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Undiagnosed Diabetes Mellitus and Related Factors in East Gojjam (NW Ethiopia) in 2016: a Community-Based Study

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Undiagnosed Diabetes Mellitus and Related Factors in East Gojjam (NW Ethiopia) in 2016: a Community-Based Study Journal of Public Health Research 2017; volume 6:834 Article Undiagnosed diabetes mellitus and related factors in East Gojjam (NW Ethiopia) in 2016: a community-based study Amsalu Taye Wondemagegn,1 Habtamu Mellie Bizuayehu,2 Dagninet Derebe Abie,3 Getachew Mengistu Ayalneh,4 Tenaw Yimer Tiruye,2 Mequanint Taddele Tessema2 1Department of Biomedical Science, School of Medicine, Debre Markos University; 2Department of Public Health, College of Health Sciences, Debre Markos University; 3Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University; 4Department of Medical Laboratory, College of Health Sciences, Debre Markos University, Ethiopia Conclusions. In conclusion, this study revealed a relatively Significance for public health high prevalence of undiagnosed DM in the study area. The occur- Currently, diabetes is the second most common non-communicable disease rence of undiagnosed DM was significantly higher when associat- in Ethiopia. Its burden is 4.8% in this country, though three quarter of its ed with the age of the participants, their marital status, history of population live with undiagnosed diabetes mellitus (DM), which could lead hypertension, diabetes family history, history of gestational dia- to several complications such as heart failure, blood vessels, eyes, kidneys, betes mellitus, current smoking practices and sedentary behaviour. and nerves damages. Evidence shows that the disease is increasing through Thus, efforts have to be made, particularly by the individuals time. Early detection of DM is vital for a timely intervention to prevent life- involved in health practice, to early detect the disease and thereby threatening complications. Efforts should be made by politicians, decision makers and other healthy institutions to implement screening modality and initiate a suitable therapeutic service, before complications arise early interventions. Introduction Abstract Diabetes is a chronic metabolic disease characterised by long- lasting hyperglycaemia, that occurs either when the pancreas does Introduction. Currently, diabetes is the second most common not produce enough insulin or when the body cannot effectively non-communicable disease (NCD) in Ethiopia. Its burden is 4.8% use the insulin it produces. Insulin is a hormone secreted by the in this country, even though three quarter of its population live pancreas that regulates blood sugar. When the body can’t produce with undiagnosed diabetes mellitus (DM), which causes compli- enough insulin or can’t use the insulin it makes, it results in high cations like heart failure, blood vessels, eyes, kidneys and nerves blood sugar values that lead to frequent urination, increased thirst damages. Early detection of DM is vital for a timely intervention and hunger.1,2 The International Diabetes Federation (IDF) esti- to prevent these life threatening complications. The aim of this mates that about 387 million (8.3%) people lived with diabetes in study was to assess the prevalence of undiagnosed DM and related 2014 and the number of individuals is expected to rise by 53% in factors in East Gojjam, North West Ethiopia, in 2016. 2035, which means 592 million cases.3,4 Materials and methods. A community-based cross-sectional Diabetes is the 4th cause of death globally. The overall risk of study was conducted among 757 individuals in East Gojjam from dying among people with diabetes at young age is double com- June to September 2016. The sampled population was selected pared with those without diabetes.3 Every 7 seconds, one person using multi-stage cluster sampling method. Basic data were col- dies because of diabetes-related cause. The overall diabetes-relat- lected in Amharic (local language) and a pretested interviewer ed death was 4.9 million per year worldwide.4,5 About eight every administered the questionnaire. Peripheral blood samples were ten people with diabetes (77%) live in low- and middle-income collected by puncturing the ring finger in order to measure fasting countries. blood glucose. Univarite and multivariate logistic regressions In Africa, this disease affected 21.5 million (5.1%) people in analysis were performed using Statistical Package for Social 2014 and is expected to raise to 41.5 million in 2035, with an Sciences (SPSS) software version 20.0. increase of 93%. Hence, the current 5.1% would rise to 5.3% in Results. The percentage of undiagnosed DM in the study area 2035. The total diabetes related death was 480,900 per year in the was 11.5% (95%CI=9.2, 13.7). The prevalence was 11.3% among region. Three quarter cases (75.1%) were dying <60 y.o., which is male vs. 11.8% among female; 13.4% in urban areas vs. 10.3% in highest percentage of deaths under the age of 60 globally.4,5 rural areas. The occurrence of undiagnosed DM was mainly asso- Ethiopia is one of the countries mostly affected by the disease. ciated with older age (AOR=5.99, 95%CI=1.54, 23.24), family According to the 2014 report of IDF, the number of adults aged history of diabetes (AOR=9.86, 95%CI=4.25, 22.89), history of 20-79 years, living with diabetes in the country was 2.135 million gestational diabetes (AOR=3.01, 95%CI=1.17, 8.39) and seden- (4.8%). The total diabetes related death was 34,262 in the tary behaviour >4 hours per day (AOR=2.13, 95%CI=1.04, 4.34). country.4,5 Being non-smoker (AOR=0.05, 95%CI=0.01, 0.17) and unmar- In North West Ethiopia, Gondar, the prevalence of the disease ried (AOR=0.09, 95%CI=0.02, 0.42) were also predictive charac- was 2.1% in rural areas and 5.1% in urban areas.6 Similarly, the teristics for undiagnosed DM in the study area. prevalence of the disease was 8% and 0.5% in Southern and [page 18] [Journal of Public Health Research 2017; 6:834] Article southwest Ethiopia respectively.7,8 In central Ethiopia, Addis different literatures. The questionnaire was translated into local Ababa, the percentage of the disease was 6.5% among Commercial language and back translated in English to maintain consistency. Bank employees.9 The disease was accounting 20% of the cases Background data were collected trough an interviewer-adminis- among patients admitted in Hospitals located in Addis Ababa, tered questionnaire. For laboratory data, fasting blood glucose was Ethiopia, which is the second most common non-communicable measured as per the WHO recommendations.11 Early in the morn- disease (NCD).10 To cure the disease about 612.2 billion US dol- ing before participants took their breakfast, peripheral blood sam- lars were used in 2014, which represent 11% of worldwide health- ples on the ring finger was punctured and collected. Plasma glu- care expenditure. This healthcare expenditure is expected to rise by cose levels was then measured using the glucose oxidase-6 phos- 627.3 billion in 2035. Africa allocates the lowest diabetes-related phate dehydrogenase method.12 Participants were classified as expenditure, 1% of worldwide total. About US $ 4.5 billion health- having DM if they had fasting glucose levels >126 mg/dL, which care expenditure was used in 2014 and this cost is expected to rise was confirmed by repeating the test on am different day.11 For data to 6.4 billion in 2035. Ethiopia is allocating about US $ 32.7 per collection and daily supervision, laboratory professionals were person.4,5 recruited from West Gojjam (a different zone) in order not to rec- The complications of DM become very severe in absence of an ognize the respondents and minimize social desirability bias. They early diagnosis. In case of severe complications, 50% of patients were trained by a principal investigator about the objective of the don’t know having DM. In 2014 about 179.2 million people world- study, confidentiality of information, blood sample taking and test- wide lived with undiagnosed DM.3 ing and about the contents of the questionnaire in detail. The out- Africa region has highest percentage of undiagnosed people come variable of study was undiagnosed DM and the independent compared to other regions. About 62.3% of persons with the dis- variables were: socio-demographic and economic characteristics eases do not know being affected by DM and about 13.4 million like age, sex, weight, height, residence, marital status, religion, people were recorded to have undiagnosed DM in 2014.4,5 educational level, income; behavioural characteristics like smok- Similarly, Ethiopia has three quarter persons (75.1%) with DM, ing, alcohol drinking, eating of vegetables and fruits, physical who do not know having it; which is about 1,603,100 people in activity status, sedentary behaviour; history of hypertension, histo- 2014.4,5 In Gondar, north west Ethiopia, about 69% individuals ry of gestational diabetes, family history of DM and others. 6 live with undiagnosed DM. As far as we know, no prior study has Operational definition been conducted in the current study area. Moreover, the level of knowledge is essential to decide whether the problem is significant Physical activity commonly refers to physical movement that or not and to give proper attention before complications occur. will improves health. Physical activity data were collected using Therefore, the present study was mainly aimed at determining the Global Physical Activity Questionnaire (GPAQ) and activity levels level of undiagnosed DM and to identify factors related to its were calculated by using the cut-off points in the analysis guide.13 occurrence. Accordingly, the subjects were categorized as having low physical activity [metabolic equivalent units (MET) <600/week], moderate physical activity [MET in between 600-1200] and high physical activity level [MET above 1200]. Materials and Methods On the other hand, sedentary behaviour was measured by ask- ing about the time spent sitting (computer use, working, watching Study design and setting television, reading) during a typical week.13 Lastly, responses were dichotomized as <4 hours/day and ≥4 hours/day.
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