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Clinical and Biochemical Features of Adult Diabetes Mellitus in Sudan
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The high prevalence of diabetes mellitus among the Sudanese population is linked to obesity, poor glycaemic control and a high rate of complications. This study investigated 1/ Leptin hormone and its correlations with different biochemical characteristics in Sudanese diabetic subjects, 2/ The impact of glycaemic control on pregnancy outcome in pregnancies with diabetes, 3/ The glycaemic response to Sudanese traditional carbohydrate foods, 4/ The influence of glucose self-monitoring on the glycaemic control among this population, 5/ The health related quality of life in Sudanese subjects with diabetes-related lower limb amputation.

Leptin was significantly lower in diabetic subjects compared with controls of same BMI in both females (P =0.0001) and males (P =0.019). In diabetic subjects, serum leptin correlated positively with the homeostatic assessment (HOMA) of both beta-cell function (P =0.018) and insulin resistance (P =.038). In controls, leptin correlated only with insulin resistance. Pregnancy complications were higher among diabetic compared with control women (P<0.0001) and varied with the type of diabetes. Infants of diabetic mothers had a higher incidence of neonatal complications than those of non-diabetic women (P<0.0001). In six Sudanese traditional carbohydrate meals over all differences in incremental AUCs were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). Millet porridge and wheat pancakes displayed significantly lower post-prandial glucose and insulin responses, whereas maize porridge induced a higher post-prandial glucose and insulin response. In type 2 diabetic subjects SMBG or SMUG was not related to glycaemic control. In type 1 diabetic subjects, SMBG was significantly associated with better glycaemic control, as assessed by HbA1c (P=0.02) and blood glucose at clinic visits (P=<0.0001), similar associations were found for SMUG respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level. Diabetic subjects with LLA had significantly poorer HRQL compared to a reference diabetic group (P=<0.0001). Duration of diabetes and amputation had negative impact on HRQL in subjects with LLA (P=<0.0001) respectively. Diabetic subjects with LLA had decreased sense of coherence and high presence of symptoms. Improving health services at the primary level is important to reduce the complications and burden of disease in the Sudanese population.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2006. , p. 47
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 144
Keywords [en]
Medicine, diabetes mellitus, leptin, gestational diabetes mellitus, pregnancy, perinatal morbidity and mortality, carbohydrate rich-meals, self-monitoring, quality of life, sense of coherence, lower limb amputation, Sudan
Keywords [sv]
Medicin
Identifiers
URN: urn:nbn:se:uu:diva-6816ISBN: 91-554-6542-0 (print)OAI: oai:DiVA.org:uu-6816DiVA, id: diva2:168200
Public defence
2006-05-22, Robergsalen, Building 40, Uppsala University Hospital, Uppsala, 09:15
Opponent
Supervisors
Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
List of papers
1. leptin concentrations in subjects with type 2 diabetes mellitus in Sudan
Open this publication in new window or tab >>leptin concentrations in subjects with type 2 diabetes mellitus in Sudan
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2002 In: Metabolism, Vol. 51, no 3, p. 304-6Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-94368 (URN)
Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
2. Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan
Open this publication in new window or tab >>Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan
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2003 In: Diabetes Res Clin Pract, Vol. 60, no 1, p. 41-7Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-94369 (URN)
Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
3. Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitus
Open this publication in new window or tab >>Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitus
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Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-94370 (URN)
Available from: 2006-05-04 Created: 2006-05-04Bibliographically approved
4. The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan
Open this publication in new window or tab >>The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan
2006 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 74, no 1, p. 90-94Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the influence of self-monitoring of glucose on the glycaemic control in Sudanese diabetic subjects.

Subjects and methods: A group of 193 consecutive type 2 and type I diabetic subjects (95 men, 98 women) were studied. In 104 subjects with type 2 diabetes fasting blood glucose was measured using a glucose meter and blood was obtained for serum glucose measurement in the laboratory. In the remaining 89 diabetic subjects random blood glucose was measured using the same glucose meter and a whole blood sample was drawn for laboratory assessment of HbA1c. Data on self-monitoring and other clinical and personal characteristics were recorded.

Results: More than 75% of either type I and type 2 diabetic patients never self-monitored blood or urine glucose. In type 2 diabetic subjects self-monitoring of blood or urine glucose was not related to glycaemic control. In type I diabetic subjects, however, self-monitoring of blood glucose was significantly associated with better glycaemic control, as assessed by HbA1c (P = 0.02) and blood glucose at clinic visits (P < 0.0001), and similar associations were found for urine glucose self-monitoring (P = 0.04 and 0.02) respectively. Neither glycaemic control nor glucose self-monitoring was associated with education level.

Conclusions: Self-monitoring of blood glucose was not found to be associated to better glycaemic control in Sudanese subjects with type 2 diabetes. In contrast, self-monitoring of both blood and urine glucose was significantly associated with glycaemic control in subjects with type I diabetes. Self-monitoring of urine glucose could be useful where measurement of blood glucose is not available or affordable.

Keywords
diabetes mellitus, self-monitoring, Sudan
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-94371 (URN)10.1016/j.diabres.2006.03.003 (DOI)000240801400013 ()16621118 (PubMedID)
Available from: 2006-05-04 Created: 2006-05-04 Last updated: 2017-12-14Bibliographically approved
5. Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation
Open this publication in new window or tab >>Health related quality of life and sense of coherence in Sudanese diabetic subjects with lower limb amputation
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2009 (English)In: Tohoku journal of experimental medicine, ISSN 0040-8727, E-ISSN 1349-3329, Vol. 217, no 1, p. 45-50Article in journal (Refereed) Published
Abstract [en]

Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

Keywords
Diabetes mellitus, Lower limb amputation, Quality of life, Sense of coherence, Sudan
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-94372 (URN)10.1620/tjem.217.45 (DOI)000262897800007 ()19155607 (PubMedID)
Available from: 2006-05-04 Created: 2006-05-04 Last updated: 2022-01-28Bibliographically approved

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