Prevalence of Undiagnosed Dysglycaemias and their Correlates amongst Hypertensive Patients in a Tertiary Health Facility in Abuja, North Central Nigeria https://doi.org/10.60787/NMJ-64-1-145
Main Article Content
Keywords
Undiagnosed Dysglycaemia, Correlates, Hypertensive Patients, Abuja
Abstract
Background: Dysglycaemia, (diabetes mellitus, DM, and Prediabetes) and Hypertension (HTN) are two common non-communicable diseases that are closely linked. Cardiovascular risk profile and cardiovascular-related death rise significantly when they co-exist. A third of cases of diabetes mellitus amongst hypertensive patients are undiagnosed and most people who are newly diagnosed have a low level of awareness. This study is therefore designed to assess the prevalence of dysglycaemia and associated factors, among hypertensive patients attending our facility.
Methodology: Clinical and laboratory information on 858 patients was extracted and analyzed. This includes sociodemographic variables such as age, sex, socioeconomic status, and level of physical activity. Also, family history of diabetes mellitus, the duration of hypertension as well as types of antihypertensives used by those already attending the clinic for hypertension care. Other variables were blood pressure, height, weight, waist and hip circumferences, and body mass index (BMI). Blood glucose and plasma lipid profile as well.
Results: More than a quatre of the patients had prediabetes. Between 2% and 6.1% had diabetes mellitus using 2HPP and FBG respectively. Following cross-tabulation, dysglycaemia was significantly associated with age, duration of hypertension, body mass index, BMI, elevated total cholesterol, LDL as well as the use of beta blockers and thiazides.
Conclusion: Dysglycaemias are common among hypertensive patients in Abuja. Age, duration of hypertension, body mass index, dyslipidemias, beta blocker, and thiazide use were positively associated with dysglycaemia. Screening for dysglycaemia is recommended for all hypertensive patients at the point of entry to care.
References
2.Chatterjee R, Narayan KMV, Lipscomb J, Jackson SL, Long Q, Zhu M et al. Screening for diabetes and prediabetes should be cost-saving in patients at high risk. Diabetes Care. 2013;36:1981-1987.
3.Unwin N, Shaw J, Zimmet P, Alberti KGMM. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med. 2002;19:70823.
4.Whitworth JA. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on the management of hypertension. J Hypertens. 2003;21:1983-1992.
5.WHO. WHO Global status report on non-communicable diseases 2010. (Accessed 2/1/2022). Available from: http://www.cabdirect.org/abstracts/20113168808.html.
6.WHO. WHO-Prevention of cardiovascular disease: guidelines for assessment and management of total cardiovascular risk. WHO; 2007. (Accessed 2/1/2022).
7.Chowdhury EK, Owen A, Ademi Z, Krum H, Johnston CI, Wing LM, Nelson MR, Reid CM. Short-and long-term survival in treated elderly hypertensive patients with or without diabetes: findings fromthe Second Australian National Blood Pressure study. Am J Hypertens2014;27:199–206
8.WHO. WHO Global Status Report on Non-Communicable Diseases 2014. (Accessed 2/1/2022).
9.Iloh GUP. Risk factors of pre-diabetes among adult Nigerians with essential hypertension in a resource-constrained setting of a primary care clinic in eastern Nigeria. Am J Heal Res. 2013;1:56.
10.Mayega RW, Guwatudde D, Makumbi F, Nakwagala FN, Peterson S,Tomson G. Diabetes and pre-diabetes among persons aged 35 to 60 years in Eastern Uganda: prevalence and associated factors. PLoS One. 2013;8:e72554.
11.Singleton JR, Smith AG, Russell JW, Feldman EL. Microvascular Complications of Impaired Glucose Tolerance. Diabetes. 2003;52:2867-2873.
12.Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001;37:1053-1059.
13.Tooke JE. Microvascular function in human diabetes. A physiological perspective. Diabetes1995; 44:721–726.
14.Jaap AJ, Shore AC, Tooke JE. Relationship of insulin resistance to microvascular dysfunction in subjects with fasting hyperglycaemia. Diabetologia1997; 40:238–243.
15.Wong TY, Shankar A, Klein R, Klein BE, Hubbard LD. Retinal arteriolar narrowing, hypertension, and subsequent risk of diabetes mellitus. Arch Intern Med2005;165:1060–1065.
16.Tal MG. Type 2 diabetes: microvascular ischemia of pancreatic islets? Med Hypotheses2009;73:357–358.
17.Balletshofer BM, Rittig K, Enderle MD, Volk A, Maerker E, Jacob S, Matthaei S, Rett K, Haring HU. Endothelial dysfunction is detectable in young normotensive first-degree relatives of subjects with type 2 diabetes in association with insulin resistance. Circulation2000;101:1780–1784
18.Wang J-S, Lee I-T, Lee W-J, Lin S-Y, Fu C-P, Lee W-L. Comparing HbA1c, fasting and 2-h plasma glucose for screening for abnormal glucose regulation in patients undergoing coronary angiography. Clin Chem Lab Med. 2015;53:1441-1449
19.Alqahtani N, Khan WAG, Alhumaidi MH, Ahmed YAAR. Use of Glycated Hemoglobin in the Diagnosis of Diabetes Mellitus and Pre-diabetes and Role of Fasting Plasma Glucose, Oral Glucose Tolerance Test. Int J Prev Med. 2013;4:1025-9.
20.Salinero-Fort MA, Burgos-Lunar C, Lahoz C,. Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Program for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study. PLoS One. 2016;11:e0158489.
21.WHO/ISH. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Hypertens; Accessed 20/01/2022:
22.American Diabetes Association. ADA Diabetes Management Guidelines A1C Diagnosis. (Accessed 21/01/2022). Available from: http://www.ndei.org/ADA-diabetes-management-guidelines-diagnosis-A1C-testing.aspx.
23.Kidney RSM, Peacock JM, Smith SA. Blood glucose screening rates among Minnesota adults with hypertension, Behavioral Risk Factor Surveillance System, 2011. Prev Chronic Dis. 2014;11:E207.
24.Mutebi E, Nakwagala FN, Nambuya A, Otim M. Undiagnosed diabetes mellitus and impaired glucose tolerance among hypertensive patients in Mulago Hospital, Kampala, Uganda. 2012;20.
25.The population of Abuja. Available from: http://worldpopulationreview.com/world‑cities/abuja‑ population. Accessed 22/01/2022.
26.Nkatha Meme, Samuel Amwayi, Ziporrah Nganga, Esther Buregyeya. Prevalence of undiagnosed diabetes and pre-diabetes among hypertensive patients attending Kiambu district Hospital, Kenya: a cross-sectional study Pan African Medical Journal. 2015; 22:286
27.Bartnik M. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: The Euro Heart Survey on diabetes and the heart. Eur Heart J. 2004;25:1880-1890.
28.Luders S, Hammersen F, Kulschewski A, Venneklaas U, Züchner C, Gansz A, et al. Diagnosis of impaired glucose tolerance in hypertensive patients in daily clinical practice. Int J Clin Pract. 2005;59:632-638
29.Ogunmola OJ, Ajani GO, Olabinri EO. Prevalence of Diabetes Mellitus in Outpatients with Essential Hypertension in a Rural Tertiary Hospital. Int J Diabetes Clin Res2019;6:115.
30.Onyegbutulem HC. Environmental and Genetic Factors in Age-related Dysglycaemia. A review. Nigerian Clinical Review. 2005; 9:5-7.
31.Onyegbutulem HC. Bornstein SR., Barthel A. Hormonal factors in Age-related dysglycaemia; a review. Postgraduate Doctor Caribbean. 2006; 22:14-15.
32.Lip S, Jeemon P, McCallum L, Dominiczak AF, McInnes GT, Padmanabhan S. Contrasting mortality risks among subgroups of treated hypertensive patients developing new-onset diabetes. European Heart Journal. 2016;37:968–974
33.Izzo R, de Simone G, Trimarco V, Gerdts E, Giudice R, Vaccaro O, et al. Hypertensive target organ damage predicts incident diabetes mellitus. European Heart Journal. 2013; 34:3419–3426
34.USPSTF the USPSTFA for HR and QRM. Screening for Type 2 Diabetes Mellitus in Adults: US -Preventive Services Task Force Recommendation Statement. Ann Intern Med(American College of Physicians). 2008;148:846
35.Onyegbutulem HC, Dogo D, Alu F. Patterns of dyslipidemia amongst hypertensive patients in Abuja, North Central Nigeria. Pan Afr Med J. 2021; 39:11.
36.Hilding A, Eriksson A-K, Agardh EE, Grill V, Ahlbom A, Efendic S. The impact of family history of diabetes and lifestyle factors on abnormal glucose regulation in middle-aged Swedish men and women. Diabetologia. 2006;49:2589-2598.
37.Fernandes Silva L, Vangipurapu J, Laakso M. The "Common Soil Hypothesis" Revisited-Risk Factors for Type 2 Diabetes and Cardiovascular Disease. Metabolites. 2021;11(10):691.
38.Salvetti A, Brogi G, Di Legge V, Bernini GP. The inter-relationship between insulin resistance and hypertension. Drugs. 1993;46Suppl 2:149-59.
39.Ferrannini E, Natali A. Insulin resistance and hypertension: connections with sodium metabolism. Am J Kidney Dis1993;21(5 Suppl 2):37–42.
40.Taylor EN, Hu FB, Curhan GC. Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care. 2006;29:1065-1070.
41.Flegal KM, Carroll MD, Kuczmarski RJ and Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord1998;22:39–47.
42.Hotamisligil GS, Arner P, Caro JF, Atkinson RL and Spiegelman BM. Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Invest 1995;95:2409–2415.
43.Hotamisligil GS, Shargill NS and Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259:87–91.
44.Burhans MS, Hagman DK, Kuzma JN, Schmidt KA, Kratz M. Contribution of Adipose Tissue Inflammation to the Development of Type 2 Diabetes Mellitus. Compr Physiol. 2018;9:1-58.
