SUBMIT MANUSCRIPT

Donnish Journal of Medicine and Medical Sciences

May 2015 Vol. 2(4), pp. 056-066

Copyright © 2015 Donnish Journals




Original Research Paper


Clinical Characteristics, Predictors of Complications and Therapeutic Options of Diabetes Mellitus among Diabetic Patients Attending a Lone Tertiary Health Facility in The Gambia


Semeeh Akinwale Omoleke1*, Yauba Saidu2, Mafomekong Ayuk Foma3, Adedapo Bashorun2 and James Jafali4

1Immunisation, Vaccines and Emergencies, World Health Organisation, Nigeria.
2Vaccinology Unit, Medical Research Council (UK) Unit, Fajara, The Gambia.
3School of Medicine and Allied Health Sciences, University of The Gambia, The Gambia.
4Statistics/Data Management Unit, Medical Research Council (UK) Unit, Fajara, The Gambia

Corresponding Author E-mail: omolekes@who.int

Accepted 19th April, 2015.



Abstract


Background

Recent studies emanating from sub-Sahara Africa suggest increasing burden of Diabetes Mellitus (DM). This is not surprising, given the unprecedented economic growth rate in sub-Sahara Africa (SSA), as it has implications on the emergence of chronic diseases. These economic gains, may however, be threatened by the debilitating impacts of chronic diseases. Sadly, limited data on the clinical characteristics and therapeutic options are available in health care settings in SSA, as these impact (negatively) on the outcome of diabetes patients’ care and management.

Method

A cross-sectional study was conducted involving 243 adult diabetic patients attending the medical out-patient unit in the lone tertiary health centre in The Gambia. We analysed clinical characteristics, socio-demographic variables, predictors of complications and therapeutic options among DM patients using relevant statistical techniques.

Results

The result of the study showed the preponderance of certain characteristics among diabetics such as Type 2 DM (93.8%), positive family history (77.8%), female (63.8%), middle age -30 and 60 years (76.1%) and poverty (67%). While 60.1% of participants had at least one complication, the common complications are lower extremity disorders (54.8%) visual disorders (46.3%), heart failure (3.2% and renal failure (2.5%). Furthermore, the predictors of having complications were being female (aOR= 5.1; p=0.0172), co-exiting hypertension (aOR=10.78; p=0.0029), duration (1-5years) of DM (aOR=2.3; p=0.0125), poor treatment compliance (aOR=3.8; p=0.0094) and physical inactivity (aOR=6.78; p=0.0039). Limited therapeutic options are available in our study setting - 45% of participants were on Glibencliamide and Metformin while 38.7% of participants were on Insulin therapy. Also the median duration of switch from Oral Hypoglycemic Agents to Insulin was 18months among this study population. 84.2% of participants had at least one episode of interrupted supply of medication within the last 6months.

Conclusion

The study has provided opportunities for policy makers and researchers to combat the damaging impacts of DM on public health and the economy as insights into the clinical characteristics, socio-demographics, predictors of complications and therapeutic challenges identified, can be used, as suggested in the paper, to map out interventions capable of mitigating the impacts of DM burden in The Gambia, and SSA at large.

Strength of the paper

1. The only study that has investigated the clinical characteristics, socio-demographics, predictor of complications and therapeutic options among diabetics in The Gambia.
2. We abstracted clinical data such as Type of DM, symptoms at presentation, complications, co-morbidities and medications from the participants’ records- this galvanised/augmented the data from direct interviews via questionnaire administration.
3. Findings from our study suggest that the earlier prediction of a shift in epidemic of DM from the elderly to the younger age group may not be far-fetched as 76% of the patients were between 30 and 60 years
4. Essentially, our study findings were consistent with previous reports-preponderance of type 2, delayed or late diagnosis, 72% of patients first presented to a traditional healer with symptoms suggestive of DM while positive family history and obesity were found to be independent risk factors. However, we found few contrary results as DM is commoner among people of lower socio-economic status (67%) while there was also a significant gender difference- female being more likely to have DM (63.8% vs 36.2%; p<0.001)
5. There is limited drug options (OHA), high rate of non-compliance to oral hypoglyacemic agent (93.4%), frequent interruption of insulin supply – all these contribute to poor management outcome.
6. As seen in other spheres (51), e-Health strategies such as the use of short messages systems (SMS) by health professionals to remind patients to take their medicines can also be a useful strategy to improve compliance in our setting.

Limitations of the study

1. Though, pockets of diabetics do patronise other health care providers (orthodox and non-orthodox) and may not have been represented, however, the study participants were recruited from the lone tertiary health facility (only referral centre) in The Gambia, where majority of the general population seek specialist treatments.
2. The majority of our study participants have little or no western education, therefore understanding of the questionnaires (written in English) were heavily dependent on the interpretations given by the interviewers, and consequently, responses from participants may be prone to both misrepresentation (of respondents) and translation bias. However, this drawback is limited or minimised owing to the fact that the interviewers were trained indigenous nurses.

Keywords: Diabetes Mellitus, The Gambia, Chronic disease, Oral Hypoglycemic Agents, Insulin, Complications, Clinical Characteristics, Predictors, e-Health and Public Health.

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Cite This Article:

Semeeh Akinwale Omoleke, Yauba Saidu, Mafomekong Ayuk Foma, Adedapo Bashorun and James Jafali. Clinical Characteristics, Predictors of Complications and Therapeutic Options of Diabetes Mellitus among Diabetic Patients Attending a Lone Tertiary Health Facility in The Gambia. Donnish Journal of Medicine and Medical Sciences 2(4) 2015 pp. 056-066.


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