Ministry of Health, Provincial Ayurveda Hospital, Dang, Nepal.
Rapti Life Care Hospital Pvt. Ltd., Tulsipur, Dang, Nepal.
J Diabetes Investig. 2023 Apr;14(4):602-613. doi: 10.1111/jdi.13985. Epub 2023 Feb 6.
AIMS/INTRODUCTION: The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly prevalent in low- and middle-income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal.
We carried out a cross-sectional study in Tulsipur Sub-Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment.
The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval [CI] 3.8-8.6%), which were associated with hypertension (P = 0.01%) and low socioeconomic status (P = 0.01). The proportion of major and/or minor ECG abnormalities was 47.8% (95% CI 40.5-51%), and were significantly associated with age (odds ratio [OR] 1.04, 95% CI 1.01-1.07), higher education (OR 3.50, 95% CI 1.31-9.33), unemployment (OR 3.02, 95% CI 1.08-8.48), body mass index (OR 1.09, 95% CI 1.02-1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19-4.93). The proportion of renal impairment was 3.5% (95% CI 1.5-4.5%) which was associated with older age (OR 1.08, 95% CI 1.00-1.17) and hypertension (OR 12.12, 95% CI 1.07-138.22).
A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus.
目的/引言：全球糖尿病的负担正在大幅增加，心血管疾病和肾脏疾病的负担也在进一步增加。这些公共卫生问题在低收入和中等收入国家（包括尼泊尔）非常普遍。然而，关于 2 型糖尿病患者的心脏和肾脏状况的证据有限。我们确定了尼泊尔 2 型糖尿病患者的心电图（ECG）异常和肾功能损害的情况。
我们在尼泊尔图尔西布尔次都市区使用多阶段分层抽样技术进行了一项横断面研究，以招募 2 型糖尿病患者。我们使用世界卫生组织逐步监测方法（WHO STEPS）问卷，并进行静息心电图检查，以收集 345 名 2 型糖尿病患者的数据。逻辑回归分析评估了与 ECG 异常和肾功能损害相关的因素。
研究表明，6.1%的参与者存在主要的 ECG 异常（95%置信区间 [CI] 3.8-8.6%），与高血压（P=0.01%）和低社会经济地位（P=0.01%）相关。主要和/或次要 ECG 异常的比例为 47.8%（95%CI 40.5-51%），与年龄（比值比 [OR] 1.04，95%CI 1.01-1.07）、较高的教育程度（OR 3.50，95%CI 1.31-9.33）、失业（OR 3.02，95%CI 1.08-8.48）、体重指数（OR 1.09，95%CI 1.02-1.17）和 2 型糖尿病病程>5 年（OR 2.42，95%CI 1.19-4.93）相关。肾功能损害的比例为 3.5%（95%CI 1.5-4.5%），与年龄较大（OR 1.08，95%CI 1.00-1.17）和高血压（OR 12.12，95%CI 1.07-138.22）相关。
相当一部分 2 型糖尿病患者存在心电图异常和肾功能损害，这与高血压显著相关。因此，高血压管理和早期筛查对于预防 2 型糖尿病患者的未来心肾并发症至关重要。
