Risk Factors of Pre-Diabetes among Adult Nigerians with Essential Hypertension in a Resource-Constrained Setting of a Primary Care Clinic in Eastern Nigeria
American Journal of Health Research
Volume 1, Issue 3, November 2013, Pages: 56-64
Received: Sep. 2, 2013; Published: Oct. 30, 2013
Views 3395      Downloads 277
Gabriel Uche Pascal Iloh, Department of Family Medicine, Federal Medical Centre, Umuahia, Abia state, Nigeria
Ndubueze Richard Uchenna, Department of Family Medicine, Federal Medical Centre, Owerri, Imo state, Nigeria
Nnadozie Paul Obiegbu, Ministry of Health, Awka, Anambra State, Nigeria and Trainer in Family Medicine Residency, Federal Medical Centre, Owerri, and Umuahia, Nigeria
Article Tools
Follow on us
Background: As the case detection of pre-diabetes(PD) increases worldwide, screening for its risk factors which overlap with those of type 2 diabetes mellitus(DM) is an important primary care challenge that is often neglected especially in under-resourced setting. Aim: This study was designed to determine the prevalence and risk factors of pre-diabetes among adult Nigerians with essential hypertension in a resource-constrained setting of a primary care clinic in Eastern Nigeria. Materials and Methods: A cross-sectional study carried out on 320 consecutive adult Nigerians with essential hypertension who were screened for PD and 106 of them who had PD and met the inclusion criteria were age and sex matched with 106 non-hypertensive and non-diabetic control. Demographic and some risk factors of PD were obtained using a pretested, structured and interviewer-administered questionnaire. Pre-diabetes was defined as fasting plasma glucose of 100-125 mg/dL and /or plasma glucose level of 140-199 mg/dL two hours after a 75g oral glucose load. Results: One hundred and six (33.1%) out of the 320 hypertensive patients screened had PD. Obesity (P=0.001), positive family history of DM (P=0.001) and inadequate physical activity (P=0.001) were significantly associated with PD. The most significant predictor of PD was obesity(OR=12.50(2.38-34.48), P=0.001).The obese patients were twelve and half times more likely to have PD compared to their non-obese counterparts. Conclusion: There was high prevalence of PD in adult hypertensive study population. Obesity, family history of DM and inadequate physical activity were proximate independent risk factors. The presence of these risk factors should therefore provide guide for screening adult Nigerians with essential hypertension for PD in primary care.
Adult, Hypertension, Nigeria, Pre-Diabetes, Primary Care, Risk Factors
To cite this article
Gabriel Uche Pascal Iloh, Ndubueze Richard Uchenna, Nnadozie Paul Obiegbu, Risk Factors of Pre-Diabetes among Adult Nigerians with Essential Hypertension in a Resource-Constrained Setting of a Primary Care Clinic in Eastern Nigeria, American Journal of Health Research. Vol. 1, No. 3, 2013, pp. 56-64. doi: 10.11648/j.ajhr.20130103.14
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of Diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-53.
Kearney PM, Whelton M, Reynolds K. Global burden of hypertension- analysis of worldwide data. Lancet 2005; 365: 217-23.
Unwin N, Setel P, Rashid S, Mugusi F, Mbanya JC, Kitange H, et al. Non-communicable diseases in sub-Saharan Africa: where do they feature in the health research agenda? Bull World Health Organ 2001; 79: 947-53.
Ogbu I. S, Neboh C. I. The prevalence of Prediabetes among hypertensive patients in Enugu, Southeast Nigeria. Niger Med J 2009: 50: 14-17.
Iloh GUP, Ofoedu JN, Njoku PU, Amadi AN, Godswill-Uko EU. Blood Glucose Control and Medication Adherence Among Adult Type 2 Diabetic Nigerians Attending A Primary Care Clinic in Under-resourced Environment of Eastern Nigeria. North Am J Med Sci.2012; 4:310-15.
Iloh GUP, Ikwudinma AO, Obiegbu NP. Obesity and Its Cardio-metabolic Co-morbidities Among Adult Nigerians in a Primary Care Clinic of a Tertiary Hospital in South-Eastern Nigeria. J Fam Med Primary Care 2013; 2: 20-26.
Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycaemia- the current status on definition and intervention. Diabet Med 2002; 19: 708-23.
Ramlo-Halsted BA, Edelman SV. The natural history of type 2 diabetes: Implications for clinical practice. Prim Care 1999; 26): 771-89.
Robinson SJ, Gordon SA, Russell JW, Feldman EL. Micro-vascular complications of impaired glucose tolerance. Diabetes 2003; 52: 2867-73.
Harris MI, Eastman RC. Early detection of undiagnosed Diabetes mellitus: a US perspective. Diabetes Metab Res Rev 2000; 16: 230-36.
Leiter L.A., Barr A., Belanger A, Labin S, Ross A, Tidesley H D. et al, Diabetes screening in Canada, (DIASCAN), study. Prevalence of undiagnosed diabetes and glucose intolerance in family physician offices. Diabetes Care 2001; 24: 1038-43.
Shyam SG, Mohammed AA, Kamlesh B, Kalyan KD. Prevalence of pre-hypertension and associated cardiovascular risk profiles among prediabetic Omani adults. BMC Public Health 2008; 8: 108.
Rolka DR, Burrows NR, Li Y, Geiss LS. Self-reported prediabetes and risk-reduction activities-US-2006. JAMA 2009; 301: 591-93.
Shobha SR, Philips S, Tamara M. Impaired glucose tolerance and impaired fasting glucose. Am Fam Physician 2004; 69: 1961-68, 1971-72.
Lorna ET, Ushma DU, Shadi C, Renu G, Diana KB, Charon G et al. Prevalence and control of diabetes and impaired fasting glucose in New York City. Diabetes Care 2009; 32: 57-62.
Shuqian L, Wenyu W, Xiaoguang Y, Elisa T, Jian Z, Yuna H et al. Prevalence of diabetes and impaired fasting glucose in Chinese adults, China National Nutrition and Health survey 2002. Prev Chronic Dis 2011; 8(1).
Shrestha UK, Singh DL, Bhattarai MD. The prevalence of hypertension and diabetes defined by fasting and 2 hour plasma glucose criteria in urban Nepal. Diabetes Medicine 2006; 23: 1130-35.
Faeh D, William J, Tappy L, Ravussin E, Bovet P. Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight. BMC Public Health 2007; 7:163.
Essien OE, Peters EJ, Udoh AE, Ekott JU, Odigwe CO. Prevalence and pattern of abnormal glucose tolerance in adult Nigerians with primary hypertension. Niger J Med 2007; 16: 50-56
Tuomilehto J, Lindstron J, Eriksson JG, Valla TT, Hamalainen H, Illane-Parikka P et al. Prevention of type 2 DM by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-50.
Kuller LH, Veletgas P, Barzilay J, Beauchamp NJ, ‘O’ leary DH, Savage PJ. Diabetes mellitus: subclinical cardiovascular disease and risk of incident mortality. Arterioscer Thromb Vasc Biol 2000; 20: 823-29.
The DECODE study: Group for the European Diabetes Epidemiology. Glucose tolerance and cardiovascular mortality: comparison of fasting and two hour diagnostic criteria. Arch Intern Med 2001; 161: 397-405.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure: The JNC VII report. JAMA 2003; 289: 2560- 72.
Mills JD, Grant PJ. Insulin resistance homeostasis factors and cardiovascular risk. Br J Diabetes Vasc Dis 2000; 2: 19-26.
Akintude AA. Epidemiological and conventional cardiovascular risk factors among hypertensive subjects with normal and impaired fasting glucose. S Afr Med J 2010; 100: 594-97.
Cynthia C, Harvey K, Bonita E, Falkner BE. The utility of fasting glucose for detection of prediabetes. Metabolism 2006; 55: 434-38.
Ibrahim T. Sample size determination. In: Research Methodology and Dissertation writing for Health and Allied Health Professionals. Abuja, Nigeria Cress Global Link Limited; 2009: p.70-75.
Araoye MO. Sample size determination. Research Methodology with Statistics for Health and Social Sciences, Ilorin, Nathadex Publishers, 2004. p.115- 21.
WHO. Survey of the STEPwise approach for the survellaince of risk factors for non-communicable diseases, Brazzaville, WHO, Region office for Africa, 2007.
Riddell M, Fowles J. How to treat prediabetes with exercise effectively. Clinical practice guide Diabetes 2010; 10-20.
Onwubere B, Kadiri S. Guidelines for the management of hypertension in Nigeria. Nigerian Hypertension Society. Enugu, Ezu Books Limited 2005.p. 1-40
Iloh GUP, Ofoedu JN, Njoku PU, Amadi AN, Godswill-Uko EU. Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria. African Journal of Primary Health Care & Family Medicine 2013 ;5: 446.
WHO. Global strategy on diet, physical activity and health. Bulletins of the WHO 2006; 5: 16-8.
Govindarajan G, Sowers JR, Stump C. Hypertension and Diabetes Mellitus. European Cardiology 2006; 2: 1-7.
Chen K, High L. Prevalence of impaired fasting glucose and type 2 diabetes mellitus in Penghu Islets, Taiwan: evidence of a rapidly emerging epidemic. Diab Res Clin Pract 2009; 44: 59-69.
Shanker JH, Mahmood SE, Joshi MC, Shaifali I. Obesity indices amongst diabetics in an urban population of Western Nepal. J. Diabetes Metab 2011; 2:134.
Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical exercise: the evidence. CMAJ 2006; 174: 801-809.
Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care 2007; 30: 744-52.
Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose response relationship? Med Sci Sports Exerc 2001; 33: 459-71.
Oyegbade OO, Abioye-Kuteyi EA, Kolawole BA, Ezeoma IT, Bello IS. Screening for diabetes mellitus in a Nigerian Family Practice Population. Am Fam Pract 2007; 49:15.
Harrison TA, Hindorff LA, Kim H, Wines RC, Bowen DJ, McGrath BB et al. Family history of diabetes as a potential public health tool. Am J Prev Med 2003; 24: 152-59.
Arslanian SA, Bacha F, Saad R, Gungor N. Family history of type 2 diabetes is associated with decreased insulin sensitivity and an impaired balance between insulin sensitivity and insulin secretion in White youth. Diabetes Care 2005; 28: 115-19.
Yoon PW, Scheuner MT, Khoury MJ. Research priorities for evaluating family history in the prevention of common chronic diseases. Am J Prev Med 2003; 24:128-35.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186