Date of Award

5-2022

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Nancy Kunyiha

Second Supervisor/Advisor

Dr Jasmit Shah

Third Supervisor/Advisor

Dr Hasina Visram

Department

Internal Medicine (East Africa)

Abstract

Background: Dysglycemia is often diagnosed late in sub-Saharan Africa with a significant number of patients presenting with complications. Data is needed to expand knowledge on the impact diabetes has on major adverse cardiovascular outcomes.

Objective: We aimed to determine the prevalence of dysglycemia in patients with stroke and Acute Coronary Syndrome (ACS) and define characteristics of the patients with dysglycemia.

Methods: A prospective cross-sectional study was conducted at Aga Khan University Hospital, Nairobi which is a tertiary facility. Consenting adults above 18 years (n=211) with stroke and acute coronary syndrome were recruited in the study in the period of April 2021 to February 2022. A study questionnaire with demographics and clinical details was used to collect data. HbA1C was used to determine the glycemic status. Bivariate analysis was used to compare patients with dysglycemia against those with no glucose abnormalities. Multivariate analysis of factors associated with dysglycemia was also done. Definition of diabetes and prediabetes was based on the American Diabetes Association and the definition of stroke and Acute Coronary Syndrome as per the American Stroke Association and American Heart Association respectively.

Results: From a total of 211 patients recruited, 111 (52.6%) had stroke and 100 (47.4%) had acute coronary syndrome. Majority of the patients’ n =144 (68.2) % were of African origin. The number of patients with dysglycemia was 144 (68.2% 95% CI: 61.5%-74.5%) with the prevalence of pre-diabetes being 64 (30.3%) and of type 2 diabetes 80 (37.9%). The average duration of diabetes in known patients was 6 years with a median HbA1C of 8.55 (7.21 -10.47). The median age of the patients was 58 (49-68) years with a male to female ratio of 2.5:1. From the study population, 137 (69.4%) had hypertension as a comorbidity. Among the patients with dysglycemia 101 (73%) also had hypertension. In the multivariate analysis, increase in age OR 1.05 (95% CI: 1.02 – 1.08, p=0.003) and higher triglyceride levels OR 2.44 (95% CI: 1.44 – 4.48, p=0.002) were significantly associated with dysglycemia. Though not significantly associated with dysglycemia, hypertension, history of previous myocardial infarction, being overweight and obese and hypokinesia on 2D transthoracic echocardiogram showed an increased odds ratio.

Conclusion: This study shows a remarkably high prevalence of dysglycemia in patients with cardiovascular disease such as acute coronary syndrome and stroke. The prevalence of prediabetes is comparable to diabetes in these patients adding to the evidence that prediabetes has more cardio-metabolic effects other than leading to type 2 diabetes. This study indicates the need to screen for glucose abnormalities in patients hospitalized with cardiovascular diseases and offer appropriate management prior to discharge.

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