Skip to main content
Download PDF

Prevalence, patterns, and determinants of vascular complications of type 2 diabetes in a teaching hospital in Addis Ababa, Ethiopia: a retrospective study

BMC Endocrine Disorders volume 24, Article number: 190 (2024) Cite this article

Abstract

Background

Patients with type 2 diabetes mellitus (T2D) have an increased risk of vascular complications. Despite the rise in the prevalence of T2D and its complications throughout the globe, there is a paucity of data regarding the prevalence and determinants of vascular complications of T2D in Ethiopia. Hence, this study aimed to assess the prevalence, patterns, and determinants of the microvascular and macrovascular complications of T2D among adult patients attending a teaching hospital in Addis Ababa, Ethiopia.

Methods

A retrospective study was done by reviewing the electronic health records of adult patients with T2D attending the general medical and endocrine referral clinics of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023. Statistical Package for Social Sciences (SPSS), version 25, was used to analyze the data. Descriptive analysis was used to summarize the sociodemographic, clinical, and laboratory profiles as well as the patterns of vascular complications of T2D. Bivariate and multivariate logistic regression models were fitted, and the crude odds ratio (COR) and adjusted odds ratio (AOR), together with the 95% confidence interval (CI), were computed to identify the determinants of microvascular and macrovascular complications of T2D.

Results

A total of 272 patients with T2D were included in this study; 50.5% were females, and the mean (± standard deviation) age was 56.3 ± 12.8 years. The majority of patients (62.5%) had diabetes for ≥ 5 years. More than half (51.5%) had poor glycemic control with glycated haemoglobin (HbA1c) value of ≥ 7%. The overall prevalence of vascular complications was 39%. The prevalence of microvascular complications was 23.5%, the most common being neuropathy (11.8%), and the prevalence of macrovascular complications was 21%, the most common being coronary artery disease (12.1%). The determinants of microvascular complications were age ≥ 60 years (AOR = 2.25, 95% CI: 1.17, 4.33), diabetes duration of ≥ 5 years (5–10 years [AOR = 3.13, 95% CI: 1.37, 7.18], and > 10 years [AOR = 3.88, 95% CI: 1.66, 9.06], and HbA1c value of ≥ 7% (AOR = 2.21, 95% CI: 1.14, 4.28). The odds of developing macrovascular complications were higher with diabetes duration of ≥ 5 to 10 years (AOR = 2.89, 95% CI: 1.37, 6.12) as compared with diabetes duration of < 5 years.

Conclusions

This study demonstrated a high prevalence of microvascular and macrovascular complications in adult patients with T2D. Older age, prolonged duration of diabetes, and poor glycemic control were identified as the determinants for the development of microvascular complications  of T2D, while prolonged duration of diabetes was the determining factor for the development of macrovascular complications. Hence, targeted initiatives are required to enhance the prevention and early detection of vascular complications of T2D in resource-limited countries like Ethiopia.

Peer Review reports

Introduction

According to the International Diabetes Federation report in 2021, an estimated 537 million adults aged 20–79 years, representing 10.5% of the world’s population, were living with diabetes mellitus, and this was predicted to increase to 643 million (11.3%) by 2030 and to 783 million (12.2%) by 2045 [1]. A systematic analysis of the Global Burden of Disease study in 2015 indicated that diabetes mellitus, together with respiratory disorders, cancer, and cardiovascular disease (CVD), was responsible for over 80% of all early deaths from non-communicable diseases [2].

Patients with type 2 diabetes mellitus (T2D) are more likely to develop microvascular complications (retinopathy, nephropathy, and neuropathy) and macrovascular complications (stroke, coronary artery disease [CAD], and peripheral arterial disease [PAD]) [3, 4]. Based on data from the DISCOVER study program, with 38 participating countries, the crude prevalence of microvascular and macrovascular complications of T2D was 18.8% and 12.7%, respectively [5]. According to this study, the most common macrovascular complications were CAD (8.2%), heart failure (3.3%), and stroke (2.2%), while the most common microvascular complications were peripheral neuropathy (7.7%), chronic kidney disease (5.0%), and albuminuria (4.3%) [5]. Based on the World Health Organization (WHO) mortality database in 108 selected countries between 2000 and 2016, there was a report of 1,904,787 diabetes-related deaths that were attributed to vascular complications (26.8%) [6].

According to a systemic review and meta-analysis that included studies primarily from east African nations, adult T2D populations in Africa had significant rates of diabetic peripheral neuropathy (38%) and retinopathy (32%) [7]. According to a study conducted in Kenya, the overall prevalence of microvascular complications of diabetes was 36.6%, peripheral neuropathy being the most prevalent, affecting 27.4% of the patients [8]. Another study conducted in Sudan revealed that 45.9% of T2D patients had any of the microvascular complications, nephropathy being the most common, with a prevalence rate of 38.8% [9].

Ethiopia is currently facing an increasing challenge from non-communicable disease, including diabetes, and according to the national WHO steps survey conducted in 2015, 3.2% of people had diabetes [10, 11]. According to different studies done in Ethiopia, a significant number of T2D patients had vascular complications. A cross-sectional study of 1,158 patients with T2D from 10 general hospitals in the Tigray region found that 54% had at least one vascular complication, the most common being retinopathy (22.6), and the others being nephropathy (19.2%), and peripheral neuropathy (11.4%) [12]. A retrospective cohort study conducted at Felege Hiwot Referral Hospital reported that the prevalence of vascular complications in T2D was 23.3% [13], and a cross-sectional study of 335 T2D patients in Dessie town hospitals found that 37.9% had microvascular complications (37.9%), the most common being retinopathy (24.8%) [14].

Factors such as poor glycaemic control, old age, and prolonged duration of diabetes were consistently reported to be associated with vascular complications of T2D. A prospective hospital-based study in India showed that the risk of complications of T2D significantly increased with patients’ age, duration of diabetes, fasting blood glucose (FBG) and low-density lipoprotein cholesterol (LDL-C) levels [15]. A study done in the Kingdom of Saudi Arabia revealed that increasing age, longer duration of diabetes, and higher glycated hemoglobin (HbA1c) values were found to be predictors of vascular complications of T2D [16]. A study done at a tertiary care hospital in Sri Lanka showed that age > 60 years, duration of diabetes for > 10 years, and HbA1c value of > 7% were risk factors for microvascular complications, while age > 60 years was the only risk factor for macrovascular complications [17]. A cross-sectional study in Dessie Town hospitals found that age 60–87 years, diabetes duration for > 5 years, and high blood pressure (BP) were all strong predictors of developing microvascular complications of T2D [14].

Despite the rise in the prevalence of T2D and its complications throughout the globe, there is a paucity of data regarding the prevalence and determinants of vascular complications of T2D in Ethiopia, with poor attention given to the macrovascular complications. Hence, this study aimed to assess the prevalence, patterns, and determinants of microvascular and macrovascular complications of T2D among patients attending a teaching hospital in Addis Ababa, Ethiopia.

Methods and materials

Study design, area, and period

This was a retrospective study on the prevalence, patterns, and determinants of vascular complications among adult T2D patients attending the general medical and endocrine referral clinics of Yekatit 12 Hospital Medical College from June 1, 2023, to November 30, 2023. The data were collected by reviewing the patients’ electronic health records (EHRs). Yekatit 12 Hospital Medical College is one of the largest public teaching hospitals in Addis Ababa, Ethiopia, providing both academic and clinical services. It has eight medical education programs, 40 medical services, and more than 300 expert doctors. The hospital has different specialty and subspecialty clinics, one of which is the endocrine subspecialty clinic, where most of the patients with endocrine disorders, including diabetic patients with uncontrolled glycaemia and complications, are followed by endocrinologists twice a week.

Source and study population

All adult patients (≥ 18 years old) with T2D who were on follow-up at the public hospitals in Addis Ababa, Ethiopia, were the source population. All patients with T2D who were on follow-up at the general medical and endocrine referral clinics of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, in the study period were the study population.

Sample size and sampling technique

The sample size (n) was determined by using the following single population proportion formula, considering a 23.3% proportion (p) of vascular complications of T2D from a previous study [13], a 95% confidence level of Zα/2 = 1.96, and a 5% margin of error (d).

n = [(Z α/2)2 x p (1-p)]/d2 = [(1.96)2 × 0.23 (1-0.23)]/ (0.05)2 = 272.

The minimum sample size was calculated to be 272, and by adding 10% for the probability of getting incomplete data, the final sample size was 299. All patients with T2D who have been on follow-up at Yekatit 12 Hospital Medical College and who fulfilled the eligibility criteria were included in the study via convenience sampling technique.

Study variables

The dependent variables were the prevalence of microvascular and macrovascular complications of T2D. Independent variables were sociodemographic data (age, sex, and marital status), medical history (duration of diabetes, types of medications, presence of hypertension [HTN], presence of dyslipidemia), clinical characteristics (systolic BP, diastolic BP, and body mass index [BMI]), and laboratory findings (FBG, HbA1c, LDL-C, creatinine, dipstick proteinuria, and 24-hour urine protein).

Eligibility criteria

All T2D adult patients (≥ 18 years old) who were attending the general medical and endocrine referral clinics of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, during the study period with complete documentation of essential data were eligible to be included in the study. Patients who were diagnosed with type 1 diabetes or gestational diabetes were excluded from the study.

Data collection method

A well-structured data abstraction tool was used to extract patients’ data from their EHRs. Data collection was done by three general practitioners, who were trained by the principal investigator on how to extract data from the EHRs. Sociodemographic data, medical history, clinical characteristics, and laboratory findings were all extracted from EHRs and documented in the data abstraction forms.

Data quality control technique

The quality of the data was ensured through training of the data collectors, close supervision, and prompt feedback. To verify the completeness of the data abstraction form, a pre-test was conducted among 5% of the patients in the study area. The data were checked for clarity, completeness, accuracy, and missing values, and appropriate corrections were made by the principal investigator.

Data processing, interpretation, and analysis

Statistical Package for Social Sciences (SPSS), version 25, was used to enter and analyze the data. Descriptive analysis was used to summarize the sociodemographic, clinical and laboratory profiles as well as the patterns of vascular complications of T2D. Continuous variables were presented as mean ± standard deviation (SD) when normally distributed or median with interquartile range (IQR) when not normally distributed. Categorical variables were presented as frequencies and percentages. Bivariate and multivariate logistic regression models were fitted, and the crude odds ratio (COR) and adjusted odds ratio (AOR), together with the 95% confidence interval (CI), were computed to identify the determinants of vascular complications of T2D. The model assumptions were fulfilled based on the Hosmer-Lemeshow test, where the P values were 0.620 and 0.082 in the multivariate logistic regression analyses used to identify the determinants of microvascular and macrovascular complications of T2D, respectively. Those variables with a P value < 0.25 in the bivariate logistic analyses were subsequently used in the multivariate analyses, and a two-tailed P value < 0.05 was regarded as statistically significant.

Operational definitions

Microvascular complication was defined by the presence of one or more of the complications, namely, nephropathy, retinopathy, or peripheral neuropathy, due to known or newly diagnosed T2D [4].

Macrovascular complication was defined by the presence of one or more of the complications, namely, CAD, stroke, or PAD, due to known or newly diagnosed T2D [4].

Diabetic nephropathy was defined by persistent albuminuria or proteinuria for at least three months and a progressive decline in renal function in patients with diabetes, with co-existing retinopathy and no evidence of alternative kidney disease [18].

Diabetic retinopathy was defined based on the results of a dilated eye examination performed by an ophthalmologist, with findings ranging from mild nonproliferative abnormalities or increased numbers of microaneurysms to the formation of new blood vessels on the retina and posterior surface of the vitreous [19].

Diabetic neuropathy was defined by the presence of symptoms and/or signs of peripheral nerve disease (sensory symptoms like numbness or burning pain and/or decreased sensation predominantly in the toes or feet) in patients with diabetes after exclusion of other causes [20].

CAD was defined by the presence of clinical (angina pectoris or anginal equivalents) and imaging (electrocardiogram, and/or echocardiography) evidences of myocardial ischaemia or infarction [21].

Stroke (cerebrovascular disease) was defined by the presence of a neurological deficit due to an acute focal injury of the central nervous system by a vascular cause, including cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage, all of which were confirmed by brain imaging [22].

PAD was defined by the presence of narrowing of peripheral arteries due to atherosclerosis diagnosed by clinical examination and arterial Doppler ultrasound [23].

Glycemic control level was defined by HbA 1c level; good glycemic control was defined by HbA1c value of < 7%, and poor glycemic control was defined by HbA1c value of ≥ 7% [24].

HTN was defined by systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg [25], or a previous diagnosis of HTN.

Target LDL-C level was defined by an LDL-C level of < 70 mg/dL for T2D patients who were ≥ 40 years old and on statin for the primary prevention of CVD, and an LDL-C level of < 55 mg/dL for those who were on statin for the secondary prevention of CVD events after developing CVD at any age [25].

Dyslipidemia was defined by any of the following abnormalities: Total cholesterol ≥ 200 mg/dL; an LDL-C ≥ 130 mg/dL; triglycerides ≥ 150 mg/dL; high-density lipoprotein cholesterol (HDL-C) ≤ 40 mg/dL in males and ≤ 50 mg/dL in females [26] or a previous diagnosis of dyslipidemia.

Results

Socio-demographic and clinical characteristics of T2D patients

There were a total of 289 adult patients with a diagnosis of T2D in the study period, and of these, 272 (94.1%) were eligible and included for analysis, and female patients accounted for 50.5%. The mean (± SD) age was 56.3 ± 12.8 years, with an age range from 30 to 92 years, and 42.6% were elderly (≥ 60 years old). Most of the patients (86%) were married. The majority of patients (62.5%) had diabetes for ≥ 5 years. There was a high prevalence of HTN (73.2%) among patients with T2D, and 51.8% had dyslipidemia. The mean (± SD) systolic BP and diastolic BP were 130 ± 18.6 and 76.5 ± 10.8 mmHg, respectively. Of all patients, 26.5% had obesity (BMI ≥ 30 kg/m2) [Table 1].

Table 1 Socio-demographic, clinical, and laboratory profiles of T2D patients attending Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023
Full size table

Laboratory findings of T2D patients

The median (IQR) FBG level was 129 (112–151) mg/dl; the mean HbA1c (± SD) value was 7.7 ± 1.9%; and more than half (51.5%) had poor glycemic control (HbA1c value of ≥ 7%). The median (IQR) serum creatinine value was 0.73 (0.56–0.90); and 10.3% had renal impairment (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2 using the CKD-EPI equation). Only 10.7% of the patients had proteinuria on dipstick urine examination, and 9.9% had a determination of 24-hour urine protein with a median (IQR) value of 481.4 (345–979) mg/24 hours. The median (IQR) LDL-C value was 78.0 (58.6–98.0) mg/dL, and of 212 patients for whom statins were prescribed with clear indications, 72.2% had met target LDL-C values [Table 1].

Prescription patterns for T2D patients

Regarding the prescription patterns of anti-diabetic regimens for T2D patients, the most commonly prescribed medications were oral anti-diabetic agents (56.2%), followed by a combination of insulin and oral anti-diabetic agents, and the least prescribed was insulin. Many of the patients (83.1%) were on statins. However, there were few patients (6.2%) that were potential candidates but were not prescribed with statins. Less than half (46%) of the patients used ACEIs or ARBs, and 29.8% of them were taking aspirin [Fig. 1].

Fig. 1
figure 1

Prescription patterns of anti-diabetic agents and other medications for T2D patients attending Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023. ACEis, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers

Full size image

Prevalence and patterns of vascular complications of T2D

Of 272 patients with T2D, 39% had at least one of the microvascular and/or macrovascular complications, and 5.5% had both microvascular and macrovascular complications. Of all patients, 23.5% had at least one of the microvascular complications, the most common being neuropathy (11.8%). Of all patients, 21% had at least one of the macrovascular complications, the most common being CAD (12.1%) [Fig. 2].

Fig. 2
figure 2

Patterns of vascular complications of T2D among patients attending Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023. CAD, coronary artery disease; PAD, peripheral arterial disease

Full size image

Determinants of microvascular complications of T2D

In the bivariate regression analysis, age ≥ 60 years (COR = 2.44, 95% CI: 1.37, 4.32, P value = 0.002), being unmarried (COR = 2.15, 95% CI: 1.04, 4.45, P value = 0.040), diabetes duration of 5–10 years (COR = 3.48, 95% CI: 1.57, 7.75, P value = 0.002) or > 10 years (COR = 5.34, 95% CI: 2.41, 11.84, P value < 0.001), HbA1c value of ≥ 7% (COR = 2.57, 95% CI: 1.42, 4.65, P value = 0.002), and systolic BP (COR = 1.02, 95% CI: 1.01, 1.04, P value = 0.009) were factors significantly associated with microvascular complications of T2D [Table 2].

In the multivariate regression analysis, age ≥ 60 years, diabetes duration of ≥ 5 years, and HbA1c value of ≥ 7% were the determinants of microvascular complications of T2D. The odds of developing microvascular complications were 2.25 times higher among T2D patients with the age of ≥ 60 years compared to those with the age of < 60 years (AOR = 2.25, 95% CI: 1.17, 4.33, P value = 0.015). The odds of developing microvascular complications were 3.13 times higher among T2D patients with diabetes duration of 5–10 years (AOR = 3.13, 95% CI: 1.37–7.18, P value = 0.007) and 3.88 times higher in those with diabetes duration > 10 years (AOR = 3.88, 95% CI: 1.66, 9.06, P value = 0.002) compared to those with diabetes duration < 5 years. The odds of developing microvascular complications were 2.21 times higher among T2D patients with a HbA1c value of ≥ 7% as compared with those with HbA1c value of < 7% (AOR = 2.21, 95% CI: 1.14, 4.28, P value = 0.019) [Table 2].

Table 2 Bivariate and multivariate regression analysis to identify the determinants of microvascular complications of T2D among patients attending Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023
Full size table

Determinants of macrovascular complications of T2D

In the bivariate logistic regression analysis, being unmarried (COR = 2.25, 95% CI: 1.07, 4.74, P value = 0.034) and diabetes duration of 5–10 years (COR = 2.89, 95% CI: 1.38, 6.03, P value = 0.005) were significantly associated with the development of macrovascular complications of T2D. In the multivariate analysis, the duration of diabetes was the determining factor for the development of macrovascular complications. The odds of developing macrovascular complications were 2.89 times higher in T2D patients with diabetes duration of 5–10 years as compared with those with diabetes duration of < 5 years (AOR = 2.89, 95% CI: 1.37, 6.12, P value = 0.005) [Table 3].

Table 3 Bivariate and multivariate regression analysis to identify the determinants of macrovascular complications of T2D among patients attending Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from June 1, 2023, to November 30, 2023
Full size table

Discussion

The socio-demographic characteristics of T2D patients observed in this study had similarities with those in other studies. Of 272 T2D patients in this study, about half (50.4%) were females, and the mean age of the patients was 56.3 ± 12.8 years. In line with these findings, the Middle East and Africa (MEA) cohort of the 3-year prospective DISCOVER study revealed that nearly half (47.5%) were females, and the mean age of patients was 54.3 ± 10.8 years [27]. Likewise, similar trends were seen in a study done in Tikur Anbessa Specialized Hospital (TASH), where the mean age of patients was 58 ± 11.2 years, albeit with a slight female predominance (57%) [28]. This implies that T2D mainly affects middle-aged individuals without a remarkable gender predilection.

There was a high prevalence of HTN (73.2%) among patients with T2D in this study, which was consistent with that of the study done at TASH, where HTN was seen in 69% of T2D patients [28]. However, the prevalence of HTN in the present study was much higher than that of the studies done in a tertiary hospital in northeast Ethiopia (43.3%) [29] and Jimma University Specialized Hospital (24.9%) [30], both of which included type 1 and type 2 diabetes. The higher proportion of HTN among T2D patients in the present study as compared to the latter studies might be due to differences in the patients’ characteristics, mainly the type of diabetes.

In this study, more than half of the patients with T2D (51.5%) had poor glycemic control, and the majority (56.2%) were prescribed oral antidiabetic agents, whereas in the study from Dessie Town hospitals, most T2D patients (85.7%) had poor glycemic control, and the majority (66.6%) were prescribed oral antidiabetic agents [14]. Similarly, in a study from TASH, 69.1% of T2D patients had poor glycemic control, and the most commonly used antidiabetic treatment regimen was the combination of metformin and insulin, prescribed for 37.5% of the patients [28]. This underscores the presence of an unmet need of glyacemic control among T2D patients and the need to optimize the prescription of anti-diabetic regimens along with diabetes education on drug adherence and lifestyle changes.

In the current study, 39% had at least one microvascular or macrovascular complication of T2D, and this figure was lower than that reported in a single-center retrospective study from Cameroon (70%) [31] and 10 general hospitals in the Tigray region (54%) [12], but it was higher than the finding reported from the studies done in Felege Hiwot Hospital (23.3%) [13] and University of Gondar Referral Hospital (28%) [32]. The wide variations in the prevalence of vascular complications of T2D in these studies might be explained by differences in the underlying sociodemographic and clinical characteristics of the patients as well as the diagnostic modalities used to detect the complications.

The prevalence of microvascular complications of T2D (23.5%) in the present study was lower than that reported in studies from other countries, including the USA (77%) [33], Brazil (41.6%) [34], China (57.5%) [35], India (48%) [36], Ghana (35.3%) [37], and Nigeria (50%) [38]. It was also lower than findings from local studies conducted in various regions of Ethiopia, including Dessie Town hospitals (37.9%) [14], Gurage zone (61%) [39], and Jimma University Hospital (41.5%) [40], though it was higher than that of the study done at the University of Gondar Hospital (20.4%) [41]. Neuropathy (11.8%) was the most common microvascular complication in the current study, followed by nephropathy, and the least common was retinopathy. A similar pattern was observed in studies from India and Nigeria, though with a higher prevalence rate of neuropathy seen in 37% and 69.6% of the patients, respectively [36, 38]. The wide variations in the prevalence of the microvascular complications of T2D among these studies may be explained by the heterogeneity of patient characteristics and differences in the screening methods used to diagnose these complications.

The prevalence of macrovascular complications of T2D in this study was 21%, which was higher than that of the studies from Saudi Arabia (12.1%) [16], Sri Lanka (13.7%) [17], but lower than that of the studies from South India (29.7%) [42], Yemen (25.4%) [43], and South Africa (56%) [44]. CAD (12.1%) was the leading macrovascular complication in the present study, consistent with that of the studies from Sri Lanka (10.6%) [17], South India (15.1%) [42], and Yemen (17.8%) [43]. The present study found that PAD (4.4%) was the least common macrovascular complication; however, it was the commonest macrovascular complication according to studies done in South India (15.1%) [42], Tigray (9%) [12], and TASH (5.8%) [45]. The lowest prevalence rate of PAD in the present study may be explained by the unavailability of the ankle-brachial index, the first-line diagnostic test for PAD, contributing to a lower rate of screening and diagnosis.

The present study revealed that age ≥ 60 years, diabetes duration of > 5 years, and HbA1c value of ≥ 7% were significantly associated with microvascular complications of T2D, and this was consistent with the findings of the studies done in Dessie Town hospitals, Ethiopia [14], Sri Lanka [17], and a tertiary health care hospital in India [36]. Likewise, poor glycemic control and longer duration of diabetes in a study from Saudi Arabia [16] and increasing age and duration of diabetes in a study from Nigeria [39] were strongly associated with the development of microvascular complications. Hypertension and dyslipidemia were not associated with microvascular complications in the present study unlike the other studies from Dessie town and Gurage zone hospitals in Ethiopia [14, 39]. Therefore, T2D patients with older age, prolonged duration of diabetes, and/or poor glycemic control require close monitoring for the prevention and early detection of microvascular complications.

Diabetes duration of 5–10 years was significantly associated with the development of macrovascular complications of T2D in the present study, which was consistent with the studies from Saudi Arabia [16] and Yemen [43]. Unlike the present study, poor glycemic control was associated with a higher prevalence of macrovascular complications in a study from Saudi Arabia [16], and age was strongly associated with the overall prevalence of macrovascular complications in studies from Yemen [43] and Sri Lanka [17]. The present study highlights the importance of diabetes duration, more than glycemic control, as a determining factor for the development of macrovascular complications. Hence, a very low threshold is required to screen T2D patients for macrovascular complications starting from the time of diagnosis of T2D, with particular emphasis on those with a prolonged diabetes duration.

There are certain limitations to this study. First, the accuracy of the EHRs of the patients might affect the reliability of the results of this study. Second, the prevalence of some vascular complications, particularly diabetic neuropathy and PAD, might be underestimated in the current study due to the limited access or unavailability of screening methods like monofilament testing and the ankle-brachial index. Finally, because of the cross-sectional nature of the study, a definite causal relationship between the determining factors and the vascular complications of T2D cannot be established.

Conclusions

This study demonstrated a high prevalence of microvascular and macrovascular complications in patients with T2D. Older age, prolonged duration of diabetes, and poor glycemic control were identified as the determinants for the development of microvascular complications of T2D, while prolonged duration of diabetes was the determining factor for the development of macrovascular complications. Hence, targeted initiatives are required to enhance the prevention and early detection of vascular complications of T2D in resource-limited countries like Ethiopia.

Data availability

All data generated or analyzed in this study are included in this manuscript.

Abbreviations

BMI:

Body mass index

BP:

Blood pressure

CAD:

Coronary artery disease

CVD:

Cardiovascular disease

FBG:

Fasting blood glucose

HbA1c:

Glycated hemoglobin

HTN:

Hypertension

LDL-C:

Low-density lipoprotein cholesterol

PAD:

Peripheral artery disease

SD:

Standard deviation

T2D:

Type 2 diabetes mellitus

WHO:

World Health Organization

References

  1. Magliano DJ, Boyko EJ. IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS. 10th ed. Brussels: International Diabetes Federation; 2021.

    Google Scholar 

  2. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the global burden of Disease Study 2015. Lancet. 2016;388(10053):1659–724.

    Article  Google Scholar 

  3. Michael J. Fowler; microvascular and macrovascular complications of diabetes. Clin Diabetes 1 April. 2008;26(2):77–82.

    Article  Google Scholar 

  4. DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 2015;1:15019.

    Article  PubMed  Google Scholar 

  5. Kosiborod M, Gomes MB, Nicolucci A, Pocock S, Rathmann W, Shestakova MV, et al. DISCOVER investigators. Vascular complications in patients with type 2 diabetes: prevalence and associated factors in 38 countries (the DISCOVER study program). Cardiovasc Diabetol. 2018;17(1):150.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Ling W, Huang Y, Huang YM, Fan RR, Sui Y, Zhao HL. Global trend of diabetes mortality attributed to vascular complications, 2000–2016. Cardiovasc Diabetol. 2020;19(1):182.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kibirige D, Chamba N, Andia-Biraro I. Et alIndicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysisBMJ. Open. 2022;12:e060786.

    Google Scholar 

  8. Ireri R, Kikuvi G, Mambo S, Cheriro B. Prevalence of Microvascular complications and Associated Risk factors among diabetes Mellitus patients attending Nyeri County Referral Hospital, Kenya: a cross-sectional study. medRxiv. 2024:2024–02.

  9. Mustafa Hussein S. Prevalence of Microvascular complications in type 2 diabetics attending a primary Healthcare Centre in Sudan. Int J Diabetes Metabolism 28 Dec. 2019;25(3–4):127–33.

    Google Scholar 

  10. Bantie GM, Wondaye AA, Arike EB, Melaku MT, Ejigu ST, Lule A, et al. Prevalence of undiagnosed diabetes mellitus and associated factors among adult residents of Bahir Dar City, northwest Ethiopia: a community-based cross-sectional study. BMJ Open. 2019;9(10):e030158.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bishu KG, Jenkins C, Yebyo HG, Atsbha M, Wubayehu T, Gebregziabher M. Diabetes in Ethiopia: a systematic review of prevalence, risk factors, complications, and cost. Obes Med. 2019;15:100132.

    Article  Google Scholar 

  12. Berhe KK, Mselle LT, Gebru HB. The magnitude of chronic diabetes complications and its associated factors among diabetic patients attending the general hospitals in Tigray region, Northern Ethiopia. PLoS ONE. 2023;18(8):e0290240.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Shita NG, Muluneh EK. Predictors of blood glucose change and vascular complication of type 2 diabetes mellitus patients in Felege Hiwot Referral Hospital, North West Ethiopia. Sci Rep. 2021;11(1):12974.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Seid MA, Akalu Y, Gela YY, Belsti Y, Diress M, Fekadu SA, et al. Microvascular complications and its predictors among type 2 diabetes mellitus patients at Dessie town hospitals, Ethiopia. Diabetol Metab Syndr. 2021;13(1):86.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Kulshrestha M, Seth S, Tripathi A, Seth A, Kumar A. Prevalence of complications and clinical audit of management of type 2 diabetes Mellitus: a prospective hospital based study. J Clin Diagn Res. 2015;9(11):OC25–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  16. Alaboud AF, Tourkmani AM, Alharbi TJ, Alobikan AH, Abdelhay O, Al Batal SM, et al. Microvascular and macrovascular complications of type 2 diabetic mellitus in Central, Kingdom of Saudi Arabia. Saudi Med J. 2016;37(12):1408–11.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Arambewela MH, Somasundaram NP, Jayasekara HBPR, Kumbukage MP, Jayasena PMS, Chandrasekara CMPH, et al. Prevalence of chronic complications, their risk factors, and the Cardiovascular Risk factors among patients with type 2 Diabetes Attending the Diabetic Clinic at a Tertiary Care Hospital in Sri Lanka. J Diabetes Res. 2018;2018:4504287.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Selby NM, Taal MW. An updated overview of diabetic nephropathy: diagnosis, prognosis, treatment goals and latest guidelines. Diabetes Obes Metabolism. 2020;22:3–15.

    Article  Google Scholar 

  19. Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL et al. Diabetic Retinopathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412–418. https://doiorg.publicaciones.saludcastillayleon.es/10.2337/dc16-2641. Erratum in: Diabetes Care. 2017;40(6):809. doi: 10.2337/dc17-er06e. Erratum in: Diabetes Care. 2017;40(9):1285.

  20. Dyck PJ, Albers JW, Andersen H, Arezzo JC, Biessels GJ, Bril V, et al. Toronto Expert Panel on Diabetic Neuropathy. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011;27(7):620–8.

    Article  PubMed  Google Scholar 

  21. Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the management of patients with chronic coronary disease. J Am Coll Cardiol. 2023;82(9):833–955.

    Article  PubMed  Google Scholar 

  22. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–89.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Endorsed by: the European Stroke Organisation (ESO), Members ATF, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, et al. ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries the Task Force on the diagnosis and treatment of Peripheral Artery diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(22):2851–906.

    Article  Google Scholar 

  24. Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, on behalf of the American Diabetes Association, et al. 6. Glycemic targets: standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S97–110.

    PubMed  Google Scholar 

  25. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, on behalf of the American Diabetes Association, et al. 10. Cardiovascular Disease and Risk Management: standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S158–90.

    Article  PubMed  CAS  Google Scholar 

  26. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol. J Am Med Assoc 285, 2486–97.

  27. Hafidh K, Malek R, Al-Rubeaan K, Kok A, Bayram F, Echtay A, et al. Prevalence and risk factors of vascular complications in type 2 diabetes mellitus: results from discover Middle East and Africa cohort. Front Endocrinol (Lausanne). 2022;13:940309.

    Article  PubMed  Google Scholar 

  28. Negash Z, Yismaw M. Management practice and contributing risk factors for chronic complications among type 2 diabetes Mellitus Adult patients in Follow-Up at a Tertiary Care Teaching Hospital. Diabetes Metab Syndr Obes. 2020;13:3969–76.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Abejew A, Agalu. Abebe Zeleke Belay, and Mirkuzie Woldie Kerie. Diabetic complications among adult diabetic patients of a tertiary hospital in northeast Ethiopia. Advances in Public Health 2015 (2015).

  30. Worku D, Hamza L, Woldemichael K. Patterns of diabetic complications at jimma university specialized hospital, southwest Ethiopia. Ethiop J Health Sci. 2010;20(1):33–9.

    PubMed  PubMed Central  Google Scholar 

  31. Stéphane MT, et al. Micro and macrovascular complications of diabetes mellitus in Cameroon: risk factors and effect of diabetic check-up - a monocentric observational study. Pan Afr Med J. 2013;15:141.

    Google Scholar 

  32. Wolde HF, Atsedeweyen A, Jember A, Awoke T, Mequanent M, Tsegaye AT, et al. Predictors of vascular complications among type 2 diabetes mellitus patients at University of Gondar Referral Hospital: a retrospective follow-up study. BMC Endocr Disord. 2018;18(1):52.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ramanathan RS. Correlation of duration, hypertension and glycemic control with microvascular complications of diabetes mellitus at a tertiary care hospital. J Neurol Exp Neural Sci. 2017;4(1):1–4.

    Google Scholar 

  34. Cardoso CR, Salles GF. Predictors of development and progression of microvascular complications in a cohort of Brazilian type 2 diabetic patients. J Diabetes Complications 2008;22(3):164–70.

  35. Li J, Chattopadhyay K, Xu M, Chen Y, Hu F, Chu J, et al. Prevalence and associated factors of vascular complications among inpatients with type 2 diabetes: a retrospective database study at a tertiary care department, Ningbo, China. PLoS ONE. 2020;15(6):e0235161.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Kumar HK, Kota S, Basile A, Modi K. Profile of microvascular disease in type 2 diabetes in a tertiary health care hospital in India. Ann Med Health Sci Res. 2012;2(2):103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Annani-Akollor ME, Addai-Mensah O, Fondjo LA, Sallah L, Owiredu EW, Acheampong E, et al. Predominant complications of type 2 diabetes in Kumasi: a 4-Year retrospective cross-sectional study at a Teaching Hospital in Ghana. Med (Kaunas). 2019;55(5):125.

    Google Scholar 

  38. Olamoyegun M, Ibraheem W, Iwuala S, Audu M, Kolawole B. Burden and pattern of micro vascular complications in type 2 diabetes in a tertiary health institution in Nigeria. Afr Health Sci. 2015;15(4):1136–41.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Gebre BB, Assefa ZM. Magnitude and associated factors of diabetic complication among diabetic patients attending gurage zone hospitals, South West Ethiopia. BMC Res Notes. 2019;12(1):780.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tilahun AN, Waqtola C, Tewodros GM, Amare DW, Yohannis M. Major micro vascular complications and associated risk factors among diabetic outpatients in Southwest Ethiopia. Endocrinol Metab Syndr. 2017;6(4):272.

    Google Scholar 

  41. Fasil A, Biadgo B, Abebe M. Glycemic control and diabetes complications among diabetes mellitus patients attending at University of Gondar Hospital, Northwest Ethiopia. Diabetes Metab Syndr Obes. 2018;12:75–83.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Govindarajan Venguidesvarane A, Jasmine A, Varadarajan S, Shriraam V, Muthuthandavan AR, Durai V, et al. Prevalence of vascular complications among type 2 Diabetic patients in a Rural Health Center in South India. J Prim Care Community Health. 2020;11:2150132720959962.

  43. Al-Khawlani A, Atef ZA, Al-Ansi A. Macrovascular complications and their associated risk factors in type 2 diabetic patients in Sana’a city, Yemen. East Mediterr Health J. 2010;16(8):851–8. PMID: 21469567.

    Article  PubMed  CAS  Google Scholar 

  44. Mtshali S, Mahomed O, Prevalence. Patient predictors, and referral patterns for diabetes-related complications treated at a Central Hospital in KwaZulu Natal. Diabetes Metab Syndr Obes. 2021;14:4181–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gedamu M, Mulusew C, Senbeta MF. Diabetic complications and Associated Factors among Diabetic patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Int J Diabetes Clin Res. 2022;9:160.

    Google Scholar 

Download references

Acknowledgements

We would like to give special thanks to the data collectors for their great commitment. We would also like to extend our sincere gratitude to the staff working in the outpatient department of Yekatit 12 Hospital Medical College for their kind cooperation during the period of data extraction.

Funding

This study received no specific grant from any funding agency in the public, commercial, or non-profit organizations.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Addis Ababa, Ethiopia

    Gashaw Solela, Henok A. Gessesse, Hailu Zegeye & Amare Worku

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia

    Beza Leulseged

Authors
  1. Gashaw Solela
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Henok A. Gessesse
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Hailu Zegeye
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Amare Worku
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Beza Leulseged
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

GS was involved in the conceptualization and design of the study, data analysis, and edition of the manuscript. HA, HZ, and AW were involved in the conceptualization of the study, data analysis, and drafting of the initial manuscript. BL was involved in the data analysis and edition of the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Gashaw Solela.

Ethics declarations

Ethics approval and consent to participate

The Institutional Review Board of Yekatit 12 Hospital Medical College (Ref No. RPO/474/23) granted ethical approval to conduct this study and waived the need for consent because only anonymized patients’ data were collected retrospectively from EHRs.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Solela, G., Gessesse, H.A., Zegeye, H. et al. Prevalence, patterns, and determinants of vascular complications of type 2 diabetes in a teaching hospital in Addis Ababa, Ethiopia: a retrospective study. BMC Endocr Disord 24, 190 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12902-024-01731-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12902-024-01731-0

Keywords

BMC Endocrine Disorders

ISSN: 1472-6823

Contact us