FREQUENCY, DISTRIBUTION AND DETERMINANTS OF DIABETES MELLITUS IN ADULT ACUTE CORONARY SYNDROME POPULATION OF D.I.KHAN DIVISION, PAKISTAN

Muhammad Marwat, Iftikhar Ahmad, Fariha Ashiq, Sania Ali, Sher Zamir, Mehboob Ur Rehman, Maryam Farid, Bakhtawar Rehman, Habiba Zahoor, Zeenat Aman, Sidra Mehmood, Summaya Roshan, Aroosa Burki, Irum Noor, Shafaq Mussadiq, Sawera Naveed

Abstract


Background: Global Health Estimates 2015 has shown IHD as second leading global cause of death and 3rd leading global cause for DALYs for 2015. The objectives of this study were to determine frequency, distribution and determinants of DM in adult acute coronary syndrome (ACS) population of D.I.Khan Division, Pakistan.

Materials & Methods: This cross-sectional study was conducted in Departments of Ophthalmology & Community Medicine, Gomal Medical College, D.I.Khan, from February 1, 2017 to April 30, 2017. 331 cases were selected with margin of error 4.511%, 90%CL and 25% prevalence of DM in 73,438 adults assumed to have IHD. All indoor adult patients of ACS were eligible. Sex, age groups, and residence and presence of DM were variables. Frequency and distribution were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association.

Results: Out of 331 patients with ACS, 225 (68.0%) were men and 106 (32.0%) women, 221 (66.8%) ≤60 years and 110 (33.2%) >60 years, and 210 (63.4%) urban and 121 (35.6%) rural. Frequency of DM was 79/331 (23.87%). Out of 79 patients with DM, men were 44 (13.29%), women 35 (10.57%), age group ≤60 years 57 (17.22%), >60 years 22 (6.65%), urban 53 (16.01%) and rural 60 (7.85%). Our prevalence of DM was lower than expected (p=.00214), our distribution by sex was similar to expected (p=.4993) while our distribution for age groups (p=.01209) and residence (p=.00005) were not similar to expected. Presence of DM was associated to sex (p=.011) but not to age groups (p=.0304) and residence (p=.5241).

Conclusion: Prevalence of DM in adult ACS population of D.I.Khan Division, Pakistan was found lower than expected. The prevalence was more in men than women, more in younger age group (≤60 years) than older age group (>60 years) and more in urban than rural population. Our prevalence of DM was lower than expected, our distribution by sex was similar to expected while our distribution for age groups and residence were not similar to expected. The presence of DM was associated to sex but not to age groups and residence.


Keywords


Acute Coronary Syndrome; Myocardial Infarction; Unstable Angina; Diabetes Mellitus; Adult; Global Health; Pakistan; Urban Population; Rural Population; Chi-square Test.

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References


Global Health Estimates 2015: Deaths by cause, age, sex, by country and by region, 2000-2015. Geneva, World Health Organization 2016 [cited 2017 May 22]. Available from: http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html

Global Health Estimates 2015: Disease burden by cause, age, sex, by country and by region, 2000-2015. Geneva, World Health Organization 2016 [cited 2017 May 22]. Available at: http://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html

Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, et al. Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease. Arch Med Res. 2015 Jul ; 46(5): 328-38. https://doi.org/10.1016/j.arcmed.2015.06.006

Moran AE, Tzong KY, Forouzanfar MH, Rothy GA, Mensah GA, Ezzati M, et al. Variations in ischemic heart disease burden by age, country, and income: the Global Burden of Diseases, Injuries, and Risk Factors 2010 study. Glob Heart 2014 Mar; 9(1): 91-9. https://doi.org/10.1016/j.gheart.2013.12.007

Zhang X, Khan AA, Haq EU, Rahim A, Hu D, Attia J, et al. Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up. Eur Heart J Qual Care Clin Outcomes 2017;3(1):47-52. https://doi.org/10.1093/ehjqcco/qcw041

WHO. Cardiovascular diseases. Key facts [Internet]. World Health Organization; Geneva. [cited 2019 Jan 17]. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

Abbas S, Kitchlew AR, Abbas S. Disease burden of ischemic heart disease in Pakistan and its risk factors. Ann Pak Inst Med Sci 2009; 5(3): 145-50.

Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes [published correction appears in Lancet 2017 Jun 3; 389 (10085):2192]. https://doi.org/10.1016/S0140-6736(17)30058-2

Tripathy JP, Thakur JS, Jeet G, Chawla S, Jain S, Pal A, et al. Prevalence and risk factors of diabetes in a large community-based study in North India: results from a STEPS survey in Punjab, India. Diabetol Metab Syndr 2017;9:8. https://doi.org/10.1186/s13098-017-0207-3

Meo SA, Zia I, Bukhari IA, Arain SA. Type 2 diabetes mellitus in Pakistan: Current prevalence and future forecast. J Pak Med Assoc 2016; 66(12): 1637-42.

Shera AS, Rafique G, Khawaja IA, Ara J, Baqai S, King H. Pakistan National Diabetes Survey: Prevalence of glucose intolerance and associated factors in Shikarpur, Sindh province. Diabetic Med 1995 Dec:12(12):1116-21. https://doi.org/10.1111/j.1464-5491.1995.tb00430.x

Shera AS, Rafique G, Khwaja IA, Baqai S, Khan IA, King H. Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in North West at Frontier Province (NWFP) of Pakistan. J Pak Med Assoc 1999 Sep; 49(9): 206-11. https://doi.org/10.1016/S0168-8227(99)00017-0

Shera As, Rafiquc G, Khawaja IA, Baqai S, King H. Pakistan National Diabetes Survey: Prevalence of glucose intolerance and associated factors in Baluchistan province. Diab Res Clin Prac 1999 Apr:44(1):49-58. https://doi.org/10.1016/S0168-8227(99)00017-0

Shera AS, Jawad F, Maqsood A. Prevalence of diabetes in Pakistan. Diabetes Res Clin Pract 2007 May;76 (2):219-22. https://doi.org/10.1016/j.diabres.2006.08.011

Shera AS, Basit A, Fawwad A, Hakeem R, Ahmedani MY, Hydrie MZ, et al. Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan. Prim Care Diabetes 2010 Jul; 4 (2): 79-83. https://doi.org/10.1016/j.pcd.2010.01.003

Basit A. Fawwad A, Qureshi H, Shera AS. Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016-2017. BMJ Open 2018;8(8):e020961. https://doi.org/10.1136/bmjopen-2017-020961

Yar HM, Shabbir K, Anwar M, Ali R. Diabetes mellitus; Frequency among general population of Rahim Yar Khan. Professional Med J Jun 2008; 15(2): 240-6.

Aamir AH, Ul-Haq Z, Mahar SA, Quresh FM, Ahmad I, Jawa A, et al. Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan. BMJ Open 2019; 9(2):e025300. https://doi.org/10.1136/bmjopen-2018-025300

Ahmed N, Kazmi S, Nawaz H, Javed M, Anwar SA, Alam MA. Frequency of diabetes mellitus in patients with acute coronary syndrome. J Ayub Med Coll Abbottabad 2014; 26(1): 57-60.

Hussain S, Sattar U, Aazha MA. Risk factors for ischemic heart disease in southern Punjab. Pak Heart J 2013; 46 (4): 232-7.

Shah S, Basharat A, Shah M, Marwat M, Billah M, Ali SM. Frequency, distribution and presentation of hypocalcemia in ß-thalassemia major. Gomal J Med Sci 2018 Jan-Mar; 16(1): 2-8. https://doi.org/10.46903/gjms/16.01.1446

Shah HU, Gul H, Khan R, Marwat M. Urethrocutaneous fistula following Snodgrass versus two stage Aivar Bracka repair of distal penile hypospadias in male children: a randomized control trial. Gomal J Med Sci 2018 Apr-Jun; 16 (2): 54-8. https://doi.org/10.46903/gjms/16.02.1284

Crandall J, Shamoon H. Diabetes mellitus. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed. Amstardam: Elsevier; 2016. p.1527-48.

WHO. HIV/AIDS. Definition of key terms [Internet]. World Health Organization; Geneva 2013. [cited 2017 Jan 17]. Available at: http://www.who.int/hiv/pub/guidelines/arv2013/intro/keyterms/en/

Raosoft® online sample size calculator [Internet]. Raosoft Inc., Seattle, Washington 2004. [accessed 2017 Jan 17]. Available from:www.raosoft.com/samplesize.html

Statistics Kingdom. Proportion confidence interval calculator [internet]. Statistics Kingdom; Melbourne, Australia 2007. [accessed 2017 Oct 12]. Available at: http://www.statskingdom.com/41_proportion_confidence_interval.html

Zar JH. Biostatistical Analysis. 5th ed. New York: Prentice-Hall, Inc.

Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th ed. Singapore: John Wily; 2005

Social Science Statistics. Statistical Tests Calculators [Internet]. [accessed 2017 Oct 12]. Available from: http://www.socscistatistics.com/tests/

Butt M, Rehman MU, Khan AR, Abrar A. Frequency of triple-vessel coronary artery disease in adult type 2 diabetics versus non-diabetics in coronary artery disease population of Islamabad, Pakistan. Gomal J Med Sci 2019 Apr-Jun; 17(2):37-41. https://doi.org/10.46903/gjms/17.02.2029




DOI: https://doi.org/10.46903/gjms/17.04.2106

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Copyright (c) 2019 Muhammad Marwat, Iftikhar Ahmad, Fariha Ashiq, Sania Ali, Sher Zamir, Mehboob Ur Rehman, Maryam Farid, Bakhtawar Rehman, Habiba Zahoor, Zeenat Aman, Sidra Mehmood, Summaya Roshan, Aroosa Burki, Irum Noor, Shafaq Mussadiq, Sawera Naveed

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