Browsing by Author "Swai, Andrew Babu Musa"

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    Diabetes mellitus in Tanzania: The challenge of its control in a developing country
    (University of Dar es Salaam, 1984) Swai, Andrew Babu Musa
    To determine the prognosis for diabetic patients in Dar es Salaam, a register has been maintained since June, 1981 of all newly diagnosed patients seen at Muhimbili Medical Centre and expected to attend the diabetic clinic for follow-up. A study of the first 200 patients revealed a high loss to follow-up. At the end of December 1983, only 84 (42%) of the patients were attending and at least 28 (14%) were already dead. Of these still attending, 36 (43%) had chronic complications. Having observed this poor prognosis, an attempt was made to determine contributory factors. Patients attending the clinic were questioned to assess their knowledge of diabetes control and the extent their own monitoring of control influenced their management of disease. It was found that the patients’ knowledge of the control of diabetes was poor, may were not testing their urine as expected and still many of those testing did not alter their diabetes management in response to the urine test results. Many found urine testing time-demanding and cumbersome. Having outlined the extent of the problem and some contributing factors, it remained to recommend solutions. The recommendations, however, would not have been complete without advice on how to interpret and apply the urine testing results and without advice on dietary measures. The renal threshold for glucose was therefore estimated in a sample of the patients to give an idea of the relation between glycaemia and glycosuria in our Dar es Salaam patients and the glycaemic response to foods commonly eaten was assessed to see if there were foods with a lesser response suitable for the patients. The mean threshold was 11.9mol/1 (range 9.4 – 16.1) implying that for fair control, the patients have to maintain their urine sugar-free. For the glycaemic responses to meals, the addition of beans or amaranth did not greatly alter the responses but good control is still possible with the staple foods used by most patients. Measure to improve the follow-up rate and the patient’s management of their diabetes are suggested.