Diabetes Mellitus in Outpatients in Debre Berhan Referral Hospital, Ethiopia

Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients.

METHODS

An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment.

RESULTS

A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment.

CONCLUSIONS

The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.

Lived Experience of People with Type 1 Diabetes in North East Ethiopia; Psycho-Social and Economical Perspective, a Phenomenological Study

Objective

To explore lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective.

Methods

A descriptive phenomenological study was conducted to explore the lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective from March 02 to March 25, 2020. A heterogeneous purposive sample method was used to choose the participants. The lead investigator used an in-depth interview to collect data, using an audio recorder and an interview guide. The data were analysed using the thematic analysis method. Atlas. ti software version 7 was used to facilitate the data analysis process.

Results

A total of 13 participants were enrolled in this study. The participants age range were 14 to 70 years and their duration of diabetes since diagnosis were from 8 months to 16 years. The three interconnected themes that emerged from the analysis are: (1) psychological experience with two sub-themes (psychological problems due to diabetes including fear and coping strategies for psychological problems), (2) social experience, which has five categories (influence on intimate relationships, influence on social participation, disclosure status, social isolation and stigma, social support, and influence on education); and (3) economic experience.

Conclusion

Fear was one of the psychological experiences felt by people with type 1 diabetes. Although type 1 diabetes is a biomedical problem, it is also accompanied by other psychological and socio-economic issues, that require a holistic approach to address it. So, health professionals should strengthen health information dissemination programs.

In-Hospital Mortality and Its Predictors among Hospitalized Diabetes Patients: A Prospective Observational Study

Background. Diabetes mellitus (DM) is one of the leading health emergencies of the 21st century and among the top ten causes of death among adults globally in 2017. Although Ethiopia has been victimized by the growing prevalence of DM, data regarding in-hospital mortality among admitted diabetic patients in Ethiopia, specifically in Jimma Medical Center (JMC), are lacking. Objective. The aim of the study is to assess in-hospital mortality and its predictors among DM patients admitted to Jimma Medical Center. Methods. A hospital-based prospective observational study was employed involving 120 diabetes patients admitted to JMC from October 01, 2020, to June 30, 2021. Data were collected on variables related to the patient, disease, medication, and clinical outcomes. Data were entered into Epidata version 4.6.0.4 for cleaning and exported to SPSS version 23.0 for analysis. Kaplan–Mayer and cox-regression analyses were used to compare the survival experience and to determine the predictors of clinical outcomes, respectively. Hazard ratio with its two-sided $p$ value <0.05 was considered to declare the statistical significance. Result. Of 120 DM patients, 81 (67.5%) of them were males. The in-hospital mortality was 13.34% (16/120). Rural residence (AHR: 3.46; 95% CI (1.12, 9.81)), age (AHR: 1.03; 95% CI: (1.001, 1.059)), admission with diabetic ketoacidosis (AHR: 5.01; 95% CI (1.12, 21.88)), and multiple comorbidities: five comorbidities (AHR: 9.65; 95% CI (1.07, 19.59)) and six comorbidities (AHR: 14.02; 95% CI (1.74, 21.05)) were independently associated with in-hospital mortality. On the other hand, exposure to nonantidiabetic medications decreased the hazard of mortality by 86.5% (AHR: 0.135; 95% CI (0.04, 0.457)). Conclusion. This study showed the rate of in-hospital mortality was noticeably high. The study showed that rural residence, age, DKA, and having comorbidities (five and six) were the statistically significant predictors of in-hospital mortality. In contrast, the use of nonantidiabetic medications such as statins, ASA, and other antihypertensive agents before admission remained protective. Thus, proper strategies have to be devised to improve in-hospital mortality among admitted DM patients.

Prevalence and associated factors of visual impairment among adult diabetic patients visiting Adare General Hospital, Hawassa, South Ethiopia, 2022

BACKGROUND

The increased prevalence of visual impairment among diabetic patients has become a major public health problem. However, there was limited information on the extent of visual impairment among diabetic patients in our country, and there was no study in the study area. Providing updated data regarding this area is critical for the prevention of visual impairment among diabetic patients.

PURPOSE

The study aimed to assess the prevalence and associated factors of visual impairment among adult diabetic patients visiting Adare General Hospital, Hawassa, South Ethiopia, 2022.

METHODS

A hospital-based cross-sectional study was conducted on adult diabetic patients from May 30 to July 15, 2022, at Adare General Hospital, Hawassa, South Ethiopia. A systematic random sampling method was used to select 398 study participants. Data was collected through a face-to-face interview, a medical chart review, and an ocular examination. A binary logistic regression was performed to identify potential risk factors for visual impairment and their strength of association was expressed using an adjusted odds ratio with a 95% confidence interval. Variables with a P-value of < 0.05 were considered statistically significant.

RESULT

In this study, a total of 391 participants were involved, with a response rate of 98.2%. The prevalence of visual impairment was 28.6% (95% CI: 24.6-33.0). Age ≥ 60 years (AOR = 4.03, 95% CI: 1.72, 10.71), poor physical exercise (AOR = 3.26, 95% CI: 1.62, 6.53), poor glycemic control (AOR = 4.34, 95% CI: 2.26, 8.34), history of eye examination (AOR = 2.94, 95% CI: 1.50, 5.76), duration of diabetes ≥ 9 years (AOR = 4.78, 95% CI: 2.11, 10.83) and diabetic peripheral neuropathy (AOR = 3.01, 95% CI: 1.21, 7.50) were positively associated with visual impairment.

CONCLUSION

The study found a high prevalence of visual impairment among adult diabetic patients. Older age, longer duration of diabetes, poor physical exercise, poor glycemic control, history of eye examination, and diabetic peripheral neuropathy were significantly associated with visual impairment. Thus, regular physical activity, good control of glucose levels, and regular eye exams were recommended for all diabetic patients.

Self-care practice, lived experience of type 1 diabetes mellitus patients at Kemisse General Hospital, North Eastern Ethiopia: Phenomenological study

Objectives:

To explore self-care experience of type 1 diabetes mellitus patients at Kemisse General Hospital, North east Ethiopia.

Methods:

A phenomenological study was conducted to explore self-care experience of type 1 diabetes mellitus patients at Kemisse General Hospital from 28 February 2020 to 15 March 2020. Participants were selected using a heterogeneous type of purposive sampling technique. Data were collected using in-depth interviews and observation with the aid of an audio recorder and interview guide by the principal investigator. The thematic analysis approach was used to analyze the data. To facilitate the data analysis process, Atlas. ti software version 7 was used.

Results:

The six interconnected themes that were emerged from the analysis are: (1) physical exercise, (2) dietary practice, (3) medication adherence, (4) self-monitoring of blood sugar, (5) problem-solving skill during hypoglycemia and hyperglycemia, and (6) diabetic foot care.

Conclusion:

The study described that type 1 diabetic patients at Kemisse general hospital faced difficulty in self-care practice, which were difficulty in medication adherence; foot care was neglected diabetes self-care, did not practice diabetes recommended dietary plan and lack of regular physical exercises. In addition to this, self-monitoring of blood sugar was not practiced regularly due to the absence of glucometer machine and financial constraints to buy test strips. In addition to diabetic patient’s role to manage hyperglycemia and hypoglycemic episode, family support was crucial to managing hypoglycemia because most of the respondent’s experience loss of consciousness during a hypoglycemic attack.

Incidence and risk factors of gestational diabetes mellitus in Goba town, Southeast Ethiopia: a prospective cohort study

OBJECTIVE

Gestational diabetes mellitus (GDM) is becoming a public health concern in low/middle-income countries, and is known to cause severe morbidity and mortality for mothers and newborns. However, evidence reported for the incidence and risk factors of GDM is scant in Ethiopia. We aimed to assess the incidence of, and risk factors for, GDM in Goba town, Southeast Ethiopia.

DESIGN

Prospective cohort study.

SETTING

Goba town, Southeast Ethiopia.

PARTICIPANTS

Four hundred eighty pregnant women on antenatal care follow-up from 30 April to 30 September 2021.

PRIMARY AND SECONDARY OUTCOMES

Incidence and risk factors of GDM using fasting capillary blood glucose. Log-binomial model was used to identify the risk factors of GDM. Adjusted relative risk (aRR), along with 95% CIs, were calculated to estimate the strength of associations.

RESULTS

The cumulative incidence rate of GDM in this study was 15.7% (95% CI: 12.3% to 19.2%). Being unemployed (aRR=2.73; 95% CI: 1.36 to 5.47), having a family history of diabetes mellitus (DM) (3.01; 2.09 to 4.35), low physical activity (2.43; 1.11 to 5.32), inadequate dietary diversity (1.48; 1.29 to 1.92), anaemia (2.51; 1.32 to 3.54) and antenatal depression (4.95; 3.35 to 7.31) were significantly associated with GDM.

CONCLUSION

The cumulative incidence of GDM was relatively high among the study participants. Having antenatal depression symptoms, low physical activity, inadequate dietary diversity, being unemployed, anaemia and a family history of DM were significant risk factors for GDM.

Association of Cytotoxic T-Lymphocyte Antigen-4 Gene Polymorphism with Type 1 Diabetes Mellitus: In silico Analysis of Biological Features of CTLA-4 Protein on Ethiopian Population

BACKGROUND

T1DM is a chronic organ-specific T-cell-mediated autoimmune disease characterized by the selective destruction of β-cells in the islets of Langerhans, resulting in insulin deficiency and hyperglycemia. Genes for cytotoxic T lymphocyte-associated antigen 4 have been hypothesized as possible contender genes for T1DM vulnerability. However, it has not been studied in the Ethiopian population yet.

OBJECTIVE

The aim of the study was to investigate CTLA-4 exon 1 was linked to A49G polymorphism with T1DM and its biological features of CTLA-4 among T1DM patients, in Ethiopia.

METHODS

A case-control study was done from December 2019 to March 2020 on 210 study participants (105 T1DM patients and 105 healthy controls). Polymerase Chain Reaction amplification with forward and reverse primers was followed by restriction fragment length polymorphism and gel electrophoresis to determine gene polymorphism. Bioinformatics data of SNP was retrieved from National Centers for Biotechnology Information databases. The chi-square test and logistic regression were used. Statistical significance was defined as a P-value of less than 0.05.

RESULTS

The CTLA-4 (+A49G) gene polymorphism was observed on 56 (26.7%) study participants, 39 (18.57%) of T1DM patients, and 17 (0.08%) were controls. In T1DM and controls, the frequency of the A allele was 73.3% and 89.5%, while the G allele was 26.7% and 10.5%, respectively. The G allele was found to be associated with T1DM (OR=3.1; 95% CI, 1.82 -5.32; P=0.001). Statistical analysis revealed an association between the likelihood of T1DM and GG genotype of the CTLA-4 (+A49G) gene polymorphism (OR=3.11; 95% CI, 1.37-10.90; P=0.01). Further in silico analyzed the SNP to assess its biological features.

CONCLUSION

The study showed as CTLA-4 (+A49G) gene polymorphism is linked with T1DM in the Ethiopian population.

Metabolic risk factors for non-communicable diseases in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Non-communicable diseases (NCDs) are causing a new and yetsignificant health challenge in low-income countries. In Ethiopia, although 39% of deaths are NCD related, the health system remains underprepared, highlighting the clear need for evidence on risk factor distributions to inform resource planning and the health response. Therefore, this review investigates prevalence distributions and sex and age variations of metabolic risk factors among Ethiopian adults.

RESEARCH DESIGN AND METHODS

This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published until 6 January 2021 were searched from PubMed, Scopus, ProQuest and Web of Science databases, reference lists of selected studies and grey literature. Studies reporting prevalence of metabolic risk factors: overweight/obesity, hypertension, impaired glucose homoeostasis and metabolic syndrome among Ethiopian adults were eligible for this systematic review and meta-analysis. Two authors independently extracted data and used the Joanna Briggs Institute tool for quality appraisal. The random effects model was used to conduct meta-analysis using Stata V.16. Subgroup analyses examined prevalence differences by region, study year, sample size and settings.

RESULTS

From 6087 records, 74 studies including 104 382 participants were included. Most showed high prevalence of metabolic risk factors. Meta-analysis revealed pooled prevalence of metabolic risk factors from 12% to 24% with the highest prevalence observed for overweight/obesity (23.9%, 95% CI 19.9% to 28.0%) and hypertension (21.1%, 95% CI 18.7% to 23.5%), followed by metabolic syndrome (14.7%, 95% CI 9.8% to 19.6%) and impaired glucose tolerance (12.4%, 95% CI 8.7% to 16.1%). The prevalence of overweight/obesity was higher in women. All metabolic risk factors were higher among people aged above 45 years.

CONCLUSIONS

A signficant proportion of Ethiopian adults have at least one metabolic risk factor for NCDs. Despite heterogeneity of studies limiting the certainty of evidence, the result suggests the need for coordinated effort among policymakers, healthcare providers, non-governmental stakeholders and the community to implement appropriate preventive measures to reduce these factors.

Prevalence and risk factors of type-2 diabetes mellitus in Ethiopia: systematic review and meta-analysis

Diabetes mellitus (DM) is a public health problem in developing as well as developed nations. DM leads to many complications that are associated with higher morbidity and mortality worldwide. Therefore, the current study was planned to assess the prevalence and risk factors of type-2 DM in Ethiopian population. Six electronic databases such as: PubMed, Scopus, Hinari, Web of science, Google Scholar, and African Journals Online were searched for studies published in English up December 30, 2020. Newcastle-Ottawa Scale was used for quality assessment of the included studies. The data was extracted by Microsoft excel and analyzed through Stata version 16 software. The random effect meta-regression analysis was computed at 95% CI to assess the pooled prevalence and risk factors of type-2 DM. Forty observational studies were included in this systematic review and meta-analysis. The pooled prevalence of DM in Ethiopia was 6.5% (95% CI (5.8, 7.3)). The sub-group analysis revealed that the highest prevalence of DM was found in Dire Dawa city administration (14%), and the lowest prevalence was observed in Tigray region (2%). The pooled prevalence of DM was higher (8%) in studies conducted in health facility. Factors like: Age ≥ 40 years ((Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.05, 3.49)), Illiterate (AOR: 2.74 (95% CI: 1.18, 6.34)), Cigarette smoking (AOR: 1.97 (95% CI: 1.17, 3.32)), Body mass index (BMI) ≥ 25 kg/m² (AOR: 2.01 (95 CI: 1.46, 2.27)), family history of DM (AOR: 6.14 (95% CI: 2.80, 13.46)), history of hypertension (AOR: 3.00 (95% CI: 1.13, 7.95)) and physical inactivity (AOR: 5.79 (95% CI: 2.12, 15.77)) were significantly associated with type-2 DM in Ethiopian population. In this review, the prevalence of type-2 DM was high. Factors like: Older age, illiteracy, cigarette smoking, MBI ≥ 25, family history of DM, history of hypertension and physical inactivity were an identified risk factors of type-2 DM. Therefore, health education and promotion will be warranted. Further, large scale prospective studies will be recommended to address possible risk factors of type-2 DM in Ethiopian population.

Sleep Quality and Associated Factors Among Diabetes Mellitus Patients in a Follow-Up Clinic at the University of Gondar Comprehensive Specialized Hospital in Gondar, Northwest Ethiopia: A Cross-Sectional Study

INTRODUCTION

Diabetic mellitus has a negative impact on the quality of sleep. It is one of the leading public health conditions which can result in poor sleep quality. Poor sleep quality is an unreported and unrecognized problem which can affect the prognosis of diabetes patients.

OBJECTIVE

The aim of this study is to assess the prevalence of poor sleep quality and its associated factors among patients with diabetes mellitus attending follow-up clinics at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019.

METHODS

An institution-based cross-sectional study was conducted among 430 diabetes mellitus patients at the University of Gondar Comprehensive Specialized Hospital from February 1, 2020 to March 28, 2020. A systematic random sampling method was used to reach the study subjects. An interviewer-administered questionnaire was used for data collection. Pittsburgh sleep quality index was used for assessing sleep quality. To explain study variables, frequency tables and percentages were used. A binary logistic regression was conducted to see the relation between dependent and independent variables.

RESULTS

A total of 430 diabetes mellitus patients participated in the study with a response rate of 100%. The overall prevalence of poor sleep quality was 47.2%. Drinking alcohol (AOR = 2.45, 95% CI: 1.28-4.69), smokers (AOR = 6.26, 95% CI: 2.04-19.21), comorbidity (AOR = 1.80, 95% CI: 1.10-2.96), BMI ≥ 30 (AOR = 4.87, 95% CI: 1.07-22.09), having type 2 diabetes mellitus (AOR = 2.16, 95% CI: 1.04-4.50), poor glycemic control (AOR = 2.61, 95% CI: 1.81-4.81) and having depression (AOR = 9.95, 95% CI: 4.85-20.38) were associated with poor sleep quality.

CONCLUSION

In this study, nearly half of the patients had poor sleep quality. Drinking alcohol, smoking, comorbidities, higher BMI, type 2 diabetes mellitus, poor glycemic control and having depression were factors in poor sleep quality. Creating awareness of the need for weight reduction, minimizing alcohol intake, cessation of smoking, and improving sleep hygiene for DM patients would be effective management for improving poor sleep quality.

Health-related quality of life and associated factors among patients with diabetes mellitus at the University of Gondar referral hospital

Background

Diabetes mellitus, which has a wide range of effects on the physical, social and psychological aspects of the well-being of a person, is a common and challenging chronic disease that causes a significant rate of morbidity and mortality. However, studies in our country, by and large, focused on the impact of the disease in terms of mortality and morbidity alone. Therefore, the objective of this study was to assess the health-related quality of life (HRQOL) and associated factors of diabetic patients at the University of Gondar referral hospital, Ethiopia.

Methods

A facility-based cross-sectional study was conducted at the University of Gondar referral hospital from April to May 2017. A generic World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to measure the HRQOL. The data were analyzed by Stata version 12. Multiple Linear Regression analysis with P-value 0.05 was used to measure the degree of association between HRQOL and independent variables.

Results

A total of 408 patients with Diabetes Mellitus were included in the study. The HRQOL scores for physical, psychological, social and environmental domains were 50.9, 54.5, 55.8 and 47.3, respectively. Diabetes-related complications had a significant association with all except the psychological domain. Higher HRQOL was associated with exercising, following the recommended diet, foot care, sensible drinking and the absence of co-morbidities. However, old age, unemployment and being single and widower had a significant association with lower HRQOL.

Conclusion

The environmental and physical domains of HRQOL scores were the lowest compared to the social and psychological domains. Old age and living in rural area had a significant association with a lower HRQOL, whereas the absence of diabetes-related complications, exercising, general diet and foot care had a significant association with better HRQOL of patients. Therefore, strong advice on the recommended lifestyle is important, and old patients and rural dwellers should get due attention. In addition, the prevention of diabetes-related complications is important to improve the patient HRQOL which is an important outcome measurement from the patient’s perspective related to the impact of the disease. Therefore, including HRQOL assessment as part of routine management is necessary.

Prevalence and Associated Factors of Diabetes Mellitus in Hosanna Town, Southern Ethiopia

Background/Objectives

Diabetes is a global public health problem, and its burden is rising, particularly in developing countries. However, limited data is available from sub-Sahara African communities to assess and monitor the disease burden. The study aimed to determine the prevalence and associated factors of diabetes in Hosanna, Ethiopia.

Methods

A community-based cross-sectional study was conducted among 634 randomly selected adults in Hosanna. The study participants were recruited by multi-stage stratified sampling. A face-to-face interview using a structured questionnaire was administered by trained nurses. Anthropometry, blood pressure and fasting blood glucose levels were measured. Diabetes mellitus was considered when the fasting blood glucose level was ≥126 mg/dl on two separate measurements or when the participant self-reported a previous diagnosis of diabetes by healthcare providers or when the participant was currently receiving treatment for diabetes. Multi-variable binary logistic regression was used to identify factors associated with diabetes mellitus.

Findings

The overall prevalence of diabetes was found to be 5.7% (95% CI; 4.0-7.7), out of which more than one third (36%) were not aware of it prior to the survey. Nearly two thirds (61.1%) of the diabetic participants were also found to be hypertensive. In the multi-variable analysis, diabetes was associated with current alcohol use, sitting on average of more than 8 hours/day, abnormal BMI and being hypertensive.

Conclusion

The prevalence of diabetes among the adult population in the town is alarming. If appropriate measures to address the burden are not emplaced, it might result in serious complications to the patients and unnecessarily high costs to the health system of the country. Active screening for raised blood glucose level should be given due consideration, particularly in the community setting. Designing health education programs on the importance of physical activity and the risks of alcohol use should also be considered.

Prevalence of depression and its associated factors among patients with diabetes mellitus at Tirunesh-Beijing general hospital, Addis Ababa, Ethiopia

BACKGROUND

Depression is one of the common and overwhelming mental disorder in diabetic patients. A little is known about the prevalence and associated factors of depression among diabetic patients at general hospitals. Therefore, this study aimed to assess the prevalence and associated factors of depression among patients with diabetes mellitus at Tirunesh-Beijing General Hospital, Addis Ababa, Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from February 8 to April 8, 2019. A systematic random sampling technique was used to select 403 participants. Depression was assessed by using patient health questionnaire-9 (PHQ-9). Oslo 3 social support scale was used to assess social support. The data were entered into Epidata version 3.1 and analyzed by the statistical package for social science version 23 software. We computed bivariate and multivariate binary logistic regressions to assess factors associated with depression. Statistical significance was declared at P-value < 0.05.

RESULTS

A total of 403 study participants were interviewed with a response rate of 99%. The prevalence of depression among diabetic patients was 21.3%. In the final multivariate analysis, diagnosed with type II diabetes mellitus, being physically disabled and having poor social support were independent predictors of depression.

CONCLUSIONS

Type II diabetes mellitus, poor social support and physical disability were factors associated with depression. An early depression-focused regular screening for diabetic patient should be carried out by trained health professionals. Linkage with mental health service providers also needs to be considered. Clinicians needs to give emphasis to diabetic patients with physically disable and poor social support.

Abnormal Glucose Metabolism and Associated Risk Factors Among Adults in Mekelle City, Ethiopia

BACKGROUND

In the past decade, the prevalence of diabetes has grown more rapidly in low- and middle-income countries than in high-income countries. In 2019, Ethiopia is the fourth highest contributor to cases with diabetes in Africa with 1.7 million total cases. The present study was aimed to determine the prevalence of abnormal glucose metabolism and associated factors in Mekelle city, Northern Ethiopia.

METHODS AND MATERIALS

Community-based cross-sectional study was conducted among 321 randomly selected participants aged 20 years and above. Sociodemographic, lifestyle, clinical, and anthropometric data were collected in accordance with the STEPwise approach as recommended by the World Health Organization (WHO) for non-communicable disease (NCDs) surveillance. Blood glucose and lipid profiles were determined using a fasting venous blood sample. Bivariate and multivariable logistic regression analysis was used to identify factors associated with abnormal glucose metabolism. The level of statistical significance was set at p ≤0.05.

RESULTS

More than half (54.8%) of the participants were women with an overall mean (±SD) age of 39.0 (±14.2) years. The overall prevalence of pre-diabetes and diabetes was 12.5% and 9.3%, respectively, with a mean (±SD) fasting blood glucose of 97.42 (±38.03) mg/dL. More than two-thirds (70.0%) of adults with diabetes were not aware of being diabetes. Advanced age, hypercholesterolemia, medium and high rank of heart rate, and raised waist to height ratio were significantly associated with a higher risk of pre-diabetes, whereas having house servant, systolic hypertension, and hypercholesterolemia were significantly associated with diabetes.

CONCLUSION

We found a high prevalence of prediabetes and diabetes with more than two-thirds (70.0%) of newly diagnosed adults with diabetes, which showed a lack of awareness in the community. Awareness creation together with access to basic diagnostics in the primary health-care settings should therefore be a top priority to prevent its progression and complication.

Diabetes Mellitus and Its Association with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Diabetes mellitus (DM) is a growing public health concern globally, including Ethiopia. Although numerous studies have been published from different parts of Ethiopia, no attempt is made so far to estimate the burden of DM at the national level. This study aims to estimate the pooled prevalence of DM and its association with hypertension in Ethiopia.

METHODS

A systematic search was conducted in major databases. Two authors extracted the necessary data and analysis was conducted using STATA version 14. Heterogeneity across the studies was evaluated by Cochran's Q test and I² statistics.

RESULTS

Eighteen studies with a total of 45,284 participants were included in this review. The pooled prevalence of DM was 4.99% (95% CI: 3.86%, 6.11%). Hypertension was significantly associated with DM (OR: 8.32; 95% CI: 3.05, 22.71).

CONCLUSION

The burden of DM in Ethiopia is considerable, and the association between diabetes and hypertension is significant. Based on the evidence, this review recommends establishing the coordinated national programs that counteract the increasing burden of DM in the country is very essential. In addition, Early hypertension screening should be done in diabetic patients to control co-morbidity and further complications.

Hypoglycemic and Toxic Effect of Morus mesozygia Leaf Extract on the Liver and Kidneys of Alloxan-Induced Hyperglycemic Wistar Rats

Purpose

We investigated the hypoglycemic and toxic effect of Morus mesozygia leaf extract on the liver and kidneys of alloxan-induced hyperglycemic wistar rats.

Method

Phytochemical analysis was done. Diabetes was induced by the use of alloxan monohydrate in six groups of rats, i.e., 200 mg/kg, 400 mg/kg, 800 mg/kg, glibenclamide, normal saline, and normal control group. Blood glucose was measured at the time of inoculation, then at 1, 2, 3, and 4 hours after. After 14 days, rats were killed under anesthesia; blood collected for measurement of total protein, albumin, TAGs, cholesterol, AST, ALT, urea, and creatinine; and whole tissue of liver and kidneys used for histological studies.

Results

The extract possessed antidiabetic effects between 400 mg/kg and 800 mg/kg doses, which we attributed to the presence of flavonoids, tannins, terpenoids, and amino acids. There was a drop in total protein and albumin with no statistical significance (P ≥ 0.05). The changes in levels of ALT, TAGs, cholesterol, AST, creatinine, and urea were not statistically different from the standard diabetic drug. The extract was protective against histological damage as there were no significant lesions suggestive of toxicities in the liver and kidneys at doses below 800 mg/kg.

Conclusion

We established credible evidence that Morus mesozygia leaf extract has hypoglycemic effects between 400 mg/kg and 800 mg/kg and that it is safe on the liver and kidneys of wistar rats at doses less than 800 mg/kg.

Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia

Background

The burden of noncommunicable disease (NCD) in Africa is on a remarkable rise exacerbating the poor public health status affected by the existing but yet unsolved communicable disease. In Ethiopia, there is a paucity of evidence regarding prevalence and risk factors to NCD.

Objective

This study sought to determine the prevalence of risk factors of NCDs, prevalence of DM and HTN, and risk factors associated with diabetes mellitus (DM) and hypertension (HTN).

Method

This is an institution based cross-sectional study conducted on a sample of 411 clients attending a university-based comprehensive specialized hospital in Southern Ethiopia. The data was collected by using a pretested interviewer-administered questionnaire and observational checklist. Frequency, proportions, bivariate and multivariate logistic regression analysis was conducted using SPSS software version 20.

Result

We identified 64.2% of the clients had at least one of the risk factors to the NCDs. One-third (33.3%) had physical inactivity, whereas 20.2% had a BMI of ≥ 25%. The prevalence of DM and HTN was 12.2% and 10.5%, respectively. The multivariate analysis demonstrated that age ≥ 60 years, physical inactivity, higher BMI, and cigarette smoking were risk factors for at least one of the NCDs.

Conclusion

The prevalence of DM and prevalence of HTN were high. The magnitudes of risk factors to NCDs among the study population were substantial. Higher BMI, physical inactivity, low fruit and vegetable consumption, alcohol use, khat chewing, and cigarette smoking were among the prevailing risk factors identified.

Access to mobile phone and willingness to receive mHealth services among patients with diabetes in Northwest Ethiopia: a cross-sectional study

OBJECTIVES

This study aimed at determining access to mobile phone and willingness to receive mobile phone-based diabetes health services as well as identify associated factors in Northwest Ethiopia.

DESIGN

An institution-based cross-sectional survey was conducted from February to March 2016.

PARTICIPANTS

Systematic randomly selected 423 patients with diabetes.

SETTING

University of Gondar Hospital diabetic clinic.

MAIN OUTCOME MEASURES

The main outcome measure was willingness to receive diabetic health service via mobile phone voice call or messaging services.

RESULTS

Out of 423 patients with diabetes, 329 (77.8%) had access to a mobile phone. Among the latter, 232 (70.5%) were willing to receive mobile phone-based health services. The educational status of patients (adjusted OR (AOR): 2.6 (95% CI: 1.2 to 5.58)), route of medication (AOR: 3.2 (95% CI: 1.44 to 7.1)), transportation mechanism (AOR: 4.1 (95% CI: 1.2 to 13.57)), travel time to health facility (AOR: 0.3 (95% CI: 0.12 to 0.82)), current use of mobile phone as appointment reminder (AOR: 2.6 (95% CI: 1.07 to 6.49)) and locking mobile phone with passwords (AOR: 4.6 (95% CI: 1.63 to 12.95)) were significantly associated with the willingness to receive mobile phone-based diabetic health services.

CONCLUSION

Access to a mobile phone and willingness to receive mobile phone-based health services were high. Educational status, route of medication, transportation mechanism, time to reach the service, using mobile phone as appointment reminder and locking mobile phone with passwords were significantly associated factors. Given the high proportion of access and willingness of patients to receive mobile phone-based health services, mHealth interventions could be helpful.

The prevalence of macro and microvascular complications of DM among patients in Ethiopia 1990-2017: Systematic review

BACKGROUND

The prevalence of diabetes mellitus (DM) has been growing rapidly in the world. It is smashing particularly the lower and middle income countries (LMICs) severely. Due to its acute and chronic complications many lives have fallen under its bad shadow. Therefore, we aimed to review the existing evidence on major types and specific complications of DM among diabetic patients in Ethiopia.

METHODS

Both relevant quantitative and qualitative studies, conducted after 1990s, investigated and reported DM and complications from MEDLINE/PubMed, CINAHL, SCOPUS, DAOJ and Cochrane library databases were explored. In addition, System for Information for grey literature in Europe (SINGLE) database was investigated for the existence of unpublished grey literature. Total of 161 titles were identified and 17 studies met the inclusion criteria. Findings were narrated descriptively.

RESULTS

In this review 17 studies were included, and both macro and micro complications were summarized. Among the diabetic complications retinopathy, nephropathy, metabolic syndrome, impotence and depression were the main findings among diabetic patients in Ethiopia.

CONCLUSION

The burden of DM and its microvascular and macrovascular complications have been increasing among diabetic patients in Ethiopia. The increased duration of the diseases, lower socio economic level, existence of other complications, old age attributed the diabetic complications. Therefore, close monitoring and follow up of diabetic patients is necessary to reduce the incidence and prevalence of diabetic complications among the patients.

Comorbidity of depression and diabetes: an application of biopsychosocial model

Background

Type 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors.

Methods

Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis.

Results

Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score.

Conclusion

Biopsychosocial variables including marital status, negative life event in the last 6 months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-016-0106-2) contains supplementary material, which is available to authorized users.

Inhibition of the Unfolded Protein Response Mechanism Prevents Cardiac Fibrosis

Background

Cardiac fibrosis attributed to excessive deposition of extracellular matrix proteins is a major cause of heart failure and death. Cardiac fibrosis is extremely difficult and challenging to treat in a clinical setting due to lack of understanding of molecular mechanisms leading to cardiac fibrosis and effective anti-fibrotic therapies. The objective in this study was to examine whether unfolded protein response (UPR) pathway mediates cardiac fibrosis and whether a pharmacological intervention to modulate UPR can prevent cardiac fibrosis and preserve heart function.

Methodology/Principal Findings

We demonstrate here that the mechanism leading to development of fibrosis in a mouse with increased expression of calreticulin, a model of heart failure, stems from impairment of endoplasmic reticulum (ER) homeostasis, transient activation of the unfolded protein response (UPR) pathway and stimulation of the TGFβ1/Smad2/3 signaling pathway. Remarkably, sustained pharmacologic inhibition of the UPR pathway by tauroursodeoxycholic acid (TUDCA) is sufficient to prevent cardiac fibrosis, and improved exercise tolerance.

Conclusions

We show that the mechanism leading to development of fibrosis in a mouse model of heart failure stems from transient activation of UPR pathway leading to persistent remodelling of cardiac tissue. Blocking the activation of the transiently activated UPR pathway by TUDCA prevented cardiac fibrosis, and improved prognosis. These findings offer a window for additional interventions that can preserve heart function.