Hindawi

Journal of Diabetes Research

Research Article
Prevalence and Risk Factors Associated with Type 2 Diabetes in
Elderly Patients Aged 45-80 Years at Kanungu District

Debrah Asiimwe, Godfrey O. Mauti , and Ritah Kiconco

Correspondence should be addressed to Godfrey O. Mauti; [email protected]

Received 31 December 2019; Accepted 11 January 2020; Published 30 January 2020

Academic Editor: Akira Sugawara

Copyright © 2020 Debrah Asiimwe et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Background. Type 2 diabetes is a worldwide disaster including in Uganda, specifically in Kanungu District which had a rise in
diabetic patients in 2018/2019 as compared to the 2017/2018 financial year. This research was determined to access the
prevalence and risk factors associated with type 2 diabetes on elderly patients aged 45-80 years attending Kanungu Health
Centre IV, Kanungu District. Methods. A cross-sectional study was conducted among patients aged 45-80 years attending
Kanungu Health Centre IV from June to August 2019. The prevalence of type 2 diabetes was determined by the blood sugar of
patients. Questionnaires were used to collect data for factors associated with type 2 diabetes. Data were statistically analyzed
using the statistical package for social sciences (SPSS) version 25 (SPSS Inc., USA) at P < 0:05. Results. The overall prevalence of
type 2 diabetes was 18.7% among the tested patients. 22.8% of diabetic patients were females as 7.8% were males. The age group
most affected by diabetes was 61-65 years. Alcoholism, smoking, body mass index (BMI), and family history were found to be
significantly associated with type 2 diabetes at P value < 0.05. Conclusion. There was a high prevalence of type 2 diabetes
observed in this study compared to studies done in previous years which raise a public health concern. This study also found
that females and patients aged 61-65 years were most affected by diabetes. Lastly, the presence of family history for diabetes,
overweight, and being obese increases the chances of acquiring type 2 diabetes.

1. Introduction 25% of adults with diabetes mellitus are under 44 years [1].
In recent studies, low-income countries of Sub-Saharan
Diabetes mellitus (DM), also termed as “sugar,” is a chronic, Africa including Uganda have the fastest growing rates of
noncommunicable disease (NCD) which has emerged as one diabetes mellitus whereby the diabetes population has drasti-
of the leading global health problem associated with the pan- cally increased from an estimated 98,000 patients in 2000 to
creas in the production of insulin leading to hyperglycemia about 1.5 million in 2010 from a population of 30 million
[1, 2]. Type 2 diabetes mellitus is associated with a combina- people [5].
tion of resistance to insulin action and inadequate compensa- Globally, according to the International Diabetes Federa-
tory insulin secretory response [3]. tion (IDF), there are 352 million adults with impaired glucose
Type 2 diabetes affects both the old and the youths and is tolerance which is a high risk of developing diabetes by
highly associated with morbidity, mortality, and a high 2045 [6]. Despite the increase in diabetes burden, interven-
health cost to individual patients, their families, and coun- tions are still poor and epidemiological data are scarce. There
tries [4]. It was found to affect 382 million (7.7%) in 2013 is no national noncommunicable disease (NCD) surveys in
and was estimated to 483 million (8.3%) by the year 2030. Uganda, so information is from a few local surveys [5].
In developed countries, more than half of the people with Despite policy stating that primary care facilities should pro-
type 2 diabetes mellitus are older than 65 years and only vide services for type 2 diabetes, studies have demonstrated
8% are less than 44 years of age. In developing countries, that most dispensaries and health centers in Uganda do not
75% of diabetic patients are 45 years old and above and provide such services. This might be due to the lack of
 1485, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/5152146 by Cochrane Peru, Wiley Online Library on [14/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 Journal of Diabetes Research

Kihiihi

Nyamirama

Kambuga
Kanyantorogo
Kirima Rugyeyo
Kayonza Kanungu TC

Mpungu Rutenga

Figure 1: Map of Uganda and Kanunga District, picture sourced from Google map.

guidelines, basic supplies, diagnostic tools, and training that Patients within the age group but were critically ill and
are frequently cited [7]. Assessing the prevalence of type 2 pregnant women were excluded from the study as only those
DM is important for national health planners; therefore, this who satisfied the inclusion criteria were enrolled in the study.
study is aimed at determining the prevalence of type 2 diabe-
tes mellitus and its associated risk factors among elderly 2.3. Blood Sample Collection and Testing. To determine the
patients aged 45-80 years attending Kanungu Health Centre prevalence of diabetes, a capillary whole blood sample was
IV, Kanungu District. collected for both random and fasting blood sugar from the
patient’s fingertip by selecting a suitable puncture site using
2. Materials and Methods a new lancet. The blood drop was placed on a test strip
attached to a glucose monitoring system (One Touch® Select
2.1. Study Area. The study was conducted at Kanungu Health Simple™) and testing was done following the manufacturer’s
Centre IV in Kanungu District (00°53 ′ 49″ S, 29°46 ′ 32″ standard operating procedure. The displayed result on the
E/0.89694°S, 29.77556°E) with a total population of 252,144. meter display that was below 11 mmol/L was recorded as ran-
Being a government health facility and its location near the dom blood sugar (RBS). If results that were displayed were
Democratic Republic of Congo (DRC) border, it receives a over 11 mmol/L on the meter display, the patient was advised
high number of patients from both Uganda and Congo for to undergo fasting blood sugar (FBS). Biosafety measure-
medical services (Figure 1). ments were followed by discarding and disposal of the used
lancet and test strip.
2.2. Study Design and Population. A cross-sectional study was The patient for FBS testing was instructed to go for over-
conducted on patients aged 45-80 years old at Kanungu night fasting equivalent to 8 hours before retesting following
Health Centre IV facility in Kanungu District from June to the procedure as described in the glucose monitoring system
August 2019. The sampling size of the study population (One Touch® Select Simple™). FBS > 7:0 mmol/L was con-
was determined with the formula; sidered positive for DM. Results were reviewed along with
the patient to ensure participation in the study and docu-
mented accordingly.
n = Z2 Pð1 − PÞ/W2 ð1Þ
2.4. Factors Associated with Type 2 Diabetes. Data were col-
lected from the participants using pretested questionnaires
where n = minimum sample size, Z = 1:96 (for 95% confi- that had social-demographic, economic factors, behavioral
dence interval), P = estimated prevalence of diabetes to be factors, physical measurements, and biochemical parameters
10.1%, and W = margin of error to be 5%. with close-ended questions to gather qualitative data from
 1485, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/5152146 by Cochrane Peru, Wiley Online Library on [14/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Journal of Diabetes Research 3

Table 1: Bivariate analysis of sex, age groups, and risk factors associated with type 2 diabetes.

Presence of DM
Frequency P value Odds ratio
Diabetic Not diabetic
Sex
Male 38 (27.3%) 3 (7.9%) 35 (92.1%)
0.045 0.275
Female 101 (72.7%) 23 (22.8%) 78 (77.2%)
Age group
45-50 53 (38.1%) 7 (13.2%) 46 (86.8%)
51-55 23 (16.5%) 7 (30.4%) 16 (69.6%)
56-60 23 (16.5%) 4 (17.4%) 19 (82.6%)
61-65 20 (14.4%) 13 (65%) 7 (35%) 0.698 1.048
66-70 2 (1.4%) 0 2 (100%)
71-75 8 (5.8%) 1 (14.3%) 7 (85.7%)
76-80 10 (7.2%) 0 10 (100%)
BP (mmHg)
Normal 46 (33.1%) 4 (11.1%) 32 (88.9%)
Prehypertensive 38 (37.3%) 7 (18.4%) 31 (81.6%) 0.147 0.663
Hypertensive 65 (46.8%) 50 (76.1%) 15 (23.1%)
BMI (kg/m2)
Underweight 7 (5%) 2 (28.6%) 5 (71.4%)
Normal 79 (56.8%) 10 (12.7%) 69 (87.3%)
0.067 0.583
Overweight 41 (29.5%) 32 (78%) 9 (22%)
Obese 12 (8.6%) 7 (58.3%) 5 (41.7%)
Smoking
Yes 118 (84.9%) 93 (78.8%) 25 (21.2%)
0.109 0.186
No 21 (15.1%) 1 (4.8%) 20 (95.2%)
Alcohol
Yes 54 (38.8%) 35 (64.8%) 19 (35.2%)
0.566 0.757
No 44 (31.7%) 7 (15.9%) 37 (84.1%)
Family history
Yes 95 (68.3%) 76 (80%) 19 (20%)
0.000 6.049
No 85 (61.1%) 7 (8.2%) 78 (91.8%)

the selected individuals. Anthropometric measurements of to be high in the age group of 61-65 with 65% followed by
blood pressure (mmHg), weight (kg), and height (cm) were the age group of 51-55 with 30.4%. The age groups of 66-70
taken at the outpatient department reception by a qualified and 76-80 showed 100% nondiabetic (Table 1).
and enrolled nurse for elderly patients aged 45-80 years. The bivalent analysis showed that sex (female), age
Height measurements were converted from cm to m2 for groups of 61-65, blood pressure (hypertensive), body mass
calculating the BMI. index (overweight and obese), smoking, alcoholism, and
family history were significantly related to being diabetic
2.5. Data Analysis. Data for sociodemographic findings and (Table 1). Multivariate analysis using backward stepwise
risk assessments were computed and analyzed using Micro- selection, variables with P value < 0.2 showed that BMI
soft excel and subjected to bivalent and multivalent analysis (obese), hypertension, smoking, and family history were sig-
by Statistical Package for Social Sciences (SPSS) version 25 nificantly related to being associated with diabetes (Table 2).
(SPSS Inc., USA) at P < 0:05.
4. Discussion
3. Results
According to this cross-sectional study, results from the RBS
3.1. Sociodemographic Findings and Risk Factors Associated and FBS tests showed that the prevalence of diabetes has
with Type 2 Diabetes. In our study, 72.7% of one hundred risen by 5.88%. Kanungu district databases had recorded 49
and thirty-nine patients who satisfied the inclusion criteria diabetic patients in the 2017/2018 financial year, whereas in
were female. 7.9% and 22.8% of the males and females, this study there were 51 newly affected patients with diabetic
respectively, were found to be diabetic. Diabetes was found condition recorded at Kanungu Health Centre [8]. Reports
 1485, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/5152146 by Cochrane Peru, Wiley Online Library on [14/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 Journal of Diabetes Research

Table 2: Multivariate analysis of risk factors associated with type 2 diabetes.

Presence of DM
Diabetic Not diabetic P value OR (95% CI)
BP (mmHg) Hypertensive 50 15 1.000
Underweight 2 5 0.811 1.355 (0.112-16.380)
BMI (kg/m2) Overweight 32 9 0.088 0.234 (0.044-1.239)
Obese 7 5 1.000
Yes 93 25 1.000
Smoking
No 1 20 0.064 0.121 (0.013-1.131)
Yes 35 19 0.000 8.452 (2.799-25.520)
Family history
No 7 78 1.000

by Chiwanga et al. [7] and Bahendeka et al. [9] showed that changing lifestyle. A study by Zunt et al. [11] suggested BMI
prevalence of diabetes was high in Uganda as compared to as one of the factors that increased the incidence of diabetes
other East African countries; they recorded a prevalence of in almost all countries. The study findings are also comparable
10.1% in rural Ugandan residents, 8.3% rural Tanzanian to a report by Bahendeka et al. [9]; he reported that personal
residents, and 2.4% in rural Kenya residents. lifestyle and eating habits which lead to overweightedness
and obesity were the primary causes of type 2 diabetes.
4.1. Sex Most Affected by Type 2 Diabetes. This study found Obesity is a risk factor for diabetes and also a continuing
that females were more affected by type 2 diabetes compared risk factor for complications in those with established diabe-
to males. These results were similar to the study by Cho et al. tes. A report by Ein et al. [12] showed that diabetic patients
[2] which stated that the mortality rate was 1.7% times higher had inherited the disease from either of the parents. Bommer
in females than males. However, this disagrees with the study et al. [6] also found that type 2 diabetes had a hereditary fac-
by Bahendeka et al. [9] who reported a prevalence of diabetes tor from a close family and was associated with gene muta-
mellitus among males and females was 1.6% and 1.1%, tions that are transferred to the genetic line of the family.
respectively. Machado-Alba et al. [10] state that females are According to this study, majority of the diabetic patients
highly affected by type 2 diabetes because they are less mus- were associated with high blood pressure (hypertension);
cular which does not support high uptake of fixed glucose research by Rahman et al. [13] showed that 20% of the dia-
load and have relatively high levels of estrogen and progester- betic population were associated with low blood pressure
one which are involved in the reduction of the whole-body and 12% had normal blood pressure. Extensive prevalence
insulin sensitivity. Additionally, Bommer et al. [6] reported of type 2 diabetes in Kanungu District might be aided by
that the females in Uganda are physically inactive by ignorance because of undiverse information concerning such
performing less exercise to burn excess fat in the body tissues, chronic disease. More so, facilities and knowledge on screen-
and yet they take an unhealthy diet containing many fats and ing diabetes are still lacking in health centers of Kanungu
starches leading to the predisposition of NCDs such as type District; furthermore, medications for diabetic patients are
2 diabetes. scarce thus leading to such high prevalence.

4.2. Age Group Most Affected by Type 2 Diabetes. This 5. Conclusion and Recommendations
study found that the age group of 61-65 years was highly
affected by type 2 diabetes mellitus, this is to some extent There was a high prevalence of type 2 diabetes observed in
in agreement with findings by Cho et al. [2], where adults this study compared to studies done in previous years which
aged 45-64 were the most diagnosed age group for type 2 raise a public health concern. This study also found that
diabetes mellitus. Research by ADA [3] showed that manage- females and patients aged 61-65 years were most affected
ment of diabetes is directly affected by gender and a person’s by diabetes. Lastly, the presence of family history for diabetes
age, where females and adults of 60 years and above are and being obese was found to increase the chances of acquir-
affected due to the coexistence of multiple medical conditions ing type 2 diabetes.
involving the heart and the kidney leading to limitation and Findings from this study recommended investment in
insufficiencies of medical prescription. research and health systems at Kanungu District to curb
down this increased rate of diabetes. Secondly, improvement
4.3. Risk Factors Associated with Type 2 Diabetes. This study and advancement of Education programs on the media are
found that the major causes of diabetes were overweighted- emphasized to sensitize the public about the burden and
ness, obesity, heredity, and lifestyle which includes smoking complications of type 2 diabetes should be emphasized.
and alcoholism, this is in line with a report by WHO [1] Thirdly, people should do regular exercise to reduce body
which suggests that Uganda like many other Sub-Saharan mass which has been found to be a continuing risk factor
countries, had risen cases of type 2 diabetes due to the rapidly for complications in those with established diabetes. Though
 1485, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/5152146 by Cochrane Peru, Wiley Online Library on [14/02/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Journal of Diabetes Research 5

family history increases the risk of getting type 2 diabetes, [9] S. Bahendeka, R. Wesonga, G. Mutungi, J. Muwonge,
adjusting environment factors such as lifestyle among other S. Neema, and D. Guwatudde, “Prevalence and correlates of
ways were seen to alter that. Therefore, eating fruits and diabetes mellitus in Uganda: a population-based national
vegetables and regular exercise are recommended to be done. survey,” Tropical Medicine and International Health, vol. 21,
no. 3, pp. 405–416, 2019.
[10] J. E. Machado-Alba, D. A. Medina-Morales, and L. F.
Data Availability Echeverri-Cataño, “Evaluation of the quality of life of
patients with diabetes mellitus treated with conventional or
The data used to support the findings of this study are
analogue insulins,” Diabetes Research and Clinical Practice,
available from the corresponding author upon request. vol. 116, no. 2, pp. 237–243, 2016.
[11] J. R. Zunt, N. J. Kassebaum, N. Blake et al., “Global, regional,
Conflicts of Interest and national burden of meningitis, 1990-2016: a systematic
analysis for the Global Burden of Disease Study 2016,” The
The authors declare that there is no conflict of interest Lancet Neurology, vol. 17, no. 12, pp. 1061–1082, 2018.
regarding the publication of this article. [12] N. Ein, B. Armstrong, and K. Vickers, “The effect of a very low-
calorie diet on subjective depressive symptoms and anxiety:
Authors’ Contributions meta-analysis and systematic review,” International Journal
of Obesity, vol. 1, no. 3, pp. 711–720, 2018.
All authors have significantly contributed in the present [13] F. Rahman, J. W. McEvoy, T. Ohkuma et al., “Effects of blood
review. All authors are in agreement with the content of pressure lowering on clinical outcomes according to baseline
the manuscript. blood pressure and cardiovascular risk in patients with type
2 diabetes Mellitus,” Hypertension, vol. 73, no. 6, pp. 1291–
1299, 2019.
Acknowledgments
This work was self-sponsored. Further gratitude is expressed
to the Kampala International University, Kanungu Health
Centre IV, Mr. Sunday Ayuba Magaji, and all the subjects
who participated in this research.

References
[1] World Health Organization (WHO), Management of sub-
stance abuse unit. Global status report on alcohol and health,
vol. 1, no. 1, 2014World Health Organization, 2014.
[2] N. H. Cho, J. E. Shaw, S. Karuranga et al., “IDF diabetes atlas:
global estimates of diabetes prevalence for 2017 and projec-
tions for 2045,” Diabetes Research and Clinical Practice,
vol. 138, no. 3, pp. 271–281, 2018.
[3] American Diabetes Association (ADA), “Classification and
diagnosis of diabetes: standards of medical care in diabetes,”
Diabetes Care, vol. 42, no. 5, pp. 13–28, 2019.
[4] J. C. Nwaokoro, B. E. Okokon, A. A. Nwaokoro et al.,
“Problems associated with treatment compliance among type
2 diabetic patients at a tertiary health institution in Nigeria,”
African Journal of Diabetes Medicine, vol. 22, no. 1,
pp. 56–70, 2014.
[5] R. Nyanzi, R. Wamala, and L. K. Atuhaire, “Diabetes and
quality of life: a Ugandan perspective,” Journal of Diabetes
Research, vol. 2014, Article ID 402012, 9 pages, 2014.
[6] C. Bommer, V. Sagalova, E. Heesemann et al., “Global eco-
nomic burden of diabetes in adults: projections from 2015 to
2030,” Diabetes Care, vol. 41, no. 5, pp. 963–970, 2018.
[7] F. S. Chiwanga, M. A. Njelekela, M. B. Diamond et al., “Urban
and rural prevalence of diabetes and pre-diabetes and risk fac-
tors associated with diabetes in Tanzania and Uganda,” Global
Health Action, vol. 9, no. 1, article 31440, 2016.
[8] R. Dehnavieh, A. Haghdoost, A. Khosravi et al., “The District
Health Information System (DHIS2): A literature review and
meta-synthesis of its strengths and operational challenges
based on the experiences of 11 countries,” Health Information
Management Journal, vol. 48, no. 2, pp. 62–75, 2019.