Hypertension among newly diagnosed diabetic patients at Mulago National Referral Hospital in Uganda: a cross sectional study

Long-term impact of an integrated HIV/non-communicable disease care intervention on patient retention in care and clinical outcomes in East Africa

OBJECTIVE

To describe rates of retention in care and control of hypertension, diabetes and HIV among participants receiving integrated care services for a period of up to 24 months in East Africa.

METHODS

Between 5 October 2018 and 23 June 2019 participants enrolled into a prospective cohort study evaluating the feasibility of integrated care delivery for HIV, diabetes and hypertension from a single point of care in Tanzania and Uganda (MOCCA study). Integrated care clinics were established in 10 primary healthcare facilities and care was provided routinely according to national guidelines. Initial follow-up was 12 months. Outcomes were rates of retention in care, proportions of participants with controlled hypertension (blood pressure <140/90 mmHg), diabetes (fasting blood glucose <7.0 mmol/L) and HIV (plasma viral load <1000 copies/ml). The study coincided with the COVID-19 pandemic response. Afterwards, all participants were approached for extended follow-up by a further 12 months in the same clinics. We evaluated outcomes of the cohort at the end of long-term follow-up.

RESULTS

The MOCCA study enrolled 2273 participants of whom 1911 (84.5%) were retained in care after a median follow-up of 8 months (Interquartile range: 6.8-10.7). Among these, 1283/1911 (67.1%) enrolled for a further year of follow-up, 458 (24.0%) were unreachable, 71 (3.7%) reverted to vertical clinics (clinics providing services dedicated to study conditions), 31 (1.6%) died and 68 (3.6%) refused participation. Among participants who enrolled for longer follow-up, mean age was 51.4 ± 11.7 years, 930 (72.5%) were female and 509 (39.7%) had multiple chronic conditions. Overall, 1236 (96.3%) [95% confidence interval 95.2%-97.3%] participants were retained in care, representing 1236/2273 (54.3%) [52.3%-56.4%] of participants ever enrolled in the study. Controlled hypertension, diabetes and HIV at the end of follow-up was, 331/618 (53.6%) [49.5%-57.5%], 112/354 (31.6%) [26.8%-36.8%] and 332/343 (96.7%) [94.3%-98.4%] respectively.

CONCLUSION

Integrated care can achieve high rates of retention in care long term, but control of blood pressure and blood sugar remains low.

Associations between abdominal obesity indices with hypertension in type 2 diabetes mellitus: Chinese visceral adiposity index

PURPOSE

This research was performed to evaluate the relationship between hypertension (HTN) and abdominal obesity index in patients with type 2 diabetes mellitus (T2DM).

METHODS

Totally 1657 participants with T2DM (mean age 54 ± 12 years; 38.02% female) were enrolled. They were divided into the groups of HTN (n = 775) and non-HTN (n = 882). Anthropometric and biochemical indicators were measured and collected. A bioelectrical impedance analyzer was used to measure visceral and subcutaneous fat areas.

RESULTS

Compared with the HTN group, the non-HTN group had a lower level of Chinese visceral adiposity index (CVAI) (p < 0.001). Meanwhile, among tertiles of CVAI, as CVAI increased, the proportion of patients with HTN increased, which was 33.51%, 44.30%, and 62.50%, respectively. CVAI was shown to have a significant positive correlation with HTN. (r = 0.258, p < 0.001). CVAI was independently related to an elevated risk of HTN by binary logistic regression analyses, and the OR was (95% CI) 1.013 (1.010-1.016, p < 0.001) after adjustment. The area under the receiver operating characteristic curve (AUC) of CVAI predicted HTN in T2DM patients was greater than those of other abdominal obesity indices (p < 0.001).

CONCLUSION

We found that CVAI was highly positively correlated with HTN in T2DM. Compared with other indices of abdominal obesity, such as WC, BMI, WHR, VAI, and LAP, the CVAI showed superior discriminative ability in T2DM complicated with HTN. Therefore, more attention should be paid to CVAI in T2DM.

Prevalence and factors associated with suboptimal blood pressure among ambulatory patients with diabetic kidney disease attending a tertiary hospital in Uganda

Background

Kidney failure prevalence is increasing among diabetic kidney disease (DKD) patients in low-income countries. Suboptimal blood pressure (BP) drives kidney failure and mortality. The burden of suboptimal BP and its associated factors among these patients are not well documented.

Objectives

To determine the prevalence of suboptimal BP and associated factors among those with DKD attending Kiruddu National Referral Hospital.

Methods

In this cross-sectional study, recruited participants were screened for DKD using urine dipsticks from 6th May 2020 to 15th July 2020. A pretested questionnaire was administered, BP, height and weight were measured. Suboptimal BP was defined as systolic BP > 130mmHg and or diastolic BP > 80mmHg. A Poisson regression model analysed the associated factors.

Results

250 participants with DKD, mean age of 52(11) years were included of whom 199 (79.6%) were female. Suboptimal BP prevalence was 84.4%, associated with past (p = 0.04) and current (p < 0.001) alcohol use, overweight (p < 0.001) and obesity (p < 0.001), wage earning (p < 0.001) and professionals (p = 0.048).

Conclusion

The prevalence of suboptimal BP was high among the overweight, obese, unemployed and alcohol users. Thus, there is a need for better BP control interventions.

Determinants of Hypertension Among Patients with Diabetes mellitus in Public Hospitals of Kembata Tambaro Zone, South Nations Nationalities and Peoples Region, Ethiopia, 2021; A Case Control Study

Introduction

Hypertension is commonly defined as a persistently raised blood pressure in which systolic blood pressure reading (SBP) is greater than or equal to 140 mmHg and diastolic blood pressure (DBP) is greater than or equal to 90 mmHg. The comorbidity of hypertension and diabetes mellitus is complex and is associated with a high risk of complications. However, there are limited studies on determinants of hypertension among patients with diabetes in Ethiopia. Therefore this study aimed to identify the determinants of hypertension among patients with diabetes mellitus in public hospitals of the Kambata Tambaro Zone, Ethiopia.

Methods and Materials

A hospital-based unmatched case-control study was conducted among a total sample of 326 patients with diabetes from June 17, 2021 to August 17, 2021. This study was conducted in five public hospitals. The data were entered into EpiData version 3.1 software and exported to and analyzed using SPSS software version 25.0. Bivariable and multivariable binary logistic regression analyses were used to determine the association between the dependent and independent variables.

Results

Of the 336 study participants, 326 diabetic patients (163 cases and 163 controls) were interviewed resulting in a response rate of 97%. Age group ≥50 years (Adjusted Odds Ratio = 7.00, 95% CI = 1.69–28.9), inactivity in physical exercise (AOR = 5.84, 95% CI = 2.47–13.81), patients who have a history of drinking alcohol (AOR = 2.61, 95% CI = 1.35–5.03) and patients who had poor knowledge on diabetes (AOR = 3.04, 95% CI = 1.69–5.47) were more likely to develop hypertension among diabetic patients.

Conclusion

This study concluded that age, inactivity in physical exercise, history of alcohol intake and poor knowledge were determinants of hypertension among diabetic patients.

Food intake and cardiometabolic risk factors in rural Uganda

BACKGROUND

Along with a nutritional transition in Sub-Saharan Africa, the prevalence of non-communicable diseases is increasing rapidly. We assess the association between food intake and cardiometabolic risk factors in a rural population in Uganda.

METHODS

The present study was based on data from a household-based case-control study of diabetic and non-diabetic households in Southwestern Uganda, 2012-2013. We analysed food intake in 359 individuals age ≥ 13 years from 87 households, using a household food frequency questionnaire, and measures of glycated haemoglobin (HbA1c), height and weight. We used multinomial logistic regression to model abnormal HbA1c (≥5.7%) and weight status (underweight, normal weight and overweight) as an outcome of total food intake and by nine food groups. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Models were adjusted for three nested sets of covariates.

RESULTS

The diet primarily consisted of staple food (cassava and plantain). High-Glycaemic Index staple food was the most consumed food group (median = 14 servings/week, p25-p75: 11-17). Milk, meat, fish and vegetables were the least consumed food groups (medians: 0-3 servings/week). Median intake of sugary food was 6 servings/week (p25-p75: 2-9). The OR of having abnormal HbA1c or being overweight increased with every weekly serving of food (1.02, 95% CI: 1.00-1.04 and 1.01 95% CI: 1.00-1.03, respectively). Of specific food groups, each weekly serving of meat increased the OR of being overweight with 33% (95% CI: 1.08-1.64), and fruit intake decreased the OR of abnormal HbA1c (0.94, 95% CI: 0.88-1.00), though this latter association was attenuated after adjustment for weight status, aerobic capacity, and socioeconomic status.

CONCLUSION

Diet was monotonous, mainly consisting of cassava and plantain, and increasing food intake was associated with abnormal HbA1c and overweight. To prevent non-communicable diseases a diet with higher intake of fish and vegetables, and less sugary food is recommended.

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa; implications for the future

BACKGROUND

Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa.

METHODOLOGY

Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa.

RESULTS

Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care.

CONCLUSION

There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored.

[Features of Cardiovascular Risk Factors, Target Organ Damage in Patients with Diabetes Mellitus Type 2 and Arterial Hypertension]

AIM

to investigate relationship between arterial hypertension (AH) and risk factors / subclinical damage of target organs in patients with type 2 diabetes mellitus (DM2).

METHODS

We included into this clinical epidemiological study 528 patients with DM2 (30.5 % men, 69.5 % women; mean age 54.1±0.3 years; 80.3 % with AH, 19.7 % without AH), who answered questions of the ARIC study questionnaire related to risk factors. Also, we studied features of target organ damage and laboratory indicators.

RESULTS

In comparison with normotensives patients with AH more frequently had ischemic heart disease (12.7±1.6 % vs. 5.8±2.3 %, p&lt;0.05), chronic heart failure (CHF) (30.9±2.2 % vs. 9.6±2.9 %, p&lt;0.001), atherosclerosis of vessels of lower extremities (69.8±2.2 % vs. 53.8±4.9 %, p&lt;0.01) and cerebral vessels (50.9±2.4 % vs. 28.8±4.4 %, p&lt;0.001), history of stroke (5.0±1.1 % vs. 0 %, p&lt;0.05), hypertonic angiopathy (14.5±1.8 % vs. 6.5±2.5 %, p&lt;0.05), low level of high density lipoprotein (87.3±2.2 % vs. 74.5±6.4 %, p&lt;0.05), electro- and echocardiographic signs of left ventricular hypertrophy (75.6±2.1 % vs. 45.4±5.1 %, p&lt;0.001; 61.1±2.6 % vs. 24.4±4.7 %, p&lt;0.001, respectively), lowering of left ventricular ejection fraction (12.5±1.7 % vs. 7.8±2.8 %, p&lt;0.001), diastolic disfunction of the left ventricle (52.6±2.7 % vs. 23.2±4.7 %, p&lt;0.001), atherosclerosis of the aorta (38.0±2.6 % vs. 20.7±4.5 %, p&lt;0.01), lowering of the ankle-brachial index (left - 29.8±2.3 % vs. 14.9±3.5 %, p&lt;0.01; right - 31.5±2.3 % vs. 9.9±3.0 %, p&lt;0.001, respectively), increased intima-media thickness of the right carotid artery (84.6±5.0 % vs. 60.0±11.0 %, p&lt;0.05).

CONCLUSION

In patients with type 2 diabetes and AH, in order to develop strategy of macro- and microvascular complications prevention, it is necessary to conduct early screening of risk factors and subclinical damage of target organs.

Predictors of isolated systolic hypertension among type 2 diabetes mellitus patients in Jimma University Specialized Hospital, Southwest Ethiopia

OBJECTIVES

Systolic blood pressure rise among T2DM patients was main risk factor for cardiovascular disease. Objective of this study was to identify predictors of isolated systolic hypertension among T2DM patients at Jimma University Specialized Hospital, 2016. We conducted cross sectional study using simple random sampling and interviewer administered questionnaire. Isolated systolic hypertension is SBP ≥ 140 mmHg and < 90 mmHg. Data entered and analyzed using Epi Data and SPSS respectively. Predictor factor was declared at p < 0.05.

RESULTS

A total of 315 T2DM took part. Prevalence of ISH was 27.6% [95% CI (22.7, 32.5%)]. One hundred sixty and two (51.4%) patients were males with mean age of 54.1 from 22 to 87 years. Male sex [AOR = 2.4, 95% CI 1.21-4.72, p = 0.012], unemployment [AOR = 3.22, 95% CI 1.48-7.03, p = 0.003], age of 47-55 [AOR = 2.63, 95% CI 1.03-6.70, p = 0.044], single [AOR = 2.26, 95% CI 1.13-4.51, p = 0.021], ≤ Grade 8 [AOR = 2.94, 95% CI 1.10-7.85, p = 0.03] and income (ETB) 501-800 [AOR = 21.9, 95% CI 7.62-63.1, p < 0.001], 801-1500 [AOR = 5.78, 95% CI 2.55-13.1, p < 0.001] and > 1500 [AOR = 4.23, 95% CI 1.74-10.30, p = 0.001] were significant factors of ISH. The health sector has to establish preventive strategies for ISH among T2DM patients by giving special attention to predictor factors.

PREDICTORS OF ARTERIAL HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN AZERBAIJAN POPULATION

The presented study in Azerbaijan is carried out for the first time within State Programs on fight against a type 2 diabetes mellitus (DM2) and other noninfectious diseases.

Aim.To define predictors of arterial hypertension (AH) in patients with DM2 in Azerbaijan population.

Material and methods. In the single-step clinical-epidemiology cohort study were included 528 patients with DM2 at the age of 30-69 (30,5% — men and 69,5% — women) who answered questions using “ARIC” questioner to define AH and its risk factors.

Results.The prevalence of AH in women (72,4%) was 2,6 times more than in men (27,6%) and the frequent occurrence of AH was at the age of 60-69 (respectively, 26,7±2,1% vs 9,6±2,9%, p<0,001). It was not determined remarkable differences between AH level and occupation status, alcohol consumption, low physical activity, feeding disorder of the patients, at the same time in patients with AH smoking frequency was about 2 times often than in others (respectively, 19,3±1,9% vs 10,6±3,0%, p<0,05). In parents of AH patients AH rates, in comparison with eutonics, were occurred like these: (respectively, in fathers 21,9±2,0% vs 12,5±3,2%, p<0,05; in mothers 42,2±2,4% vs 26,9±4,3%, p<0,01), in mothers DM2 (respectively, 33,7±2,3% vs 221 ±4,1 %, p<0,05), overweight and obesity were watched much more often (95,0±1,1% vs 88,5±3,1%, p<0,05), at the same time these patients were suffered from abdominal obesity (respectively, 96,5±0,9% vs 89,4±3,0%, p<0,01). The mean values of systolic and diastolic arterial pressure (respectively, 148,3±1,1 vs 119,8±1,3 Hg, p<0,001 and 85,9±0,5 vs 74,8±0,8 Hg, p<0,001) were often determined in patients with AH, and on the other hand in these patients were noted prevalence of anxious syndrome (respectively, 78,5±2,0% vs 72,1±4,4%, p<0,05) and depression (68,2±2,3% vs 62,5±4,7%, p>0,05). Regardless of AH level in all patients was noted stress (respectively, 99,8±0,2% vs 100,0±0,0%, p>0,05), which changed for the worse life quality of the patients with AH significantly (respectively, 1,0±2,2% vs 61,5±4,8%, p<0,05).

Conclusion.For patients with DM2 in Azerbaijan cohort female sex, increasing of the age, body mass index, abdominal obesity and anxious conditions are significant risk factors for AH. Presence of AH in both parents and DM2 in mothers increase this risk significantly, which decrease life quality of these patients.