Ugandan scientists seek answers to rising diabetes burden in rural areas

July 18, 2024 in Letters by Editor

Puzzled by the high incidence of diabetes in a resource deprived rural community, researchers from Uganda’s Medical Research Council (MRC), are now investigating possible links between early-childhood nutrition and an individual’s predisposition to diabetes and hypertension in later life.

The studies, led by Dr Bernard Mpirwe, a public health specialist, are being conducted within the Kyamulibwa General Population Cohort (GPC), a community of some 25,000 volunteers spread across 26 villages surrounding the MRC’s Kyamulibwa Field Station.

Studies into diabetes form part of several ongoing investigations into the prevalence of noncommunicable diseases, including hypertension in resource-deprived communities.

Speaking to a gathering of journalists, researchers and members of the Kyamulibwa GPC Community Advisory Board July 11, Dr Mpirwe revealed that the researchers were prompted to open the new line of inquiry, after finding that more people than expected in Kyamulibwa, were diabetic.

“The prevalence rates were surprising because before we embarked on the studies, we expected to find a diabetes prevalence rate of around 2 percent of the study population. When we got the results from the actual study however, prevalence was three-fold our initial estimates,” he explained.

Of the 5000 adults sampled, 300 were found to be diabetic. This was considered too high in a community where lifestyles normally associated with diabetes and hypertension, were almost non-existent. Furthermore, even the physical characteristics of some of the people who tested positive for  diabetes, were not anywhere close to what is commonly accepted as physical symptoms of diabetes.

With time, even some of the infants that were turning up with mothers at the diabetes clinic  at the health centre attached to the field station, were positive for diabetes.

This was strange because in the global north, diabetes tends to be associated more with age and obesity.

“This led us to wonder about what factors could be behind these numbers in such a setting,” Mpirwe said.

The researchers are now working to establish if the manifestations they are seeing in Kyamulibwa, could be related to mothers nutrition during pregnancy and by extension,  early life nutrition of the child from the womb up to the first five years of life.

“If you don’t get proper nutrition at that stage of life, could that be a predisposing factor to diabetes in later life?”

Researchers are now digging into medical records, including birth data, to see if there was nutrition insufficiency at the time of their birth. Established 35 years ago, to conduct long-term research into HIV prevalence in Kyamulibwa, the field station has accumulated data over time, which scientists can fall back to, to find associations between the past and present.

In determining if someone born in the area suffered nutrition insufficiency, researchers look at indicators such as birthweight, or stunting between ages 0-5 years. Low birth weight means that ones’ mother was not feeding adequately while pregnant.

Susceptibility to diabetes infants and young people is determined by exposing them to sugar, and observing how the body processes it over a set period of time.

Dr Joseph Mugisha, a field epidemiologist and head of the Kyamulibwa GPC Field Station, says the ongoing studies are important for a number of reasons.  Early detection of diabetes or hypertension, is critical to achieving positive outcomes from interventions for its management or treatment.

Individuals who are predisposed but have not progressed to sickness, can be given guidance on lifestyle that could prevent them from developing the disease. Those that have already developed the condition can be administered appropriate treatment that improves the quality of their lives.

The studies from Kyamulibwa, will add to the global body of knowledge about the factors behind diabetes among resource-poor populations and inform strategies for prevention and improving access to treatment.

Dr Mpirwe said the studies in Kyamulibwa were also being used to validate the efficacy of diagnostic kits. This is has become important given the proliferation of self-test kits on the market, some which might not have been calibrated for local conditions.