Cardiovascular risk factors associated with type 2 diabetes mellitus as seen at the Kenyatta National Hopital
Background: There is an emerging epidemic of cardiovascular disease and type 2 diabetes in developing countries with rising associated morbidity and mortality. Diabetes has its greatest impact throughout the vascular system with, macrovascular disease being the leading cause of death and reduction in quality of life of individuals with type 2 diabetes. There is often clustering of multiple risk factors for vascular disease that often predates the clinical diagnosis of type 2 diabetes. No data exist on the prevalence of established cardiovascular risk factors in patients with type 2 diabetes at Kenyatta National Hospital (KNH). Objectives: The aim of the study was to determine the prevalence of certain established cardiovascular risk factors, specifically, cigarette smoking, obesity, hypertension, poor glycaemic control, dyslipidaemia, hyperhomocysteinaemia and microalbuminuria, in patients with type 2 diabetes seen at the diabetic outpatient clinic at KNH. Methods: A random sample of type 2 diabetics seen at the diabetic outpatient clinic at KNH was selected and data obtained on age, sex, duration of diabetes, history of cigarette smoking and personal and family history of hypertension and vascular disease in first-degree relatives. Body mass index (8M I), waist circumference, waist-hip ratio (WHR) and resting blood pressure were recorded. A fasting venous blood sample was taken to determine glycated haemoglobin level, fasting lipid profile (total cholesterol, HDL-cholesterol, LDL• cholesterol and triglycerides), fasting blood glucose, and homocysteine level,and a spot specimen of urine was screened for microalbuminuria. RESULTS: 108 type 2 diabetics were studied, 54 males and 54 females, with mean age 55.7 years and mean duration of diabetes 7.5 years. Fifty.two patients (48.1%) were on oral hypoglycaemic agents (OHA), 6 (5.6%) on insulin alone and 50 (46.3%) on combined OHAs and insulin treatment. Age and sex as vascular risk factors (males > 45 years and females > 55 years) were found in 28 males (51.9%) and 50 females (92.6%). There were 6 (5.6%) current smokers, all males. The mean BMI was 26.9 kg/m2, with 70 patients (64.8%) being either overweight or obese. The mean WHR was 0.88 and the mean waist circumference was 91'.4 cm, females being more likely than males to have an abnormal WHR and we (p<0.001). Seventy patients (64.8%) were hypertensive, all poorly controlled. The mean glycated haemoglobin level (HbA1c) was 8.8% with 75 patients (70.1%) having HbA1c >7.0%, while the mean fasting blood glucose (FBG) was 9.4 mmol/l with 88 patients (81.5%) having FBG >6.0 mrnol/l. Dyslipidaemia was found in 101 patients (93.5%), 93 (86.1 %) having raised total cholesterol and 88 (81.5%) having raised LDL cholesterol. Fifty eight patients (53.7%) had hyperhomocysteinaemia with a mean homocysteine level of 11.6 urnol/l. Microalbuminuria was found in 17 patients (15.7%). All patients had at least two cardiovascular risk factors present (excluding diabetes itself), with 86 patients (79.6%) having at least five risk factors present, more in males than females. Conclusions:There is a high prevalence of vascular risk factors,frequently multiple, in patients with type 2 diabetes seen at KNH.