Background: Chronic complications reduce quality of life, increases diabetes related mortality and overburden the public health services. This study aims to assess the prevalence of chronic complications and its associated factors among diabetic patients at Nigist Eleni Mohammed Memorial Hospital, Hossana, South Ethiopia. Method and Materials: We conducted a hospital based cross-sectional study. A simple random sampling technique was used to select 266 participants from the follow up clin ic of the hospital. Data were collected using semi structured questionnaire, weight, height, waist and hip circumference measurements and patients chart review. Descriptive statistics was used to describe the study variable. Bivariate and multivariate logistic regression analysis was used to identify factors associated with chronic diabetic complications. Result: Out of 247 diabetic subjects, 114 (46.2%) were found to have at least one chronic complication that included, hypertension 59 (23.9%), diabetes related eye disease 29 (11.7%), neuropathy 25 (10.1%) and nephropathy 16 (6.5%). Compared to age group 15 - 29 there was higher risk of chronic complications for those who were in age groups 45 - 64, [AOR = 2.50, (95% CI): (1.20, 5.22)] and ≥65 years, [AOR = 7.18, (95% CI): (2.10, 24.87)]. Duration of diabetes > 10 years [AOR = 2.87, (95% CI): (1.20, 6.88)], and not performing self-monitoring of blood glucose, [AOR = 15.22, (95% CI): (3.07, 75.48)] were also strongly associated with chronic complications of diabetes mellitus. Conclusion and Recommendation: Considerable number of diabetic participants in this study area had at least one chronic complication. Attention should be given to older diabetic patients and longer diabetic duration. Diabetic education should focus on health benefit of self-monitoring of blood glucose.
The worldwide prevalence of diabetes mellitus (DM) estimated to grow to 366 million to 440 million by 2030, with three-quarters of patients with diabetes living in low-income countries and the greatest relative increases will occur in the Middle Eastern Crescent, sub-Saharan Africa (SSA), and India [
The chronic complications of diabetes mellitus affect many organ systems and are responsible for majority of morbidity and mortality associated with the disease [
Consequently, the total cost to manage chronic complications in diabetics far outweighs the cost of effective primary and secondary prevention [
Various factors including type II diabetes mellitus [
At Nigist Eleni Mohammed Memorial Hospital, South Ethiopia (i.e. the study area) chronic complication of diabetes and its associated factors were not studied. The hospital 2013 nine month report showed that DM is the six leading causes of admission and ten top cause of chronic disease morbidity [
The combined effects of diabetes and its chronic complication place further strain on the patient, family and overburden public health services. Therefore, we aimed to assess the prevalence of chronic complications and its associated factors among diabetic patients attending chronic care follow up clinic of Nigist Eleni Mohammed Memorial Hospital, Hossana, South Ethiopia.
This hospital based cross sectional study was conducted from October 7-November 5/2013 at Nigist Eleni Mohammed Memorial Hospital, which is located in Hossana town, South Ethiopia. The Hospital serves for about 1,506,733 million populations. The chronic care follow up clinic of the hospital provide services for a total of481 diabetic patients and to congestive heart failure, hypertensive and asthmatic patients for five days a week (i.e. Monday to Friday). On a monthly interval insulin is provided free of charge for insulin treated diabetic patients and the follow up service is provided by medical doctors.
The source populations were all diabetic patients registered and has a follow up visit in the hospital chronic care clinic. The study population were diabetic patients whose age is >15 years. The sample size was calculated using single population proportion with finite correction formula, considering the proportion of diabetic patients with chronic complication to be 52.5% [
Data was collected using semi structured questionnaire, weight, height, hip and waist circumference measurements and patient chart review. The questionnaire was initially prepared in English and it was translated to Amharic for the purpose of data collection. Then the Amharic questionnaire was back translated to English to check for any inconsistency in the meaning of the words and/or concepts. Before data collection training was provided for data collectors and supervisor on the objective, process of data collection and how to take anthropometric measurements. Pretesting of the instrument was made before the commencement of the actual data collection. Data were collected from selected diabetic patients during the follow up visit to the clinic (i.e. Exit interview) in a separate room. The data collectors were supervised on daily basis for completeness and consistency of the filled questionnaire.
Weight was measured two times with minimum clothing and no shoe using Seca electronic weighing scale in kilogram (kg) to the nearest 0.1 kg. The weight scale was checked against zero reading before weighing every diabetic participant. Height was measured in a standing position in centimeter to the nearest 1 centimeter (cm). Waist circumference was measured at a level midway between lower rib margin and iliac crest on a horizontal plane around the body [
Diabetes self-care practice was assessed using Summary Diabetes Self-Care Activity (SDSCA) measure [
Participants whose waist to hip circumference ratio ≥ 90 centimeter for male and ≥85 centimeter for female were considered centrally obese [
A diabetic patient with at least one microvascular complication (i.e. Retinopathy, neuropathy and nephropathy) or macro vascular complication (i.e. coronary heart disease, peripheral vascular disease and hypertension) or non-vascular complication (i.e. skin infection, foot ulcer and impotence) was coded as having chronic complication. A diabetic patient who had no any documented chronic complications listed above was coded “No chronic complication”.
After data collection each questionnaire was checked for completeness. Data was entered in to and analyzed using SPSS version 16 computer software. Descriptive statistics like frequency tables, graphs and descriptive summaries were used to describe the study variables. Chi-square test was used to see the existence of association between dependent and each independent variable. Those variables with p-value of <0.25 in bivariate analysis were entered in to backward multiple binary logistic regression model. P-value < 0.05 was considered statistically significant. Interactions between variables were checked.
Before data collection, ethical clearance was obtained from ethical clearance committee of Jimma University, college of public health and medical science. A formal letter of cooperation was submitted to Nigist Eleni Mohammed Memorial Hospital. Verbal informed consent was obtained from each study participants.
Out of 266 sampled subjects, 247 participated making the response rate 92.9%. The rest 19 (7.1%) were excluded because they gave incomplete information. Of all participants, 147 (59.5%) were male. Mean age (±SD) was 43.5 (±13.5) years ranging between 17 and 71 years. Majority of the participants 111 (44.9%) were in the age range of 45 - 64 years. More than three fourth 188 (76.1%) were Hadiya by ethnicity, 170 (70.9%) were married and 70 (28.3%) were illiterate. Urban residence accounted for 155 (62.8%) and 88 (35.6%) of the patient were employed (
Two hundred and fourteen (86.6%) were found to have adequate dietary practice. Majority 191 (77.3%) and 56 (22.7) had inadequate exercise and medication intake respectively. Only 17 (6.9%) were performed self-moni- toring of blood glucose and 237 (96%) had inadequate foot care practice. Cigarette smoking accounted for 6 (2.4%) of diabetic participants (
Of the participants, 159 (64.4%) were found to have uncontrolled glycemic level. Normal waist to hip ratio were found in 81 (32.8%) and the rest were centrally obese. Of all diabetic participants 121 (49%) had normal body mass index and the rest 20 (8.1%), 94 (38.1%) and 12 (4.8%) were underweight, overweight and obese respectively (
Of the total 247 diabetic participants, more than half 133 (53.8%) had no documented chronic complications and 114 (46.2%) had at least one chronic complications.
Regarding the type of complications, proportion of diabetic eye disease, neuropathy and nephropathy were 29 (11.7%), 25 (10.1%) and 16 (6.5%) respectively. Out of the total participants 59 (23.9%) had hypertension. Impotence was documented in 3 (1.2%) of diabetic patients. One (0.4%) of the participants had Foot ulcer (
Of the factors entered into multivariable logistic regression model only patient’s age, duration of diabetes and self-monitoring of blood glucose (SMBG) showed significant association with chronic complications among diabetic patients.
Diabetic patients between age 45 - 64 were 2.50 times more likely [AOR = 2.50, 95% CI: (1.20, 5.20)] to have chronic complications than age 15 - 29. Diabetic patients with age ≥ 65 years were 7.18 times more likely [AOR = 7.18, 95% CI: (2.10, 24.87)] to have chronic complications than those between age 15 - 29. Diabetics with >10 year duration of diabetes were 2.87 times more likely to have chronic complications [AOR = 2.87, 95% CI: (1.20, 6.88)] than <5 years duration of diabetes. Additionally, Diabetic patients who did not monitored their blood sugar level were 15.22 times more likely [AOR = 15.22, 95% CI: (3.07, 75.48)] having chronic complications than those who monitored their blood sugar level (
This study demonstrated that the overall prevalence of chronic complications among diabetic patients was 46.2%. Our finding is lower than a study done in Jimma University Hospital, Ethiopia 52.5% [
Chronic complication | |||||
---|---|---|---|---|---|
Characteristics | Yes N (%) | No N (%) | Total N (%) | COR" (95% CI) | |
Sex | |||||
Male | 67 (45.6) | 80 (54.4) | 147 (59.5) | 1 | |
Female | 47 (47) | 53 (53) | 100 (40.5) | 1.06 (0.64, 1.76) | |
Age | |||||
15 - 29 | 17 (32.1) | 36 (67.9) | 53 (21.7) | 1 | |
30 - 44 | 11 (20.4) | 43 (79.6) | 54 (21.9) | 0.54 (0.23, 1.30) | |
45 - 64 | 63 (56.8) | 48 (43.2) | 111 (44.9) | 2.78 (1.40, 5.53)‡ | |
≥65 | 23 (79.3) | 6 (20.7) | 29 (11.7) | 8.12 (2.79, 23.61)‡ | |
Ethnicity | |||||
Hadiya | 87 (46.3) | 101 (53.7) | 188 (76.1) | 1 | |
Others* | 27 (45.8) | 32 (54.2) | 59 (23.9) | 0.98 (0.55, 1.76) | |
Marital status | |||||
Married | 34 (47.2) | 38 (52.8) | 175 (70.9) | 1 | |
Not married** | 80 (45.7) | 95 (54.3) | 72 (29.1) | 0.94 (0.54, 1.63) | |
Educational status | |||||
Illiterate | 36 (51.4) | 34 (48.6) | 70 (28.3) | 1 | |
Elementary | 27 (39.7) | 41 (60.3) | 68 (27.3) | 0.62 (0.31, 1.22) | |
Secondary+*** | 51(46.8) | 58 (53.2) | 109 (44.1) | 0.83 (0.46, 1.56) | |
Place of residence | |||||
Urban | 74 (47.7) | 81 (52.3) | 155 (62.8) | 1 | |
Rural | 40 (43.5) | 52 (56.5) | 92 (37.2) | 0.84 (0.50, 1.42) | |
Occupation | |||||
Employed | 43 (48.9) | 45 (51.1) | 88 (35.6) | 1 | |
Housewife | 23 (53.5) | 20 (46.5) | 43 (17.1) | 0.83 (0.40, 1.73) | |
Student | 18 (64.3) | 10 (35.7) | 28 (11.3) | 0.53 (0.22, 1.28) | |
Merchant | 19 (65.5) | 10 (34.5) | 29 (11.7) | 0.50 (0.21, 1.20) | |
Farmer | 24 (57.1) | 18 (42.9) | 42 (17) | 0.72 (0.34, 1.50) | |
Daily worker | 6 (35.3) | 11 (61.7) | 17 (6.9) | 1.75 (0.59, 5.15) | |
Family history | |||||
Yes | 30 (48.4) | 32 (51.6) | 62 (25.1) | 1 | |
No | 103 (55.7) | 82 (44.3) | 185 (74.9) | 1.34 (0.72, 2.48) | |
Duration of diabetes (In year) | |||||
<5 | 52 (34.7) | 98 (65.3) | 150 (60.7) | 1 | |
5 - 10 | 32 (57.1) | 24 (42.9) | 56 (22.7) | 2.51 (1.34, 4.70)‡ | |
>10 | 30 (73.2) | 11 (26.8) | 41 (16.6) | 5.14 (2.38, 11.08)‡ | |
Type of diabetes | |||||
Type I | 19 (33.9) | 37 (66.1) | 56 (22.7) | 1 | |
Type II | 95 (49.7) | 96 (50.3) | 191 (77.3) | 1.93 (1.04, 3.59)‡ |
*Amhara, Guraghe, Kembata, Silte, Wolayta and/or Tigre; ***7 - 12 grade, diploma and/or degree; ‡P-Value < 0.05; "Crude odd ratio.
Chronic complication | |||||
---|---|---|---|---|---|
Characteristics | Yes N (%) | No N (%) | Total N (%) | COR** (95%CI) | |
Diet | |||||
Adequate | 113 (52.8) | 101 (47.2) | 214 (86.6) | 1 | |
Inadequate | 20 (60.6) | 13 (39.4) | 33 (14.4) | 1.38 (0.65, 2.91) | |
Exercise | |||||
Adequate | 38 (67.9) | 18 (32.1) | 56 (22.7) | 1 | |
Inadequate | 95 (49.7) | 96 (50.3) | 191 (77.3) | 0.27 (0.24, 0.92)* | |
SMBG | |||||
Yes | 2 (11.8) | 15 (88.2) | 17 (6.9) | 1 | |
No | 112 (48.7) | 118 (51.3) | 230 (93.1) | 7.12 (1.59, 31.84)* | |
Medication | |||||
Adequate | 122 (53.7) | 105 (46.3) | 227 (91.9) | 1 | |
Inadequate | 11 (55.0) | 9 (45.0) | 20 (8.1) | 1.05 (0.42, 2.64) | |
Foot care | |||||
Adequate | 6 (60) | 4 (40) | 10 (4) | 1 | |
Inadequate | 127 (53.6) | 110 (46.4) | 237 (96) | 0.77 (0.21, 2.79) | |
Smoking | |||||
Yes | 3 (50) | 3 (50) | 6 (2.4) | 1 | |
No | 111 (46.1) | 130 (53.9) | 241 (97.6) | 0.85 (0.17, 4.32) |
*P-value < 0.05; **Crude odd ratio.
Chronic complication | |||||
---|---|---|---|---|---|
Measurement | Yes N (%) | No N (%) | Total N (%) | COR* (95%CI) | |
Fasting blood sugar | |||||
<126 mg/dl | 39 (44.3) | 49 (55.7) | 88 (35.6) | 1 | |
≥126 mg/dl | 75 (47.2) | 84 (52.8) | 159 (64.4) | 1.12 (0.67, 1.89) | |
Waist to hip ratio | |||||
Normal | 32 (39.5) | 49 (60.5) | 81 (32.8) | 1 | |
Central obesity | 32 (39.5) | 84 (50.6) | 166 (67.2) | 1.49 (0.87, 2.56) | |
Body mass index | |||||
Underweight | 11 (55) | 9 (45) | 20 (8.1) | 1.74 (0.67, 4.49) | |
Normal | 50 (41.3) | 71 (58.7) | 121 (49.0) | 1 | |
Overweight | 45 (47.9) | 49 (52.1) | 94 (38.1) | 1.30 (0.76, 2.24) | |
Obese | 8 (66.7) | 4 (33.3) | 12 (4.8) | 2.84 (0.81, 9.95) |
*Crude odd ratio.
Chronic complications | ||||
---|---|---|---|---|
Factors | Yes N (%) | No N (%) | AOR** (95%CI) | |
Age | ||||
15 - 29 | 17 (32.1) | 36 (67.9) | 1 | |
30 - 44 | 11 (20.4) | 43 (79.6) | 0.56 (0.23, 1.39) | |
45 - 64 | 63 (56.8) | 48 (43.2) | 2.50 (1.20, 5.22)* | |
≥65 | 23 (79.3) | 6 (20.7) | 7.18 (2.10, 24.87)* | |
Duration of DM (Year) | ||||
<5 | 52 (34.7) | 98 (65.3) | 1 | |
5 - 10 | 32 (57.1) | 24 (42.9) | 1.94 (0.94, 4.0) | |
>10 | 30 (73.2) | 11 (26.8) | 2.87 (1.20, 6.88)* | |
Exercise | ||||
Adequate | 18 (31.6) | 39 (68.40) | 1 | |
Inadequate | 96 (50.5) | 94 (49.5) | 1.83 (0.91, 3.69) | |
SMBG | ||||
Yes | 2 (11.8) | 15 (88.2) | 1 | |
No | 112 (48.7) | 118 (51.3) | 15.22 (3.07, 75.48)* |
*P-value < 0.05; **Adjusted odd ratio.
Hypertension was found in 23.9% of diabetic patients. Similar finding was reported from Hawassa and Jimma University Hospitals, Ethiopia [
The proportion of neuropathy 10.1% and nephropathy 6.5% obtained in this study were in agreement with a study done at yekatit 12 hospital, Ethiopia [
Diabetic eye disease was documented among 11.7% of diabetic patients. This finding was less compared to studies done in Jimma, which was 33.8% [
Compared to age group of 15 - 29 year diabetics there was higher risk of chronic complications for those who were in age groups of 45 - 64 and ≥65 year diabetics. This finding is congruent with studies done in china, Libya and camerone [
The current study revealed that diabetic patients who did not perform self-monitoring of blood glucose were 15.22 times more likely to have chronic complication than those who performed self-monitoring of blood glucose. A retrospective cohort study conducted in Germany has shown similar finding, in which diabetic patients in non-SMBG subgroup were associated with chronic complications [
Our study has some limitation and hence interpretation of the results needs certain consideration. Chronic complications, type of diabetes and fasting blood sugar data’s were collected retrospectively and incompleteness of patent charts was one of the short coming of this study. Most diabetic patients particularly type II diabetics develop chronic complication before the time of diabetes diagnosis and we can’t relate duration of diabetes and chronic complication because of lead time bias. But the result suggests that long history of diabetes duration is risk factor for chronic complication. Self-care practice was measured using Summary diabetes self-care activity measurement tool which has acceptable reliability and validity. However not validated locally might lead to misclassification and subjected to subjective response and recall bias.
Overall, about 46.2% of diabetic patients had chronic complications. Hypertension, diabetes related eye disease, neuropathy and nephropathy were the major chronic complications among diabetic patients. Age between 45 - 64 and ≥65 years, >10 year duration of diabetes and not performing self-monitoring of blood glucose were strongly associated with chronic complications. Prevention and management of chronic complications in diabetic patients should primary target age groups of 45 - 64 and ≥65 years and those with >10 year duration of diabetes through strengthening early diagnosis and improving case management. Diabetes education should focus on health benefit of self-monitoring of blood glucose and improving diabetes education strategy on self-moni- toring of blood glucose needs special warrant.
Dawit Jember Tesfaye,Fasil Tessema,Mohammed Taha, (2015) Coexistence of Chronic Complications among Diabetic Patients at Nigist Eleni Mohammed Memorial Hospital, Hossana, South Ethiopia. Open Access Library Journal,02,1-10. doi: 10.4236/oalib.1101218