosed diabetic patients in tropical Africa. DESIGN: Prospective study of all newly diagnosed diabetic patients registered at a major urban hospital between 1 June 1981 and 31 May 1987. SETTING: Muhimbili Medical Centre, Dar es Salaam, Tanzania. PATIENTS: 1250 Patients: 874 men, 376 women. RESULTS: 272 (21.8%) Patients had diabetes requiring insulin, 825 (66.0%) had diabetes not requiring insulin, and 153 (12.2%) had diabetes of uncertain type. Most patients (1103, 88.2%) presented with the classic symptoms of diabetes. The peak time of presentation of diabetic patients requiring insulin was at age 15 to 19 years. Male manual workers and peasant farmers with diabetes not requiring insulin presented at a significantly older age and had a lower body mass index than sedentary office workers. Forty six (18.1%) of the patients requiring insulin diabetes and 111 (14.4%) not requiring insulin had first degree relative with diabetes. Twenty seven per cent of patients were underweight (body mass index less than 20 kg/m2) and 14.6% were obese (body mass index greater than 30 kg/m2). Hypertension was diagnosed in 211 (26.7%) of 791 patients not requiring insulin. Nine (3.3%) of those requiring insulin may have had the protein deficient type of diabetes related to malnutrition. The fibrocalculous variety of diabetes related to malnutrition was not observed. CONCLUSIONS: Newly presenting diabetic patients in Tanzania with diabetes requiring insulin are older at presentation than those in Britain; most diabetic patients present with diabetes not requiring insulin and a smaller proportion of Tanzanian patients are obese. Most have a lower socioeconomic state than diabetic patients in Britain. There are often delays in diagnosis in Tanzania, and there is a higher incidence of death shortly after presentation.

Adolescent↗
PubMed1990

Diabetes in tropical Africa: a prospective study, 1981-7. II. Course and prognosis.

OBJECTIVE: To determine the clinical course of diabetes mellitus in tropical Africa. DESIGN: Continuing care and follow up until 31 March 1989 of all newly diagnosed diabetic patients registered at one hospital between 1 June 1981 and 31 May 1987. SETTING: Muhimbili Medical Centre, Dar es Salaam, Tanzania. SUBJECTS: 1250 Newly diagnosed diabetic patients seen over a six year period. 272 (21.8%) Had diabetes requiring insulin, 825 (66.0%) diabetes not requiring insulin, and 153 (12.2%) diabetes of uncertain type. MAIN OUTCOME MEASURES: Survival rates during each year of follow up. RESULTS: 205 (16.4%) Patients were known to have died, 126 (61.5%) in hospital and 79 (38.5%) in the community. At least a further 71 patients were likely to have died. The five year survival rates (95% confidence intervals) for patients with diabetes requiring and not requiring insulin were 71% (62% to 80%) and 84% (80% to 89%) respectively for known deaths and 60% (51% to 69%) and 82% (77% to 86%) respectively for known plus probable deaths. 49 (3.9%) Patients died at the time of presentation. Severe diabetic ketoacidosis and infection were responsible for most deaths in patients with diabetes requiring insulin. Infection was responsible for 24% of deaths in patients with diabetes not requiring insulin and was the main cause of death in the group with uncertain type of diabetes. Cardiovascular and renal causes were responsible for 24% of hospital deaths of patients with diabetes not requiring insulin. Diabetes requiring insulin, young age, and ketonuria at presentation were associated with a significantly worse five year survival on multivariate analysis. On univariate analysis underweight, female sex, low educational background, and manual occupations were additional factors with a worse prognosis. CONCLUSION: Diabetes in sub-Saharan Africa is, in many patients, a serious disease with a poor prognosis. Most deaths, however, are due to preventable causes. More effort is therefore required to increase public awareness of diabetes and to improve patient detection, management, and follow up.

Cause of Death↗
PubMed1990

Increased prevalence of diabetes mellitus in patients with pulmonary tuberculosis in Tanzania.

Glucose tolerance was assessed, according to WHO diagnostic criteria, in 506 consecutive African patients admitted with sputum-positive pulmonary tuberculosis to the tuberculosis wards of Muhimbili Medical Centre, Dar es Salaam. Nine (1.8%) patients were known to have diabetes. Following a 75 g oral glucose tolerance test (OGTT) diabetes was diagnosed in a further 25 (4.9%) patients giving an overall crude diabetes prevalence rate of 6.7%. Impaired glucose tolerance (IGT) was present in 82 (16.2%) subjects. A repeat OGTT was carried out in the 25 patients found to have diabetic values after the first test. Eight (28%) of the 25 patients reverted to normal glucose tolerance after the second test, 6 (24%) to IGT, and 11 (48%) remained with blood glucose values in the diabetic range, giving a crude diabetes prevalence rate of 4%. In a survey of glucose tolerance, using similar methodology, in 693 members of an urban community in Dar es Salaam the prevalence rates of diabetes and IGT were 0.9% and 8.8% respectively. Diabetes was therefore at least four times as common in the tuberculosis patients (p less than 0.001), and IGT twice as frequent (p less than 0.0001). This study confirms the relationship between diabetes and tuberculosis. Those caring for patients with tuberculosis should be aware of the increased prevalence of diabetes in their patients, since failure to diagnose the problem may adversely affect prognosis.

Adolescent↗
PubMed1990

Islet cell antibodies are not specifically associated with insulin-dependent diabetes in Tanzanian Africans.

The prevalence of islet cell antibodies (ICA and CF-ICA) together with other organ-specific auto-antibodies was investigated in 122 newly presenting black Tanzanian diabetic patients in Dar es Salaam. ICA were found in three (8.6%) IDDM patients and five (6.8%) insulin-requiring NIDDM patients; six of the eight were also CF-ICA positive. Altogether 22% of patients showed one or more positive autoantibody result but there was no clustering of response, and no association of ICA with other antibodies except for two NIDDM subjects who showed one other positive result. There were no differences between insulin-requiring (IDDM) and NIDDM subjects or between younger (less than 30 years) and older patients. We conclude that there is no major association between diabetes and islet cell antibodies in black Tanzanians.

Adolescent↗
PubMed1990

Diabetes and impaired glucose tolerance in an Asian community in Tanzania.

The prevalence of diabetes and impaired glucose tolerance has been determined in an Asian Muslim community in Dar-es-Salaam, Tanzania. Two-h oral glucose (75 g) tolerance tests were performed on 1049 subjects over 14 years old, who were fasting, from a random sample of families. The overall age and sex-adjusted prevalence of diabetes was 7.1% (4.4% known, 2.7% previously undiagnosed) with a steady increase from 0.8% at 15-24 years and 3.0% at 25-34 years, to 24.9% for 65 years and over. Impaired glucose tolerance (IGT) rates ranged from 11.4% (15-24 years) to 22.3% (over 64 years). The overall age-adjusted prevalence of IGT was 21.5%. The mean body indices (BMIs) were 24.3 and 26.4 for males and females, respectively, but age-adjusted diabetes rates were similar in the two sexes (7.0% and 7.6%, respectively). Diabetes and IGT were commoner in those with BMI greater than 25 only in the older age groups. Diabetes and IGT were commoner in those with a family history of diabetes. Increasing parity was also associated with a higher diabetes prevalence. Diabetes and IGT are thus common in Asians in Tanzania, in contrast to the indigenous community. Rates are indeed higher than in most other immigrant Asian communities.

Adolescent↗
PubMed1990

Tuberculosis in diabetic patients in Tanzania.

During a 1-7 year follow-up of 1250 African diabetic patients at Muhimbili Medical Centre, Dar es Salaam, 68 (5.4%) were known to have developed pulmonary tuberculosis and two (0.2%) spinal tuberculosis. In 18 (25.7%) of the 70 patients tuberculosis was diagnosed prior to the diagnosis of diabetes, and in 32 (45.7%) after the diagnosis of diabetes. In 20 (28.6%) patients tuberculosis and diabetes were diagnosed at approximately the same time with most presenting with symptoms of diabetes. The prevalence of tuberculosis was greater in the young, in those with a low body mass index (BMI), in patients with insulin-dependent diabetes mellitus compared to those with non-insulin-dependent diabetes mellitus (9.0% vs 2.7%) and in those whose diabetes was poorly controlled. Seventeen (24.3%) of the 70 patients are known to have died. Pulmonary tuberculosis may progress rapidly and a high index of suspicion is required. It remains a significant cause of morbidity and mortality among diabetic patients in developing countries.

Adolescent↗