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British Journal of Healthcare and Medical Research - Vol. 10, No. 6
Publication Date: December 25, 2023
DOI:10.14738/bjhmr.106.15943.
Nyirenda, C., Namfukwe, T., Maliko, C., Chinkoyo, S., Zulu, M., Maksoud, G., & Chimese, M. (2023). Prevalence and Pattern of
Complications Associated with Type 2 Diabetes Mellitus among Patients Presenting to a Tertiary Hospital in Zambia. British Journal
of Healthcare and Medical Research, Vol - 10(6). 118-126.
Services for Science and Education – United Kingdom
Prevalence and Pattern of Complications Associated with Type 2
Diabetes Mellitus among Patients Presenting to a Tertiary
Hospital in Zambia
Christopher Nyirenda
Copperbelt University, School of Medicine,
Department of Clinical Sciences Ndola, Zambia
Taonga Namfukwe
Copperbelt University, School of Medicine,
Department of Clinical Sciences, Ndola, Zambia
Catherine Maliko
Ndola Teaching Hospital,
Public Health Nursing School, Ndola, Zambia
Sebastian Chinkoyo
Copperbelt University, School of Medicine,
Department of Clinical Sciences, Ndola, Zambia
Mabvuto Zulu
Copperbelt University, School of Medicine,
Department of Clinical Sciences, Kitwe, Zambia
Gamal Maksoud
Copperbelt University, School of Medicine,
Department of Clinical Sciences, Ndola, Zambia
Mwinsa Chimese
Ndola Teaching Hospital,
Department of Medicine, Ndola, Zambia
ABSTRACT
Objective: To establish the prevalence and type of complications associated with
type 2 diabetes mellitus among patients reporting for care at the Ndola Teaching
Hospital. Design and Methods: The study team conducted a medical record based
retrospective study which primarily assessed clinicians’ compliance to the
recommended standards of management of diabetic patients. Further, the study
examined the records for the presence and type of complications reported among
the type 2 diabetic patients presenting for care. The study was undertaken at Ndola
Teaching Hospital, a tertiary referral hospital in the Copper belt province of Zambia.
The target population were adult male and female patients with type 2 diabetes.
The period under review was from January 2022 to December 2022. The sample
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119
Nyirenda, C., Namfukwe, T., Maliko, C., Chinkoyo, S., Zulu, M., Maksoud, G., & Chimese, M. (2023). Prevalence and Pattern of Complications
Associated with Type 2 Diabetes Mellitus among Patients Presenting to a Tertiary Hospital in Zambia. British Journal of Healthcare and Medical
Research, Vol - 10(6). 118-126.
URL: http://dx.doi.org/10.14738/bjhmr.106.15943.
size estimate was determined using the Cochrane formula and a systematic random
sampling procedure was applied to select the population of interest. A data
abstraction sheet was used to collect the relevant medical information suggesting
baseline characteristics and DMT2 associated complications. The type of
complications was recorded based on the clinical and laboratory examination
findings. The data was analyzed using excel and SPSS version 26. Results: Up to 90
eligible patient files representing the study subjects, 65.6% were female and 34.4%
were males. The age range of the sampled population was from 20 to 80 years with
most of the patients falling between 50-64 years representing about 34% and the
least age category of above 80 years representing 2.25% of the study subjects. The
mean age was 54 years. A number of files were devoid of a targeted comprehensive
physical examination assessment. For example, out of 90 patients sampled, (n=12,
13.3%) had comprehensive foot examination and only 28.9% had their eyes fully
examined. The most common complications associated with DMT2 were
retinopathy (n=19, 21.1%), nephropathy (n=15, 16.7%), neuropathy (n=12, 13.3%)
and coronary artery disease (n=10, 11.1%). Conclusion: Neurovascular
complications are relatively common among the type 2 diabetes mellitus patients
presenting for care at Ndola Teaching Hospital and do signify the need to optimize
the standard of care administered.
Keywords: Complications, Diabetes mellitus, Prevalence, Patterns
INTRODUCTION
Background to the Problem
Diabetes mellitus, a condition arising from a relative or absolute lack of the hormone insulin is
one of the major endocrinopathies known and a growing disease burden globally. The disease
is broadly classified into type 1 which usually develops in childhood or adolescence and the
type 2 previously referred to as adult onset and commonly associated with excess body weight
and physical inactivity and results from the body’s ineffective use of insulin. More than 95% of
people with diabetes have type 2 diabetes [1]. According to a World Health Organization (WHO)
report, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes
occurred before the age of 70 years in 2019. Another 460 000 kidney disease deaths were
caused by diabetes, and raised blood glucose caused around 20% of cardiovascular deaths [2].
In Zambia, DMT2 was becoming an emerging public health concern. As of 2008, estimates
indicated that Zambia maybe one of the countries with a high prevalence of non-communicable
diseases in the world [3]. A population-based survey conducted in Zambia in 2012 found the
prevalence of T2DM to be 2.1% among men and 3.0% among women [4].
Diabetes mellitus type 2 requires consistent long term follow up with reviews involving
comprehensive clinical assessments, laboratory works and appropriate therapeutic and
lifestyle measures administered per the expected prescribed standard of care. However,
delivery of adequate and appropriate clinical care to diabetic patients may be compromised by
the non-availability or inconsistent provision of the necessary resources for optimal care. This
may result in poor glycemic control increased morbidity and mortality among the affected
clients. Neurological, cardiovascular and renal complications associated with type 2 diabetes
may contribute significantly to poor clinical outcomes in the predisposed patients as suggested
by findings in one European based study [5]. Routine measurements such as blood glucose,
hemoglobin A1c (HbA1c), lipid determination, blood pressure measurement, annual eye and
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 6, December- 2023
Services for Science and Education – United Kingdom
albumin screening have proved to be effective in identifying and treating patients at risk. These
goals are expected to lead to a reduction in the burden of diabetes and its complications.
However, treatment is not consistently implemented in clinical practice guidelines. Such
guidelines may help well to improve health care, because they specify optimal management for
care providers and allow adherence to be monitored [6].
Negligence of certain screening tests in diabetes mellitus type 2 patients has been associated
with adverse outcomes including the development of significant micro and macro vascular
diseases, worsening of biochemical profile and causes mortality [7]. In resource limited settings
like Zambia, the care of patients with diabetes mellitus type 2 is often constrained by
inadequate human resource, high patient load, inadequate and inconsistent laboratory and
pharmacy supplies. This study therefore seeks to establish the prevalence and pattern of
complications associated with type 2 DM among patients presenting for care at a tertiary
hospital in Zambia
LITERATURE REVIEW
Diabetes mellitus is defined as a chronic disease that develops when the pancreas does not
produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin
is a hormone that regulates blood glucose. Hyperglycemia, which is a condition suggesting
raised blood sugar, is a common result of uncontrolled diabetes and over time leads to serious
damage to many of the body's systems, especially the nerves and blood vessels [1]. Diabetes
mellitus is one of the major metabolic diseases encountered and presenting significant
challenges to the health sector in both the developed and developing world populations due to
its increasing prevalence. It is the most common non-communicable disease worldwide and the
fourth to fifth leading cause of death in developed countries [8]. Diabetes mellitus is likely to
present a major health threat especially in the developing world due to poorly performing
economies and corresponding resource limitations in the health sector. Diabetes is a complex,
chronic illness requiring continuous medical care with multifactorial risk-reduction strategies
beyond glycemic control. Ongoing diabetes self-management education and support are critical
to preventing acute complications and reducing the risk of long-term complications. Significant
evidence exists that supports a range of interventions to improve diabetes outcomes [9].
Several long-term studies have shown that improved glucose control as a result of this
partnership can delay the onset and progression of many long-term complications in diabetes,
such as blindness, amputations and kidney disease, and thereby result in the avoidance of costs
related to such complications [10]. Taking control of diabetes to improve quality of life has put
the spotlight on the need for additional support and education for patients with type 2 diabetes.
The epidemic of Type 2 diabetes mellitus and its complications poses a major health threat
epidemic in nearly every population and it is proposed that without effective prevention and
control programs, the prevalence will continue to increase globally most likely as a result of
rising overweight and obesity rates, lifestyle, dietary changes, and an ageing population. The
occurrence of diabetes mellitus has not only affected developed countries but is on the rise in
low- and middle-income countries. However, the health systems in low- and middle-income
countries have mainly targeted healthcare provision for acute episodic conditions and not
medical care for chronic conditions [11]. The complications of diabetes mellitus have
traditionally been divided into macro vascular complications (for example, cardiovascular
disease (CVD)) and micro vascular complications (for example, complications affecting the