Characteristics of insulin requiring diabetes in rural northern Ethiopia--a possible link with malnutrition?

We have examined 100 consecutive insulin-treated diabetic patients from the Diabetic Clinic at Mekelle Hospital in Tigray, Northern Ethiopia; an area of low socio-economic status recently affected by severe famine. The study was conducted over a six month period (1997). Mean age of onset of diabetes was 27 +/- 10 y (SD) and there was a male excess (3.1:1.0). Body Mass index (BMI) at diagnosis was very low at 15.8 +/- 2.8. Because of erratic insulin supply 48 (48%) had interrupted insulin treatment in the past for a mean duration of 9 +/- 12 weeks (range 1-78). Despite this, only 2 (4%) developed ketoacidosis (DKA). The patients thus have features suggestive of malnutrition-related diabetes mellitus (MRDM) possibly of the "malnutrition-modulated" (MMDM) type in view of the apparent absence of overt exocrine pancreatic disease. The famine in this area 10 years previously may be of relevance to the aetiology of diabetes in these patients.