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Oct 7, 2022Keywords:
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Material submitted for publication in the Journal of Endocrinology, Metabolism and Diabetes of South Africa (JEMDSA) is accepted provided it has not been published elsewhere. JEMDSA reserves copyright of the material published. Neither JEMDSA nor the Publisher may be held responsible for statements made by the authors.
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Glycaemic control and family history of diabetes mellitus: is it all in the genes?
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a familial condition with a strong genetic component. International studies have highlighted associations between a positive family history of diabetes (FHD) and poorer glycaemic control. No current data are available on this association within the context of HIV.
Objectives: To determine a relationship between FHD and glycaemic control in patients living with DM (PLWD) in an HIV endemic area.
Methods: Standardised clinic sheets were used from the DM clinic at Edendale Hospital, Pietermaritzburg, South Africa, from January 1, 2019 to December 31, 2019. Statistical analysis was done.
Results: This study had 957 patients living with diabetes (PLWD); 498 (52.2%) had a positive FHD while 456 (47.8%) had no FHD. There were 146 (15.3%) HIV-infected patients; with 84 (57.5%) on a fixed dose combination (FDC) of anti-retroviral treatment (ART). Patients aged between 18 and 30 with a maternal FHD had significantly higher mean HbA1c levels than those without a maternal FHD (HbA1c: 10.80% vs. 9.72%, p = 0.025). Patients living with type 1 DM (PLWT1DM) in the HIV-uninfected cohort had significantly higher HbA1c levels than patients living with type 2 DM (PLWT2DM) (10.38% vs. 9.46%, p = 0.002). HIV-infected PLWD (PLWDH) on a FDC with a positive FHD had significantly higher HbA1c levels than those without a FHD (9.52% vs. 8.52%, p = 0.04). PLWDH with a positive maternal FHD on an FDC had increased HbA1c levels (9.81% vs. 8.55%, p = 0.009).
Conclusion: Genes significantly affect glycaemic control among PLWD. PLWT1DM and PLWDH with a positive FHD (especially a maternal FHD) should be regarded as being in a higher risk category requiring more intensive lifestyle and therapeutic intervention to achieve optimal diabetes control. Our study suggests that a positive FHD affects glycaemia in PLWT1DM as significantly, if not more, than in PLWT2DM and recommends screening for a FHD to be incorporated in the comprehensive management of DM.
