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Diabetes mellitus is becoming more common in African cities, where it may affect up to 7% of the hospital population. It particularly affects poor male patients and 73 to 80% of those affected have non insulin-dependent diabetes. The frequency of non-obese, poorly cetogenic patients is high in Sub-Saharan Africa. This may be due to malnutrition, with a deficit either in protein or in calories. Such malnutrition is a major public health problem affecting children in Sudanese and Sahelian areas and may interact with environmental and genetic factors. In equatorial environments, the toxic effects of alcohol abuse on the pancreas are simply another environmental factor, reducing the endocrine function of the pancreas. These observations are important because: 1) diabetes mellitus has a severe social impact in this area and 2) nutrition has a general effect on the pathogenesis of diabetes mellitus.

This study took place between January and September 1996. The inclusion criteria was a blood cholesterol concentration of at least 2.5 g/l. Thirty-three patients were included. They were aged from 37 to 77 years, with a mean age of 59 (+/- 9.4) years. Twenty-six were women and seven were men. The mean age of the women was 58.9 (+/- 10) years and that of the men was 61 (+/- 6.1) years. Sixteen patients were from urban areas, 14 from semi-rural areas and 3 were of rural origin. The mean duration of diabetes was 9 (+/- 6.5) years. Mean post-prandial blood glucose concentration was 2.2 (+/- 1.0) g/l. Mean body mass index was 25.6 (+/- 5.6). Mean systolic blood pressure was 15.0 (+/- 2.5) cm Hg and mean diastolic blood pressure was 9.0 (+/- 1.3) mm Hg. Blood cholesterol concentration was between 2.5 g/l and 5.6 g/l, and mean HDL cholesterol concentration was 0.7 (+/- 0.4) g/l. Mean blood triglyceride concentration was 1.0 (+/- 0.4) g/l. Body mass index was negatively correlated with high cholesterol levels (r = -0.29). Hypercholesterolemia was primary, with no associated high triglyceride concentration. Cholesterol levels were also negatively correlated with post-prandial blood glucose concentration (r = -0.1). Thus, treatment should involve the prescription of drugs to reduce blood lipid concentration rather than just the restriction of lipid intake.