Diabetes Mellitus:Trend,Risk Factors and Hyperglycemic crisis among adults in Selected Public Hospitals in Tigrai Region:a Multi - Facility Study
| dc.contributor.advisor | Deyessa,Negussie(MD, Ph.D.) | |
| dc.contributor.author | Tedla,Getachew Gebremedhin | |
| dc.date.accessioned | 2026-06-22T16:14:39Z | |
| dc.date.available | 2026-06-22T16:14:39Z | |
| dc.date.issued | 2024-09 | |
| dc.description.abstract | Background: Diabetes mellitus is a pressing global health crisis, profoundly impacting mortality rates, morbidity, and economic stability. Type 1 and Type 2 diabetes are particularly severe public health challenges in low- and middle-income countries like Ethiopia, where urban diabetes incidence is alarmingly on the rise. The disease triggers serious acute and chronic complications, diminishing quality of life and inflating healthcare costs. Hyperglycemic crises, rampant in low-income settings such as Ethiopia, further exacerbate the burden, leading to disability, reduced life expectancy, and escalated healthcare expenses. Despite being a leading cause of hospital admissions and deaths, comprehensive data on diabetes trends, Type 2 diabetes risk factors among middle-aged adults, and treatment outcomes for hyperglycemic crises remain scarce in Ethiopia and other sub-Saharan African nations. Objective: This study aimed to assess time trends in proportions of people with type 1 and type 2 diabetes and risk factors for type 2 diabetes among people attending adult medical outpatient departments, and treatment outcomes of patients with hyperglycemic crises admitted in adult medical wards in selected public hospitals in Tigrai Region. Methods: A comprehensive study conducted across seven public hospitals in the Tigrai Region aimed to investigate time trends in the proportion of type 1 and type 2 diabetes cases alongside hyperglycemic crises. This retrospective cross-sectional hospital-based research spanned from September 2018 to June 2019. It involved the extensive review of 299,806 adult patient records from registry logbooks, 3056 medical charts focusing on diabetes trends, and 589 cases of hyperglycemic crises using a data abstraction checklist. Additionally, a matched case-control study at Ayder Comprehensive Specialized Hospital explored factors associated with type 2 diabetes among middle-aged adults. The study employed rigorous methods, including lottery-based sampling, to select 120 confirmed type 2 diabetes patients and 240 non-diabetic controls aged 45 to 64 years consecutively. Data collection utilized the WHO STEPS protocol customized for the local context to comprehensively assess the case-control study's socio-demographic, lifestyle, physical, and biomarker measurements. For the trend analysis of type 1 and type 2 diabetes, an Extended Mantel-Haenszel chi-square test of the linear trend was used. Associations between exposure and outcome variables in the case-control study were determined using bivariate and multivariable conditional logistic regression. The study employed descriptive statistics and a logistic regression model to determine the relationship between exposure and outcome variables for hyperglycemic crises related to in-hospital mortality using SPSS version 25. The significance level was set at p < 0.05 (two-tailed) for all statistical tests. The overall findings were presented using figures, tables, and text. Ethical approval and permissions were secured, ensuring compliance with ethical standards and participant confidentiality throughout the study. Results: From September 1, 2013, to August 31, 2018, among 299,806 adult patients receiving care at outpatient departments, the proportion of people with confirmed diabetes was 10.2 per 1000 adult patients (95% CI: 9.8-10.6). The proportion of people with diabetes significantly rose from 6.8 to 14.3 per 1000 adult patients during this period. Specifically, the proportion of type 1 diabetes increased from 1.0 to 2.2 per 1000 adult urban residents (Ptrend=0.002) and from 1.2 to 2.6 per 1000 adult rural residents (Ptrend=0.001). Similarly, the proportion of type 2 diabetes increased from 6.9 to 14.0 per 1000 adult urban residents (P trend=0.001) and from 4.0 to 9.5 per 1000 adult rural residents (Ptrend=0.001). Notably, this increase was more pronounced among women for both type 1 and type 2 diabetes. The mean ages of cases and controls were similar at 55.9±5.0 years and 55.7±4.8 years, respectively. The odds of Type 2 diabetes were significantly higher among urban residents (AOR=5.1, 95% CI [2.0, 13.2]), widowhood individuals (AOR=3.3, 95% CI [1.3, 8.6]), divorced individuals (AOR=2.8, 95% CI[1.1,7.3]), a positive family history of diabetes (AOR=5.4, 95% CI [2.4, 12.5]), daily alcohol consumption (AOR=3.5, 95% CI [1.2, 10.2]), consumption of white rice as a favorite food (AOR=3.8, 95%CI [1.2,11.6]), elevated waist circumference (AOR=2.4, 95% CI [1.1,5.0]), and elevated waist-to-height ratio (AOR=4.4, 95% CI [1.7, 11.2]), hypertension (AOR=3.0, 95% CI [1.7,5.5]), dyslipidemia (AOR=2.8, 95% CI [1.5, 5.4]), Conversely, engaging in moderate to vigorous intensity leisure physical activity was associated with lower odds of Type 2 diabetes (AOR=0.27, 95% CI [0.1, 0.72]). The mean age of patients with diabetic ketoacidosis and hyperosmolar hyperglycemic state was 42.9(±13.6) and 59.3(±11.2) years, respectively. About 24.2% of diabetic ketoacidosis and 42% of hyperosmolar hyperglycemic state patients were precipitated by infection, and also 163(37.6%) diabetes ketoacidosis and 33(21.2%) hyperosmolar hyperglycemic state were newly diagnosed diabetes patients. The in-hospital mortality was 78(13.2%), of which 43(7.3%) deaths were in patients with hyperosmolar hyperglycemic states. Rural residents had a higher proportion of in-hospital mortality (17.9%) compared to urban residents (10.4%). Patients without a history of diabetes were younger (mean age 43.9±12.6 vs. 48.4±14.9), more likely to reside in rural areas (53.1% vs. 30.3%), and had a lower proportion of Type 2 diabetes (38.3% vs. 53.7%), hyperosmolar hyperglycemic state (15.8% vs. 31.8%), and lower proportion of in-hospital mortality (8.7% vs. 15.5%) compared to those with known diabetes. Rural residence (AOR 3.1, 95% CI 1.8-5.4), history of stroke (AOR 2.7, 95% CI 1.3-5.6), Type 2 diabetes (AOR 2.3, 95% CI 1.1-4.7), hyperosmolar hyperglycemic state (AOR 2.4, 95% CI 1.1-5.4), and prior diabetes history (AOR 2.0, 95% CI 1.04-3.8) were significantly associated with increased mortality risk. Conversely, presentation with excessive thirst was associated with lower in-hospital mortality risk (AOR 0.47, 95% CI 0.27-0.81). Conclusions: The proportion of people with type 1 and type 2 diabetes has increased among urban and rural residents over time during the study period. Factors such as urban residency, widowhood/divorce, family history of diabetes, daily alcohol consumption, white rice, elevated waist circumference, hypertension, and dyslipidemia were associated with a higher risk of type 2 diabetes. In contrast, engagement in moderate to vigorous physical activity was protective. Rural residents and patients with hyperosmolar hyperglycemic states had higher in-mortality, with a history of stroke, type 2 diabetes, hyperosmolar hyperglycemic state, and history of diabetes being significant predictors, while polydipsia was protective. Health education is crucial for raising awareness about substance misuse, physical activity, and healthy eating habits at workplaces, schools, and community and family levels. Targeted screening programs for patients with existing diabetes may reduce morbidity and mortality if cost-effective interventions (for example education on healthy eating, regular physical activity, medication, and self-monitoring of blood glucose) are available. A feasible option might be to implement diabetes screening for patients aged 45 and above and those with known diabetes risk factors attending hospital adult medical outpatient departments for co-existing illnesses(patients with malaria, tuberculosis, hypertension, and so on). Furthermore, decentralizing diabetes care services to lower-level health facilities, enhancing the efficiency of bidirectional referral systems and ensuring the quality, availability, and affordability of insulin and other diabetes commodities are imperative to improve outcomes for people with diabetes in Ethiopia and similar settings. | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/8562 | |
| dc.language.iso | en_US | |
| dc.publisher | Addis Ababa University | |
| dc.subject | Trend | |
| dc.subject | type 1 diabetes | |
| dc.subject | type 2 diabetes | |
| dc.subject | middle age adults | |
| dc.subject | hyperglycemic crisis | |
| dc.title | Diabetes Mellitus:Trend,Risk Factors and Hyperglycemic crisis among adults in Selected Public Hospitals in Tigrai Region:a Multi - Facility Study | |
| dc.type | Thesis |