Prevalence of prediabetes and related cardiovascular risk factors among Employees of Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia


 Background: Pre-diabetes, also known as intermediate hyperglycaemia; is defined as a glycemic state which is higher than normal, but lower than the threshold for full blown diabetes. It is considered as an important risk factor for diabetes and its associated complications. However evidences show that these consequences can be averted or delay through lifestyle modifications. Therefore determining its magnitude is a critical step to plan for such mitigation measures. Methods: A cross sectional study was conducted on employees of a tertiary care hospital from March - June/2019 . Socio-demographic data were collected using self-administered questionnaire. Anthropometric and blood pressure measurements were performed following WHO guideline. Biochemical parameters were assayed following standard operating procedures. SPSS version 20 was used for data entry and analysis. Categorical variables were summarized using frequencies and percentages. Normality test was performed in advance of describing the numeric data and log transformations were carried out when appropriate. International Diabetes Federation (IDF) and American Diabetes Association (ADA) criteria were used to classify the glycemic status. Likewise IDF and revised National Cholesterol Education Program Adult treatment panel III (NCEP ATP III) were employed for the diagnosis of metabolic syndrome. Result: we engaged a total of 265 employees in this study. About 35.1% were males and 64.9% were females. Median age was 29 (9) years. Prediabetes was diagnosed in 5.7 % and 18.1% of the participants based on IDF and ADA criteria respectively. While equally 3.4% of them had FBS levels that satisfy the criteria for diagnosis with frank diabetes. In addition 55.1% had a metabolic risk as implied by their waist to height ratio (WHtR), 24.2% had hypertriglyceridemia, 27.9% had above optimal LDL and 57% had decreased HDL. Taken together 17.9% and 21.9% of the participants had metabolic syndrome according to IDF and revised NCEP ATP III criteria respectively. Magnitude of dysglycemia and metabolic syndrome found to increase with age of employees. Conclusion: the prediabetes and metabolic syndrome prevalence observed in the hospital employees was comparable with the general population. Key words: Prediabetes, metabolic syndrome, hospital employees

Result: we engaged a total of 265 employees in this study. About 35.1% were males and 64.9% 27 were females. Median age was 29 (9) years. Prediabetes was diagnosed in 5.7 % and 18.1% of 28 the participants based on IDF and ADA criteria respectively. While equally 3.4% of them had 29 FBS levels that satisfy the criteria for diagnosis with frank diabetes. In addition 55.1% had a 30 metabolic risk as implied by their waist to height ratio (WHtR), 24.2% had hypertriglyceridemia, 31 hemoglobin A1C levels of 5.7-6.4% as additionally introduced by the American Diabetes 48 Association (ADA) (3).

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Prediabetes produces no symptoms but it is a substantial risk factor for developing type-2 51 diabetes mellitus and its sequel, which include heart disease, stroke, nerve damage, kidney 52 failure, and eye problems (4,5). It has been estimated that a pre-diabetic person is 5 to 15 times 53 more likely to develop type-2 diabetes mellitus compared to a person with normal blood glucose 54 levels (6,7). Likewise in comparison with adults who have normal glucose; people with impaired 55 fasting glucose have a two-to three-fold increased prospective risk of cardiovascular events, 56 which are most marked in younger subjects (8). Additionally Shreds of evidence show that some 57 long-term damage to the body, especially the heart and circulatory system, may already be 58 occurring during pre-diabetes (9).

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Nevertheless, studies report that for pre-diabetic patients, lifestyle modification can help prevent 61 or reduce its progression to diabetes by 40-70%. This emphasizes the need for early diagnosis, 62 initiate evidence-based intervention and closely monitor cases (10,11). Unfortunately, majority 63 of the people have no idea that they have pre-diabetes as the condition develops gradually and 64 without warning. The symptoms of type 2 diabetes (frequent urination, excessive thirst, The sample size was calculated based on the reported prevalence of pre-diabetes indicated in a 103 study conducted in Ambo, North West Ethiopia, which was 19.5% (16). The calculation was 104 done using a single population proportion formula considering 5% tolerable error and 95% 105 confidence level. Accordingly, the minimum sample size was 241. However, considering a 10%   Standing height without shoes was measured to the nearest 0.1 cm using portable height 129 measuring equipment (SECA 877). Weight was also measured to the nearest 0.1 kg with 130 participants wearing light clothing and without shoes using a pre-calibrated digital weighing 131 scale (SECA 877). Body mass index (BMI) was calculated as weight divided by height squared 132 (kg/m2). Waist circumference was measured using a constant tension tape across the umbilicus 133 level. Similarly hip circumference was measured at the highest extension of the buttock. Both 134 measurements were carried twice and the average value was recorded.

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Blood pressure was measured using a validated blood pressure machine (OMRON M2 device).

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Two readings were taken for systolic blood pressure (SBP) and diastolic blood pressure (DBP).

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The initial measurement was done after the patient took 10 minutes rest. The second 138 measurement was taken 5 minutes right after the initial measurement. An average of the two was 139 recorded as per the WHO recommendation.  has the same cut-off value for IGT (140-200 mg/dL) but has a lower cut-off value for IFG (100-160 125 mg/dL) and has additional hemoglobin A1c (HbA1c) based criteria of a level of 5.7% to 161 6.4% for the definition of prediabetes (19,20). Since the oral glucose tolerance test (OGTT) is 162 technically demanding and the cost for HbA1c is expensive, the classification of subjects in this 163 study was made based on impaired fasting glucose (IFG).

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Data quality management and control 166 To assert the quality of data, the questionnaire was pretested and the entire data collection 167 process was strictly supervised, during the data collection. Additionally, the questionnaires were     In this study 5.7 % and 18.1% of the participants were in the prediabetic range based on the IDF 235 and ADA criteria respectively. While equally 3.4% of participants had their FBS values in the 236 diabetic range according to both IDF and ADA criteria, table 3. The impairments in fasting blood 237 sugar were found to increase with the age of the participants with apex at 40 -49 years (figure 1).