Prevalence and risk factors for undiagnosed diabetes mellitus among patients seen in Thika Level 5 Hospital in Kiambu County, Kenya

Abstract

Background: Globally, about 537 million people have Diabetes Mellitus (DM), the majority (70%) living in low- and middle-income countries while 1.5 million deaths are directly attributed to DM each year. The burden is forecasted to be at 643 million by the year 2030. In Africa, the proportion of undiagnosed DM stands at 53.7%. According to estimates, 43.7% of Kenyans with DM have not received a diagnosis. Opportunistic screening is important in lowering the proportion of undiagnosed DM as well as reducing the latent period of DM during which there are no symptoms. The late diagnosis and treatment of DM is linked with the increased occurrence of acute and chronic complications, highlighting the need for early diagnosis of DM. Objectives: To determine the prevalence of undiagnosed DM, level of physical activity extent of alcohol and tobacco consumption, level of knowledge of DM in patients attending Thika Level 5 Hospital, Kiambu County. Methods: A cross-sectional study utilizing both quantitative and qualitative approaches was conducted in Thika Level 5 Hospital. A sample size of 375 adult patients presenting at the outpatient department were purposively selected as they exited the consultation rooms. A modified WHO STEPS was used to collect quantitative data while an FGD guide was used to collect qualitative data. Random blood sugar was done as part of the survey and those with a random blood sugar ≥ 7.8 mmol/l were requested to return for a fasting blood sugar, a cut-off of ≥7.0 mmol/l established a DM diagnosis. Qualitative data was collected through four Focus Group Discussions (FGDs) using an FGD guide. The Statistical Package for Social Sciences (SPSS) was used to analyze data. Univariate analysis and comparative analysis were used to analyze quantitative data and show the association between DM and body mass indices respectively. Logistic regression was used to measure the relationship between undiagnosed DM and the various risk factors. Results: About 3.2% of the participants had undiagnosed DM. There was a family history of DM in 33.3% (p=0.042) of the participants with DM. Participants aged 60 years and above had the highest percentage of those diagnosed with DM (33.3%, p=0.003), versus those without. Seven of the DM participants had elevated blood pressure (p= 0.007) indicating a strong correlation of an elevated blood pressure and DM. Findings from FGDs indicated that there was limited knowledge of DM. Conclusion: Elevated diastolic blood pressure above 90 mmhg, family history of DM and age above 60 years showed significant association with undiagnosed DM. Recommendation: There should be targeted DM screening for patients presenting in the outpatient department with elevated blood pressure, those aged 60 years and above, and those with a family history of DM.