Adequacy of control of cardiovascular risk factors in ambulatory patients with type 2 diabetes attending diabetes out-patients clinic at a county hospital, Kenya

Abstract

Background: Type 2 diabetes is associated with substantial cardiovascular morbidity and mortality arising from the high prevalence of cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, poor glycaemic control and albuminuria. Adequacy of control of these risk factors determines the frequency and outcome of cardiovascular events in the patients. Current clinical practice guidelines emphasize primary prevention of cardiovascular disease in type 2 diabetes. There is scarce data from the developing countries, Kenya included, on clinical care of patients with type 2 diabetes in the regions that are far away from tertiary health facilities. So we determined the adequacy of control of the modifiable risk factors: glycaemic control, hypertension, dyslipidemia, obesity and albuminuria in the study patients from rural and peri-urban dwelling. Methods: This was a cross-sectional study on 385 randomly selected ambulatory patients with type 2 diabetes without overt complications. They were on follow up for at least 6 months at the Out-patient diabetes clinic of Nyeri County Hospital, a public health facility located in the central region of Kenya. Results: Females were 65.5%. The study subjects had a mean duration of diabetes of 9.4 years, IQR of 3.0-14 years. Their mean age was 63.3 years, IQR of 56-71 years. Only 20.3% of our subjects had simultaneous optimal control of the three (3) main cardiovascular risk factors of hypertension, high LDL-C and hyperglycaemia at the time of the study. The prevalence of cardiovascular risk factors were as follows: HbA1c above 7% was 60.5% (95% CI, 55.6-65.5), hypertension, 49.6% of whom 76.6% (95% CI, 72.5-80.8) were poorly controlled. High LDL-Cholesterol above 2.0 mmol/L was found in 77.1% (95% CI 73.0-81.3) and Albuminuria occurred in 32.7% (95% CI 27.8-37.4). The prevalence of the other habits with cardiovascular disease risk were: excess alcohol intake at 26.5% (95% CI 27.8-37.4) and cigarette-smoking at 23.6%. A modest 23.4% of the treated patients with hypertension attained target blood pressure of <140/90 mmHg. Out of a paltry 12.5% of the statin-treated patients and others not actively treated, only 22.9% had LDL-Cholesterol of target <2.0 mmol/L. There were no obvious socio-demographic and clinical determinants of poor glycaemic control. However, old age above 50 yrs., longer duration with diabetes above 5 yrs. and advanced stages of CKD were significantly associated with hypertension. Female gender and age, statin non-use and socio-economic factor of employment were the significant determinants of high levels of serum LDL-cholesterol.

Factors related to self-care activities of patients with type 2 diabetes mellitus

“…6,8,9,19 The data of this study confirmed a positive association between healthy eating and low income, a situation that is not consistent with the literature, which points to evidence that access to a healthy diet is directly related to socioeconomic conditions. 20 We also found an inverse but weak correlation of healthy eating with fasting blood glucose, suggesting that adopting an adequate diet may cooperate in metabolic control.…”

“…Furthermore, under 55-year olds showed a better behavior regarding blood sugar testing. 9 Given this scenario, it is believed that the low means found for blood sugar testing in the present study can be explained by the fact that this sample is mostly constituted by elderly people and probably, also, the participants had type 2 DM, rather than type 1, since this activity was correlated with the duration of insulin use.…”

“…5,9,17,18 Recent research, which identified the most important activities in the control of glycated hemoglobin, suggested that the correct use of medications may be the most important behavior for blood sugar control among adults with diabetes and low socioeconomic status thus demonstrating the importance of reaffirming behavior among diabetics.…”

“…2,3 Self-care in the management of diabetes mellitus includes adherence to healthy eating, physical activity, periodic blood sugar testing, the correct intake of prescribed medications, proper foot care, and the ability to resolve conflicts and deal positively with the presence of a chronic pathological condition. 4 National [5][6][7] and international studies 8,9 have sought to study this behavior and correlate it to clinical and socioeconomic variables. However, the results are heterogeneous reflecting the need to conduct research on the issue in different social and clinical contexts.…”

The Burden of Unrecognised Chronic Kidney Disease in Patients With Type 2 Diabetes at a County Hospital Clinic in Kenya: Implications to Care and Need for Screening

“…Improved public health systems by governments, however should equalize opportunities for access to quality care, in this context, of high-risk diabetic patients like these in our study. The audit part of this study has been published (58). However, that spot urine test for albuminuria and occasional kidney function test for eGFR are not often done on these clinic attending patients, as standard of care, this paper was done to unmask the clinical information missed out on them.…”