Mtshali Sifiso, Mahomed Ozayr
Discipline of Public Health Medicine, University of KwaZulu Natal, Durban, South Africa.
Diabetes Metab Syndr Obes. 2021 Oct 7;14:4181-4188. doi: 10.2147/DMSO.S320652. eCollection 2021.
Poor diabetes control can result in short- and long-term neuropathic, microvascular, and macrovascular complications. In addition to the socioeconomic impact that diabetes and its complications has on patients, incremental financial costs are added to health-care systems. This study aimed to assess prevalence, patient-related factors, and referral patterns for patients with diabetes-related complications managed at Inkosi Albert Luthuli Central Hospital (IALCH) betweenJanuary 1, 2014 and December 31, 2015.
The retrospective cross-sectional study was done on all adult patients (aged >18 years) with diabetes consulted at IALCH. Primary outcome measures were the proportion with diabetes-related complications and the source of referrals. Logistic regression analysis was done to identify predictors of diabetes complications.
Of all adult diabetes patients consulted, 7,761 (47.4%) presented with one or more diabetes-related complications and 56% (4,321) had experienced macrovascular complications. Cardiovascular complications (2,576, 33%) were the most common complications, followed by peripheral vascular disease (1,755, 23%). Microvascular complications included retinopathy (1,656, 21%), nephropathy (118, 14%), and neuropathy (702, 9%). After multivariate analysis, all four factors (age >58 years, male sex, Indian ancestry, and non-insulin dependent diabetes mellitus remained statistically significant for an increased likelihood of developing cardiovascular complications. Indian ancestry was not associated with increased odds of peripheral vascular disease.
Macrovascular diseases were the main complications. Older age, male sex, Indian ancestry, and non-insulin dependent diabetes mellitus were associated with macrovascular complications. A combination of health-promotion and behaviour-modification programs is required prior to or early in the disease course. Appropriate and more aggressive management at primary-care level using evidence-based clinical guidelines is essential to prevent complications.
糖尿病控制不佳可导致短期和长期的神经病变、微血管病变和大血管病变并发症。除了糖尿病及其并发症对患者造成的社会经济影响外，还会给医疗保健系统增加额外的经济成本。本研究旨在评估2014年1月1日至2015年12月31日期间在因科西·阿尔伯特·卢图利中央医院（IALCH）接受治疗的糖尿病相关并发症患者的患病率、患者相关因素及转诊模式。
对IALCH所有就诊的成年糖尿病患者（年龄>18岁）进行回顾性横断面研究。主要结局指标为糖尿病相关并发症的比例及转诊来源。采用逻辑回归分析确定糖尿病并发症的预测因素。
在所有就诊的成年糖尿病患者中，7761例（47.4%）出现一种或多种糖尿病相关并发症，56%（4321例）发生大血管并发症。心血管并发症（2576例，33%）是最常见的并发症，其次是外周血管疾病（1755例，23%）。微血管并发症包括视网膜病变（1656例，21%）、肾病（118例，14%）和神经病变（702例，9%）。多因素分析后，年龄>58岁、男性、印度裔和非胰岛素依赖型糖尿病这四个因素在发生心血管并发症的可能性增加方面仍具有统计学意义。印度裔与外周血管疾病发生几率增加无关。
大血管疾病是主要并发症。年龄较大、男性、印度裔和非胰岛素依赖型糖尿病与大血管并发症有关。在疾病进程之前或早期需要结合健康促进和行为改变计划。在初级保健层面采用基于证据的临床指南进行适当且更积极的管理对于预防并发症至关重要。
