Prevalence and correlates of cardiac abnormalities amongst newly diagnosed Type 2 diabetes mellitus patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Background: Type 2 Diabetes Mellitus (T2DM) is a major risk factor for cardiovascular disease (CVD), the leading cause of mortality globally. Its prevalence is increasing globally and in Kenya; it is currently estimated at 3.3%, with the projection of reaching 4.5% by the year 2025. It has a long asymptomatic latent period (prediabetes) that is associated with increased risk of CVD. Incidence of CVD is 2-3 times higher in T2DM than in those without. Identifying underlying cardiac abnormalities at the time of diagnosis of T2DM by echocardiogram and electrocardiogram can guide timely interventions that prevent, reverse, or delay cardiovascular complications. Data on preexisting cardiac abnormalities amongst newly diagnosed T2DM patients in our setting is limited. Objective: To determine the prevalence and correlates of cardiac abnormalities amongst newly diagnosed T2DM patients seen at Moi Teaching and Referral Hospital (MTRH). Methods: This cross-sectional study was conducted between November 2021 and July 2022 at the MTRH diabetic clinic and medical wards.160 newly diagnosed (≤6months) T2DM patients were recruited using consecutive sampling. Sample size was calculated by Fishers Exact and Peduzzi formulae. Participants’ socio-demographic and clinical characteristics were captured on interviewer-administered structured questionnaires. The dependent variable was a composite of functional and structural cardiac abnormalities assessed for by echocardiogram and electrocardiogram. The independent variables were age, sex, smoking, HbA1C, body mass index, albuminuria, dyslipidemia, creatinine clearance, hypertension and calculated 10-year atherosclerotic CVD (ASCVD) risk. Continuous variables (Age, HbA1C, DM duration) were summarized as mean (SD) or median (IQR). Categorical variables such as ASCVD risk categories and smoking history were summarized as frequencies and proportions. Bivariate and multivariate logistic regression analysis was done to test for associations. Statistically significant variables (P value <0.05) on bivariate analysis were entered into a multivariable model and strength of association calculated as adjusted odds ratio with 95% confidence intervals. Results: Of the 160 participants recruited, the mean age was 56(SD±11) years, females were 85(53.1%), the median diabetes duration was 4 months and the mean HbA1c was 8.99%(SD±4).The prevalence of composite cardiac abnormalities was 54.7% (95%CI 47-63).Isolated functional and structural cardiac abnormalities were present in 83.8%(95%CI77.9-89) and 62.9%(95%CI 50-70) respectively. Prevalence of specific structural abnormalities was: Left ventricular hypertrophy (17.5%), ST segment abnormalities (6.9%), T wave abnormalities (51%) and wall motion abnormalities (13.2%). Functional abnormalities were present in: left ventricular systolic dysfunction (15%) left ventricular diastolic dysfunction [(LVDD) 66.87%], arrhythmias (37.1%) and conduction abnormalities (37.1%). In multivariate logistic regression analysis, only abnormal creatinine clearance (<90ml/min/1/73m2) was independently associated with composite cardiac abnormalities [odds ratio 2.43 (1.03-5.94)]. Conclusions: The prevalence of composite cardiac abnormalities was 54.7%, isolated structural and isolated functional cardiac abnormalities were present in 83.8% and 62.9% of the newly diagnosed T2DM participants respectively. LVDD and T wave abnormalities being the most prevalent .Abnormal creatinine clearance (<90ml/min/1/73m2) was independently associated with the composite cardiac abnormalities. Recommendations: Amongst newly diagnosed T2DM patients, early assessment for cardiac abnormalities is crucial, especially in the presence of abnormal creatinine clearance (<90ml/min/1.73m2).