Hospitals in the country are detecting a high prevalence of diabetes among lean people, contrary to the conventional picture that links the disease to obesity, a new report indicates.
Dr Davis Kibirige, a specialist in diabetes management, who led the diabetes study, told this publication that of the 500 study participants with type 2 diabetes, 160 (32 per cent) and 340 (68 per cent) were lean and non-lean, respectively.
Dr Kibirige is a researcher at the Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, in Entebbe. Lean people are those with a body mass index (BMI) of less than 25kg/m2.
Type 2 diabetes presents with symptoms such as increased thirst, frequent, frequent urination, increased hunger, unintended weight loss, fatigue, blurred vision and tingling or numbness of the hands or feet.
Dr Kibirige said study dubbed the Uganda Diabetes Phenotype (UDIP) research, was done between February 2019 and October 2020 in Mengo, Rubaga, Nsambya, Masaka, Kirrudu, Kisubi and Namungona hospitals.
“The role of the study was to understand how diabetes presents in our Ugandan patients. What we found out was that these patients that have a normal body mass index (BMI), their pancreas basically just doesn’t produce enough insulin,” Dr Kibirige said, adding that, “This results in very high blood sugar levels and it is the reason they develop diabetes.”
The pancreas is the organ in the body responsible for the production of insulin, the hormone that controls sugar levels in the body.
The lead researcher said that because they are small in size, “we assume that even the pancreas in the body is small and thus produce very small insulin.”
“In line with the fact that these patients may have a very small pancreas, we think it seems, very early in their life, when they were still children or in the wombs of their mothers, they experienced an environmental insult,” he said.
Dr Kibirige explained that it is either a mother did not feed very well when she was pregnant or the child was malnourished in their early years.
“Usually malnutrition affects the development of body organs. So many of them developed a very small pancreas or kidneys or even the heart. And because of that, they are very prone to developing diabetes, hypertension or heart failure. That's why pregnant women should eat well,” he said.
“We also think they might have specific genes that affect the pancreas or production of hormones in the pancreas. Those are the areas that we intend to explore further to get a definite answer,” he added.
Dr William Lumu, the Uganda Diabetes Association (UDA) president on the other hand, said the findings would be essential in improving diabetes management.
“Many of our patients with diabetes are usually small patients and many times they don’t respond to tablets that are given. What this study has added to us is that these patients should be treated differently from what we have been giving them in terms of tablets,” he said.
The national survey done six years ago put the prevalence of diabetes in Uganda at 1.4 per cent, a figure Dr Lumu said was very low compared to what they are seeing in health facilities.
Dr Kibirige on the other hand said their next challenge is to find the best drug to treat “very small patients” who have low body mass index (BMI) and very high blood sugar levels.
“Because the pancreas is not working very well, we may assume insulin use is appropriate to supplement. In those patients where you have tested and found the pancreas is working normally, you can give medicine to stimulate the pancreas to produce more insulin. There is a need to do a study to understand how best this works and this is the work that we plan to do next,” he said.
Dr Charles Oyoo Akiya, the commissioner for non-communicable diseases at the Ministry of Health, while commenting on the report, said they would use the findings to inform policymaking and improve diabetes care.
He said the government is increasing efforts to support medical research in the country.