The Prevalence of Metabolic Syndrome and Its Components among Type 2 Diabetes Mellitus Patients at a Tertiary Hospital, Northwest Ethiopia

Diabetic dyslipidemia and its predictors among people with diabetes in Ethiopia: systematic review and meta-analysis

BACKGROUND

Dyslipidemia is an imbalance of lipid profiles. It increases the chance of clogged arteries and may cause heart attacks, strokes, and other circulatory disorders. Dyslipidemia affects the general population, but its severity is higher in diabetic populations. As a result, the chance of dyslipidemia-associated morbidity and mortality is highest in diabetic patients. In Ethiopia, around 2 to 6.5% of the population live with diabetes, but their lipid profiles are inconsistent across the studies. Therefore, this study aimed to estimate the pooled prevalence of diabetic dyslipidemia and its predictors among people with diabetes in Ethiopia.

METHOD

A systematic review and meta-analysis was conducted. The searches were carried out in MEDLINE via PubMed and OVID, EBSCO, Embase, and other supplementary gateways such as Google and Google Scholar, for articles published up to June 2023. The articles were searched and screened by title (ti), abstract (ab), and full text (ft). The quality of the eligible studies was assessed by the Newcastle-Ottawa scale. The heterogeneity was detected by the Cochrane Q statistic test and the I-squared (I2) test. Then subgroup analysis and meta-regression analysis were used to identify the source of the variations. A random or fixed-effect meta-analysis model was used to estimate the overall pooled prevalence and average effects. The publication bias was assessed by the funnel plot asymmetry test and/or Begg and Mazumdar's test for rank correlation (p-value < 0.05). The protocol has been registered in an international database, the prospective register of systematic reviews (PROSPERO), with reference number CRD42023441572.

RESULT

A total of 14 articles with 3662 participants were included in this review. The pooled prevalence of diabetic dyslipidemia in Ethiopia was found to be 65.7% (95% confidence interval (CI): 57.5, 73.9), I2 = 97%, and p-value < 0.001. The overall prevalence of triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) were found to be 51.8% (95% CI: 45.1, 58.6) and 44.2% (95% CI: 32.8, 55.7), respectively, among lipid profiles. In meta-regression analysis, the sample size (p value = 0.01) is the covariate for the variation of the included studies. Being female (adjusted odds ratio (AOR): 3.9, 95% CI: 1.5, 10.1), physical inactivity (AOR: 2.6, 95% CI: 1.5, 4.3), and uncontrolled blood glucose (AOR: 4.2, 95% CI: 1.9, 9.4) were found to be the determinants of dyslipidemia among diabetic patients.

CONCLUSION

This review revealed that the prevalence of diabetic dyslipidemia is high among people with diabetes in Ethiopia. Being female, having physical inactivity, and having uncontrolled blood glucose were found to be predictors of dyslipidemia among people with diabetes. Therefore, regular screening of lipid profiles and the provision of lipid-lowering agents should be strengthened to reduce life-threatening cardiovascular complications. Furthermore, interventions based on lifestyle modifications, such as regular physical activity and adequate blood glucose control, need to be encouraged.

Prevalence of dyslipidemia among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

Background

Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown. This systematic review and meta-analysis aimed to determine the prevalence of dyslipidemia among persons with T2D in Africa.

Methods

Medline, Embase, Global Health, Scopus, and Web of Science were searched on 5 December 2023. This review adhered to the PRISMA guidelines and was prospectively registered on PROSPERO. The prevalence data for dyslipidemia was pooled through a random-effects meta-analysis. The authors assessed heterogeneity and publication bias using I 2 statistics and Egger's test, respectively.

Results

Our search identified 8035 records, of which 60 articles involving 20 034 individuals with T2D were included in this review. The pooled prevalence of dyslipidemia recorded 38.6% (95% CI: 34.1-43.4) for high TC (≥ 5.2 mmol/l), 52.7% (95% CI: 44.2-61.1) for high low-density lipoprotein cholesterol (LDL-C) (≥ 2.6 mmol/l), 43.5% (95% CI: 37.1-50.0) for low high-density lipoprotein cholesterol (HDL-C) (< 1.0 mmol/l in men and less than 1.3 mmol/l in women), and 37.4% (95% CI: 32.2-42.9) for high triglycerides (TG) (≥ 1.7 mmol/l). Subgroup analysis based on gender indicated a notably higher prevalence of dyslipidemia among females compared to males.

Conclusion

Dyslipidemia is prevalent among persons with T2D in Africa. This highlights the need for early screening, diagnosis, and management of dyslipidemia to mitigate the risk of cardiovascular complications in this population.

Exploring the Prevalence and Components of Metabolic Syndrome in Sub-Saharan African Type 2 Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis

Background

Type 2 diabetes mellitus and metabolic syndrome represent two closely intertwined public health challenges that have reached alarming epidemic proportions in low- and middle-income countries, particularly in sub-Saharan Africa. Therefore, the current study aimed to determine the weighted pooled prevalence of metabolic syndrome and its components among individuals with type 2 diabetes mellitus in sub-Saharan Africa as defined by the 2004 National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III 2004) and/or the International Diabetes Federation (IDF) criteria.

Methods

A systematic search was conducted to retrieve studies published in the English language on the prevalence of metabolic syndrome among type 2 diabetic individuals in sub-Saharan Africa. Searches were carried out in PubMed, Embase, Scopus, Google Scholar, African Index Medicus, and African Journal Online from their inception until July 31, 2023. A random-effects model was employed to estimate the weighted pooled prevalence of metabolic syndrome in sub-Saharan Africa. Evidence of between-study variance attributed to heterogeneity was assessed using Cochran's Q statistic and the I2 statistic. The Joanna Briggs Institute quality appraisal criteria were used to evaluate the methodological quality of the included studies. The summary estimates were presented with forest plots and tables. Publication bias was checked with the funnel plot and Egger's regression test.

Results

Overall, 1421 articles were identified and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and 30 studies that met the inclusion criteria were included in the final analysis. The weighted pooled prevalence of metabolic syndrome among individuals with type 2 diabetes mellitus in sub-Saharan Africa was 63.1% (95% CI: 57.9-68.1) when using the NCEP-ATP III 2004 criteria and 60.8% (95% CI: 50.7-70.0) when using the IDF criteria. Subgroup analysis, using NCEP-ATP III 2004 and IDF criteria, revealed higher weighted pooled prevalence among females: 73.5% (95% CI: 67.4-79.5), 71.6% (95% CI: 60.2-82.9), compared to males: 50.5% (95% CI: 43.8-57.2), 44.5% (95% CI: 34.2-54.8), respectively. Central obesity was the most prevalent component of metabolic syndrome, with a pooled prevalence of 55.9% and 61.6% using NCEP-ATP III 2004 and IDF criteria, respectively. There was no statistical evidence of publication bias in both the NCEP-ATP III 2004 and IDF pooled estimates.

Conclusions

The findings underscore the alarming prevalence of metabolic syndrome among individuals with type 2 diabetes mellitus in sub-Saharan Africa. Therefore, it is essential to promote lifestyle modifications, such as regular exercise and balanced diets, prioritize routine obesity screenings, and implement early interventions and robust public health measures to mitigate the risks associated with central obesity.

Metabolic syndrome and its associated factors among type 2 diabetic patients in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia Region

Background

Patients with diabetes mellitus (DM) are prone to modifiable and non-modifiable complications, which can be grouped under metabolic syndrome (MetS). Evaluating MetS in patients with diabetes is critical for the prevention of cardiovascular disease among patients with DM. In Ethiopia, more specifically in the southwest of Ethiopia, these kinds of information are lacking. Thus, this study estimated the prevalence of metabolic syndrome among type 2 diabetic patients and its associated factors.

Methods

A health facility-based cross-sectional study was done from May 1 to 30, 2021. The data were collected using structured questionnaires, laboratory investigations, and anthropometric measurements. MetS was diagnosed using the modified International Diabetic Federation guidelines (IDF) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The data was entered into Epidata and analyzed using SPSS software. Bivariable and multiple variable logistic regression was done to identify the factors associated with MetS. In multiple-variable logistic regression analysis, variables that have a p-value ≤ 0.05 were declared to have statistical significance.

Result

The majority (31.4%) of study participants were within the age group of 41-50 years and the mean ± SD of age is 51.75 ± 11.66, and 54.9% of them were men. In this study, the prevalence of MetS was 31.4% and 41.2% using the IDF and NCEP-ATP III criteria, respectively. Being a woman (AOR = 11.33, 95% CI; 3.73, 34.34; p < 0.001), having a lower level of education (AOR=7.10, 95% CI; 1.88, 26.70; p <0.004), and performing high physical activities (AOR=0.08, 95%CI; 0.01, 0.40; p <0.002) were significantly associated with MetS.

Conclusion

According to this study, the magnitude of Metabolic Syndrome in Mizan-Teppi University Teaching Hospital was 31.4% and 41.2% using IDF and NCEP-ATP III criteria, respectively. Being a woman and having a lower level of education increased the odds of MetS among patients with DM while performing high physical activities decreased the odds of MetS among patients with DM. Therefore, to prevent metabolic syndrome among type 2 DM patients in the study area, it is crucial to focus on women and individuals who have not had access to adequate education. One way to do this is by prioritizing interventions that involve physical activity.

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

BACKGROUND

There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.

METHODS

We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I².

RESULTS

A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.

CONCLUSION

Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

Determinants of metabolic syndrome among patients attending diabetes clinics in two sub-urban hospitals: Bono Region, Ghana

BACKGROUND

Over 70% of individuals with type 2 diabetes mellitus (T2DM) may have metabolic syndrome in sub-Saharan Africa. Evidence about the prevalence, clustering, and determinants of metabolic syndrome components is needed to guide the implementation of interventions to prevent cardiovascular diseases in low-income countries.

METHODS

A clinic-based cross-sectional study was conducted among 430 out-patients attending two-selected diabetes mellitus clinics in the Bono Region of Ghana. Data was collected in June 2016 among participants aged 30-79 years. The prevalence of metabolic syndrome was assessed using the harmonized definition. Patients were interviewed using semi-structured questionnaires and T2DM status was confirmed by reviewing medical records. The components of MS that were assessed included body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein (HDL)-cholesterol, and blood glucose. Multiple logistic regression models were constructed to evaluate the risk factors of MS.

RESULTS

The mean age of participants was 58.8 ± 11.49 years. The prevalence of MS was 68.6% (95% CI: 64.0-72.8), higher among women (76.3%, 95% CI: 70.6-81.2) than men (58.0%, 95% CI: 35.0-49.4) and in the 50-59-year age group (32.1%). The majority of participants [248 (57.7%)] had either two [124 (28.8%)] or four [124 (28.8%)] components of MS. Excluding fasting blood glucose (78.4%), the predominant components of MS identified in the study were reduced HDL cholesterol (70.2%), high waist circumference (60.9%), and elevated systolic blood pressure (49.8%). The study found that the odds of MS in women are 2.2-fold higher than in men (95% CI: 1.29-3.58, p = 0.003). Duration of T2DM (OR 5.2, 95% CI: 2.90-9.31, p < 0.001) and overweight status (OR 6.1, 95% CI: 3.70-10.07 p < 0.001) were also found to be significant determinants of MS.

CONCLUSIONS

Metabolic syndrome was common among patients attending routine diabetes mellitus clinics in sub-urban hospitals in the middle belt of Ghana. Significant factors associated with metabolic syndrome included being female, living with diabetes for more than five years, and being overweight. Nationwide advocacy for routine screening and prevention of the syndrome should be initiated to prevent cardiovascular disease and mortality in this vulnerable population.

Association of Seaweed Consumption with Metabolic Syndrome and Its Components: Findings from the Korean Genome and Epidemiology Study

This study aimed to investigate the association between seaweed consumption and the odds of developing metabolic syndrome in middle-aged and elderly Koreans. The study included 5777 adults aged 40-69 years from 2001 to 2002 in the Ansan and Ansung cohorts of the Korean Genome and Epidemiology Study. Data on the consumption of seaweed, including laver and kelp/sea mustard, were obtained using a semiquantitative food frequency questionnaire. Multivariable logistic regression models were used to assess the association between seaweed consumption and the odds of developing metabolic syndrome and its components. Women in the highest tertile of laver consumption had lower odds of developing metabolic syndrome than those in the lowest tertile (adjusted odds ratio [AOR]: 0.70; 95% confidence interval [CI]: 0.54-0.92). Both men and women in the highest tertile of laver consumption had lower odds of abdominal obesity than those in the lowest tertile (AOR: 0.64, 95% CI: 0.42-0.98 for men; AOR: 0.53, 95% CI: 0.39-0.72 for women). These findings suggest that laver consumption is inversely associated with the odds of developing metabolic syndrome and abdominal obesity in Korean adults.

Prevalence of central obesity and associated factors in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Obesity is a global public health concern that is now on the rise, especially in low- and middle-income nations. Despite the fact that there are several studies reporting the prevalence of central obesity among adults in Ethiopia, there is a lack of a systematic review and meta-analysis synthesizing the existing observational studies. Therefore, this systematic review and meta-analysis aimed to determine the prevalence of central obesity and its associated factors in Ethiopia.

METHODS

Online libraries such as PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 16). Forest plots, Begg's rank test, and Egger's regression test were all used to check for publication bias. To look for heterogeneity, I² was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region and study setting. In addition, the pooled odds ratio for related covariates was calculated.

RESULTS

Out of 685 studies assessed, 20 met our criteria and were included in the study. A total of 12,603 people were included in the study. The prevalence of central obesity was estimated to be 37.31% [95% confidence interval (CI): 29.55-45.07]. According to subgroup analysis by study region and setting, the highest prevalence was observed in the Dire Dawa region (61.27%) and community-based studies (41.83%), respectively. Being a woman (AOR = 6.93; 95% CI: 3.02-10.85), having better socioeconomic class (AOR = 5.45; 95% CI: 0.56-10.34), being of age 55 and above (AOR = 5.23; 95% CI: 2.37-8.09), being physically inactive (AOR = 1.80; 95% CI: 1.37-2.24), being overweight (AOR = 4.00; 95% CI: 2.58-5.41), being obese (AOR = 6.82; 95% CI: 2.21-11.43), and having hypertension (AOR = 3.84; 95% CI: 1.29-6.40) were the factors associated with central obesity.

CONCLUSION

The prevalence of central obesity was high in Ethiopia. Being a woman, having a higher socioeconomic class, being older, being physically inactive, being overweight or obese, and having hypertension were all associated. Therefore, it is vital for the government and health organizations to design and implement preventive measures like early detection, close monitoring, and positive reversal of central obesity in all patients and the general population. High-quality investigations on the prevalence of central obesity in the Ethiopian people are required to better understand the status of central obesity in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022329234.

Magnitude of metabolic syndrome in Gondar town, Northwest Ethiopia: A community-based cross-sectional study

Background

Metabolic syndrome (MetS) is becoming a major public health problem globally; it is clear that the burden of MetS is rapidly increasing the rates of non-communicable diseases (NCD). In Ethiopia studies done so far have shown a large disparity in magnitude of the prevalence of MetS and were mainly institution-based studies. Therefore, this study assess the prevalence of MetS among adults who are residing in Gondar city using Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) assessment tool. The findings are imperative to developing and strengthening national NCD prevention and control programs.

Methods

This study was conducted in Gondar city Northwest Ethiopia in 2018. It employs a community-based cross-sectional study design among 3,227 individuals 18 years of age or older. Data was collected using the WHO stepwise tool, lipid profile, blood pressure (BP), waist circumference (WC) body mass index (BMI), fasting blood glucose levels (FG), and anthropometric measurements. The prevalence estimation was made along with a 95% confidence interval (CI). The Kappa statistic was used to analyze the statistical agreement between ATP III and IDF definitions of the MetS. Stratified analysis was also performed for description and analysis components using ATP III and IDF as an outcome.

Result

Of the total study participants (3227), 3059 (94.8%) were included in the final analysis and 52.5% were female. The mean (±SD) age of the study participant was 40.8 years (16.2 ±SD). The overall prevalence of MetS using ATP III was 11.2% [95%CI: 10.1, 12.3] and using IDF was 11.9% [95%CI: 10.8, 13.2]. The sex-specific proportion was high in females rather than males irrespective of the criteria. The overall level of agreement between ATP III and IDF prevalence was 91.7% and the Kappa statistics was 0.594. Older age, low-density lipoprotein cholesterol, body mass index, being female, born in an urban area, consumption of an alcoholic drink in the preceding 30 days, and non-fasting practice was significantly associated with MetS.

Conclusion and recommendation

There was a higher prevalence of metabolic syndrome among females than males irrespective of metabolic syndrome diagnostic criteria. This also shows good agreement between ATP III and IDF. Being female, urban birthplace, frequent alcohol consumption in the last 30 days, and non-fasting practice are factors associated with higher rates of metabolic syndrome. Hence, awareness campaigns, physical exercise, and nutrition education intervention should be undertaken to promote health behavioral practice.

Predictors of Lipid Profile Abnormalities Among Patients with Metabolic Syndrome in Southwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Lipid profile abnormalities are an integral part of metabolic syndrome (MetS) and major underlying causes of cardiovascular disease (CVD) and type-2 diabetes mellitus (T2DM). Lipid profile abnormalities in a patient with MetS are resulted due to the presence of central obesity and insulin resistance. In Ethiopia, the burden and predictors of lipid profile abnormalities in a patient with MetS are not well known. Thus, this study aimed to determine the prevalence of lipid profile abnormalities and predictors among patients with MetS in southwest Ethiopia.

METHODS AND MATERIALS

A cross-sectional study was conducted among 381 patients with MetS from September to December 2019 with a response rate of 100%. A structured questionnaire was used to collect data on socio-demographic and behavioral factors. Waist circumference, height, weight, and blood pressures were measured. The venous blood sample was collected for glucose and lipid profile determination. Data were entered and analyzed by using SPSS version 21. Binary logistic regression and Pearson's correlation analyses were performed. A p-value was set at a <0.05 for statistical significance.

RESULTS

In this study, about 58% of participants were at least one or more lipid profile abnormalities with the 95% CI (52.8-62.7). About 67.2%, 44.6%,18.4%, and 14.2% of study participants were low HDL, high TG, LDL, and TC, respectively. Central obesity (adjusted odds ratio (AOR): 1.89, 95% CI: 1.14-3.14), increasing age (AOR: 2.08, 95% CI: 1.27-3.4), higher BMI (AOR: 2.06, 95% CI: 1.23-3.4), being hypertensive (AOR: 3.48, 95% CI: 2.12-5.7) and increasing blood glucose level (AOR: 2.34, 95% CI: 1.36-4.03) were independent predictors of lipid profile abnormalities (dyslipidemia).

CONCLUSION

In this study area, a high (58%) prevalence of dyslipidemia was observed in study participants, and increasing age, higher BMI, central obesity, hypertension, and high blood glucose level were identified as independent predictors of dyslipidemia among patients with MetS. Prevention and control of dyslipidemia and its predictors among patients with MetS were recommended.

Metabolic syndrome and its associated factors in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Metabolic syndrome (MetS) is a common complex entity that has emerged as a worldwide epidemic and major public health concern. The incidence of MetS often parallels the incidence of obesity and it is even worst among people living with comorbidities like; HIV/AIDS, hypertension, and mental illness. Therefore, there was an urgent need to summarize the extent and risk factors of MetS in Ethiopia.

METHODOLOGY

This systematic review was conducted according to the PRISMA guideline to investigate the prevalence of MetS and contributing factors. English language-based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to the prevalence of MetS. A random-effects model was employed to estimate the pooled prevalence of MetS, and it was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2.

RESULT

A total of 25 studies with 21,431 study participants were included for this systematic review and meta-analysis. The pooled prevalence of MetS was 30.0% (95% CI: 24.0-36.0%, I2 = 99.19%, p < 0.001) with a high degree of heterogeneity across studies. Subgroup analysis with the target population showed that metabolic syndrome was most prevalent among type II diabetic 56% (95% CI: 47 - 64) and hypertensive patients 44% (95% CI: 35 - 53). Increased age, female gender, being overweight and obese, having a high educational level and income, physical inactivity, and being on treatment of chronic diseases like, diabetes mellitus, hypertension and HIV/AIDS were the most frequently reported risk factors of MetS regardless of the study population.

CONCLUSION

The prevalence of the MetS is high and rising in Ethiopia. Therefore, the preventative strategy should be considered to reduce the risk of morbidity or mortality related to metabolic syndrome.

Hypertriglyceridemia and Other Plasma Lipid Profile Abnormalities among People Living with Diabetes Mellitus in Ethiopia: A Systematic Review and Meta-Analysis

Background

Dyslipidemia is one of the leading causes of cardiovascular complications in diabetes mellitus (DM) patients. Though it is a major public health problem in Ethiopia, there is no a nation-wide study to determine dyslipidemia among DM patients yet. Therefore, this systematic review and meta-analysis intended to estimate the prevalence of hypertriglyceridemia and other plasma lipid abnormalities among people living with DM in Ethiopia.

Methods

We systematically searched PubMed, Google Scholar, African Journals Online, Hinari, and direct Google. Studies conducted until May 9, 2020, that reports the prevalence of dyslipidemia among people living with DM were included. The DerSimonian and Laird random-effects model was used to determine the pooled prevalence of lipid profile abnormalities. Heterogeneity was checked using the I ² statistic, whereas publication bias was tested by funnel plot and Egger's test. Besides, subgroup and sensitivity analyses were performed.

Results

We used 18 primary studies, including 4961 participants living with DM, which met the eligibility criteria for the meta-analysis of hypertriglyceridemia. The estimate of hypertriglyceridemia (≥150 mg/dl) was 48.15% (95% CI: 38.15-58.15, I ² = 98.4%) after performing the main meta-analysis using the random-effects model. The subgroup analysis showed a higher pooled estimate of hypertriglyceridemia among T2DM (57.80% (95% CI: 50.50-65.10), I ² = 92.5%), studies that used probability sampling technique (59.09% (95% CI: 43.58-74.59), I ² = 98.6%, p < 0.001), and studies from primary data sources (51.43% (95% CI: 40.72-62.13), I ² = 98.0%, p < 0.001). Moreover, the estimated pooled prevalence of the total plasma cholesterol (TC ≥ 200 mg/dl) was 34.08% (95% CI: 28.41-39.75, I ² = 92.4%), LDL - C ≥ 100 mg/dl was 41.13% (95% CI: 27.15-55.11, I² = 98.8%), and HDL ≤ 40 mg/dl for men and ≤ 50 mg/dl for women was 44.36% (95% CI: 31.82-56.90, I ² = 98.8%).

Conclusions

The pooled prevalence of hypertriglyceridemia and other lipid abnormalities among DM patients was relatively high in Ethiopia. It strongly suggests the need to give maximal attention to the adherence of DM management to reduce the circulatory lipid profile abnormalities and subsequent complications. Prospero Registration. CRD42020182291.

Prevalence of Metabolic Syndrome and Factors Associated With It Among Adults of West Gojjam: A Community-Based Cross-Sectional Study

BACKGROUND

Metabolic syndrome is a cluster of risk factors for cardiovascular diseases, indicating great clinical attention. However, much less attention has been given to metabolic syndrome in the study area.

OBJECTIVE

The objective of this study is to determine the prevalence of metabolic syndrome and its associated factors in the adult population of West Gojjam zone, Ethiopia.

METHODS

A community-based cross-sectional study was conducted in West Gojjam from September 15 to October 20, 2018. A total of 627 participants were randomly selected. The data were collected using the WHO STEP-wise approach for non-communicable diseases by contextualizing the instrument based on the study questions. The collected data were entered into and analyzed in SPSS version 20. Binary logistic regression was used to identify predictors of the dependent variable. The odds ratio was used to measure the strength of association between variables. For all statistical significance tests, the cut-off value set was p < 0.05 with CI of 95%.

RESULTS

In the studied region, high prevalence of metabolic syndrome at 17.3% is documented. In the final model, age (adjusted odds ratio [AOR] = 1.02, CI: 1.01-1. 05), occupation (AOR = 2.97, CI: 1.25-7.04), a moderate or high level of physical activity (AOR = 0.28, CI: 0.14-0.56 and AOR = 0.42, CI: 0.18-0.97) and type of oil used for cooking (AOR = 2.62, CI: 1.87-7.86) are significantly associated with metabolic syndrome.

CONCLUSION

The prevalence of metabolic syndrome in this study is high, and it is determined by age, occupation, physical activity and type of oil used for cooking. Designing an intervention which focuses on promoting a healthy lifestyle like physical activity and using oils which are liquid at room temperature to prevent the risk of major non-communicable diseases is needed.

Urine Uric Acid Excretion Levels are Positively Associated with Obesity and Abdominal Obesity in Type 2 Diabetes Patients without Chronic Kidney Disease

PURPOSE

We aimed to investigate whether urine uric acid excretion (UUAE) levels are associated with obesity and abdominal obesity in patients with type 2 diabetes (T2D).

METHODS

There were 2785 type 2 diabetic patients in this cross-sectional study. Obesity was defined as BMI ≥ 25 kg/m², and abdominal obesity was defined as waist circumference (WC) ≥90 cm for men and WC ≥ 80 cm for women based on World Health Organization (WHO) recommendations for Asians. Chronic kidney disease (CKD) was defined as the estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² and/or urinary albumin excretion (UAE) ≥300 mg/24h. 24-h UUAE was determined enzymatically using a single 24-hour urine collection. All the subjects were stratified into quartiles based on UUAE levels. Both obesity and abdominal obesity were compared among the UUAE quartile groups, respectively. Furthermore, the associations of UUAE with obesity and abdominal obesity were analyzed in both CKD and non-CKD patients, respectively.

RESULTS

There was an obvious increased trend in both obesity prevalence (36.2%, 41.5%, 46.3%, and 63.4%, respectively, p < 0.001 for trend) and abdominal obesity prevalence (58.1%, 61.2%, 64.7%, and 75.8%, respectively, p < 0.001 for trend) in patients with T2D across the UUAE quartiles after controlling for age, sex and diabetes duration. Multiple logistic regression analyses revealed independent associations between UUAE quartiles and obesity (p < 0.001) and abdominal obesity (p < 0.001) in all patients. However, UUAE was significantly associated with obesity and abdominal obesity only in the T2D patients without CKD (p < 0.001 in model 1, model 2, model 3 and model 4, respectively).

CONCLUSION

Increased UUAE levels were significantly associated with the presence of obesity, especially abdominal obesity in T2D patients without CKD.

The Prevalence of Metabolic Syndrome in Ethiopian Population: A Systematic Review and Meta-analysis

Background

The metabolic syndrome is a clustering of hyperglycemia/insulin resistance, hypertension, dyslipidemia, and obesity which are risk factors for cardiovascular disease, type 2 diabetes and stroke, and all-cause mortality. The burden of metabolic syndrome is emerging alarmingly in low- and middle-income countries such as Ethiopia; however, there is lack of comprehensive estimation. This study aimed to determine the pooled prevalence of metabolic syndrome in Ethiopia.

Methods

This systematic review and meta-analysis included original articles of observational studies published in the English language. Searches were carried out in PubMed, Google Scholar, and Africa Journals from conception to August 2020. A random-effects model was used to estimate the pooled prevalence of metabolic syndrome in Ethiopia. Heterogeneity was assessed using the I 2 statistic. Subgroup analysis was also conducted based on sex/gender and study subjects. Egger's test was used to assess publication bias.

Results

Electronic and gray literature search retrieved 942 potentially relevant papers. After removing duplicates and screening with eligibility criteria, twenty-eight cross-sectional studies were included in this meta-analysis. The pooled prevalence of metabolic syndrome in Ethiopia was found to be 34.89% (95% CI: 26.77, 43.01) and 27.92% (95% CI: 21.32, 34.51) by using NCEP/ATP III and IDF criteria, respectively. The weighted pooled prevalence of metabolic syndrome was higher in females 36.74% (95% CI: 20.72, 52.75) and 34.09% (95% CI: 26.68, 41.50) compared to males 22.22% (95% CI: 14.89, 29.56) and 24.82% (95% CI: 18.34, 31.31) by using IDF and NCEP/ATP III criteria, respectively. Subgroup analysis based on the study subjects using NCEP/ATP III showed that the weighted pooled prevalence was 63.78%(95% CI: 56.17, 71.40), 44.55% (95% CI: 30.71, 52.38), 23.09% (95% CI: 19.74, 26.45), 20.83% (95% CI: 18.64, 23.01), and 18.45% (95% CI: 13.89, 23.01) among type 2 diabetes patients, hypertensive patients, psychiatric patients, HIV patients on HAART, and working adults, respectively. The most frequent metabolic syndrome components were low HDL-C 51.0% (95% CI: 42.4, 59.7) and hypertriglyceridemia 39.7% (95% CI: 32.8, 46.6).

Conclusions

The findings revealed an emerging high prevalence of metabolic syndrome in Ethiopia. Therefore, early intervention is required for the primary prevention of the occurrence of metabolic syndrome and the further reduction of the morbidity and mortality related to it.

Metabolic syndrome and lifestyle factors among type 2 diabetes mellitus patients in Dessie Referral Hospital, Amhara region, Ethiopia

Background

The prevalence of metabolic syndrome is rising at an alarming rate and more common among Type 2 Diabetes Mellitus patients in the world. The risk for cardiovascular disease is greater among individuals who have a combination of Type 2 Diabetes Mellitus and metabolic syndrome compared to those who have either alone.

Objective

To assess the proportion of metabolic syndrome and lifestyle factors among Type 2 Diabetes Mellitus Patients in Dessie Referral Hospital, Amhara Region, Ethiopia.

Methods

A hospital-based cross-sectional study was conducted from February to March 2017 among 343 randomly selected Type 2 Diabetes Mellitus patients. Three definitions of Metabolic syndrome were considered. Multivariable logistic regression analysis was conducted to identify factors associated with metabolic syndrome. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) were reported to show the strength of association. Statistical significance was declared at P-value < 0.05.

Result

The proportion of metabolic syndrome was 50.3%, 59.4% and 64.5% according to 2005 International Diabetes Federation, revised ATP III and 2009 harmonized criteria, respectively. Being female (AOR = 2.43; 95% CI = 1.40, 4.21), consumption of red meat (AOR = 2.61; 95% CI = 1.28, 5.33), sedentary leisure time activity (AOR = 2.65; 95% CI = 1.47, 4.78), coffee intake (AOR = 0.43; 95% CI = 0.21, 0.86), BMI ≥ 25 kg/m² (AOR = 9.59; 95% CI = 4.98, 18.47), 40–49 years of age (AOR = 2.74, 95% CI = (1.02, 7.37), 50–59 years of age (AOR = 4.22; 95% CI = 1.60, 11.11) and ≥70 years of age (AOR = 4.51, 95% CI = 1.44, 14.15) were significantly associated with metabolic syndrome.

Conclusion and recommendation

The proportion of metabolic syndrome was high among Type 2 Diabetes Mellitus patients. Overweight and obesity, being female, age of respondent, intake of coffee, regular red meat consumption, and sedentary leisure-time activity were factors associated with metabolic syndrome. Counseling of Type 2 Diabetes Mellitus patients on the need for spending leisure time with activities, intake of coffee, control of body weight, and avoidance of regular red meat consumption is recommended.

Metabolic syndrome among type 2 diabetic patients in Sub-Saharan African countries: A systematic review and meta-analysis

BACKGROUND AND AIMS

Metabolic syndrome is one of the serious public health problems among type 2 diabetic patients. Despite a number of studies have been conducted, there is no overall estimation on the prevalence of metabolic syndrome among type 2 diabetic patients in Sub-Saharan African countries. Therefore, this study aimed to estimate the pooled prevalence of metabolic syndrome in patients with type 2 diabetes mellitus in Sub -Saharan African countries.

METHODS

PubMed, Web of Science, African Journals Online, Google Scholar, Scopus, and Wiley Online Library databases from inception to April 27, 2020 were searched to identify relevant studies. The I² statistic was used to check heterogeneity across the included studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, and 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was deployed to determine the effect of a single study on the overall estimation. All statistical analyses were done using STATA™ Version 14 software.

RESULT

In this meta-analysis, a total of 23 studies with 6482 study participants were included. The estimated prevalence of metabolic syndrome in Sub-Saharan African countries was 59.62% (95% CI: 52.20, 67.03). Based on the subgroup analysis, the highest prevalence of metabolic syndrome (61.14%, 95% CI: 51.74, 70.53) was reported in Ethiopia. Additionally, the highest prevalence of metabolic syndrome was reported across studies using the diagnostic criteria of National Cholesterol Education Program Adult Treatment Panel III 64.8% (95% CI: 54.74, 74.86), followed by International Diabetic Federation (57.15%), and World health Organization (53.12%) definitions.

CONCLUSION

Almost two out of three type 2 diabetic patients in Sub-Saharan African countries have metabolic syndrome, which implies that its prevalence is high in patients with type 2 diabetes mellitus. Therefore, policymakers need to design efficient strategies and guideline to reduce and control the burden of metabolic syndrome and its impact among diabetic population.

Relationship of metabolic syndrome defined by IDF or revised NCEP ATP III with glycemic control among Malaysians with Type 2 Diabetes

BACKGROUND

The chronic complications of Type 2 Diabetes (T2D) such as macrovascular disease is amplified with the increase in the number of metabolic syndrome (MetS) risk factors. This research aims to study the relationship of MetS, diagnosed by the International Diabetes Federation (IDF) or revised National Cholesterol Education Programs Adult Treatment Panel III (NCEP ATP III) criteria, with glycemic control, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), C-peptide, and insulin resistance in T2D patients.

METHODS

The study is a cross-sectional observational study which, involved 485 T2D patients who are receiving treatment at the University Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia. The MetS among the T2D patients was diagnosed based on IDF and revised NCEP ATP III criteria. C-peptide and HbA1c levels were determined by an automated quantitative immunoassay analyzer and high-performance liquid chromatography, respectively. The MetS factors; FBG, triglyceride, and high-density lipoprotein cholesterol were measured by spectrophotometer.

RESULTS

Application of the IDF and revised NCEP ATP III criteria respectively resulted in 73% and 85% of the T2D subjects being diagnosed with MetS. The concordance of these criteria in diagnosing MetS among T2D patients was low (κ = 0.33, P < 0.001). Both IDF and revised NCEP ATP III criteria indicated that T2D patients with 5 MetS factors had higher insulin resistance (P = 2.1 × 10-13; 1.4 × 10-11), C-peptide (P = 1.21 × 10-13; 4.1 × 10-11), FBG (P = 0.01; 0.021), and HbA1c (P = 0.039; 0.018) than those T2D patients without MetS, respectively.

CONCLUSION

Although there is a low concordance between IDF and revised NCEP ATP III criteria in the diagnosis of MetS among T2D patients, both criteria showed that T2D patients with 5 MetS factors had higher insulin resistance, C-peptide, FBG, and HbA1c.

Very low-density lipoprotein cholesterol is associated with extent and severity of coronary artery disease in patients with type 2 diabetes mellitus

Objective:

Patients with type 2 diabetes mellitus usually have multiple cardiovascular disease risk factors. The objective of this study was to examine the severity and associated risk factors in coronary artery disease patients with type 2 diabetes mellitus.

Methods:

Two hundred and five coronary artery disease patients with type 2 diabetes mellitus and 205 age-, gender- and smoking-matched coronary artery disease patients without type 2 diabetes mellitus were recruited from the Department of Cardiology of our hospital. Demographic and clinical data were collected for all participants. Severity of coronary artery disease was assessed using Gensini scoring system, the number of diseased coronary arteries, and the extent of coronary stenosis.

Results:

Coronary artery disease patients with type 2 diabetes mellitus had higher Gensini scores (p < 0.01), more numbers of diseased coronary arteries (p < 0.001), and higher degrees of coronary stenosis (p = 0.05) than coronary artery disease patients without type 2 diabetes mellitus. The plasma levels of very low-density lipoprotein cholesterol (p < 0.001) and triglycerides (p < 0.001) were also higher in coronary artery disease patients with type 2 diabetes mellitus than in coronary artery disease patients without type 2 diabetes mellitus. In coronary artery disease patients with type 2 diabetes mellitus, very low-density lipoprotein cholesterol was positively correlated with Gensini scores (r = 0.15, p = 0.03), the number of diseased coronary arteries (r = 0.15, p = 0.04), and the extent of coronary stenosis (r = 0.14, p = 0.05) by partial correlation analysis after controlling for other lipid parameters, and independently associated with Gensini scores (beta = 0.18, p = 0.02) and the number of diseased coronary arteries (odds ratio = 2.09, p = 0.05) after adjusting for other cardiovascular risk factors in the following multiple regression analysis.

Conclusion:

Very low-density lipoprotein cholesterol may represent a marker for the severity of coronary artery disease and be a target for the treatment in diabetic patients. Further research is needed to determine whether very low-density lipoprotein cholesterol plays a causal role of coronary artery disease in diabetic patients.

A Comparative Prevalence Of Metabolic Syndrome Among Type 2 Diabetes Mellitus Patients In Hawassa University Comprehensive Specialized Hospital Using Four Different Diagnostic Criteria

BACKGROUND

Recognition of MetS in type two diabetic patients is important in starting the appropriate preventive and therapeutic measures. The commonly used definitions of MetS have similarities and discrepancies. Different definitions defined metabolic syndrome differently. IDF, WHO, NCEP-ATP III, and the harmonized definitions were used frequently to determine the prevalence of metabolic syndrome.

OBJECTIVES

This study was aimed to investigate the prevalence of MetS and its associated factors among patients with type 2 Diabetes Mellitus using four definitions and to identify the concordance and the difference of these four definitions.

METHODS

A cross-sectional study was conducted from February 28 to May 30/2017 at Hawassa university comprehensive specialized hospital. The study involved 314 study participants selected by simple random sampling technique. Logistic regression was used to determine associated factors of metabolic syndrome, and kappa statistics was used to determine the concordance between different definitions of metabolic syndrome. In any cases, a p-value of <0.05 was considered to be statistically significant.

RESULT

The prevalence of metabolic syndrome according to IDF, WHO, harmonized, and NCEP-ATP III diagnostic criteria was 59.9%, 31.2%, 65.6%, and 70.1%, respectively. Our study found the maximum agreement between IDF and NCEP criteria (K=0.54, P<0.001) and IDF and Harmonized(K=0.65, P<0.001). Uric acid level was associated factor of metabolic syndrome by all the four definitions, and total cholesterol was associated factors by the three definitions.

CONCLUSION

The prevalence of metabolic syndrome varies based on the definition used and the highest prevalence of MetS was observed with NCEP-ATP III and the different types of criteria do not always diagnose the same group of individuals.