Prevalence and determinants of undiagnosed diabetes mellitus among patients presenting for elective surgery at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Diabetes mellitus (DM) is a group of metabolic disorders characterized by chronic hyperglycemia due to defects in insulin secretion, action, or both. The International Diabetes Federation estimates that over 10.5% of adults aged 20–79 years globally have diabetes, with half undiagnosed. In Kenya, the true prevalence is unclear, and the reported 3% likely underestimates the burden. Routine diabetes screening is uncommon, particularly among elective surgical patients. Known risk factors include age, overweight/obesity, physical inactivity, poor diet, family history, and comorbidities such as hypertension and dyslipidaemia. However, local evidence on these determinants remains limited, underscoring the need to assess undiagnosed diabetes among elective surgical patients. Objective: To determine the prevalence of undiagnosed DM and describe the social, demographic, economic, lifestyle and clinical factors associated with undiagnosed DM among patients presenting for elective surgery at Moi Teaching and Referral Hospital (MTRH). Methods: This was a descriptive cross-sectional study conducted in four surgical wards of MTRH (Kilimanjaro, Longonot, Rehema, and Sergoit). A total of 540 adult patients (≥18 years) admitted for elective surgery with unknown diabetes status were recruited through consecutive sampling. Data was collected using a structured questionnaire and clinical measurements, including fasting plasma glucose. Undiagnosed diabetes mellitus was defined as fasting plasma glucose ≥7.0 mmol/L with no prior history of diabetes. Ethical approval was obtained from the Institutional Research and Ethics Committee (IREC) of Moi University/MTRH, and permission to undertake the study was granted by hospital management. Written informed consent was obtained from all participants. Data were analyzed using SPSS version 20. Descriptive statistics were used to summarize variables as frequencies and percentages (n, %). Associations were assessed using binary logistic regression, with results presented as odds ratios (OR) and 95% confidence intervals (CI). Statistical significance was set at p<0.05. Results: The prevalence of undiagnosed DM among patients presenting for elective surgery in MTRH was 3.5%. The highest prevalence was found in the age group 36-55 years, with a rate of 6.3%. Single individuals exhibited a significantly higher likelihood of undiagnosed DM (p-value of 0.029). Additionally, business persons and those employed portrayed a higher likelihood of undiagnosed DM with statistically significant associations (p-values of 0.04, 0.01 and 0.02 respectively). Although clinical, lifestyle and dietary factors were found to be associated with the undiagnosed DM, these relationships were not statistically significant. Conclusion: There is a higher proportion of persons with undiagnosed diabetes among those presenting for elective surgery at MTRH compared to the general population. Among those presenting for elective surgery, the middle-aged, and employed are at a higher risk of undiagnosed diabetes. Recommendations: Routine screening is recommended in all adults undergoing elective surgery at the Moi Teaching and Referral Hospital and similar healthcare facilities to enable early detection and appropriate management of undiagnosed diabetes. The Ministry of Health Kenya should incorporate opportunistic diabetes screening into national guidelines and strengthen implementation across hospital settings