PREVALENCE OF DIABETIC COMPLICATIONS IN NEWLY DIAGNOSED TYPE 2 DIABETES PATIENTS IN PAKISTAN: FINDINGS FROM NATIONAL REGISTRY

Authors

  • Fareed Uddin National Institute of Diabetes and Endocrinology
  • Beena Ali sanofi-aventis Pakistan limited
  • Nabeea Junaid sanofi-aventis Pakistan limited

Abstract

Background: This study was conducted to assess the prevalence of micro- and macrovascular complications in patients with newly diagnosed type 2 diabetes (T2DM) in Pakistan. Methods: In this multicentre, observational, cross-sectional disease registry, patients (aged ≥18 years) who were diagnosed at enrolment with T2DM, defined by fasting blood glucose (FBG) ≥126 mg/dL and/or glycated haemoglobin (HbA1c) ≥6.5%, were enrolled. Microvascular complications were ascertained by objective examination while macrovascular complications were identified from patients’ medical history. Descriptive statistics were used for data analysis. Results: Data from 891 patients were analysed in the study. Mean [±standard deviation (SD)] HbA1c, FBG, and random blood glucose were 9.9% (±2.2%), 193.4 (±74.0) mg/dL, and 294.3 (±72.7) mg/dL, respectively. Obesity (n=689, 77.3%) and familial history of diabetes (n=575, 64.3%) were the most common risk factors for T2DM. Overall prevalence of micro- and macrovascular complications was 68.6% [n=611, 95% confidence interval (CI): 65.4–71.5] and 9.0% (n=80, 95% CI: 7.3–11.0), respectively. Neuropathy, nephropathy, and retinopathy were reported in 59.6% (95% CI: 56.3–62.8), 24.4% (95% CI: 21.6–27.2), and 15.9% (95% CI: 13.7–18.5) of the patients, respectively. Oral antidiabetic agents and insulin were prescribed to 839 (94.2%) and 140 (15.7%) patients, respectively. All study patients received education on T2DM management, mostly from the investigators, and also from diabetes educators and nurses. Conclusions: The prevalence of micro- and macrovascular complications of T2DM is high, indicating a delay in diagnosis of disease. In order to counter the burden of diabetic complications, optimum strategies for screening of the general population are required.Keywords: Type 2 diabetes mellitus; Complications; retinopathy; neuropathy; nephropathy; myocardial infarction; stroke; acute coronary syndrome; peripheral arterial disease; Pakistan

Author Biographies

Fareed Uddin, National Institute of Diabetes and Endocrinology

MBBS, Diploma in Diabetes and MSBEContact DetailsPostal address: H. No. 1-A-12/1-A, Nazimabad, Karachi, Pakistane-mail addresses: f.uddin@duhs.edu.pkphone number: +92-333-2183716

Beena Ali, sanofi-aventis Pakistan limited

MBBS; Senior Medical Manager

Nabeea Junaid, sanofi-aventis Pakistan limited

Clinical Operations Manager @ sanofi

References

International Diabetes Federation. IDF Diabetes Atlas – 8th Edition. 2017 [Internet]. [cited 2017 Dec 8]. Available from: http://www.diabetesatlas.org/across-the-globe.html

WHO. Top 10 causes of death, 2015. [Internet]. Geneva, Switzerland: WHO, 2017. [cited 2017 Dec 8]. Available from: http://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/

WHO. Global Report on Diabetes, 2016 [Internet]. Geneva, Switzerland: WHO, 2016. [cited 2018 Jan 21]. Available from: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf?ua=1&utm_source=blog&utm_campaign=rc_blogpost

Shera AS, Rafique G, Khwaja IA, Ara J, Baqai S, King H. Pakistan national diabetes survey: prevalence of glucose intolerance and associated factors in Shikarpur, Sindh Province. Diabet Med 1995;12(12):1116–21.

Shera AS, Rafique G, Khawaja IA, Baqai S, Khan IA, King H. Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in Baluchistan province. Diabetes Res Clin Pract 1999;44(1):49–58.

Shera AS, Rafique G, Khwaja IA, Baqai S, Khan IA, King H. Pakistan National Diabetes Survey prevalence of glucose intolerance and associated factors in North West at Frontier Province (NWFP) of Pakistan. J Pak Med Assoc 1999;49(9):206–11.

Basit A, Hydrie MZ, Ahmed K, Hakeem R. Prevalence of diabetes, impaired fasting glucose and associated risk factors in a rural area of Baluchistan province according to new ADA criteria. J Pak Med Assoc 2002;52(8):357–60.

Jafar TH, Levey AS, White FM, Gul A, Jessani S, Khan AQ, et al. Ethnic differences and determinants of diabetes and central obesity among South Asians of Pakistan. Diabet Med 2004;21(7):716–23.

Shera AS, Jawad F, Maqsood A. Prevalence of diabetes in Pakistan. Diabetes Res Clin Pract 2007;76(2):219–22.

Shera AS, Basit A, Fawwad A, Hakeem R, Ahmedani MY, Hydrie MZ, et al. Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan. Prim Care Diabetes 2010;4(2):79–83.

Mahar PS, Awan MZ, Manzar N, Memon MS. Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study. J Coll Physicians Surg Pak 2010;20(8):528–32.

Zafar J, Bhatti F, Akhtar N, Rasheed U, Bashir R, Humayun S, et al. Prevalence and risk factors for diabetes mellitus in a selected urban population of a city in Punjab. J Pak Med Assoc 2011;61(1):40–7.

Meo SA, Zia I, Bukhari IA, Arain SA. Type 2 diabetes mellitus in Pakistan: current prevalence and future forecast. J Pak Med Assoc 2016;66(12):1637–42.

Heydari I, Radi V, Razmjou S, Amiri A. Chronic complications of diabetes mellitus in newly diagnosed patients. Int J Diabetes Mellit 2010;2:61–3.

Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev 2013;93(1):137–88.

Tanzil S, Jamali T. Obesity, an emerging epidemic in Pakistan – a review of evidence. J Ayub Med Coll Abbottabad 2016;28(3):597–600.

American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care 2015;38:S8–16.

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87(1):4–14.

Litwak L, Goh SY, Hussein Z, Malek R, Prusty V, Khamseh ME. Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multination A1chieve study. Diabetol Metab Syndr 2013;5(1):57.

Gedebjerg A, Almdal TP, Berencsi K, Rungby J, Nielsen JS, Witte DR, et al. Prevalence of micro- and macrovascular diabetes complications at time of type 2 diabetes diagnosis and associated clinical characteristics: a cross-sectional baseline study of 6958 patients in the Danish DD2 cohort. J Diabetess Complications 2018;32(1):34–40.

Deepa DV, Kiran BR, Gadwalkar SR. Macrovascular and microvascular complications in newly diagnosed type 2 diabetes mellitus. Indian J Clin Pract 2014;25:644–8.

Gill HK, Yadav SB, Ramesh V, Bhatia E. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus. J Postgrad Med 2014;60(3):270–5.

Kostev K, Jockwig A, Hallwachs A, Rathmann W. Prevalence and risk factors of neuropathy in newly diagnosed type 2 diabetes in primary care practices: a retrospective database analysis in Germany and U.K. Prim Care Diabetes 2014;8(3):250–5.

Lakhiar MA, Shahbaz NM, Bughio AH, Prakash J. Frequency of peripheral neuropathy in newly diagnosed patients of diabetes mellitus II on clinical and electrophysiological basis. Pak J Neurol Sci 2014;9(4):31–5.

Jammal H, Khader Y, Alkhatib S, Abujbara M, Alomari M, Ajlouni K. Diabetic retinopathy in patients with newly diagnosed type 2 diabetis mellitus in Jordan: prevalence and associated factors. J Diabetes 2013;5(2):172–9.

Kostev K, Rathmann W. Diabetic retinopathy at diagnosis of type 2 diabetes in the UK: a database analysis. Diabetologia 2013;56(1):109–11.

Bansal D, Gudala K, Esam HP, Nayakallu R, Vyamusani RV, Bhansali A. Microvascular complications and their associated risk factors in newly diagnosed type 2 diabetes mellitus patients. Int J Chron Dis 2014;2014:201423.

Chowdhury SR, Thomas RL, Dunseath GJ, Peter R, Rees DA, North RE, et al. Diabetic retinopathy in newly diagnosed subjects with type 2 diabetes mellitus: contribution of ß-cell function. J Clin Endocrinol Metab 2016;101(2):572–80.

Wahab S, Mahmood N, Shaikh Z, Kazmi WH. Frequency of retinopathy in newly diagnosed type 2 diabetes patients. J Pak Med Assoc 2008;58(10):557–61.

Jamil K, Iqbal Y, Zia S. and Khan QA. Frequency of retinopathy in newly diagnosed patients of type 2 diabetes mellitus. Pak J Ophthalmol 2014;30(1):38–41.

Khan KA, Kamran SM, Qureshi MN, Jamal Y. Frequency of retinopathy in newly diagnosed patients of type 2 diabetes mellitus (DM). Pak Armed Forces Med J 2015;65:63–7.

Sosale A, Prasanna Kumar KH, Sadikot SM, Nigam A, Bajaj S, Zargar AH, et al. Chronic complications in newly diagnosed patients with type 2 diabetes mellitus in India. Indian J Endocrinol Metab 2014;18(3):355–60.

Zoungas S, Chalmers J, Ninomiya T, Li Q, Cooper ME, Colagiuri S, et al. Association of HbA1c lvels with vascular complications and death in patients with type 2 diabetes: incidence of glycaemic thresholds. Diabetologia 2012;55(3):636–43.

Ali A, Iqbal F, Taj A, Iqbal Z, Amin MJ, Iqbal QZ. Prevalence of microvascular complications in newly diagnosed patients with type 2 diabetes. Pak J Med Sci 2013;29(4):899–902.

UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352(9131):837–53.

Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358(24):2560–72.

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009;360(2):129–39.

Brown N, Critchley J, Bogowicz P, Mayige M, Unwin N. Risk scores based on self-reported or available clinical data to detect undiagnosed type 2 diabetes: a systematic review. Diabetes Res Clin Pract 2012;98(3):369–85.

Salinero-Fort MA, Burgos-Lunar C, Lahoz C, Mostaza JM, Abanades-Herranz JC, Laguna-Cuesta F, et al. Performance of the Finnish Diabetes Risk Score and a simplified Finnish Diabetes Risk Score in a community-based, cross-sectional programme for screening of undiagnosed type 2 diabetes mellitus and dysglycaemia in Madrid, Spain: the SPREDIA-2 study. PLoS One 2016;11(7):e0158489.

Riaz M, Basit A, Hydrie MZ, Shaheen F, Hussain A, Hakeem R, et al. Risk assessment of Pakistani individuals with diabetes (RAPID). Prim Care Diabetes 2012;6(4):297–302.

Ishaque A, Shahzad F, Muhammad FH, Usman Y, Ishaque Z. Diabetes risk assessment among squatter settlements in Pakistan: a cross-sectional study. Malays Fam Physician 2016;11(2-3):9–15.

Published

2019-01-15