Pneuropathy among diabetes patients at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Diabetic autonomic neuropathy (DAN) is a common and serious complication of Type 2 Diabetes Mellitus (T2DM), with reported prevalence ranging from 16% to 70%. It significantly affects quality of life and increases morbidity and mortality. Although key risk factors have been identified, the prevalence and contributing factors in our setting remain unclear. Understanding these would help guide better screening, prevention, and management strategies. Objectives: To determine the prevalence and factors associated with autonomic neuropathy among patients with (T2DM) at the Moi Teaching and Referral Hospital (MTRH). Methods: This study was a cross-sectional analysis conducted at the MTRH diabetes outpatient clinic. The study population included 344 adult patients with T2DM from March to August 2024. Diabetic autonomic neuropathy was assessed using the COMPASS-31 questionnaire. A standard interviewer-administered questionnaire was then used to collect socio-demographic and clinical data. The independent variables were age, sex, marital status, level of education, HbA1C, body mass index, statin use, hypertension, dyslipidemia, and creatinine clearance. Categorical variables were summarized using frequency tables, percentages, and bar graphs. Mean, median, and interquartile ranges were used to summarize continuous variables. The association between diabetic autonomic neuropathy and independent variables was assessed using bivariate and multivariate analysis. Results. The mean age of study participants was 61.0 years (SD 9.8). The mean HbA1c was 9.6 (SD 4.5)%. The median duration of diabetes was 8.62 (IQR 4-12years. Females constituted 65.4% of all study participants. The prevalence of DAN was established to be 53.2% based on the COMPASS 31 questionnaire weighted score. Analysis of autonomic dysfunction according to the domains affected revealed that the most affected domains were the gastrointestinal (65.41%), secretomotor (62.41%), and pupillomotor (53.78%). The orthostatic domain had a prevalence of 53.78%, followed by the vasomotor domain at 48.26%, and the bladder domain had 31.40%. On multivariable regression models, DAN was inversely correlated with the use of lipid-lowering agents. There was a positive association between DAN and kidney dysfunction as measured by estimated glomerular filtration rate (eGFR). Conclusion. Our findings revealed a high prevalence of DAN among individuals in outpatient care for T2DM in MTRH indicating a significant clinical problem.There was an inverse correlation between DAN and the use of lipid-lowering agents. There was a positive association between DAN and kidney dysfunction Recommendation. Assessment of autonomic neuropathy should be integrated in the care of persons with diabetes, given the high prevalence of DAN in this study population and the rising global burden of diabetes