DIABETES MELLITUS
PREVALENCE OF UNDIAGNOSED DIABETES MELLITUS AND ITS DETERMINANTS AMONG PATIENTS PRESENTING FOR ELECTIVE SURGERY AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET KENYA
JOAN KIMETTO
1 Background
Patients with diabetes have an increased propensity to develop infections and cormobidities and are thus frequently admitted to hospital for treatment and/or surgical intervention (Moss et al., 1999). It has also been reported that at least 81% of DM cases in Africa remain undiagnosed (Diabetes Atlas, 2013). It is therefore possible that many patients presenting for elective surgery at MTRH have undiagnosed DM and are therefore at a risk of having post-operative surgical and anesthetic complications. There is no documentation/evidence of DM screening routinely done before surgery in MTRH.
1.1 Justification
The outcomes of this study will help in designing hospital-based diabetes screening guidelines for pre-operative care of surgery patients and thus improve surgical outcomes in the MTRH set up.
1.2 Research question
What are the determinants of undiagnosed DM among patients presenting for elective surgery at MTRH? Objectives
2 Objective
The main objective is to describe the prevalence and determinants of undiagnosed DM among patients presenting for elective surgery at MTRH Specific Objectives
- To determine the prevalence of undiagnosed DM among patients presenting for elective surgery at MTRH
- To determine the socio-demographic and economic characteristics associated with undiagnosed DM among patients presenting for elective surgery at MTRH
- To determine the clinical factors associated with undiagnosed DM among patients presenting for elective surgery at MTRH?
2.1 Dependent variable
‘New DM’ or undiagnosed DM will be defined as: a fasting blood sugar (FPG) level ≥7mmol/l with no prior history of DM. ‘No DM’ will be FBG levels less than 7mmol/l with no prior history of DM
2.2 Independent variables:
2.2.1 Socio-demographic and economic
- Age-The patients will be grouped in 5 years intervals of age starting from 18 years onwards.
- Sex-Both male and females will be included and studied for associations and significance.
- Occupation-Continuous from unemployed to people of different occupations
- Education-Categorized into primary, secondary, university and tertiary level of education
- Income-Categorized to as < Kshs 5000, 5,001 - 20,000 and >20,000
- Marital status-Categorized to single, married, widowed, divorced
2.2.2 Clinical
- Blood pressure-The patients’ blood pressure will be categorized into; elevated blood pressure (>140/90 mmHg) and normal (<140/90mmHg. (NCEP, 2002).
- Fasting blood sugar-This will be categorized into two: High FBS as 7mmol/L and above and normal FBS, below 7mmol/L (ADA)
- Smoking- The patients use of tobacco; yes or no categories
- Alcohol use- The patients’ use of alcohol; Yes or no categories
- Cardiac history- Included history of patient him/herself and that of family members.
- Body Mass Index- Analyzed as categorical variable with categories of underweight, normal, overweight and obese
- Diet-Categorised as to whether they take fruits and vegetables daily; yes or no categories
- Physical activity- Categorised as to whether they take part in daily physical exercises; yes or no categories
- Lipid profile-Two categories will be made; dyslipidemic or normal lypid profile in accordance to NCEP, 2002.
3 Univariate Analysis
3.1 Figure 1: Prevalence of Diabetes Meletus
4 Bivariate Analysis
4.1 Table 1: Socio-demographic and economic characteristics | Diabetes status
Table 1: Socio-demographic and economic characteristics | Diabetes status | |||||
| DM STATUS |
| |||
Variable | Overall, N = 5401 | Diabetes, N = 191 | No Diabetes, N = 4081 | Pre Diabetes, N = 1131 | p-value2 |
AGE | 45.6 (18.3) | 47.3 (12.4) | 45.0 (18.4) | 47.4 (18.6) | 0.2 |
GENDER | 0.4 | ||||
Female | 214.0 (39.6%) | 7.0 (36.8%) | 156.0 (38.2%) | 51.0 (45.1%) | |
Male | 326.0 (60.4%) | 12.0 (63.2%) | 252.0 (61.8%) | 62.0 (54.9%) | |
MARITAL STATUS | 0.12 | ||||
Divorced/separated | 11.0 (2.0%) | 2.0 (10.5%) | 7.0 (1.7%) | 2.0 (1.8%) | |
Married | 382.0 (70.7%) | 13.0 (68.4%) | 281.0 (68.9%) | 88.0 (77.9%) | |
Single | 104.0 (19.3%) | 2.0 (10.5%) | 85.0 (20.8%) | 17.0 (15.0%) | |
Widowed | 43.0 (8.0%) | 2.0 (10.5%) | 35.0 (8.6%) | 6.0 (5.3%) | |
RELIGION | 0.3 | ||||
Christian | 513.0 (95.0%) | 19.0 (100.0%) | 390.0 (95.6%) | 104.0 (92.0%) | |
Muslim | 27.0 (5.0%) | 0.0 (0.0%) | 18.0 (4.4%) | 9.0 (8.0%) | |
RESIDENCE (URBAN OR RURAL) | 0.5 | ||||
Rural | 389.0 (72.0%) | 12.0 (63.2%) | 292.0 (71.6%) | 85.0 (75.2%) | |
Urban | 151.0 (28.0%) | 7.0 (36.8%) | 116.0 (28.4%) | 28.0 (24.8%) | |
LEVEL OF EDUCATION | 0.3 | ||||
College | 66.0 (12.2%) | 2.0 (10.5%) | 48.0 (11.8%) | 16.0 (14.2%) | |
None | 36.0 (6.7%) | 2.0 (10.5%) | 21.0 (5.1%) | 13.0 (11.5%) | |
Primary school | 207.0 (38.3%) | 7.0 (36.8%) | 163.0 (40.0%) | 37.0 (32.7%) | |
Secondary school | 207.0 (38.3%) | 8.0 (42.1%) | 155.0 (38.0%) | 44.0 (38.9%) | |
Tertiary/University | 24.0 (4.4%) | 0.0 (0.0%) | 21.0 (5.1%) | 3.0 (2.7%) | |
OCCUPATION | 0.7 | ||||
Business person | 130.0 (24.1%) | 5.0 (26.3%) | 91.0 (22.3%) | 34.0 (30.1%) | |
Employed | 82.0 (15.2%) | 4.0 (21.1%) | 63.0 (15.4%) | 15.0 (13.3%) | |
Farmer | 164.0 (30.4%) | 6.0 (31.6%) | 126.0 (30.9%) | 32.0 (28.3%) | |
Retired | 13.0 (2.4%) | 0.0 (0.0%) | 12.0 (2.9%) | 1.0 (0.9%) | |
Unemployed | 151.0 (28.0%) | 4.0 (21.1%) | 116.0 (28.4%) | 31.0 (27.4%) | |
INCOME | 0.4 | ||||
5,001-20,000 | 165.0 (30.6%) | 7.0 (36.8%) | 125.0 (30.6%) | 33.0 (29.5%) | |
Above 20,001 | 46.0 (8.5%) | 1.0 (5.3%) | 40.0 (9.8%) | 5.0 (4.5%) | |
Below 5,000 | 328.0 (60.9%) | 11.0 (57.9%) | 243.0 (59.6%) | 74.0 (66.1%) | |
N/A | 1 | 0 | 0 | 1 | |
HOUSING | 0.3 | ||||
Permanent | 161.0 (29.8%) | 6.0 (31.6%) | 123.0 (30.1%) | 32.0 (28.3%) | |
Semi permanent | 274.0 (50.7%) | 10.0 (52.6%) | 198.0 (48.5%) | 66.0 (58.4%) | |
Temporary | 105.0 (19.4%) | 3.0 (15.8%) | 87.0 (21.3%) | 15.0 (13.3%) | |
1Mean (SD); n (%) | |||||
2Kruskal-Wallis rank sum test; Pearson's Chi-squared test; Fisher's Exact Test for Count Data with simulated p-value | |||||
4.2 Table 2: Clinical factors | Diabetes status
Table 1: Clinical factors | Diabetes status | |||||
| DM STATUS |
| |||
Variable | Overall, N = 5401 | Diabetes, N = 191 | No Diabetes, N = 4081 | Pre Diabetes, N = 1131 | p-value2 |
BMI | 23.7 (4.6) | 23.2 (3.9) | 23.5 (4.5) | 24.4 (4.8) | 0.3 |
DM HISTORY | 11.0 (2.0%) | 0.0 (0.0%) | 8.0 (2.0%) | 3.0 (2.7%) | 0.8 |
BP HISTORY | 87.0 (16.1%) | 2.0 (10.5%) | 64.0 (15.7%) | 21.0 (18.6%) | 0.6 |
DM FAMIL HISTORY | 97.0 (18.0%) | 4.0 (21.1%) | 68.0 (16.7%) | 25.0 (22.1%) | 0.4 |
BLOOD PRESSURE | >0.9 | ||||
Elevated (>140/90 mmHg) | 153.0 (28.3%) | 5.0 (26.3%) | 116.0 (28.4%) | 32.0 (28.3%) | |
Normal (<140/90mmHg) | 387.0 (71.7%) | 14.0 (73.7%) | 292.0 (71.6%) | 81.0 (71.7%) | |
CIGARRETTES | 0.8 | ||||
No | 464.0 (85.9%) | 16.0 (84.2%) | 353.0 (86.5%) | 95.0 (84.1%) | |
Yes | 19.0 (3.5%) | 0.0 (0.0%) | 14.0 (3.4%) | 5.0 (4.4%) | |
Yes but stopped | 57.0 (10.6%) | 3.0 (15.8%) | 41.0 (10.0%) | 13.0 (11.5%) | |
ALCOHOL INTAKE | 0.9 | ||||
No | 368.0 (68.1%) | 12.0 (63.2%) | 280.0 (68.6%) | 76.0 (67.3%) | |
Yes | 97.0 (18.0%) | 3.0 (15.8%) | 73.0 (17.9%) | 21.0 (18.6%) | |
Yes but stopped | 75.0 (13.9%) | 4.0 (21.1%) | 55.0 (13.5%) | 16.0 (14.2%) | |
PHYSICAL EXERCISE | 0.019 | ||||
No | 322.0 (59.9%) | 9.0 (47.4%) | 231.0 (56.9%) | 82.0 (72.6%) | |
Yes | 212.0 (39.4%) | 10.0 (52.6%) | 171.0 (42.1%) | 31.0 (27.4%) | |
Yes but stopped | 4.0 (0.7%) | 0.0 (0.0%) | 4.0 (1.0%) | 0.0 (0.0%) | |
N/A | 2 | 0 | 2 | 0 | |
REASON FOR NOT EXERCISING | 0.020 | ||||
Health reasons | 188.0 (57.3%) | 3.0 (33.3%) | 128.0 (54.2%) | 57.0 (68.7%) | |
I don't have time | 64.0 (19.5%) | 4.0 (44.4%) | 51.0 (21.6%) | 9.0 (10.8%) | |
I don't like exercises | 22.0 (6.7%) | 0.0 (0.0%) | 20.0 (8.5%) | 2.0 (2.4%) | |
Others | 54.0 (16.5%) | 2.0 (22.2%) | 37.0 (15.7%) | 15.0 (18.1%) | |
N/A | 212 | 10 | 172 | 30 | |
FRUITS INTAKE | >0.9 | ||||
Daily | 157.0 (29.1%) | 6.0 (31.6%) | 118.0 (28.9%) | 33.0 (29.2%) | |
Not daily | 383.0 (70.9%) | 13.0 (68.4%) | 290.0 (71.1%) | 80.0 (70.8%) | |
VEGETABLES INTAKE | 0.053 | ||||
Daily | 463.0 (85.7%) | 17.0 (89.5%) | 357.0 (87.5%) | 89.0 (78.8%) | |
Not daily | 77.0 (14.3%) | 2.0 (10.5%) | 51.0 (12.5%) | 24.0 (21.2%) | |
1Mean (SD); n (%) | |||||
2Kruskal-Wallis rank sum test; Fisher's Exact Test for Count Data with simulated p-value | |||||
5 Appendix
5.1 Ordinal Data analisis
As we know that Wilcoxon Rank-Sum test can often be used provided the two independent samples are drawn from populations with an ordinal distribution.
For ordinal data, we are assuming a significance level of α = 0.05. We have a paired data over here.So,We can do hypothesis testing (two Tailed Test) to identify the given research proposition:
Hypothesis:
Null Hypothesis, Ho, MedianDifference = 0
Alternative Hypothesis, Ha, MedianDifference ≠ 0
Wilcoxon Rank-Sum Test For paired data set with ties,
WilcoxonRankSumtest was used for ordinal cohttps://rpubs.com/mominulislam2329/WilcoxonRankSumtest