Risk Factors for Diabetic Complications among Diabetic Patients, Chirumanzu District, Zimbabwe, 2011

Introduction: Diabetic complications are largely a result of elevated blood sugar and are responsible for most deaths due to diabetes mellitus. Strict blood sugar control, achieved through adherence to treatment and lifestyle modifications such as physical activity and eating a healthy diet, is critical in the reduction of the incidence of these complications. This study assessed the factors associated with diabetic complications in both outpatients and hospitalized patients. Methods: We conducted a 1:1 unmatched case-control study among diabetic patients attending hospitals in Chirumanzu District, Midlands Province, Zimbabwe. Structured interviewer administered questionnaires were used to collect data on socio-demographic, knowledge and practices, treatment and health services risk factors. Univariate descriptive statistics such as proportions, means and medians were calculated. Bivariate and stratified analyses were done before stepwise logistic regression to identify independent risk factors. Data were analyzed using Epi-INFO Results: We enrolled 68 cases and 68 controls with a median ages of 51.5(Q1=43, Q3=61) and 52.5(Q1=43.5, Q3= 60.5) respectively. The majority were females 86 (63.3%). The major diabetic complication was severe hyperglycemia 44/68 (64.7%). Socio-demographic factors associated with diabetic complications were: Being unmarried [OR=3.68, 95%CI(1.70-8.07)], being widowed [OR=2.93,CI(1.14-7.68)], Having attained at most primary education [OR=2.83, 95%CI(1.29-6.25)] and urbanized residence [OR=2.48; 95%CI,(1.17-5.28)]. A significant practice factor was: Eating sugar containing diet[OR=3.9, 95%CI(1.86-8.18)].Treatment risk factors were: Insulin therapy [OR=3.83, 95%CI(1.78-8.34)], Missing doses [OR=6.63, 95%CI(3.08-14.29)] and co-morbidity with hypertension [OR=4.10, 95%CI(2.01-8.39)]. Distance from hospital >5km [3.97, 95%CI 1.77-9.00)] and failure to get drugs [OR=3.12, 95%CI (1.54-6.32)] were significant health services factors associated with complications. Health education [OR=0.274, 95%CI (0.134-0.56)], being already on treatment [OR=0.36, 95 %CI (0.165-0.779)] and having a treatment supporter [OR=0.24, 95%CI (0.115-0.49)] were protective factors. Independent risk factors were: Insulin therapy (p-value0.018), missed treatment doses (p-value=0.0113), co-morbidity with hypertension (p-value=0.0019) and failing to get drugs (p-value<0.001). Conclusion: The major socio-demographic and treatment related risk factors are largely functions of the patients’ knowledge and practices which can be mitigated by simple and inexpensive interventions. The health services factors found are a reflection of the coverage and efficiency of health services in the district which need to be addressed at national level. We therefore recommend the inclusion of health education in the treatment package for diabetic patients, community health education and the decentralization of diabetes care and treatment to rural health centres.