Volume 83, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The aim of this study was to describe the current status of diabetes care in an urban diabetes clinic in Malawi and the prevalence of human immunodeficiency virus (HIV) in this population, investigating possible associations between HIV and diabetes. A systematic prospective survey of patients attending the diabetes clinic at a teaching hospital in Blantyre, Malawi was conducted. Six hundred twenty patients were assessed. Seventy-four percent had glycosylated hemoglobin (HbA1C) > 7.5%. Systolic blood pressure was > 140 mm Hg in 52% of patients. Hypertension was more common in patients with raised creatinine ( < 0.003), retinopathy ( = 0.01), and stroke ( < 0.0002). Microvascular complication rates were high, specifically nephropathy (34.7%), retinopathy (34.7%), and neuropathy (46.4%). HIV seroprevalence was 13.7%. HIV-positive subjects had a lower body mass index (BMI) and lower fasting blood sugar, and they were more likely to have albuminuria (48.0% versus 33.3%; < 0.05). Control of glycemia and hypertension were poor, and microvascular complications were common. Nephropathy in diabetic patients may be affected by HIV status.


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  1. Mathers C, Loncar D, , 2006. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3: e442.[Crossref]
  2. Roglic G, Unwin N, Bennett P, Mathers C, Tuomilehto J, Nag S, Connolly V, King H, , 2005. The burden of mortality attributable to diabetes: realistic estimates for the year 2000. Diabetes Care 28: 21302135.[Crossref]
  3. King H, Aubert R, Herman W, , 1998. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21: 14141431.[Crossref]
  4. Holman R, Paul S, Bethel M, Neil H, Matthews D, , 2008. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med 359: 15651576.[Crossref]
  5. The Diabetes Control and Complications Trial Research Group, 1993. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 329: 977986.[Crossref]
  6. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group, 2000. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N Engl J Med 342: 381389.[Crossref]
  7. Kengne A, Amoah A, Mbanya J, , 2005. Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation 112: 35923601.[Crossref]
  8. Gill G, Gebrekidan A, English P, Wile D, Tesfaye S, , 2008. Diabetic complications and glycemic control in remote North Africa. QJM 101: 793798.[Crossref]
  9. Neuhann H, Warter-Neuhann C, Lyaruu I, Msuya L, , 2002. Diabetes care in Kilimanjaro region: clinical presentation and problems of patients of the diabetes clinic at the regional referral hospital-an inventory before structured intervention. Diabet Med 19: 509513.[Crossref]
  10. Tien P, Schneider M, Cole S, Levine A, Cohen M, DeHovitz J, Young M, Justman J, , 2008. Antiretroviral therapy exposure and insulin resistance in the Women's Interagency HIV study. J Acquir Immune Defic Syndr 49: 369376.[Crossref]
  11. Beadles W, Jahn A, Weigel R, Clutterbuck D, , 2009. Peripheral neuropathy in HIV-positive patients at an antiretroviral clinic in Lilongwe, Malawi. Trop Doct 39: 7880.[Crossref]
  12. Wyatt C, Morgello S, Katz-Malamed R, Wei C, Klotman M, Klotman P, D'Agati V, , 2009. The spectrum of kidney disease in patients with AIDS in the era of antiretroviral therapy. Kidney Int 75: 428434.[Crossref]
  13. O'Brien E, Asmar R, Beilin L, Imai Y, Mallion J, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, Pickering T, Redon J, Staessen J, Stergiou G, Verdecchia P, , 2003. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 21: 821848.[Crossref]
  14. Smieja M, Hunt D, Edelman D, Etchells E, Cornuz J, Simel D, , 1999. Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research. J Gen Intern Med 14: 418424.[Crossref]
  15. Abbas Z, Lutale J, Game F, Jeffcoate W, , 2008. Comparison of four systems of classification of diabetic foot ulcers in Tanzania. Diabet Med 25: 134137.[Crossref]
  16. Younis N, Broadbent D, Vora J, Harding S, , 2003. Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool Diabetic Eye Study: a cohort study. Lancet 361: 195200.[Crossref]
  17. Gill G, Price C, English P, Eriksson-Lee J, , 2002. Traditional clay pots as storage containers for insulin in hot climates. Trop Doct 32: 237238.[Crossref]
  18. United Kingdom Prospective Diabetes Study Group, 1998. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 317: 703713.[Crossref]
  19. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, 2002. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Am Med Assoc 288: 29812997.[Crossref]
  20. Wright JJ, Dunn J, Cutler J, Davis B, Cushman W, Ford C, Haywood L, Leenen F, Margolis K, Papademetriou V, Probstfield J, Whelton P, Habib G, , 2005. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. J Am Med Assoc 293: 15951608.[Crossref]
  21. Nyamu P, Otieno C, Amayo E, McLigeyo S, , 2003. Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi. East Afr Med J 80: 3643.
  22. Kumwenda J, Mateyu G, Kampondeni S, van Dam A, van Lieshout L, Zijlstra E, , 2005. Differential diagnosis of stroke in a setting of high HIV prevalence in Blantyre, Malawi. Stroke 36: 960964.[Crossref]
  23. Warren G, , 2002. Practical management of neuropathic feet. Trop Doct 32: 201205.[Crossref]
  24. Read O, Cook C, , 2007. Retinopathy in diabetic patients evaluated at a primary care clinic in Cape Town. S Afr Med J 97: 941944.
  25. Ashaye A, Arije A, Kuti M, Olusanya B, Ayeni E, Fasanmade A, Akinlade K, Obajimi M, Adeleye J, , 2008. Retinopathy among type 2 diabetic patients seen at a tertiary hospital in Nigeria: a preliminary report. Clin Ophthalmol 2: 103108.[Crossref]
  26. Mash B, Powell D, du Plessis F, van Vuuren U, Michalowska M, Levitt N, , 2007. Screening for diabetic retinopathy in primary care with a mobile fundal camera—evaluation of a South African pilot project. S Afr Med J 97: 12841288.
  27. Motala A, Pirie F, Gouws E, Amod A, Omar M, , 2001. Microvascular complications in South African patients with long-duration diabetes mellitus. S Afr Med J 91: 987992.
  28. Keeton G, Smit R, Bryer A, , 2004. Renal outcome of type 2 diabetes in South Africa—a 12-year follow-up study. S Afr Med J 94: 771775.
  29. Lutale J, Thordarson H, Abbas Z, Vetvik K, , 2007. Microalbuminuria among Type 1 and Type 2 diabetic patients of African origin in Dar Es Salaam, Tanzania. BMC Nephrol 8: 2.[Crossref]
  30. Lucas G, Mehta S, Atta M, Kirk G, Galai N, Vlahov D, Moore R, , 2007. End-stage renal disease and chronic kidney disease in a cohort of African-American HIV-infected and at-risk HIV-seronegative participants followed between 1988 and 2004. AIDS 21: 24352443.[Crossref]
  31. Ross M, Klotman P, , 2004. HIV-associated nephropathy. AIDS 18: 10891099.[Crossref]
  32. Gupta S, Smurzynski M, Franceschini N, Bosch R, Szczech L, Kalayjian R, , 2009. The effects of HIV type-1 viral suppression and non-viral factors on quantitative proteinuria in the highly active antiretroviral therapy era. Antivir Ther 14: 543549.
  33. Han T, Naicker S, Ramdial P, Assounga A, , 2006. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa. Kidney Int 69: 22432250.[Crossref]
  34. Gerntholtz T, Goetsch S, Katz I, , 2006. HIV-related nephropathy: a South African perspective. Kidney Int 69: 18851891.[Crossref]
  35. Simpson D, Kitch D, Evans S, McArthur J, Asmuth D, Cohen B, Goodkin K, Gerschenson M, So Y, Marra C, Diaz-Arrastia R, Shriver S, Millar L, Clifford D, , 2006. HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology 66: 16791687.[Crossref]
  36. Lichtenstein K, Armon C, Baron A, Moorman A, Wood K, Holmberg S, , 2005. Modification of the incidence of drug-associated symmetrical peripheral neuropathy by host and disease factors in the HIV outpatient study cohort. Clin Infect Dis 40: 148157.[Crossref]
  37. Ances B, Vaida F, Rosario D, Marquie-Beck J, Ellis R, Simpson D, Clifford D, McArthur J, Grant I, McCutchan J, , 2009. Role of metabolic syndrome components in HIV-associated sensory neuropathy. AIDS 23: 23172322.[Crossref]
  38. Grinspoon S, , 2009. Diabetes mellitus, cardiovascular risk, and HIV disease. Circulation 119: 770772.[Crossref]
  39. van der Valk M, Bisschop P, Romijn J, Ackermans M, Lange J, Endert E, Reiss P, Sauerwein H, , 2001. Lipodystrophy in HIV-1-positive patients is associated with insulin resistance in multiple metabolic pathways. AIDS 15: 20932100.[Crossref]
  40. Brown T, Cole S, Li X, Kingsley L, Palella F, Riddler S, Visscher B, Margolick J, Dobs A, , 2005. Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med 165: 11791184.[Crossref]
  41. Mutimura E, Stewart A, Rheeder P, Crowther N, , 2007. Metabolic function and the prevalence of lipodystrophy in a population of HIV-infected African subjects receiving highly active antiretroviral therapy. J Acquir Immune Defic Syndr 46: 451455.[Crossref]
  42. Levitt N, Bradshaw D, , 2006. The impact of HIV/AIDS on Type 2 diabetes prevalence and diabetes healthcare needs in South Africa: projections for 2010. Diabet Med 23: 103104.[Crossref]

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  • Received : 17 Feb 2010
  • Accepted : 19 May 2010

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