Retinopathy, nephropathy, neurological complications and risk profile in recently diagnosed type 2 diabetics at Kenyatta National Hospital

Abstract

Background: Type 2 diabetes is an increasingly important health problem in Kenya. As type 2 diabetes is characterised by a variable period of metabolic abnormalities prior to clinical diagnosis, microvascular complications may be present at or soon after the diagnosis of diabetes. The microvascular complications cause significant morbidity and even mortality yet their development and progression is largely preventable through modification of associated modifiable risk factors such as smoking, dyslipidemias, hypertension and hyperglycaemia. Their most effective management is therefore through primary and secondary intervention measures. There is no local data as to the prevalence of these complications and risk factors in the recently diagnosed type 2 diabetics. Objectives: The aim of this study was to determine the prevalence of diabetic retinopathy, polyneuropathy, autonomic neuropathy and microalbuminuria as a marker of nephropathy in type 2 diabetic patients, and the prevalence of some associated risk factors within 2 years of the clinical diagnosis of diabetes. Materials and methods: This was a cross sectional descriptive study undertaken in the diabetic outpatient clinic of Kenyatta National Hospital. Type 2 diabetic patients were recruited and underwent a clinical evaluation and screening for retinopathy, polyneuropathy, autonomic neuropathy and nephropathy. Laboratory tests undertaken were fasting blood sugar, glycated haemoglobin Alc, lipid profile, serum creatinine and a semiquantitative microalbuminuria assay. Results: 100 patients were studied. The mean age of the patients was 53.7 + 9.3 years. Family history of diabetes and hypertension was present in 48% and 24% of the patients respectively. 28% of the patients had a smoking record although current smokers were 7%. Obesity was frequently seen with 66% classifying as obese and this was preponderant in females (p<0.05). Hypertension was noted in 50% of which 24% were newly detected, none of the hypertensives was achieving optimal blood pressure control. Ideal glycaemic control was being achieved in only 29% of the patients. Dyslipidemias were also frequently observed. Diabetic polyneuropathy was present in 28%, autonomic neuropathy in 27%, albuminuria in 26% and retinopathy in 7%. Over 50% of the patients presented with at least one complication. Conclusion: The prevalence of microvascular complications is already quite high at or soon after diagnosis of type 2 diabetes in our patients. They have also a high prevalence of associated modifiable risk factors. Prevention strategies are warranted and justified by the high prevalences at primary, secondary and tertiary levels.