Prevalence and Risk Factors of Hyperglycemia among Diabetic and Non-Diabetic Rural Population in North Sudan

Special Article - Diabetes

Austin Med Sci. 2018; 3(4): 1031.

Prevalence and Risk Factors of Hyperglycemia among Diabetic and Non-Diabetic Rural Population in North Sudan

Abdelaziz OM1*, Elhassan MAY2, Magzoob M3, Siddig AAM4, Handady MO5 and Alawad MAA6

1Department of Internal Medicine, University of Dongola, Sudan

2Department of Medicine, University of Kordofan, Sudan

3Department of Medicine, International University of Africa, Sudan

4Department of Internal Medicine, Sudan

5Department of Obstetrics and Gynecology, Sudan

6Department of Medicine, University of Medical Sciences and Technology, Sudan

*Corresponding author: Abdelaziz OM, Department of Internal Medicine, Faculty of Medicine & Health Sciences, University of Dongola, Sudan

Received: August 23, 2018; Accepted: October 08, 2018; Published: October 15, 2018

Abstract

Background: Diabetes Mellitus (DM) is a major health problem worldwide with significant morbidity and mortality. Pre-diabetes (or “intermediate hyperglycemia”), based on glycemic parameters above normal but below diabetes thresholds is a high risk state for diabetes with an annualized conversion rate of 5%-10%; with similar proportion converting back to norm glycaemia.

Objectives: To determine the prevalence and associated risk factors of hyperglycemia among diabetic and non-diabetic rural population at Alkhannag village.

Methodology: It was descriptive cross-sectional community-based study carried out at Alkhannag Village during the period June-November, 2016. Four hundred and thirty (430) participants of 18 or more years of age living at the village at the time of the study were incorporated. Data was collected by structure questionnaire. Capillary blood glucose was obtained by a finger puncture under aseptic conditions to measure a random blood glucose using a portable electronic glucose monitor (CERA-CHEK1070®, Ceragem Medisys, Korea).

Results: 430 participants were selected, the age distribution ranged from 18 to 95 years with a mean (standard deviation) age of 38.87 years. The random blood glucose ranged from 65 to 478mg/dl with a mean (SD) of 160.83 mg/dl. High random blood glucose of 140mg/dl or more was detected in a hundred and seventy nine out of the four hundred and thirty participants (41.6%), 32.4% of them were not diabetic, 20.5% of the non-diabetic and 82.3% of the diabetic participants had a random blood glucose of =140mg/dl. Obesity was detected in 41.1% of the participants. Pre hypertension and hypertension were found in 50% and 20.7% respectively. The study finds strong association between the following risk factors and hyperglycemia P value >0.05 (age, six, tribe, education, marital status, and family history of DM or HIN, smoking, BMI and high blood pressure).

Conclusion: Our study demonstrated a high prevalence of hyperglycemia among diabetic and non-diabetic rural population in Sudan. Our results also showed that most of the diabetic participants had high RCBG, and poor control, which necessitates better health education.

Keywords: Hyperglycemia; RCBG; Prevalence; Risk factors

Introduction

Diabetes Mellitus (DM) is a group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action or both.

DM is a major health problem with significant morbidity and mortality. The number of patients with type 2 diabetes is increasing rapidly in both developed and developing countries around the world. This emerging pandemic is driven by the combined effects of population ageing, rising levels of obesity and inactivity and changes in dietary habits [1].

Prediabetes or (“intermediate hyperglycemia”), based on glycemic parameters above normal but below diabetes thresholds is a high-risk state for diabetes with an annualized conversion rate of 5%- 10%; with similar proportion converting back to norm glycaemia. The prevalence of prediabetes is increasing worldwide and it is projected that >470 million people will have prediabetes in 2030. Prediabetes is associated with the simultaneous presence of insulin resistance and Β-cell dysfunction, abnormalities that start before glucose changes are detectable [2].

Estimated number of people having DM was 415 million in 2015 and is expected to be 642 million in 2040, 5 million adults died from DM in 2015 [1], The proportion of undiagnosed diabetes is 46.5% in the world with the highest proportion being in Africa (66.7%) [3]. The number of diabetic patients was estimated to be 35.4 million in Middle East and North Africa region in 2015. The prevalence of diabetes is 7.7% in adults (20-79 years) in Sudan in 2015 [3]. Previous studies showed the highest prevalence rates of diabetes in the Northern State compared to other parts of Sudan [4,5]. The aim of this study was to determine the prevalence of diabetes, its associated risk factors, and the proportion of undiagnosed DM in a rural population in the northern part of Sudan.

Material and Methods

It was descriptive cross-sectional community-based study carried out at Alkhannag Village during the period June-November, 2016. The study was conducted in two stages. The first stage was a houseto- house survey of the whole village when all the adults (18 or more years) present at the village at the time of survey were registered in data sheets, including the name, age and whether they had DM or hypertension or both. The total number of participants at this stage was 1491. In the second stage, a sample of 430 was selected from those who agreed to come to the village’s health center and who were willing to provide blood samples. Those who were seriously ill or had recent history of hospitalization due to any ailments were excluded from the study. Demographic data, past history or family history and treatment history of DM or hypertension as well as smoking habits and regular exercise were obtained from the participants by a structured questionnaire. The arterial blood pressure was measured using mercury sphygmomanometers. The American Heart Association Guidelines for In-Clinic Blood Pressure Measurement [6] were applied for the participants. Capillary blood glucose was obtained by a finger puncture under aseptic conditions to measure a random blood glucose using a portable electronic glucose monitor (CERA-CHEK1070®, Ceragem Medisys, Korea).

The Body Mass Index (BMI) is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). The BMI was determined by using World Health Organization (WHO) classification for obesity [7,8]. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) classification of hypertension [9], was used for this study. For the purpose of this study, participants with random capillary blood glucose of 140mg/dl (7.8mmol/L) or more were considered as having hyperglycemia or uncontrolled DM if they are known to be diabetic.

Statistical analysis was performed via SPSS software (SPSS, Chicago, IL, USA). Continuous variables were compared using student’s t test (for paired data) or Mann–Whitney U test for nonparametric data. For categorical data, comparison was done using Chi-square test (X2) or Fisher’s exact test when appropriate. A P value of ‹0.05 was considered statistically significant.

Ethical clearance and approval for conducting this research was obtained from the State Ministry of Health and informed verbal consent was obtained from every respondent who agreed to participate in the study. Of course, the respondents informed that the study is not associated with experimental or therapeutic intervention while information was collected from them.

Results

1491 people were registered during the initial house-to-house survey at the village. The age distribution ranged from 18 to 95 years with a mean (standard deviation) age of 38.87 years. A male of 120 years of age was excluded because he was bed-ridden and was not eligible for the second stage of the study. 176 of the 1491 participants (11.8%) had diabetes mellitus, 141 (9.5%) had hypertension and 60 (4%) had both DM and hypertension.

In the second stage of this study, the random blood glucose ranged from 65 to 478mg/dl with a mean (SD) of 160.83 mg/dl. Table 1 shows the demographic and clinical characteristics of the 430 participants studied. It was observed that 241 (56.1%) participants were female and 44.7% were in the age group of 18-40 years. Most of participants 231 (53.7%) were secondary school, 211 (49.0%) had family history of DM and HIN. Majority of participants 352 (81.9%) not smoker and only 77 (17.9%) had regular exercise. Obesity was detected in 41.1% of the participants. Pre hypertension and hypertension were found in 50% and 20.7% respectively.