JMIR Publications

ABSTRACT

Background:

The burden of diabetes mellitus (diabetes) is increasing worldwide. In 2017, 15 million people were estimated to have diabetes in Africa, and is projected to reach 40.7 million by 2045. In Zimbabwe, the prevalence increased from 0.4% in the 1980s to 5.7% in 2014. The prevalence and incidence of diabetic complications in the Africa region is poorly documented and varies between countries. Type 1 and type 2 diabetes, hybrid diabetes and other types of diabetes may occur. Although tests to confirm aetiology are in use in most well-resourced countries. there is little information on the aetiological types of diabetes in Africa, where classification is often based on age and clinical features at presentation. This may lead to selection of inappropriate treatment.

Objective:

To characterize the aetiological types of diabetes and to determine the prevalence of chronic complications in adult patients in Zimbabwe, with newly diagnosed diabetes; additionally, to determine the incidence and risk factors for the development of complications of diabetes after 2 years follow - up in patients with type 2 diabetes, who are complication-free at baseline.

Methods:

This will be a cross-sectional and prospective observational study. The cross-sectional (Baseline/Phase1) study will be conducted in patients presenting for the first time to the diabetes service at two referral hospitals and two diabetes clinics in Bulawayo, Zimbabwe. Consenting participants will have the following: questionnaire information for demographic, social and medical history, clinical examination for complications, and special investigations. Laboratory tests include serum urea, creatinine and electrolytes, liver function tests, lipids, plasma glucose, HbA1c, serum C-peptide, spot urine (dipstick, albumin and creatinine) and ẞ cell antibodies (anti-glutamic acid decarboxylase, anti-islet auto antigen, anti-insulin antibodies, anti-islet cell antibodies and anti-zinc transporter 8 antibodies). All patients will have retinal photography, 12 lead electrocardiograph, and measurement of carotid intima-media thickness and arterial stiffness. A two year follow up (Prospective/Phase2) study will be undertaken in a subgroup of patients, diagnosed with type 2 diabetes and free of diabetes complications at presentation. Participants in the Prospective Study will be reviewed every 6 months. At each visit, in addition to all variables collected at baseline, data on diabetes management and drug therapy compliance will be obtained.

Results:

Results will describe the spectrum of diabetes and complications found at diagnosis (Phase1), and the incidence and risk factors associated with the development of complications of diabetes (Phase2).

Conclusions:

Information on types of diabetes and related complications identified in the study can hopefully be used to formulate screening and management guidelines for diabetes patients in Zimbabwe.