Patterns and determinants of dyslipidemias among patients with type 2 diabetes mellitus at Kenyatta National Hospital.

Abstract

Background: Dyslipidemia is markedly common in type 2 Diabetes Mellitus patients and one of the modifiable risk factors for cardiovascular disease, which is responsible for the increased burden of disease and mortality in diabetic patients. The use of lipid-lowering agents and lifestyle modification remains a fundamental approach in controlling diabetic dyslipidemia. However, suboptimal treatment of lipid abnormalities and underutilization of lipid-lowering agents in high-risk individuals, including patients with T2DM, remains a common challenge in clinical practice. There is inadequate information on the level of control of lipids profile and the determinants among patients with T2DM, especially in low and middle-income countries in Africa, including Kenya. Broad Objective: The study aimed at evaluating the patterns and determinants of dyslipidemias among patients with type 2 Diabetes mellitus in a tertiary level facility in Kenya. Methodology: A hospital-based cross-sectional survey was done. A total of 235 participants aged between 40-75 years old with T2DM were randomly selected. A researcher administered a questionnaire, and abstraction forms were used to collect the data. STATA Version 13 was used to analyze the data. Both descriptive and inferential statistics used to summarize the study results and deduce inferences between the dependent and explanatory variables. Bivariate and multivariate logistic regression models were applied to establish the association between the outcome variable and independent variables with the level of significance set at p≤0.05. Results: A total of 235 T2DM participants were involved, of which the majority were female, 60.4%. The median age of participants was 60 (52-67) and hypertension was the prevalent comorbidity (60.9%). Statins were the only lipid-lowering agents prescribed 63.8%, with most participants prescribed moderate atorvastatin intensity (57.4%). Lifestyle modification strategies indicated for lipid modification included dietary change (69.2%), moderate physical exercise (58.5%), and control of social habits such as smoking and excessive alcohol intake. Isolated dyslipidemia with elevated LDL-c was the most prevalent dyslipidemia pattern followed combined elevated TG and LDL-c. Adherent to lipid-lowering agents was observed in only 48% of the participants. The proportion of participants with optimal LDL-C control (<2.6 mmol/l, TG (<1.7 mmol/l), HDL >1.04 mmol/l(male) and >1.30 mmol/l( female) and non HDL-C < 3.37 mmol/L was 50.2%, 17%, 88.2% and 72.3%, respectively. Adherent to lipid lowering and the use of lipid-lowering agents (statins) was significantly associated with LDL-c target control (AOR 2.0; CI 1.16-3.47; p=0.013), and (aOR 2.2;CI 1.26-4.03 ;p=0.006). Predictors for optimal non-HDL-C control include; higher level education (aOR 2.2.;CI-1.00- 4.87:p=0.04), lipid lowering agent use( aOR 2.0;CI 1.01-3.88:p=0.024) and hypertension (aOR 2.0;CI 1.04-3.67 : p=0.036). Conclusion: The control of dyslipidemia among T2DM patients attending the outpatient clinic at KNH is still inadequate because of the underutilization of lipid-lowering agents and patients’ non-adherence to lipid-lowering therapy. Recommendations: The utilization of lipid-lowering drugs among T2DM patients should be enhanced. This can be achieved through sensitizing both the prescribers and patients.