Incident prediabetes/diabetes and blood pressure in urban and rural communities in the Democratic Republic of Congo

Joyce D Hightower¹, C Makena Hightower², Beatriz Y Salazar Vázquez^2,3, Marcos Intaglietta^2
1Department of Health Projects, Kinshasa, Democratic Republic of Congo; ²Department of Bioengineering, University of California, San Diego, CA, USA; ³Facultad de Medicina, Universidad Juárez del Estado de Durango, Durango, México

Background: The Democratic Republic of Congo (DRC) faces increased morbidity and mortality due to treatable and preventable noncommunicable diseases. However, it continues to struggle with political and economic instability, which impedes much needed health infrastructure improvements. The present study was designed as a low-cost determination of the prevalence of incident prediabetes/diabetes in the DRC.
Method: Fasting blood glucose, body mass index, blood pressure, and age were assessed in adult participants in health screenings conducted throughout urban and rural DRC. Communities were divided into three categories, based on physical activity (means of transport) and diet, ie, traditional (nonmotorized transport and vegetable/starch-based diets); transitional (incorporating traditional practices with motorized transport) and modern (motorized transport and protein/processed foods). Fasting blood glucose and blood pressure were established using finger prick blood samples and monitors approved by the US Food and Drug Administration.
Results: The prevalence of incident prediabetes/diabetes was over 47% for the traditional population, 88.6% for the transitional population, and 91.4% for the modern communities. Fasting blood glucose levels analyzed through an analysis of covariance, with age and body mass index as covariates, demonstrated that fasting blood glucose levels of male and female subgroups in the traditional community (101.8 ± 29.3 mg/dL and 95.4 ± 27.8 mg/dL, respectively), were significantly reduced compared with the transitional (122.1 ± 19.4 mg/dL and 122.8 ± 23.9 mg/dL), and modern (118.8 ± 15.9 mg/dL and 114.1 ± 17.1 mg/dL) populations. Additionally, for the male and female subgroups, logistic regression analysis confirmed a significant association between incident prediabetes/diabetes, fasting blood glucose, diet, and level of physical activity.
Conclusion: There is a higher than expected prevalence of incident prediabetes/diabetes in the DRC adult population, without a clear association with risk factors pertaining to diet, level of physical activity, body mass index, and blood pressure. The substantial morbidity and mortality associated with diabetes highlights the critical need for further and more precise diabetic diagnostic testing throughout the DRC.

Keywords: fasting blood glucose, incident diabetes, Democratic Republic of Congo, urban, rural