Surveys carried out by the Ministry of Health and Quality of Life and Collaboration Centres of the World Health Organization in the years 1987, 1992 and 1998 had shown that there is rising prevalence of Type 2 diabetes in the Island nation of Mauritius and Rodrigues. One in five Mauritian adults is likely to be affected Of significance , the rate of poorly controlled diabetic patients was high , being around 40 % of the diagnosed cases.Fasting plasma glucose has been the sole indicator used to assess glycemic control in the patients. Glycated haemoglobin has been known to be a better indicator as reported in various studies elsewhere. However, it was important to assess the suitability of this test and to determine the appropriate cut off value to help in the management of treatment of diabetic patients in Mauritius. A cohort of diagnosed cases of diabetic was studied over the period of 1997 to 2001. Fasting plasma glucose, serum fructosamine and glycated haemoglobin were assayed at various intervals to compare glycemic status in those patients. Haemoglobin variants were screened in representative samples of nonnal adults and diabetic patients to detennine the prevalence in the population. Laboratory tests were also carried to detennine the effect of any interference on those indicators. As a substudy , a group of patients were given intensive intervention with an education module and the indicators were compared for any significant change. Results of the study have shown that :
(a) The prevalence of haemoglobin variants is 1.2°/,. in the normal adult population of Mauritius and Rodrigues; the majority being HbS (1.1'/o) and the other type detected was HbC (0.1%) ; Very low prevalence was detected in the cohort studied.
(b) The best indicator for glycemic control is HbA1C with a cut off value of 7.5%. An appropriate cut off value when using fasting plasma glucose is 9.0 mmol/L.
(c) The poorly controlled diabetic patients comprise of a majority of insulin requiring cases of whom a significant number could be Type 1 cases.
(d) Intensive intervention with well defined education component has a beneficial effect on glycemic status ,which can be assessed by HbA1c (a complex of glucose and haemoglobin) as indicator.
(e) The interference by haemoglobin variants on the three indicators studied was not significant.
It is therefore recommended that:
(a) HbA1C be used as routine indicator for glycemic control in diabetic patients. This will also necessitate standardized methodology with appropriate quality control. There must be a well defined protocol for clinicians to use this service in the most cost effective way.
(b) Education be made an integral component of intervention for diabetic patients .This will require adequate monitoring and evaluation. HbA1C will be the indicator of choice.
(c) Further studies be carried to : Determine the proportion of known Type 2 diabetic patients who resemble Type 1 and require insulin treatment; Detect onset of complications in long standing poorly controlled cases; Assays of microalbuminuria, insulin response , and Cpeptide concentration will be appropriate.
⢠Initiate suitable intervention programme for diagnosed cases of diabetes, with emphasis on education . Monitoring and evaluation will involve HbA1C as main indicator. Develop a laboratory method to determine HbA1C or equivalent indicator which can be adapted in the Mauritian context as an appropriate , cost effective and cost efficient procedure to be used in the decentralized services of diabetes care in Mauritius.