Abstract:

Background: Estimated number of adults living with diabetes mellitus will be 552 million worldwide by 2030. Dyslipidemia is highly prevalent among diabetes patients and has been found to play key role in progression of diabetic micro vascular complications. At Bugando Medical Centre (BMC). Diabetic nephropathy was 83.7%, studies for studies for diabetic associated retinopathy have not been conducted at our centre.

Routine screening for diabetic eye complications is not currently being conducted as per WHO recommendation, hence the extent of this problem is not known. Baseline lipid profiles and regular lipid monitoring are also not routinely done, due to frequent out-stocks of reagents for testing and high cost, hence profiles of our patients and outcome for those on therapy are not known.

Objective: To determine the prevalence of dyslipidemia and their association with micro vascular complications among diabetic patients attending Bugando medical centre clinic.

Methods: This was a hospital based cross sectional study. Participants were enrolled from Bugando Medical Centre diabetic clinic. Participants were interviewed through designed modified WHO STEPS questionnaire. Anthropometric measurements, Blood pressure and retinal photos for both eyes were taken, interpretation of photos was done by ophthalmologist from both Bugando Medical Centre and Cornell University. After overnight fasting Blood samples for Triglycerides (TGs), Total Cholesterol (TC), Glycated Hemoglobin (HbAIc) and fasting Blood Glucose (FBG) were collected. Clear catch urine for proteinuria was collected.

Results: A total of 178 participants were included, with median duration since diagnosis of diabetes mellitus being 72 months, inter quartile range of 36-144. Glycated hemoglobin ≥ 7% found in 158 (88.8%) of participants. Metformin use in 69.7%, and majority 83/124 (66.9%) were not on optimal dose yet not controlled. Central obesity was found in 51.2% participants and was more common in females 88/109 (80.7%). Dyslipidemia was found in 66.9% of study participants. Elevated TC was found in 61.8%. Fifty nine participants (33.2%) had both elevated TC and TGs. Prevalence of retinopathy among participants with elevated TC and elevated TGs was 48.2% and 58.8 respectively. Elevated TC and TGs had significant association with retinopathy, with both having P-value of < 0.001. Both TC and TGs also has significant association with macula oedema. Nephropathy in 28.2% and 22.1% of participants with elevated TC and elevated TGs respectively. Elevated TC was significant associated with proteinuria with p-value of 0.012. Statin use in 43 (24.2%) of participants and majority 26 (60.5%) being on atorvastatin 20mg. Of those on statin 25 (58.1%) attained TC levels below 5.2mmol/L. Only 1/3 of participants with both diabetes mellitus and Hypertension were on statins.

Conclusion and Recommendations: Study group had poor Glycemic control and were not on optimal doses, even for the metformin monotherapy. Elevated total cholesterol and triglycerides in highly prevalent among diabetic patients and associated with both retinopathy & maculopathy. Patients with multiple cardiovascular disease risks were not on lipid lowering drugs. It is recommended that, objective review for Glycemic control and other cardiovascular disease risks of all diabetes mellitus patients at least twice a year, then drugs and doses adjusted accordingly. Ophthalmologist review at enrollment in Diabetic clinic and thereafter as per findings.