Diabetes Diagnosis, Management, Prevention and Education in Guinea-Bissau

Summary

Type 2 diabetes (T2D) will affect \~650 million adults worldwide by 2040 and about as many will have pre-diabetes. Chronic hyperinsulinemia/insulin resistance precedes T2D development. Studies link insulin resistance with chronic inflammation and oxidative stress. In Guinea-Bissau, a low-income country in West Africa, the T2D incidence is largely unknown and there is an acute lack of diabetes doctors, nurses and other diabetes educators. They hardly have access to insulin, and mortality from T2D complications is high. Previous studies by the Bandim Health Project (www.bandim.org) in the country show that the Bacillus Calmette-Guérin (BCG) vaccine has non-specific effects, well beyond tuberculosis prevention, conferring a general protection against unrelated pathogens. At the same time, studies from the US have also shown that BCG can significantly improve glycemic control in Type-1 diabetes (T1D) patients. Yet, no such studies have been done in T2D or pre-diabetes. The purpose of the present study is to administer BCG to patients with pre-diabetes, in order to reduce hyperinsulinemia/chronic inflammation, a novel strategy to flatten the growing T2D incidence.

Timeline

Start

2023-12-01

Primary completion

2027-08-01

Completion

2029-08-01

Publications

• Background Correia JC, Lopes A, Iala CB, Sanca NA, Bidonga A, Lagger G, Golay A, Castellsague MP. Diabetes management in Guinea Bissau: a situational analysis. Pan Afr Med J. 2019 Sep 4;34:10. doi: 10.11604/pamj.2019.34.10.19874. eCollection 2019.
• Background Byberg S, Bundesen C, Rudolf F, Haraldsdottir TL, Indjai L, Barai R, Beck-Nielsen H, Sodemann M, Jensen DM, Bjerregaard-Andersen M. Diabetes in urban Guinea-Bissau; patient characteristics, mortality and prevalence of undiagnosed dysglycemia. Glob Health Action. 2020 Dec 31;13(1):1802136. doi: 10.1080/16549716.2020.1802136.
• Background Benn CS, Roth A, Garly ML, Fisker AB, Schaltz-Buchholzer F, Timmermann A, Berendsen M, Aaby P. BCG scarring and improved child survival: a combined analysis of studies of BCG scarring. J Intern Med. 2020 Dec;288(6):614-624. doi: 10.1111/joim.13084. Epub 2020 May 25.
• Background Schaltz-Buchholzer F, Aaby P, Monteiro I, Camala L, Faurholt Simonsen S, Nortoft Frankel H, Lindberg Larsen K, Golding CN, Kollmann TR, Amenyogbe N, Stabell Benn C, Bjerregaard-Andersen M. Immediate Bacille Calmette-Guerin Vaccination to Neonates Requiring Perinatal Treatment at the Maternity Ward in Guinea-Bissau: A Randomized Controlled Trial. J Infect Dis. 2021 Dec 1;224(11):1935-1944. doi: 10.1093/infdis/jiab220.
• Background Aaby P, Benn CS. BCG: new life for a centenarian vaccine. Lancet Infect Dis. 2021 Jul;21(7):897-898. doi: 10.1016/S1473-3099(20)30714-3. Epub 2021 Feb 17. No abstract available.
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• Background Faustman DL, Wang L, Okubo Y, Burger D, Ban L, Man G, Zheng H, Schoenfeld D, Pompei R, Avruch J, Nathan DM. Proof-of-concept, randomized, controlled clinical trial of Bacillus-Calmette-Guerin for treatment of long-term type 1 diabetes. PLoS One. 2012;7(8):e41756. doi: 10.1371/journal.pone.0041756. Epub 2012 Aug 8.
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• Background Bjerregaard-Andersen M, Hansen L, da Silva LI, Joaquim LC, Hennild DE, Christiansen L, Aaby P, Benn CS, Christensen K, Sodemann M, Jensen DM, Beck-Nielsen H. Risk of metabolic syndrome and diabetes among young twins and singletons in Guinea-Bissau. Diabetes Care. 2013 Nov;36(11):3549-56. doi: 10.2337/dc12-2653. Epub 2013 Aug 15.
• Background Haraldsdottir TL, Rudolf F, Bjerregaard-Andersen M, Joaquim LC, Stochholm K, Gomes VF, Beck-Nielsen H, Ostergaard L, Aaby P, Wejse C. Diabetes mellitus prevalence in tuberculosis patients and the background population in Guinea-Bissau: a disease burden study from the capital Bissau. Trans R Soc Trop Med Hyg. 2015 Jun;109(6):400-7. doi: 10.1093/trstmh/trv030. Epub 2015 Apr 26.
• Background Steiniche D, Jespersen S, Erikstrup C, Krarup H, Handberg A, Ostergaard L, Haraldsdottir T, Medina C, Gomes Correira F, Laursen AL, Bjerregaard-Andersen M, Wejse C, Honge BL; Bissau HIV Cohort study group. Diabetes mellitus and impaired fasting glucose in ART-naive patients with HIV-1, HIV-2 and HIV-1/2 dual infection in Guinea-Bissau: a cross-sectional study. Trans R Soc Trop Med Hyg. 2016 Apr;110(4):219-27. doi: 10.1093/trstmh/trw017.
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• Background Hennild DE, Bjerregaard-Andersen M, Joaquim LC, Christensen K, Sodemann M, Beck-Nielsen H, Jensen DM. Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau. BMC Endocr Disord. 2016 Aug 4;16(1):46. doi: 10.1186/s12902-016-0126-6.
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• Background Abdulrehman MS, Woith W, Jenkins S, Kossman S, Hunter GL. Exploring Cultural Influences of Self-Management of Diabetes in Coastal Kenya: An Ethnography. Glob Qual Nurs Res. 2016 Apr 8;3:2333393616641825. doi: 10.1177/2333393616641825. eCollection 2016 Jan-Dec.

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