Prevalence and factors associated with glycemic, blood pressure and lipid control among diabetic patients attending Mulago Hospital

Abstract

Morbidity from diabetes is a consequence of both microvascular and macrovascular disease and atherosclerosis remains the most important cause of morbidity and mortality in patients with diabetes mellitus. Large scale randomised controlled trials have provided an abundance of evidence that treating risk factors can reduce complications by up to 75%. Therapeutic targets for glycemic, blood pressure and lipid control have been provided that if met would reduce the morbidity and mortality associated with diabetes. However, evidence from a limited number of studies indicates that many people with diabetes do not achieve recommended targets for these factors. Although some studies have been done relating to optimal control of the three parameters among diabetic patients, there is still limited information in this area in Sub Saharan Africa and particularly Uganda. Objectives: We set out to establish the proportion of patients attending our clinic in Mulago Hospital who achieve combined glycemic, blood pressure and lipid targets and the factors associated with attainment of these targets. Methodology: This was a cross sectional study carried out among patients 18 years and above with a diagnosis of diabetes made for not less than one year attending Mulago hospital diabetic outpatient clinic. Consenting adults who fulfilled the inclusion criteria were recruited consecutively until a sample size of 384 patients was achieved. A pretested questionnaire was administered to the study patients. Body weight, height and blood pressure were taken. Laboratory tests done on the participants included fasting lipid profiles and glycosylated hemoglobin. Data entry was done using Epi data version 3.5.1 and thereafter exported to STATA version 10.0 for analysis. Factors found to be significantly associated with optimal control of the three treatment parameters were determined at multivariate level. Results: We recruited three hundred and eighty four patients with diabetes into the study. The patients age range was 18- 81years with a mean age of 51.6years.Majority were females 71.9% and only 30.5% lived within 5kms to the hospital. Attainment of combined treatment targets for all three parameters of glycemic, blood pressure and lipid control was low at 4.7%. The attainment of individual treatment parameters of glycemic, blood pressure and lipid control were 40.4%, 61.2% and 13.8% respectively with hypertension being the most optimally controlled. Factors found to be associated with optimal control of the three parameters at multivariate analysis were increasing age and male gender. Conclusion: Generally, all the three parameters of diabetes management were not optimally controlled in Mulago hospital, the worst being lipids. This is also likely to be the case in other public health facilities in Uganda. The prevalence optimal control of the combined treatment parameters was very low (4.7%). There was gender disparity as males were more associated with optimal glycemic, blood pressure and lipid control among diabetic patients in Mulago Hospital. Age was also found to be a factor as it showed that older persons had better control. Recommendations: There should be more emphasis on attainment of the treatment goals through education of patients, carrying out routine screening tests, provision of adequate treatments and monitoring of the patients. Education and sensitization through media, health talks at the health facilities should target more women and the younger age groups. The screening of lipids and provision of lipid lowering drugs should be increased amongst the patients in the clinic to improve on lipid control. But also improve blood pressure and glycemic control through more frequent monitoring. A focused diabetes treatment programme by the Ministry of Health through up scaling of diabetes treatment centres and outreach programmes should be put in consideration.