Macroangiopathic Complications and Associated Factors in Type 2 Diabetics at CNHU-HKM ()
1. Introduction
Diabetes is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defective insulin secretion and/or insulin resistance or both [1] [2] . Today it constitutes a major public health issue. According to the International Diabetes Federation (IDF), diabetes is one of the world’s ten leading causes of death. It is a costly pathology due to its chronicity and the severity of its complications [3] . Thus, the relative risk of stroke is 2 to 5, coronary insufficiency 2 to 4, and arteritis of lower extremity 5 to 10. Among the complications linked to diabetes, cardiovascular accidents remain the most amazing. They represent the leading cause of death in diabetics. In fact, approximately one in two diabetic patients dies from cardiovascular disease [3] [4] . This falls under diabetic macroangiopathy, the entities of which are silent myocardial ischemia, strokes and arteritis of the lower limbs.
2. Method
Our study was carried out in the Endocrinology, Metabolism and Nutrition clinic of the National Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM). It was a descriptive cross-sectional study with analytical aims. It took place over a 3-yearperiod from January 1, 2019 to December 31, 2021. Included in the study are type 2 diabetic patients who were seen (consulted or hospitalized) in our department at the CNHU-HKM in Cotonouduring this period and having a complete and usable medical file. Excluded are type 2 diabetic patients with an incomplete or unusable file and pregnant women with diabetes. Screening used was the manual processing of registers and files of every patient that match upour inclusion criteria. The dependent variable of our study is the occurrence of macroangiopathic complications (stroke, OALL, silent myocardial ischemia,). The independent variables are sociodemographic, cultural and economic factors (age, sex, ethnicity, profession, socio-economic level, educational level, marital status, factors relating to diabetes: Type of diabetes, duration of diabetes, balance of diabetes: HbA1c, monitoring of diabetes, drug treatment, chronic complications of diabetes, dyslipidemia). An individual survey form developed for this purpose was used for the collection. Data entry was done using Epi info 7.1 software. The data analysis was done using the following software: Epi info 7.1, Epi-data 3.1 and Excel 2016. Verification and clearance were carried out with STATA MP14 Comparison of the frequencies and percentages represented by the qualitative variables was carried out with the Pearson Chi square test or the Fisher exact test if the chi square test condition was not respected; the comparison of the means represented by the variables is made with the Student test. A p < 0.05 was considered statistically significant. In multivariate analysis, the logistic regression model was applied.
3. Results
From January 1, 2019 to December 31, 2021, we identified 150 type 2 diabetic patients at CNHU-HKM. Among these patients, 90 had at least one entity of macroangiopathy. Its prevalence was therefore 60%. The average age of the patients was 57.69 ± 1.77 years. The median age was 58 years and the range were 30 and 90 years. Patients over 60 years old were the most represented. There were as many men as women. The sex ratio was 1: Table 1.
Associated factors with diabetes monitoring: Table 2.
Diabetes monitoring was irregular for the majority of patients and HbA1c was above 7% in most cases. Glycemic balance was observed in 19 patients among the 125 for whom it was available (i.e. 16%). Glycated hemoglobin averaged 10.48% ± 0.72%. The median value was 10.20% and the extremes were 4.8 and 18.90%.
3.1. Cardiovascular Risk Factors
A large number of women with abdominal obesity were observed. Ninety-seven patients (or 64.7%) had high blood pressure with 85 (or 87.6%) observing a treatment. Six patients (4%) were tobacco users and averaging 114 packs/year. Thirty-three patients (22%) consumed alcohol and on average 20.09 grams/day.
Within seventy-seven patients (51.7%) having a family background of high blood pressure, 43 of them was first-degree relatives (55.6%).
85 patients had first-degree relatives (69.7%) among the one hundred and twenty-two patients (81.3%) with a family history of diabetes.
3.2. Macroangiopathy
Seventeen patients (11.3%) had a stroke, including 16 (94.1%) an ischemic stroke and 1 (5.9%) a hemorrhagic stroke. There was a recurrence for 4 (23.5%).
Silent myocardial ischemia was found in 26 of these patients on the EKG (27.3%).
OALL in its clinical manifestation, intermittent claudication, was found in 13 patients (or 8.7%), including 2 in stage I, 7 in stage II, 2 in stage III and 1 in stage IV.
Distal pulses were present for the majority of patients 72.6%.
Arterial ultrasound of the PAD pelvic limbs was done for 60 patients (i.e. 40%). PAD was identified in 45 (75%) and the degree of stenosis was 46.97% ± 25.36% on average.
Associated factors with the occurrence of macroangiopathy in diabetics from the CNHU-HKM of Cotonou: Table 3.
There is a statistically significant association between age, the duration more than 15 years and history of high blood pressure in the patient when macroangiopathy occur. On the other hand smoking, alcohol, medical treatment, physical activity and sex are not associated with the occurrence of macroangiopathic complications
3.3. Mortality
Total mortality was 7.3%, concerning 11 patients out of the 150 with macroangiopathy. Stoke was the main cause of death.
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Table 1. Distribution of patients according to age and sex.
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Table 2. Distribution of patients according to factors associated with diabetes monitoring.
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Table 3. Associated factors to macroangiopathy occurrence in diabetics at CNHU-HKM de Cotonou.
4. Discussion
In our study the prevalence of diabetic macroangiopathy was 60%. Similar figures were found by Sarr et al. (57.8%) [5] . On the other hand, prevalences lower than ours were found by Khanouach et al. 27.6% [6] . The average age of the patients was 57.69 ± 1.77 years. This average is close to Diagne’s et al. studies, 58.72 ± 11.7.
The sex ratio was 1 in our study. However, Diagne et al. and Charles et al. found respectively 1.11 and 1.36 in favor of women [7] [8] .
There is a statistically significant association between age, duration more than 15 years and history of blood pressure within patient enduring macroangiopathy in our study. A similar result was reported in the study by Roux et al. where the patients’ diabetes had been evolving for 15.7 ± 7.2 years [9] .
Tobacco is one of the most important cardiovascular risk factor; we have identified 4% of smoking patients. Studiesby Sow et al., Yameogo et al. and Diagne et al., found higher results with respectively 9.1%, 7.2% and 5.7% of diabetics who smoke [7] [10] [11] .
Identifying 127 patients out of the 150 with dyslipidemia, (84.7%) confirms UKPDS conclusions that showed the effect of diabetes on plasma lipids thus contributing to excess cardiovascular risk [12] . In addition, a statistically significant link was found between the occurrence of a macroangiopathy entity and dyslipidemia (p < 0.05). Our figures are, however, higher than those of Sow et al. (31.8%) [10] and Yameogo et al. (43.08%) [11] .
Silent myocardial infarction was found in 26 patients or 27.4%. This is close to that found by Sarr et al., 24% [5] . Khochtali et al., in diabetics aged over 65 (20%) [13] . In a study on the blood pressure level of diabetics conducted in 2009, Lokrou et al. found 14% of diabetics suffering from coronary artery disease [14] . Whereas in 1998 the rate of dyslipidemic diabetics suffering from latent myocardial infarction was 15.1% [15] . Similar proportions were found by Ndiaye et al. on one hand (14.2%) [16] and by Khanouach et al. on the other hand (13.8%) [6] .
Our figures are also higher than those of Koate et al. who diagnosed silent myocardial infarction in 9.25% of diabetic patients [17] and those of Sow et al. silent myocardial infarction (0.36%) [10] . Diagne et al. found 50.02% ischemic heart disease among type 2 diabetic patients [7] . Stroke concerns 11.3% of patients in our series with 94.1% ischemic stroke and 5.9% hemorrhagic stroke.
Limit of study: The type of study (retrospective) is the main limitation because we were limited in the description of certain symptoms that were not always reported in the records.
5. Conclusion
The prevalence of macroangiopathy was 60%. Stroke 11.3%, silent myocardial infarction 27.3%, and OALL 46.97%. The mortality rate linked to macroangiopathy is 7.3%, hence the importance of prevention which involves screening for risk factors.