Factors Associated with Poor Glycemic and Lipid Levels in Ambulatory Diabetes Mellitus Type 2 Patients in Asmara, Eritrea: A Cross-Sectional Study
Oliver Okoth Achila, Millen Ghebretinsae, Abraham Kidane, Michael Simon, Shewit Makonen, Yohannes Rezene
Abstract
Objective . There is a dearth of relevant research on the rapidly evolving epidemic of diabetes mellitus (particularly Type 2 diabetes mellitus) in sub-Saharan Africa. To address some of these issues in the Eritrean context, we conducted a cross-sectional study on glycemic and lipid profiles and associated risk factors. Methods . A total of 309 patients with diabetes mellitus on regular follow-up at the Diabetic and Hypertensive Department at Halibet Regional Referral Hospital, Asmara, were enrolled for the study. Data on specific clinical chemistry and anthropomorphic parameters was collected. Chi-squared (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup></mml:math>) test or Fischer’s exact test was used to evaluate the relationship between specific variables. Multivariate logistic regression (backward: conditional) was undertaken to identify the factors associated with increased odds of suboptimal values in glucose and specific lipid panel subfractions. Results . High proportions of patients (76.7%) had suboptimal levels of HbA1c with a <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mtext>mean</mml:mtext><mml:mo>±</mml:mo><mml:mtext>SD</mml:mtext></mml:math> of <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mn>8.6</mml:mn><mml:mi>%</mml:mi><mml:mo>±</mml:mo><mml:mn>1.36</mml:mn></mml:math>, respectively. In multivariate regression analysis, the likelihood of <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mtext>HbA</mml:mtext><mml:mn>1</mml:mn><mml:mtext>c</mml:mtext><mml:mo>≥</mml:mo><mml:mn>7</mml:mn><mml:mi>%</mml:mi></mml:math> was higher in patients with abnormal WHR (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mtext>AOR</mml:mtext><mml:mo>=</mml:mo><mml:mn>3.01</mml:mn></mml:math>, 95% CI, 3.01 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mn>1.15</mml:mn><mml:mo>–</mml:mo><mml:mn>7.92</mml:mn><mml:mo>=</mml:mo><mml:mn>0.024</mml:mn></mml:math>)) and in patients without hypertension (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mtext>AOR</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.97</mml:mn></mml:math>, 95% CI (1.06–3.56), <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mi>p</mml:mi><mml:mo>=</mml:mo><mml:mn>0.021</mml:mn></mml:math>). A unit reduction in eGFR was also associated with <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mtext>HbA</mml:mtext><mml:mn>1</mml:mn><mml:mtext>c</mml:mtext><mml:mo>≥</mml:mo><mml:mn>7</mml:mn><mml:mi>%</mml:mi></mml:math> (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mtext>AOR</mml:mtext><mml:mo>=</mml:mo><mml:mn>0.99</mml:mn></mml:math>, 95% CI (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mn>0.98</mml:mn><mml:mo>–</mml:mo><mml:mn>1</mml:mn><mml:mo>=</mml:mo><mml:mn>0.031</mml:mn></mml:math>)). In a separate analysis, the data shows that 80.9% of the patients had dyslipidemia. In particular, 62.1% of the patients had <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M12"><mml:mtext>TC</mml:mtext><mml:mo>≥</mml:mo><mml:mn>200</mml:mn></mml:math> mg/dL (risk factors: sex, hypertension, and HbA1c concentration), 81.6% had <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M13"><mml:mtext>LDL</mml:mtext><mml:mo>‐</mml:mo><mml:mtext>C</mml:mtext><mml:mo>≥</mml:mo><mml:mn>100</mml:mn></mml:math> mg/dL (risk factors: sex and hypertension), 56.3% had <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M14"><mml:mtext>TG</mml:mtext><mml:mo>≥</mml:mo><mml:mn>150</mml:mn></mml:math> (risk factors: sex, HbA1c, and waist circumference), 62.8% had abnormal HDL-C (risk factors: waist circumference), 78.3% had <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M15"><mml:mtext>non</mml:mtext><mml:mo>‐</mml:mo><mml:mtext>HDL</mml:mtext><mml:mo><</mml:mo><mml:mn>130</mml:mn></mml:math> mg/dL (risk factors: duration of disease, reduced estimated glomerular filtration rate, and HbA1c), and 45.3% had abnormal TG/HDL (risk factors: sex, age of patient, FPG, and waist circumference). Conclusions . The quality of care, as measured by glycemic and specific lipid targets, in this setting is suboptimal. Therefore, there is an urgent need for simultaneous improvements in both indicators. This will require evidence-based optimization of pharmacological and lifestyle interventions. Therefore, additional studies, preferably longitudinal studies with long follow-up, are required on multiple aspects of DM.