A Survey of the Management, Control, and Complications of Diabetes Mellitus in Patients Attending a Diabetes Clinic in Blantyre, Malawi, an Area of High HIV Prevalence

Danielle B. Cohen Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Theresa J. Allain Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Simon Glover Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Daniel Chimbayo Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Helen Dzamalala Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Helma W. C. Hofland Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Ndaziona P. K. Banda Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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Eduard E. Zijlstra Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

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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 (P < 0.003), retinopathy (P = 0.01), and stroke (P < 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%; P < 0.05). Control of glycemia and hypertension were poor, and microvascular complications were common. Nephropathy in diabetic patients may be affected by HIV status.

Author Notes

*Address correspondence to Danielle B. Cohen, Department of Medicine, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi. E-mail: danbcohen@yahoo.com

Financial support: This work was supported by a grant from the Dutch Society of Tropical Medicine.

Authors' addresses: Danielle B. Cohen, Theresa J. Allain, Simon Glover, Daniel Chimbayo, Helen Dzamalala, Helma W. C. Hofland, Ndaziona P. K. Banda, and Eduard E. Zijlstra, Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi, E-mails: danbcohen@yahoo.com. theresa.allain@googlemail.com, simontheeyeman@hotmail.com, danielchimbayo@yahoo.com, eziwawo@medcol.mw, HoflandH@maasstadziekenhuis.nl, npkbanda2000@yahoo.com, and e.e.zijlstra@erasmusmc.n.

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