Poor Trends in Glycemic, Weight and Blood Pressure Control during Screening in Population among Small town of Karachi

Introduction

Diabetes is one of the five leading causes of death worldwide and remains to be an expanding global health crisis the world preva- lence of diabetes according to the International Diabetes Federa- tion (IDF). In age 20-79, was 6.4%, affecting 285 million in 2010, and expectedly increasing to 7.7% (439 million) by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in de- veloped countries [1-3]. Pakistanis have rising diabetes incidence and prevalence which is associated with increase in life, demo- graphics and social conditions, consumption of unhealthy diets and physical inactivity leading to obesity and hypertension, due to the increasing urbanization and social development more than 46% of diabetes patients specially women s are unaware of their condition and a large pool of individuals are in the pre-diabetic state or with undiagnosed diabetes in small towns [4-8]. Chronic obesity leads to increased insulin resistance that can develop into type 2 diabetes, most likely because adipose tissue, (especially the intra-abdominal) is a source of hormones and cytokines. On the other hand, type 2 diabetes may cause obesity as an effect of the changes in metabolism and other deranged cell behavior atten- dant on insulin resistance. The combined environmental-genetic influence on developing DM can be evidenced. Knowledge and awareness about diabetes, its risk factors, complications and man- agement are important aspects for better control and better quality of life (QOL) in patients, especially in developing countries like Pakistan where diabetes its related hypertension and obesity are in escalation but still important differences in these risk factors have not been fully explored [9].

Aims and Objectives

Diabetes and its related risks are globally elevated in South Asians. Prevention and control of diabetes-related Hypertension and Obe- sity need to be structured. There is clear potential in reducing di- abetes Hypertension Obesity and their related mortality and mor- bidity by addressing risk which has not been fully evidenced yet at both primary and secondary prevention levels [9]. We conducted this study to explore the variations in the impact of risk factors, analyze the prevalence of prediabetes and diabetes and to evalu- ate the influence of some demographic criteria, weight, and blood pressure upon blood glucose among the Pakistani population of small towns.

Material and methods

Population based Cross-sectional survey (2017 June-2021 June). Participants visiting for the screening in medical camps from the nearby small towns of Karachi City with help of Sindh Gradu- ate Association and Go Red for Women Program Pakistan Cardi- ac Society. A total of 377 were screened out of 1289 individuals aged 15-70years but complete data for all persons was available for analysis Table 1.

Screening and risk assessment were performed with question- naires. which consists demographic criteria, e.g., age, marital status etc., life style, Chronic Diseases (perceived Health Status) risk factors, e.g., tobacco use, HTN, DM, BMI. The questionnaire takes 20 minutes to complete a signed consent to take part in the screening plan was obtained from participants [9,10]. An analysis based on the performed free measurement of blood glucose con- centration with enzymatic assay techniques, prediabetes screening analyses with fasting plasma glucose (FPG); the 75-g oral glucose tolerance test (OGTT), and casual (random) plasma glucose (RPG) level. The basal mass index was calculated and stratified as per WHO classification was defined in (kg/m²) l as underweight <20, normal weight 20-24.9, overweight 25-29.9, and obesity stag- es stage-1 (30 - 34.9), stage-2 (35 - 39.9), morbid obesity ≥40). Higher threshold cut off of BP for diabetic patients was kept at 130/80mmhg [11].

In the second phase of analysis, we examined the effect of the risk factors on RPG (measured) as a frank diabetes/prediabetes disease state, BP measurement and checked the BMI or any complication occurred during the period and Patients were reviewed for treat- ment and prevention achieved benefit of diabetic patients with re- lated risks. Analysis was performed with cross-tabulation, as in chi-square test. The SPSS software for Microsoft-version-20 was used for statistical analyses. The statistical analysis approach prin- cipally encompassed descriptive statistics.

Results

A total of 377 out of 1289 people who attended the screening camps were known diabetics with median age was 46.7 (QR 11.9) years with 66% being above 40 years. 60.2% people had poor gly- cemic control using an optimum of <7.8 mmol/L. (>140mg/dl) and 54.59% with blood sugars exceeding 10 mmol/L (>180mg/ dl). Newly diagnosed Diabetics with Impaired glucose tolerance were 90 (12%) on sugar above (>140mg/dl) vs 20 (03%) sugar (>180mg/dl) Table 2.

                                                                                                       Table 2

Among screened persons 32% (419) were hypertensive, 42% (161) were diabetics and 28.3% were non-diabetics. HBA1c < 7% was about 50% in persons being hypertensive in spite of the treatment when a higher threshold of 130/80 mmHg as recommended in care diabetics was used. When a BP cut off of 140/90 mmHg was used,59.4% of diabetics were found to have coexisting hypertension that was poorly controlled Table 3.

Prevalence of the Hypertension varied in the different ethnic groups and areas. The age-standardized prevalence of hypertension was highest among Balochis (25.3% in men and 41.4% in women), then Pashtuns (23.7% in men and 28.4% in women), Muhajirs (24.1% in men and 24.6% in women), and lowest among Punjabis (17.3% in men and 16.4% in women) and Sandhi’s (19.0% in men and 9.9% in women) (P = 0.001) Table 4.

Almost two-thirds of screened patients for the Diabetes were either overweight (34.7%) or obese (29.9%). The mean BMI is among the non-diabetics was 26.75kg/m2. 58% of diabetics had a BMI of above 25 with a mean BMI of 27.13 kg/m2and in 32% diabetics BMI was above 30 kg/m2 as a measure of obesity was found in 62% of women and 52%men were either overweight or obese with 33.3% of the women. 92 (12%) were those not known to have diabetes or with impaired glucose tolerance newly diagnosed diabetics women had BMI of above 30 as compared to 19% in men. The mean waist circumference (WC) was 94.7 ± 13.3 cm; and 27.9% had central obesity (WC ≥102 cm) in screened group Table 5.

The BMI increased with age and 65% of these >41 years were either overweight or obese.

In the second phase of analysis, the prevalence of the ultimate re- search outcome, which is prediabetes/diabetes, among the study population was examined. Age, and SBP were significantly related to the development of prediabetes/diabetes; BMI was not. The ten- dency for recording high BMI levels (>25 and ≥40 kg/m2 among those with reported history of DM was higher than with recording normal.

Discussion

HTN, DM, Obesity is an exacerbating public health problem in developing countries like Pakistan, is most likely result of an im- balanced diet, lack of physical activity, and various other social and demographic factors like age, and family history etc. Mur- ray & Lopez, et al (1997), Jafar, et al (2003), Jafar, et al (2005), Rahman, et al (2006), Abbas, et al (2009). [12-17], in the present study of 377 out of 1289 adults with diabetes with poor glycemic control, hypertension and BMI acted as a random audit record of screening at medical camps of clinical services. As the effective- ness of screening depends on the setting in which it is performed and should the positively screened fail to obtain appropriate fol- low-up care. so, these patients of our study were screened during the medical camps criteria for the screening met 1-4 of the follow- ing conditions in asymptomatic populations [18,19].

• The disease represents an important health problem that im- poses a significant burden on the population,

• The natural history of the disease is understood

• There is a recognizable preclinical stage during which the dis- ease can be diagnosed

• Reliable tests are available that can detect such preclinical stage

• Treatment after early detection yields benefits superior to those obtained when treatment is delayed,

• The costs of treatment are reasonable and are balanced in rela- tion to health expenditures, and resources are available to treat newly diagnosed cases,

• Screening will be a systematic ongoing process and not mere- ly an isolated one-time effort. The data revealed that majority of known diabetes patients are at a risk of long-term complications owing to Overweight and obesi- ty (58%), Poor controlled blood pressure (59.4%), Poor glycemic control (60.2%). The high number of people in the pre-diabetic’s state or with undiagnosed diabetes represented a large pool of in- dividuals who were supposed to be at risk of presenting with long- term complications of Diabetes. Importantly, age was strongly correlated with all the risks, including WC, BMI, and SBP. Asso- ciation of glycemic control on the basis of fasting plasma glucose was also assessed and hypertension was significantly found to be associated with poor glycemic control. Two third of our subjects with type 2 diabetes were obese with a BMI>25 Kg/m; according to the recommendations of the WHO Asia-Pacific Regional Office. with females more obese as compared to males’ similar pattern in other Asian Countries. and a strong correlation between BMI and WC was observed in study.

In practice, WC has been widely used to endorse the presence of “central obesity”, which is a pivotal factor contributing to insu-lin resistance. Different cut-off points for obesity, ranging from 78 cm, as in assessing some male Asian populations with one or more cardiovascular risk factors and for identifying those with a BMI above normal to 102 cm, which is the generally international cutoff for male obesity (and 88 cm for obesity in females), have been in use, based on ethnicity, risk profile, anthropometric and demographic traits, as well as the prevailing dietary behavior [20].

In Osaimi and collaborates (2007) worked to determine the prev- alence and CVD risks in a suburban community in eastern Ri- yadh district, KSA, 71/451 (15.8%) of those surveyed had type 2 diabetes [21]. The findings of study suggest that complications are more in subjects with Diabetes and Hypertension and obesity. Obese subjects had a positive association with systolic and diastol- ic blood pressure suggesting that losing weight could also have a beneficial effect on blood pressure in diabetic subjects. This was evident by association of hypertension with FPG and of diastolic hypertension with hyperglycemia. Systolic blood pressure had an association with those subjects who had any microvascular com- plications. Diastolic blood pressure was only associated with those having nephropathy. So, tight control of Blood pressure is manda- tory [20, 22,23].

Explanations for the discrepancy between adequacy of DM man- agement. Improperly high plasma glucose (IHPG) in diabetics of- ten accompanies comorbid conditions, such as infection, stress or other health challenges. Which need to keep our diabetic group under close surveillance and guidance by an efficient health edu- cation plan in order to reduce fluctuation of plasma glucose level [24,25]. So, that complication can be postpone Adopting an inte- grated diabetes management strategy which appreciates the role of continuous patient and family education and close follow up bridges the gap between policy and the health outcomes, e.g., in terms of better control of diabetes Hypertension, body mass and abdominal size, and glucose level monitoring at different age phases of our community [26].

Conclusion

In conclusion this study shows the mostly diabetics were having poor glycemic, Hypertension and Weight control. As the majority of known diabetes patients are at risk of long-term complications owning to overweight and obesity (58%), Poorly controlled blood pressure (59.4%), Poor glycemic control (60.2%). Prediabetes and uncontrolled diabetes are relatively prevalent among the study group. This information could be very helpful in planning health- care strategies. A preventive approach to revert the predisposition of prediabetes in WD recruit’s population is quite promising. Em- phasis should be on the promotion of early detection of diabetes through screening and diabetes education. Weight control, Strict blood pressure and glycemic control essential for prevention of long-term complications of diabetes in under develop areas of Pa- kistan.

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