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Short Term Use of Empagliflozin Does Not Improve Left Ventricular Function in Non-Diabetic Hypertensive Patients: Results from a Non-Randomised Controlled Trial

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World Journal of Cardiovascular Diseases 2020年第8期10卷 563-571页

作者： Liliane Mfeukeu-Kuate jean-claude Katte Krystel Ebo jean claude mbanya Eugene Sobngwi Department of Internal Medicine and Specialities Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Cardiology Unit Yaoundé Central Hospital Yaoundé Cameroon National Obesity Center and Endocrinology and Metabolic Disease Unit Yaoundé Central Hospital Yaoundé Cameroon Laboratory of Molecular Medicine and Metabolism Biotechnology Center University of Yaoundé 1 Yaoundé Cameroon

Background: A selective inhibitor of sodium-glucose cotransporter 2 (SGLT2), empagliflozin, has demonstrated its effects in reducing cardiovascular mortality and hospitalization rates for heart failure in type 2 diabetes patients. However, the cardiac-intrinsic mechanism for this cardiovascular benefit has not been sufficiently studied. We therefore aimed to investigate the effect of empagliflozin on left ventricular function in a group of patients with grade I hypertension. Methods: We carried out a single-arm non-randomized clinical trial at the National Obesity Centre in Yaoundé over a period of 8 months (October 2016 to May 2017), where patients were assigned to receive 25 mg of empagliflozin once daily. Cardiac ultrasound, 24-hour ambulatory blood pressure measurement, resting electrocardiography and biological assessment were carried out at baseline and at the end of a 6-week treatment period with empagliflozin. The primary outcome was the improvement of the left ventricular relaxation evaluation criteria. Ethical approval was obtained from the Centre Regional Ethics Committee in Yaoundé, Cameroon. Results: A total of 11 patients were treated (median observation time, 6 weeks). We noted a non-significant improvement in the early lateral annular velocity from 9.7 [9.2 -

关键词： Empagliflozin Cardiovascular Mortality Mitral Velocity E’ ABPM ECG

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Effect of Binge Drinking on Glucose Metabolism in Occasional Drinkers: An Experimental Study

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Open Journal of Endocrine and Metabolic Diseases 2018年第1期8卷 49-58页

作者： Nawé Justine Astrid Ngandeu Armand mbanya Eric Lontchi-Yimagou Vicky Kamwa jean Louis Nguewa jean-claude Katte Andrea Michèle Audrey Omengue Simeon-Pierre Choukem Mesmin Dehayem jean-claude mbanya Eugene Sobngwi Yaounde Central Hospital National Obesity Center Yaoundé Cameroon Cocody’s CHU Abidjan Ivory Coast Diabetes Research and Training Center and Division of Endocrinology Department of Medicine Albert Einstein College of Medicine New York NY USA Laboratories of Molecular Medicine and Metabolism Biotechnology Center University of Yaoundé Yaoundé Cameroon Inserm UMRS 1138 Cordeliers Research Centre University of Paris Paris France Department of Internal Medicine Faculty of Medicine and Biomedical Sciences University of Yaoundé Yaoundé Cameroon Departments of Internal Medicine and Pediatrics Faculty of Health Sciences University of Buea Buea Cameroon Health and Human Development (2HD) Research Group Douala Cameroon

Binge drinking is a major public health problem that affects all age groups. Its relation to the risk of impaired glucose metabolism and diabetes is unclear due to controversial findings in animal models and lack of studies in humans. We performed an experimental study on 10 adult volunteers (7M/3F) under the age of 40 who were occasional binge drinkers. In all participants, we performed a baseline two-hour euglycemic hyperinsulinemic clamp at 80 mU•m−2•min−1 at baseline for comparison with an age and sex matched control population of non-drinkers. On a second occasion, before and after ingestion of 78 g of alcohol (beer) in 2 hrs we also measured insulin sensitivity using a 15-minute short insulin tolerance test in drinkers. Blood glucose was also measured every 15 mins over 2 hours during alcohol ingestion. Volunteers were aged 27.6 ± 5.7 years, with a BMI of 23.1 ± 2.8 kg/m2, and ALAT of 24.7 ± 3.0 UI/L. Insulin sensitivity evaluated by the clamp technique was higher in occasional drinkers (M = 12.7 ± 3.4 mg•kg−1•min−1 vs. 8.0 ± 2.3 mg•kg−1•min−1 in non-drinkers, p = 0.011). Acute alcohol ingestion was associated with a non-significant trends towards improved glucose disappearance during short insulin tolerance test (KITT 2.53% ± 0.22%/min before vs. 3.11% ± 1.15%/min after;p = 0.122). Beer consumption induced a significant increase in capillary glycaemia of 78% (p = 0.001). Bingeing was associated with reduced insulin secretion (Homa-β 113.5 ± 22.7 vs. 155.4 ± 57.6;p = 0.047). Binge drinking may induce an increase in insulin sensitivity but acutely decrease insulin secretion.

关键词： Glucose Metabolism Binge Drinking Insulin Sensitivity Insulin Secretion

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Genetic Predisposition for Type 2 Diabetes Mellitus in a Cameroonian Population: Contribution of rs4731702 (C/T) Polymorphism of Krüppel-Like Factor 14 Gene

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Open Journal of Genetics 2021年第2期11卷 9-22页

作者： Magellan Guewo-Fokeng Eugene Sobngwi Barbara Atogho-Tiedeu Eric Lontchi-Yimagou jean-Paul Chedjou jean-claude mbanya Wilfred F. Mbacham Department of Biochemistry Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon The Biotechnology Centre University of Yaoundé I Nkolbisson Yaoundé Cameroon Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Department of Biochemistry Faculty of Science University of Yaoundé I Yaoundé Cameroon

Introduction: Krüppel Like Factor 14 (KLF14) gene has recently been identified as a master gene for multiple metabolic phenotypes. The aim of the research study was to investigate the relationship between KLF14 rs4731702 (C/T) gene polymorphism with Type 2 Diabetes Mellitus (T2DM) in a Cameroonian population. Patients and Methods: This case-control study was conducted in 85 patients with T2DM and 95 healthy normoglycemic controls. All were nonrelated, of Cameroonian origin, and were adults aged 24 years old and above. Demographic, clinical and biological data were collected, and biochemical explorations were performed using enzymatic colorimetric methods. The genotyping of KLF14 rs4731702 (CT) gene polymorphism was done by the Polymerase Chain Reaction and Restriction Fragment Length Polymorphism. Results: In comparing the Cameroonian population that consisted of 85 patients with T2DM and 95 healthy controls, the minor or risk allele of the rs4731702 (C/T) polymorphism of the KLF14 gene was T (63.53% diabetic patients vs. 26.32% healthy controls, OR = 4.877 and p Conclusion: This study has demonstrated for the first time the relationship between the KLF14 rs4731702 (C/T) gene polymorphism and T2DM in this Cameroonian population. This gene polymorphism could be a promising target for personalized medicine through the development of clinical genetic testing.

关键词： Genetic Krüppel-Like Factor 14 Gene Type 2 Diabetes Mellitus Cameroon

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Transient Hypogonadism Induced by SARS-CoV-2 during COVID-19 in Men Aged under 65 Years

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Open Journal of Endocrine and Metabolic Diseases 2022年第1期12卷 1-8页

作者： Etoa Etoga Martine claude Biwole Sida Ghislaine Ama Moor Vicky Ongmeb Boli Anne Ndi Manga jean Arnaud Dehayem Yefou Mesmin Mendane Mekobe Francine jean claude mbanya Sobngwi Eugène Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Endocrinology and Metabolic Diseases Unit Yaoundé Central Hospital Yaoundé Cameroon Department of Physiologic Sciences and Biochemistry Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon

Background: The presence of the angiotensin-converting enzyme 2 (ACE2) receptor, the main entry receptor for SARS-CoV-2 in lung alveolar tissue, in Sertoli and Leydig cells of the adult testis, may suggest possible testicular involvement during SARS-CoV-2 infection. Our aim was to investigate the impact of COVID-19 on gonadal function in men. Methods: This was a cross-sectional descriptive and analytical study in a population of men aged below 65 years of age with SARS-CoV-2. Not included in the study were any subjects on testosterone replacement therapy or with a known condition that could create hypogonadism. We recruited patients through a questionnaire and then performed total testosterone and SHBG analysis at 8 hours and 2 months post infection by ELISA. We used the Spearman Rho test for statistical analysis of correlations. The significance level was set at 0.05. Results: The sample consisted of 40 male COVID positive patients with a mean age of 46.4 ± 11.8 years. Eight patients were reviewed after infection. The mean total testosterone was 11 ng/ml ± 2.4 and the SHBG was 113 nmol/l ± 66.9 during infection. In the 8 patients reviewed after infection, median total testosterone decreased during infection (11 ng/ml) and increased after infection (12.7 ng/ml), this result was statistically significant (P = 0.028). Median SHBG during infection was increased (115.7 nmol/l) and after infection was decreased (82 nmol/l). There was a statistically significant (P = 0.04) and positive correlation between serum testosterone and SHBG levels in patients with severe infection. Conclusion: There could be a transient relative hypogonadism during SARS-CoV-2 infection, more marked in the severe forms of the disease with a tendency to improve after infection.

关键词： COVID-19 Testosterone Severity

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Clinical, Psycho-Social and Metabolic Profile of Women with Hirsutism in Yaounde

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Open Journal of Endocrine and Metabolic Diseases 2022年第11期12卷 225-237页

作者： Francine Mendane Ekobena Martine claude Etoa Etoga Laurence Carole Ngo Yon Mesmin Dehayem Sandrine Ongnesseck Nengom Eliane Ngassam Vanessa Balla Eugène Sobngwi jean claude mbanya Internal Medicine Essos Hospital Centre Yaoundé Cameroon Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon National Obesity Centre Diabetes and Metabolic Diseases Unit Yaoundé Central Hospital Yaoundé Cameroon Faculty of Medicine and pharmaceutical Sciences University of Douala Douala Cameroon Regional Hospital of Nkongsamba Nkongsamba Cameroon

Background: Hirsutism is a clinical situation in Cameroon which is poorly elucidated due to a paucity of clinical and biological data;hence our interest in this study. The aim of this work was to describe the clinical, psycho-social and metabolic profile of women with hirsutism in Yaoundé. Materials and Methods: This was a descriptive cross-sectional study carried out from May 2013 to December 2013. Participants were recruited by announcement through social media. Our study included women at least 18 years old, not in menopausal, not pregnant, not breastfeeding, with hirsutism regardless of severity. They were assessed through an interrogation, anthropometric parameters, a physical examination using the modified Ferriman and Gallwey score, the measurement of fasting capillary blood glucose and a lipid profile. The psycho-social assessment was carried out using a pre-designed questionnaire on the participant’s perception and daily experience with hirsutism. The metabolic syndrome was established according to the criteria of the International Diabetes Federation of 2005 and the National Cholesterol Education Program-third adult treatment panel of 2001. Results: We recruited 60 women aged 27.6 ± 7.0 years. The median Ferriman and Gallwey score was 12. The mean duration of evolution was 9 years. A family history of hirsutism was found in 88.8% of the participants, especially in the mother. Signs of virilization were found in 3.3% of the participants. Association was found between menstrual cycle abnormalities and severity of hirsutism (p = 0.023). Psycho-socially, 58.8% of women found hirsutism normal. The metabolic syndrome was found in 21.7% and 18.3% according to the IDF and NCEP-ATP III, respectively. Conclusion: Hirsutism in our context seems normal to most of our participants. It is, however, associated with menstrual irregularities, signs of virilization and metabolic syndrome. As a result, hirsutism merits further study on a large-scale with emphasis on etiology

关键词： Hirsutism hyperandrogenism Yaoundé Ferriman and Gallwey

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Short-Term Effects of Liraglutide versus Vildagliptin on Insulin Secretion and Sensitivity in Type 2 Diabetes: A Single Blinded Randomized Controlled Trial (LIRAVIS Study)

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Journal of Diabetes Mellitus 2023年第1期13卷 45-57页

作者： Martine claude Etoa Etoga Estelle Amandine Well Simeon Pierre Choukem Mesmin Dehayem Francine Mendane Mekobe Anne Boli Ongmeb Astasselbe Hadja Inna jean claude mbanya Eugene Sobngwi National Obesity Center Yaoundé Central Hospital Yaoundé Cameroon Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Internal Medicine Faculty of Medicine and Pharmaceutical Sciences University of Dschang Dschang Cameroon Health and Human Development (2HD) Research Network Douala Cameroon Internal Medicine Essos Hospital Centre Yaoundé Cameroon Faculty of Health Sciences University of Bamenda Bamenda Cameroon Department of Internal Medicine Faculty of Medicine and Biomedical Sciences University of Garoua Garoua Cameroon Laboratory of Molecular Medicine and Metabolism Biotechnology Center University of Yaoundé 1 Yaoundé Cameroon

Background: We aimed to evaluate the short-term metabolic effects of a GLP-1a, (liraglutide) versus a DPP-4i, (vildagliptin) in a group of sub-Saharan type 2 diabetes patients. Methods: We conducted a randomized controlled single blinded clinical trial in 14 uncontrolled type 2 diabetes patients (HbA1c ≥ 53 mmol/mol) with mean duration of diabetes of 8 [1 - 12] years and median age of 57 [49 - 61] years. Baseline treatment consisted of metformin in monotherapy or metformin plus sulfonylureas. Participants were randomly allocated to 2 groups of add-on 1.2 mg/day subcutaneous liraglutide in group 1 or 100 mg/day of oral vildagliptin in group 2 for 2 weeks. In all participants, insulin secretion in response to mixed meal tolerance test, insulin sensitivity by 80 mU/m2/min hyperinsulinemic-euglycemic clamp, body composition, and lipid profile were measured before and after intervention. Results: At the end of intervention, insulin sensitivity remained unchanged both with liraglutide from 6.6 [4.2 - 7.9] to 6.9 [4.3 - 10.8] mg/kg/min;p = 0.61 and vildagliptin from 7.1 [5.3 - 9.0] to 6.5 [5.6 - 9.4] mg/kg/min (p = 0.86). The area under the C-peptide curve varied from 5.5 [1.0 - 10.9] to 14.9 [10.8 - 17.2] nmol/L/120min, p = 0.09 in group 1 and from 1.1 [0.5 - 14.1] to 13.0 [9.6 - 16.9] nmol/L/120min (p = 0.17) in group 2. LDL Cholesterol levels decreased significantly with liraglutide from 0.85 g/L [0.51 - 1.02] to 0.54 g/L [0.50 - 0.73] (p = 0.04) but not with Vildagliptin. Body weight tended to decrease in group 1 (−0.6 kg) versus modest increase in group 2 (+1.1 kg). Conclusion: Short-term metabolic effects of Liraglutide and Vildagliptin add-on therapy are comparable in sub-Saharan type 2 diabetes patients with a more favorable trend for Liraglutide on body weight, lipid profile, and insulin secretion.

关键词： Insulin Sensitivity Insulin Secretion Liraglutide Vildagliptin Incretinomimetics

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Epidemiological Profile of Obesity among Health Staff at the YaoundéCentral Hospital and at the YaoundéUniversity Teaching Hospital

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World Journal of Cardiovascular Diseases 2019年第8期9卷 511-523页

作者： Sylvie Ndongo Amougou Liliane Linda Yangou Tchangoum Marie Ntep Gweth Dieudonné Danwe Camille Mba Maadjjhou Samuel Kingue jean claude mbanya Faculty of Medicine and Biomedical Sciences University of Yaoundé I Yaoundé Cameroon Yaoundé University Teaching Hospital Yaoundé Cameroon Higher Institute of Medical Technology Yaoundé Cameroon Yaoundé Central Hospital Yaoundé Cameroon

Background: Obesity is a real pandemic and with ever increasing prevalence. Health professionals play a vital role in the fight against this condition. They are also affected by obesity and could be even more affected than the general population. These health workers sometimes have a wrong perception of their own weight which interferes with their ability to counsel their patients. The purpose of this study was to determine the prevalence and factors associated with obesity among health care workers and increase their awareness of the problem. Methodology: This was a cross-sectional study conducted at the Yaoundé Central Hospital (YCH) and the Yaoundé University Teaching Hospital (YUTH) during a 6 months period. The data were collected through a questionnaire structured according to WHO STEP wise approach to chronic disease risk factor surveillance (STEPS). We measured weight, height, waist circumference, and blood pressure according to the WHO STEPS procedure. The Chi square test and logistic regression were used to measure the association between the qualitative variables. A p value 0.05 was considered statistically significant. Results: A total of 350 health personnel participated in this study. The prevalence of obesity was 30.3%. That of abdominal obesity was 46.9%. The factors independently associated to overall obesity were age > 40 years [OR = 2.22 95% CI (1.28 - 3.87)], nursing assistant profession [OR = 2.31 95% IC (1.21 - 4.41)] and high blood pressure [OR = 3.38 95% CI (1.16 - 9.84)] and to abdominal obesity, age > 40 years [OR = 3.35 95% CI (1.96 - 5.71)], female gender [OR = 5.47 95% CI (2.95 - 10.14)], marriage [OR = 1.84 95% CI (1.08 - 3.14)], and High blood pressure [OR = 3.76 95% CI (1.01 - 13.94)]. Conclusion: Obesity is very common among YCH and YUTH staff. Staff awareness and the introduction of proper lifestyle promotion programs are more than ever needed to win the fight against obesity.

关键词： Epidemiological Profile Obesity Health Personnel Yaoundé

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Insulin Sensitivity of Term Newborns Exposed in Utero to HIV and Antiretrovirals in Yaoundé

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Open Journal of Endocrine and Metabolic Diseases 2023年第9期13卷 161-172页

作者： Francine Mendane Ekobena Audrey Christance Donfack Hortence Fouedjio Suzanne Ngo Um Sap Martine claude Etoa Etoga Mesmin Dehayem Anne Boli Ongmeb Gabriel Loni Ekali jean claude mbanya Eugène Sobngwi Internal Medicine Unit Essos Hospital Center Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Obstetrics and Gynecology Unit Yaoundé Central Hospital Yaoundé Cameroon Mother and Child Center Chantal Biya Foundation Yaoundé Cameroon Endocrinology and Metabolic Diseases Unit Yaoundé Central Hospital Yaoundé Cameroon Faculty of Health Sciences of Bamenda Bamenda Cameroon Biotechnology Center University of Yaoundé 1 Yaoundé Cameroon

Introduction: Antiretrovirals (ARVs) and the human immunodeficiency virus (HIV) are implicated in the onset of insulin resistance. They cross the placental barrier thereby inducing early modifications of the fetal environment. The aim of our study was to assess insulin sensitivity in full-term newborns exposed in utero to HIV and ARVs in Yaoundé. Materials and Methods: We conducted an analytical cross-sectional study in 2 maternities in the city of Yaoundé from November 2021 to June 2022. We generated two groups of newborns (NBs): one group born to HIV positive mothers on ARVs and the other control group born to HIV negative mothers. Clinical data from mothers and NBs were collected. A homeostatic model assessment of insulin resistance (HOMA-IR) like index with C peptide served to assess insulin sensitivity. We used the Spearman correlation to measure the strength of association between insulin sensitivity and the different variables. A p-value Results: Of 70 neonates included, 35 were born to HIV positive mothers on ARVs and 35 to HIV negative mothers. The median age of HIV positive and negative mothers was 30 (27 - 32) and 34 (24 - 47) years, respectively (p = 0.791). The body mass index before pregnancy as well as the average newborn weights were comparable in both groups. The ARV protocol associating Tenofovir, Lamivudine, Efavirenz was used by 97.1% of HIV positive mothers. In the exposed NBs group, C peptide was significantly lower (p < 0.001) and blood glucose significantly higher (p < 0.001). The median values of HOMA-IR were 1.4 (0.8 - 1.9) and 2 (1.4 - 2.6) (p = 0.001) for exposed and unexposed NBs, respectively. Conclusion: Newborns exposed to HIV and ARVs had lower C peptide levels and were more sensitive to insulin. Close metabolic monitoring of these newborns would allow early diagnosis and management of any glucose regulation disorder.

关键词： Insulin Sensitivity Newborns Antiretrovirals HIV C Peptide HOMA-IR

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Prevalence and Correlates of Macrovascular Complications at Type 2 Diabetes Diagnosis in a Tertiary Hospital in Yaoundé, Cameroon

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Journal of Diabetes Mellitus 2023年第4期13卷 269-283页

作者： Francine Mendane Ekobena Martine claude Etoa Etoga Mesmin Dehayem Carole Laurence Ngo Yon Pauline Ngo Balôgôg Guy Dieudonné Mvogo André Pascal Kengne Eugène Sobngwi jean claude mbanya Internal Medicine Unit Essos Hospital Center Yaoundé Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé 1 Yaoundé Cameroon Endocrinology and Metabolic Diseases Unit Yaoundé Central Hospital Yaoundé Cameroon Faculty of Medicine and pharmaceutical Sciences University of Douala Douala Cameroon Medical Analysis Laboratory Essos Hospital Center Yaoundé Cameroon Department of Public Health Kesmonds International University Ngaoundéré Cameroon Department of Medicine University of Cape Town Cape Town South Africa Non-Communicable Diseases Research Unit South African Medical Research Council Cape Town South Africa

Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at T2D diagnosis in Yaoundé, Cameroon. Materials and Methods: We conducted a cross-sectional study at the Essos Hospital Center in Yaoundé from January 2017 to June 2021. We recruited patients newly diagnosed with T2D who, simultaneously, with assessed macrovascular complications including stroke, myocardial infarction (MI) and arterial foot ulcer (AFU). Correlates were investigated using Chi square test and logistic regressions. The significance level was set at 5%. Results: In all, 286 newly diagnosed diabetic patients (51.7% being men) were included. The mean age was 52.6 ± 12.3 years. Prevalent cardiovascular risk factors at diabetes diagnosis were a dyslipidemia (63.6%), sedentary lifestyle (57.7%) and family history of type 2 diabetes (51.6%). The prevalence of macrovascular complications was 17.5% with 8.4% stroke, 5.6% myocardial infarction and 3.4% arterial foot ulcer. Hypertension was associated with all macrovascular complications (p Conclusion: Macrovascular complications are frequent at type 2 diabetes diagnosis and are represented by stroke and myocardial infarction in our study, highlighting the importance of cardiovascular risk evaluation and reduction in people with diabetes right from diagnosis.

关键词： Diabetes Mellitus Macrovascular Complications Cameroon

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Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa

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World Journal of Diabetes 2015年第16期6卷 1312-1322页

作者： Koffi Alouki Hélène Delisle Stéphane Besancon Naby Baldé Assa Sidibé-Traoré Joseph Drabo Francois Djrolo jean-claude mbanya Serge Halimi Department of Nutrition Faculty of MedicineUniversity of MontrealDowntown Station Santé-Diabète (NGO) Mali Chapter Endocrinology Department Donka Teaching Hospital Internal Medicine Department Bamako University Hospital Internal Medicine Department Ouagadougou University Hospital Endocrinology Department National University Health Centre Department of Internal Medicine and Specialties Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé I University Joseph Fourier and University Hospital Centre

AIM: To design a medical cost calculator and show that diabetes care is beyond reach of the majority particularlypatients with ***: Out-of-pocket expenditures of patients for medical treatment of type-2 diabetes were estimated based on price data collected in Benin,Burkina Faso,Guinea and Mali. A detailed protocol for realistic medical care of diabetes and its complications in the African context was defined. Care components were based on existing guidelines,published data and clinical experience. Prices were obtained in public and private health facilities. The cost calculator used Excel. The cost for basic management of uncomplicated diabetes was calculated per person and per year. Incremental costs were also computed per annum for chronic complications and per episode for acute complications. RESULTS: Wide variations of estimated care costs were observed among countries and between the public and private healthcare system. The minimum estimated cost for the treatment of uncomplicated diabetes(in the public sector) would amount to 21%-34% of the country's gross national income per capita,26%-47% in the presence of retinopathy,and above 70% for nephropathy,the most expensive complication. CONCLUSION: The study provided objective evidence for the exorbitant medical cost of diabetes considering that no medical insurance is available in the study countries. Although the calculator only estimates the cost of inaction,it is innovative and of interest for several stakeholders.

关键词： Diabetes Non-communicable diseases Africa Advocacy Cost-of-illness

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