Prevalence of Metabolic Syndrome among Sudanese Type 2 Diabetic Patients

Special Article - Diabetes

Austin Med Sci. 2018; 3(3): 1030.

Prevalence of Metabolic Syndrome among Sudanese Type 2 Diabetic Patients

Alawad AAM1* and Makeen AM2s

1Department of Medicine, University of Gezira, Sudan

2Department of Medicine, International University of Africa, Sudan

*Corresponding author: Ahmed Ali Mohamed Ahmed Alawad, Faculty of Medicine, University of Gezira Wad Medani, P.O 20, Sudan

Received: August 22, 2018; Accepted: September 11, 2018; Published: September 18, 2018


Background: This cross-sectional study was carried out to know the prevalence of metabolic syndrome among the type 2 diabetic patients in Sudan.

Materials and Methods: One hundred patients aged 30-79 (mean age 53.41 ± 13.30) years with established type 2 diabetes visiting diabetes center, Wad Medani, Sudan on July 2014 were included in the study. National Cholesterol Education Adult Treatment Panel III (NCEP ATPIII) definition of the metabolic syndrome with ethnic threshold on abdominal obesity was used. Forty sex (46%) participants fulfilled all 5 criteria for metabolic syndrome.

Results: Among the patients having metabolic syndrome, hypertension was seen in 23 (50%) participants, raised serum triglyceride levels were found in 37 (80.43%) patients, decreased serum HDL cholesterol levels were found in 30 (65%) participants while in 25 (54.35%) participants increased waist circumference was found. There was a higher frequency of metabolic syndrome in obese (81.58%) and in overweight (79.49%) subjects.

Conclusion: This study indicates significant prevalence of metabolic syndrome among type 2 diabetic patients with strong association of obesity.

Keywords: Metabolic syndrome; National cholesterol education program; Abdominal obesity; Body mass index


Metabolic syndrome (MetS), a group of metabolic abnormalities, includes abdominal obesity, low level of High-Density Lipoprotein Cholesterol (HDL-C), high triglycerides level, hypertension and hyperglycemia. According to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) individuals with MetS are at risk of developing Cardiovascular Disease (CVD) and insulin resistance, which confers risk for type 2 Diabetes [1].

Contributing factors for hyperglycemia can be defects in insulin secretion, action or both. Incidence of diabetes in developing countries is increasing and is one of the leading causes of morbidity and mortality. Reaven observed that many risk factors (such as dyslipidemia, hypertension, and hyperglycemia) commonly cluster together [2]. He called it syndrome X. World Health Organization (WHO) gave the first global definition of MetS, however the requirement of using euglycaemic clamp to measure insulin sensitivity made the WHO definition impossible to be employed in either clinical or epidemiological practices. National Cholesterol Education Program (NCEP) of USA introduced new definition of MetS. 2 Diagnostic criteria of NCEP for MetS became popular because of its simplicity and feasibility since its components can be determined routinely and in research settings [3]. International Diabetes Federation (IDF) presented new definition, which emphasizes abdominal obesity as an important component of MetS.

Obesity has increased in developing countries. Abdominal obesity in particular, is responsible for several metabolic and cardiovascular problems. High risk of developing both diabetes and cardiovascular disease associated with obesity may be due to a predisposition to abdominal obesity leading to metabolic syndrome. There have been many studies done on the prevalence of risk factors for developing metabolic syndrome in Sudan [4].

This study aimed to assess incidence of metabolic syndrome in patients with T2DM who visited Diabetes center in central Sudan in 2014. We used the national cholesterol education program adult treatment panel III (NCEP ATP III) definition of the MetS to observe the frequency of metabolic syndrome in type 2 diabetic patients in our study.

Materials and Methods

This is a prospective observational cross-sectional study. One hundred patients aged 30-79 (mean age 53.41 ± 13.30) years with established type 2 diabetes visiting diabetes center, Wad Medani, Sudan on July 2014 were included in the study. The target group was outpatients with a history of Type 2 diabetes.

The population included in the study had diabetes for a year or more, some under medication and some under diet control. The exclusion criteria were coexistence of any other serious illness. Patients were asked for clinical history of ischemic heart disease, arrhythmias, renal failure and other chronic diseases. Each patient was asked for the demographic details (age, sex), duration of diabetes, any medication, hypertension, consuming alcohol and smoking habits. They were also enquired about their job.

After the patient’s consent, the Blood Pressure (BP) was measured in sitting position using the auscultator method. The Height and weight of each candidate was taken in an upright standing position without shoes. BMI was calculated as weight in Kilogram (Kg) divided by height squared (m2). The waist circumference was measured over a light garment at a level midway between lower rib margin and iliac crest using the WHO guideline for waist circumference measurement. All the subjects were on overnight fast (about 12 hours) for checking fasting blood sugar level, uric acid and lipid profile.

In our current study, we used the NCEP ATP III definition of metabolic syndrome to observe the frequency of metabolic syndrome. According to which the participants are said to be suffering from metabolic syndrome when they meet three or more of the following:

Data were entered into a Microsoft Excel spreadsheet and the statistical analysis was conducted using SPSS (Version 19). Statistical analysis was carried out using descriptive and analytical statistics. Simple frequencies and cross tabulation were done. Chi square test was used for proportions. Stratification for the patient’s sex and educational level was done when relevant. P value of less than 0.05 was considered statistically significant. The consent of the patients was obtained. A full explanation of the purposes and nature of the study was conveyed to them. The potential participants were clearly assured that their participation in this study is voluntary any data obtained would be treated confidentially and for the purpose of the research only.


This study included 100 Sudanese adult patients with Type 2 diabetes mellitus. Women comprised the majority of the participants, 59 (59%), while the men comprised 41 (41%).

The patients were stratified to age group and sex (on a basis of a 10 years interval). A large fraction of the patients were female 20 (33.8%) within the age group 40-49 years, compared to 14 (34.1%) for male patients at the same age group. In general, the least percentage of female patients (10%) was on age group of 30 -39 years, compared to 7.3% of male patients on the same age group. The patients were stratified to marital status of patient. A large fraction of patient were married 91 (91%) and 9 (9%) were single.

The patients were stratified to Residence 58 (58%) were urban, while 42 (42%) were rural. The patients were stratified to education status of patients. The majority had high secondary education 52 (52%). The patients were stratified to smoking the majority are nonsmokers 72 (72%), while 28 (28%) were smokers. The patients were stratified to economic status 68 were low economic status while 32 were moderate economic status. The patients were stratified to knowledge about DM 52 had knowledge while 48 had no knowledge about it.

Among all patient, 23 (23%) had diabetes for less than 5 years, while 45 patients (45%) had had diabetes between 6-10 yeas. while those having diabetes for 1-15 years and 16-20 years were 31 patients for each group (31%). Two patients (2%) had diabetes for more than 20 years. Regarding the distribution of types of treatments of diabetes mellitus among the patients, the most prevalent treatment (beside diet) was the Oral Hypoglycemic Agents (OHA), which was used, by 59 (59%) of the patients; 39 patients (39%) were put on insulin injection and diet. The patients who were under dietary control only were 2 (2%). The patients were stratified to degree of activity majority of them 85 (85%) had soft activity while 15 (15%) had hard activity.

The patients were stratified to presence of cardio-vascular complications 80 (80%) had no complications while 20% had it. One of the major characteristics studied was the Body Mass Index (BMI) which is used an indicator of body weight. The underweight patients were 5 patients (5%), while normal weight patient were 50 (50%); the overweight patients were 22 (22%) and obese patients were 23 (23%). Regarding male patients, the value of waist circumference value was normal (= 101 cm) among 28 patients (68.2%), while abdominal obesity (= 102 cm) was found in 13 patients (31.8%). Regarding female patients, the value of waist circumference value was normal among 29 patients (49.1%), while abdominal obesity was found in 30 patients (50.9%).

For the majority of patients, 49 (49%), the systolic pressure was between 130-149 mmHg, but a lesser number of patients, 2, (2%), the systolic pressure between 170 – 189 mmHg. For the majority of patients, 44 (44%), the diastolic pressure was between 80-89 mmHg; in 40 patients (40%), the diastolic pressure was between 90-99; in 5 patients (5%) diastolic pressure was between 100-109 mmHg, but only one patient (1%) was between 110-119 mmHg.

Regarding the distribution of HbA1c among patients, 69 patients (69%) were in fair glycaemic control (= 7%); while 31 patients (31%) while were in poor glycaemic control (= 7%). Most of patients 82 (82%) had serum uric acid level = 7.2 and 18 (18%) had serum level = 7.2. Ten patients (10%) had hypercholesterolemia; 3 patients (3%) showed high LDL level; 16 patients (16%) had hypertriglyceridemia; 11 male patients (26.8%) had low HDL, (‹40 mg/dl); 42 female patients (72.4%) had low HDL.

According to criteria adopted by the study methodology, 46 patients fulfilled the required criteria of diagnosis of metabolic syndrome, constituting 46% of the total number of the study patients. Tables 1 and 2 show details on Sex, education level, age, and type of treatment, duration of diabetes, glycaemic control, waist circumference, body mass index, systolic blood pressure, and diastolic blood pressure of the patients. The majority of the patients were female (63%). Most of the patients had high secondary education 23, 50%). Their age mean was 57 ± 8.2 years. Twenty-nine patients (63%) were on oral hypoglycaemic agents. The mean duration of diabetes among our patients was 11.14 ± 5.61 years. Twenty-seven patients (58.7%) were in fair glycaemic control. The mean waist circumference for males was 107.2 ± 12.3 centimeters, while that for females was 97 ± 6.8 centimeters. The mean BMI for the patients was 32.8 ± 4.9. The mean systolic blood pressure was 150 ± 22 mmHg, while the diastolic blood pressure was 88 ± 17 mmHg.