Dietary cassava, beta-cell function and hyperbolic product loss rate in type 2 diabetes patients from South Kivu

Objective. Cassava, a major carbohydrate source in Africa, contains potentially diabetogenic chemicals, although its consumption is not associated with incident diabetes. As it is not known whether cassava intake impairs residual beta-cell function in patients with type 2 diabetes (T2D), our study compared the metabolic phenotypes of diet- and/or oral antidiabetic drug (OAD)-treated T2D patients in South Kivu (Democratic Republic of the Congo) with [Cassava (+); n= 147] and without [Cassava (-); n=46] self-reported cassava consumption. Design & methods. A total of 193 patients [male:female (%) 37:63; mean +/- 1 SD age: 56 +/- 11 years] were interviewed to determine the frequency and distribution of eight major dietary carbohydrate (CHO) sources (cassava, plantain, rice, maize, bread, sorghum, potatoes and legumes). Fasting glucose, insulin and lipid levels were obtained after an overnight fast and OAD discontinuation. Cassava (+) and Cassava (-) groups were compared for HOMA indices of insulin sensitivity (S), beta-cell function (B), hyperbolic product (B x S) and B x S loss rate (B x S LR). Results. Diabetes duration was 6 +/- 7 years, age at diabetes diagnosis was 51 +/- 11 years and BMI was 25 +/- 5 kg/m(2). Cassava intake was reported by 76% of patients, and amounted to 29 +/- 11% of their daily CHO intake. The Cassava (-) group ate more plantain, maize, bread and potatoes, and less sorghum. Age, gender and age at diabetes diagnosis did not differ between Cassava (+) and (-) patients, nor did BMI, fat mass, waist circumference, lipid profile and metabolic syndrome prevalence. HOMA indices of S, B, B x S and B x S LR did not differ significantly between groups-Cassava (+) vs (-): S, 114 +/- 56% vs 114 +/- 60%; B, 34 +/- 30% vs 39 +/- 32%; B x S. 38 +/- 35% vs 40 +/- 31%; and B x S LR, 1.19 +/- 0.84% vs 1.09 +/- 0.65% per year-nor did the glucose-lowering modalities. Conclusion. Cassava consumption in South Kivu is not associated with changes in T2D phenotype or in the glucose homoeostasis determinants S, B, B x S and B x S LR. Cassava consumption does not accelerate beta-cell function loss in such a population, whose markedly compromised glucose homoeostasis renders them vulnerable to environmentally acquired beta-cell impairment. (c) 2009 Elsevier Masson SAS. All rights reserved

Hypertension, insulin resistance and chronic kidney disease in type 2 diabetes patients from South Kivu, DR Congo

Objectif : Évaluer la fréquence et les déterminants de l’hypertension artérielle dans un groupe de diabétiques de race noire habitant l’Est de la République Démocratique du Congo. Méthodologie : Les dossiers de 98 patients diabétiques suivis à l’hôpital général de référence de Bukavu entre 2005 et 2007 ont été analysés. L’hypertension artérielle était définie par une pression artérielle supérieure ou égale à 140/90 mmHg et l’insulinosensibilité (HOMA S) déterminée à partir du modèle HOMA (insulinorésistance (IR), définine par HOMA S < 50 %). Les patients ont été phénotypés sur le plan cardiométabolique selon les critères non-tensionnels du syndrome métabolique. La probabilité de l’hypertension artérielle a été modélisée par régression logistique multiple. Résultats : La présente étude note une prévalence élevée de l’hypertension artérielle (59,6 %) et de la maladie rénale chronique (66 %) contrastant avec une fréquence faible de l’insulinorésistance (5,2 %) et de l’obésité (18,6 %). De plus, l’hypertension artérielle n’était pas corrélée à l’insulinorésistance [régression de PAS par %S : coefficient de régression (IC à 95 %) par %, 0,007 (−0,090–0,104) mmHg ; coefficient de corrélation, 0,00 ; p = 0,89], [régression de PAD par %S :−0,004 (−0,053–0,045) mmHg ; 0,00 ; 0,87], de même qu’il n’y avait pas de différence quant à la fréquence du syndrome métabolique modifié entre les hypertendus et les non hypertendus [38,6 % versus 33,3 % ; p = 0,60]. En analyse multivariée, l’excès pondéral [OR ajusté=3,20 (IC à 95 % :1,19–8,61) ; p = 0,02] et la MRC [2,49 (0,98–6,34 ; 0,05] étaient retrouvés comme déterminants majeurs de l’hypertension artérielle. Conclusion : Le syndrome métabolique est faiblement prédictif d’insulinorésistance absolue dans une population de diabétiques de type 2 au sein de laquelle la fréquence d’hypertension artérielle est élevée et celle de l’insulinorésistance basse. L’excès pondéral indépendamment de l‘insulinorésistance et la maladie rénale chronique fréquente chez les diabétiques du type 2 en Afrique sub-saharienne chez lesquels la maladie est mal contrôlée pourraient jouer un rôle majeur dans le déterminisme de l’hypertension artérielle.Objective: To assess the frequency and determinants of high blood pressure (HBP) in a group of type 2 black diabetics living in the east of Democratic Republic of Congo. Methodology: The medical records of 98 diabetic patients followed at the General Reference Hospital in Bukavu between 2005 and 2007 were collected and analyzed. Hypertension was defined as blood pressure ≥ 140/90 mmHg. Insulin sensitivity (HOMA S; %) was determined with the HOMA model, with insulin resistance (IR) representing HOMA S-1 and defined from HOMA S values < 50%). Patients were phenotyped regarding their cardiometabolic profile using metabolic syndrome criteria (minus that for HBP). The probability of hypertension was assessed by multiple logistic regression. Results: There was an overall high prevalence of HBP (59.6%) and of chronic kidney disease (66%) contrasting with a low frequency of insulin resistance (5.2%) and obesity (18.6%). In addition, hypertension was not associated with insulin resistance [regression of SBP by % S: regression coefficient, 0.007 (-0.090-0.104) mmHg; correlation coefficient, 0.00; p = 0.89], [regression of DBP by % S: -0.004 (-0.053-0.045) mmHg; 0.00; 0.87]. There was no significant difference in prevalence of metabolic syndrome changed between hypertensive and normotensive patients [38.6% versus 33.3%, p = 0.60]. In multivariate analysis, overweight [OR adjusted = 3.20 (95%: 1.19-8.61), p = 0.02] and CKD [2.49 (0,98-6.34; 0.05] were found as major determinants of hypertension. Conclusion: The metabolic syndrome is poorly predictive of an absolute decrease in insulin sensitivity in a type 2 diabetes population, in which the prevalence of hypertension was high, and that of insulin resistance low. Overweight independently of insulin resistance and chronic kidney disease common in type 2 diabetes in Sub-Saharan Africa in which the disease is poorly controlled may play a major role in the determinism of hypertensio