Predictors of blood glucose change and vascular complication of type 2 diabetes mellitus patients in Felege Hiwot Referral Hospital, North West Ethiopia

Vitamin B12 Deficiency among Metformin Treated Type 2 Diabetic Mellitus Patients Visiting the Department of Medicine of a Tertiary Care Centre

Introduction

About 424.9 million people worldwide are affected by Diabetes mellitus. Prevalence among people 20-79 years old in Nepal was 4% in 2017. It is associated with microvascular and macrovascular complications such as peripheral neuropathy leading to risk of foot ulcers and amputation, and impaired sensation in their feet. The study aimed to find the prevalence of vitamin B12 deficiency among metformin-treated type 2 diabetic patients visiting the Department of Medicine of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted in a tertiary care centre between 24 May 2021 to 24 May 2022 after obtaining ethical approval from the Institutional Review Committee. Patients who visited the Department of Medicine and gave informed consent were included in the study. Patients with underlying comorbidities were excluded from the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 330 patients, vitamin B12 deficiency was seen in 33 (10%) (6.76-13.24, 95% Confidence Interval). Among them, 27 (81.82%) were male and 6 (18.18%) were female.

Conclusions

The prevalence of vitamin B12 deficiency was found to be higher than other studies done in similar settings.

Keywords

diabetic neuropathy; metformin; type 2 diabetes; vitamin B12.

Glycemic control and its associated factors in type 2 diabetes patients at Felege Hiwot and Debre Markos Referral Hospitals

Poor glycemic control is a main public health problem among type 2 diabetes mellitus (T2DM) patients and a significant cause of the development of diabetic complications. This study aimed to assess the glycemic control status and its associated factors among type 2 diabetes patients in Felege-Hiwot and Debre Markos Referral Hospitals. A retrospective cohort study was conducted at Felege-Hiwot and Debre Markos Referral Hospitals from December 2014 to December 2015. We have reviewed the chart of these patients until January 2020. Type 2 diabetic patients on follow-up at Felege-Hiwot and Debre Markos Referral Hospitals who fulfilled the inclusion criteria of the study were included. The primary outcome was the level of blood glucose during the study period. Good glycemic control was defined as patients whose average fasting blood glucose measurement for three consecutive visits was between 70 and 130 mg/dL. A generalized linear mixed autoregressive order one model was used to identify the determinants of glycemic control. A total of 191 patients with 1740 observations were included in the study. The overall prevalence of good glycemic control was 58.4% (95% CI: 57.159.7%). The factors associated with good glycemic control at 95% confidence level adjusted odds ratio were being residing in rural (CI: 0.454, 0.614), negative proteinuria (CI: 1.211, 1.546), diastolic blood pressure < 90 (CI: 1.101, 1.522), systolic blood pressure < 140 (CI: 1.352, 1.895), serum creatinine (CI: 0.415, 0.660), duration per visit (CI: 0.913, 0.987), duration since diagnosis (CI: 0.985, 0.998), weight ≥ 78 kg (CI: 0.603, 0.881). Age 38–50, 51–59 and 60–66 years (CI: 1.267, 1.776), (CI: 1.057, 1.476) and (CI: 1.004, 1.403), respectively. The overall prevalence of poor glycemic control was high at Debre Markos and Felege Hiwot Referral Hospital. Living in a rural area, older age (≥ 67 years), positive proteinuria, higher weight (≥ 78 kg), higher serum creatinine levels, higher duration per visit, higher time duration of T2DM since diagnosis, and developing hypertension (SBP ≥ 140, DBP ≥ 90) were the predictors of lower good glycemic control achievements of T2DM patients. In response to this finding, an aggressive intervention that targets improving glycemic control is required.

Predictors of blood glucose change and microvascular complications of type 2 diabetes mellitus patients in Felege Hiwot and Debre Markos referral hospital, North West Ethiopia

BACKGROUND

Microvascular complications lead to disability, dependency, and accelerated morbidity and mortality. This study aimed to identify predictors of blood glucose change and time to microvascular complications among patients with type 2 diabetes.

METHODS

A retrospective cohort study was conducted among type 2 diabetes mellitus patients enrolled between December 2014 and December 2015 at Felege Hiwot and Debre Markos Referral Hospital. A total of 318 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Microvascular Complications in Type 2 Diabetes Mellitus Patients.

RESULTS

The prevalence of microvascular complications in Type 2 diabetes patients was 26.3%, 95%confidence interval(CI):(21.5, 31.1). Of which, half of the patients developed a microvascular complication after 30 months from the onset of the follow-up. The significant predictors of developing microvascular complication were positive proteinurea (adjusted hazard ratio (AHR) = 1.418, 95%CI: 1.080, 1.861), Serum creatinine (AHR = 3.704, 95%CI: 1.992, 6.887), Weight (AHR = 1.058, 95%CI: 1.023, 1.094), and log fasting blood glucose(log(FBS))(AHR = 1.013, 95%CI: 1.010, 1.015). The predictors of fasting blood glucose progression were higher baseline FBS(est(estimate) = 0.002,95%CI:0.0018, 0.0022), Systolic blood pressure (SBP) (est = 0.003, 95%CI: 0.002, 0.004), diastolic blood pressure (DBP) (est = 0.002, 95%CI: 0.0002, 0.004), and age (est = 0.003, 95%CI: 0.001, 0.004).

CONCLUSION

The progression of the fasting blood glucose level for rural patients was faster than for urban patients. Patients having higher baseline FBS, previous hypertension history, higher SBP, higher DBP, older age, and fewer visits to the hospital have a relatively more progressive change in blood sugar levels. Patients having higher triglyceride levels, positive proteinuria, higher fasting blood sugar, higher weight, and a lesser number of hospital visits have a higher risk of developing a complication. In response to this finding, an aggressive intervention that targets to prevent microvascular complications is required.