Prevalence of Microvascular Complications in Type 2 Diabetics Attending a Primary Healthcare Centre in Sudan

Abstract

Background: Diabetes mellitus (DM) has become a global public health challenge. The increasing urbanisation and the significant lifestyle changes have resulted in an unprecedented rise in the rates of type 2 DM and, consequently, its microvascular complications which are the major outcome of the disease. It is the low- and middle-income countries where 80% of the diabetic patients live that face the greatest burden of the disease. Study Objectives: Our primary objective was to estimate the frequency of microvascular complications among patients diagnosed with type 2 DM. Our secondary objective was to investigate the relationship between the microvascular outcomes and the different characteristics and potential variables among patients with type 2 DM. Methodology: An observational descriptive clinic-based cross-sectional survey was conducted to calculate the prevalence of microvascular complications of type 2 DM and the associated risk factors in a lower middle-income country, Sudan. The study was carried out at Shambat Primary Healthcare Clinic during the period between May and June 2018. All patients aged 20 years and above visiting the clinic were included. Patients excluded from selection were those on steroid therapy and those having bilateral eye cataract. A total of 209 patients constituted the sample and were selected through systemic random sampling. Statistical analysis was carried out using SPSS software version 21. For the continuous variables, the mean was used as a measure of central tendency and the standard deviation as a measure of dispersion. The associations between the microvascular complications and the other variables were analysed using the χ² test. The p value was used as a test for statistical significance. Results: The response rate to the survey was 72.6%. The age of the enrolled subjects ranged from 24 to 88 years. Males constituted 61.7% of the study sample and females 38.3%. The mean body mass index (BMI) was 26.92 ± 2.06. Out of 209 patients known to have type 2 DM, 96 (45.9%) developed any of the microvascular complications. Nephropathy was the most frequent with a prevalence of 38.8%, followed by retinopathy and neuropathy with a frequency of 23.9 and 22.5%, respectively. The presence of other co-morbidities, namely hypertension, ischaemic heart disease, chronic kidney disease and dyslipidaemia, was a predictor for the occurrence of the small-vessel conditions. Conclusions: This study is probably the first of its kind to shed light on the magnitude of the microvascular complications of DM in Sudan. The yielded results reveal a significant burden caused by microvascular complications in the country. The concurrent presence of other chronic medical disorders, namely hypertension, ischaemic heart disease, chronic kidney disease and dyslipidaemia, amplifies the risk for the development of microvascular sequelae. The mean BMI of the sample reflects an overweight trend. Facing the high tide of the metabolic syndrome and its sequelae requires a holistic perspective and a multidisciplinary approach. The health authorities and other stakeholders need to prioritise healthcare expenditure and invest more in DM research. A national diabetes registry will serve as a key player in guiding the efforts.