The prevalence of microvascular complications and associated factors among newly diagnosed diabetic patient in Dar es Salaam

Abstract

Background: Prevalence of diabetes Mellitus is on an increase worldwide and Tanzania is not exempted. Type 2 diabetes (T2D) is a very common disease, characterized by an asymptomatic phase between the actual onset of diabetic hyperglycaemia and clinical diagnosis. This asymptomatic phase has been estimated to last up to 4–7 years, and it has been reported that about 30–50% cases of type 2 diabetic patients remained undiagnosed. This prodromal stage is associated with the development of microvascular complications of diabetes before clinical diagnosis of diabetes. Scarce data on the prevalence of diabetes mellitus, and microvascular complications among known diabetic patients is available in Tanzania, however little is known about the status of nephropathy, retinopathy, neuropathy and hypertension at diagnosis of Type 2 diabetes Objective: To determine the prevalence of microvascular complications among newly diagnosed Type 2 diabetic patients in Dar es Salaam. Methodology: Cross-sectional survey conducted in three diabetic clinic, Amana, Temeke and Muhimbili Hospital from April to November 2015. A total of 195 newly diagnosed T2D patients diagnosed within 3 months. Newly diagnosed diabetes patient were enrolled by consecutive sampling technique. Data was collected via clinical record forms and patients were screened for diabetic complications, hypertension, and dyslipidaemia and other associated risk factors. Family history was also recorded. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy. Data was entered into a pre-designed Ms Excel spreadsheet and then imported into SPSS 15.0 for analysis Chi squared test and t test were used to test categorical and numerical variables against chronic complications of diabetes respectively. Multivariate logistic regression were performed to determine the effect of various predictors on chronic complications. Results Of the 195 newly diagnosed T2DM patients recruited majority 90 (46.2%) were recruited from Muhimbili National Hospital, 62 (31.8%) and 43 (22.0%) recruited from Temeke and Amana Hospital respectively A total of 104 (53.3%) patients were found to have at least one microvascular complication, while peripheral neuropathy was observed in 72 (36.9%) participants, diabetic retinopathy in 30 (15.4%), patients microalbuminuria in 19 (9.7%) participants and diabetic nephropathy found in 28 (14.4%) patients. Independent predictors for nephropathy were family history of diabetes (OR 2.5, CI 1.13 - 5.79), obesity (OR 0.34, CI 0.13-0.93), higher waist – hip circumference (OR 3.0, CI 1.11-8.15) and hyperlipidemia(OR 5.0, CI 1.79 14.44) Significant predictors for neuropathy were age more than 46 years (OR 2.8, CI 1.24-6.24), family history of diabetes (OR 2.3, CI 1.13-4.48), and high blood pressure (2.27, CI 1.11-4.64). The only significant predictor of retinopathy was raised serum creatinine 2.95(1.03-8.44) 0.044 Patient with diabetic retinopathy were 4 times more likely to have microalbuminuria and overall diabetic nephropathy Conclusions The present study was the first national hospital based urban study of microvascular complications among newly diagnosed diabetes mellitus In our study prevalence of any microvascular complications of diabetes among newly diagnosed diabetes patients was high, stood at 53.3%, neuropathy was 36.9%, nephropathy was 14.5%, and retinopathy was 15.4%.