Q J Med 1991; 81: 829-835
© 1991 Association of Physicians
research-article |
Patterns of Insulin Dependence in an African Diabetic Clinic
Department of Medicine, Baragwanath Hospital, University of Witwatersrand PO Bertsham, Johannesburg, South Africa
Accepted for publication 24 July 1991.
SUMMARY
Analysis of the age of onset of diabetes amongst insulin-treated patients in a large African diabetic clinic revealed a bimodal type of distribution, 23 per cent having an age of onset before 30 years and 77 per cent with onset at 
30 years of age. All 66 of the young insulin-treated group (21.7±4.8 years (mean±1 SD)), and a random selection of 50 older insulin-treated patients (49.7±10 years), were studied. The older group were better controlled (HbA1 8.4±1.7 per cent vs. 10.8±2.6 per cent, p<0.001), on lower doses of insulin (49±23 vs. 71±23 u/day, p<0.001) and had higher body mass index (26.0±5.6 vs. 21.8±3.5, p<0.001). Serum C-peptide (0.24±0.15 vs. 0.07±0.10 nmol/l, p<0.0001), and C-peptide/glucose ratio (2.57±2.65 vs. 0.56+0.98 nmol/mmolx 102, p<0.001) were very significantly higher in older patients. Patients with later onset disease thus had better preservation of pancreatic function, higher body mass index and better glycaemic control on lower doses of insulin. These features suggest that older insulin-treated patients could in fact be ‘Type 2’ or non-insulin dependent patients, and the condition may be controllable with diet and/or oral hypoglycaemic agents, at least in some.
*Present address: Diabetes Centre, Walton Hospital, Liverpool L9 1AE, and Department of Tropical Medicine and Infectious Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA. UK.