Patterns and Factors Associated With Dyslipidemia among Type 2 Diabetes Patients Attending Chronic Disease Management Clinics in Turbo Sub-County, Uasin Gishu County, Kenya

Abstract

A large number of deaths worldwide are attributed to non-communicable diseases (NCDs). These NCDs are leading causes of deaths to more people yearly compared to other causes put together. Statistics show that about 80% of NCDs deaths happen in middle and low-income countries. Diabetes, an important NCD, contributes to this large mortality mainly through cardiovascular complications. Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus.The aim of this study was to determine dyslipidemia prevalence, patterns and the associated factors among type 2 diabetes mellitus patients attending Chronic Disease Management clinics (CDM) in Turbo sub-county, Uasin Gishu County, Kenya. This was a cross sectional study conducted between 2015 and 2016 atHuruma County hospital and Turbo health centre CDM clinics. Data was collected from 208 randomly selected participants using: structured questionnaires; health records and Focus Group Discussions (FGDs). Two FGDs were conducted each with 10 patients on knowledge, attitude and practice towards dyslipidemia and other cardiovascular risk factors. Laboratory investigations were also done to determine the lipid profile and fasting blood sugar. Quantitative data were analyzed using SAS 9.2.Wilcoxon test was used to compare lipid parameter means of males and females. Chi square was used to compare proportion between dysipidemia cases and normal. All variables at p≤0.2 in the univariate/bivariate analysis were included in the multivariable model. Using backward elimination criteria, variables that had a p value of <0.05 were considered significant. Qualitative data collected from FGDs were analyzed thematically. A total of 179 out of 208 (86.1%) patients had dyslipidemia. Up to 49% had elevated LDL-C, 71% low HDL-C, 47% high TC and 51% high TGs. Employment status [OR 3.1; (95% CI 1.3-7.5); p=0.01], BMI [OR 2.7; (95% CI 1.3-5.9); p=0.0007], FBS [OR 3.4; (95% CI 1.6-7.1); p=0.001] and physical activity [OR 4.8; (95% CI 1.1-21.2); p=0.04] were significantly associated with dyslipidemia. The study revealed a high prevalence of dyslipidemia among T2DM patients with a greater proportion reported in females. Low HDL-C was the most common pattern while elevated TC was least. High prevalence of dyslipidemia among T2DM patients attending CDM clinics in Turbo Sub-County require therapeutic and lifestyle modification coupled with enhanced patient education. Improved awareness of dyslipidemia and advanced training of care providers are important in reducing preventable cardiovascular episodes.