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Multicenter Study
. 2019 Dec;9(2):020426.
doi: 10.7189/jogh.09.020426.

Prevalence and determinants of type 2 diabetes among lean African migrants and non-migrants: the RODAM study

Felix P Chilunga  1 , Peter Henneman  2 , Karlijn Ac Meeks  1   3 , Erik Beune  1 , Ana Requena-Méndez  4 , Liam Smeeth  5 , Juliet Addo  5 , Silver Bahendeka  6 , Ina Danquah  7 , Matthias B Schulze  8 , Joachim Spranger  9 , Ellis Owusu-Dabo  10 , Kerstin Klipstein-Grobusch  11   12 , Marcel Mam Mannens  2 , Charles Agyemang  1
Affiliations
Multicenter Study

Prevalence and determinants of type 2 diabetes among lean African migrants and non-migrants: the RODAM study

Felix P Chilunga et al. J Glob Health. 2019 Dec.

Abstract

Background: Exposure to adverse conditions earlier in life-course can predispose to type 2 diabetes in adulthood, irrespective of body mass index (BMI). However, the burden of type 2 diabetes in lean Africans is not well understood despite higher exposure to adverse early life conditions. Mirroring ongoing epidemiological transition, we assessed the burden and determinants of type 2 diabetes in a homogenous group of lean Ghanaians residing in rural and urban Ghana, and as migrants in Europe.

Methods: Baseline data from 2179 RODAM study participants with BMI<25kg/m2 (25-70 years) were analyzed. Prevalence and determinants of type 2 diabetes were estimated using logistic regression analysis. Adjustments were made for socio-demographic and lifestyle factors, use of anti-diabetic medication and optimal blood glucose control.

Results: Prevalence of type 2 diabetes in rural, urban and migrant lean participants were 3.5%, 8.9% and 7.5% respectively, representing 55.4%, 35.6%, 13.2% of all participants with type 2 diabetes. Compared with lean rural participants, the odds of type 2 diabetes were higher in lean urban participants (adjusted OR = 8.81, 95% CI = 6.56-11.06), followed by migrants (5.27, 95% CI = 3.51-6.91). Irrespective of site, determinants of type 2 diabetes in lean participants include; presence of hypertension, physical inactivity, hypercholesterolemia and age (>45 years).

Conclusions: Our study shows a high prevalence of type 2 diabetes among lean African populations in different geographical settings. Future studies are needed in-order to examine how contextual differences are related to the pathophysiology of type 2 diabetes in lean individuals.

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Conflict of interest statement

Competing interests: The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Crude and age -standardized prevalence of type 2 diabetes in underweight/normal weight urban residents, rural residents and migrants. Age-standardized prevalence of type 2 diabetes in underweight/ normal weight participants includes confidence intervals as follows; rural residents 3.52% (95% CI = 2.29-4.45), urban residents 8.93% (95% CI = 6.59-11.27), migrants 7.49% (95% CI = 4.89-6.85). T2D – type 2 diabetes mellitus.
Figure 2
Figure 2
Proportion of type 2 diabetes in underweight / normal weight participants within the RODAM study. T2D – type 2 diabetes mellitus.
Figure 3
Figure 3
Odds of type 2 diabetes in underweight/normal weight urban residents and migrants, compared to rural – Ghanaians. Data are odds ratio (95% Confidence Interval). Model 1 – adjusted for age, sex and education. Model 2 – Model 1 with further adjustment for alcohol consumption, smoking, physical activity, hypercholesterolemia, hypertension and length of stay in the migrants. Model 3 – Model 2 with further adjustment for blood glucose control (HbA1c <7% (53 mmol/mol)) and diabetes treatment (diet, oral medication and insulin use).
See this image and copyright information in PMC

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