Classification and dramatic epidemic of diabetes mellitus in Kinshasa Hinterland: the prominent role of type 2 diabetes and lifestyle changes among Africans.

Abstract

BACKGROUND: Classification of diabetes mellitus is not easily stated in Central Africa using the current diabetes classification of World Health Organization/American Diabetes Association. The objective of the study is to determine the prevalence, classification and risk factors of diabetes mellitus in Kinshasa Hinterland. METHODS: A multilevel and stratified random sample cross-sectional study included 9770 black Africans (4580 men and 5190 women) aged 12 years and above in urban metropolitan (Kinshasa city) and rural (Kikwit) areas. Participants were examined and administered a structured questionnaire and a capillary whole blood glucose test was done. RESULTS: The mean age of participants was 46 +/- 15 years. Overall crude and age adjusted prevalences of diabetes were 25% (n = 2472) and 18%, respectively. Using WHO/ADA classification, Type diabetes (80%) was commoner than undetermined form (12%), Type 1B (3.5%), Type 1A (2.5%) and Other specific types (2%). According to plasma insulin and plasma C-peptide levels, participants with undetermined form were classified Type 2 diabetics. Thus, the rate of Type 2 diabetes among diabetics was estimated 92%. Urban location, age, abdominal obesity arterial hypertension, physical inactivity, inappropriate diet (lack of fruits-vegetables, refined sugar, animal fat and protein, starvation, social inequalities, cigarette smoking, alcohol intake were significantly and positively associated with diabetes in general and type 2 diabetes in particular. CONCLUSION: The high prevalence of diabetes is due to the unexpected high rates of type 2 diabetes, aging, urbanization, and sedentary lifestyle consequences. The majority of risk factors of diabetes are potentially modifiable by primary prevention.