Spouses of patients with diabetes mellitus type 2 at increased risk of high blood glucose levels

doi:10.4236/ojpm.2013.31008

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Vol.3, No.1, 58-63 (2013) Open Journal of Preventive Medicine

http://dx.doi.org/10.4236/ojpm.2013.31008

Spouses of patients with diabetes mellitus type 2 at

increased risk of high blood glucose levels*

Ganiyu Lanre Yahaya1, Alero Ann Robert s2*, Victor Akpan Inem2

1Department of Family Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria

2Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria

*Corresponding Author: [email protected]

Received 29 December 2012; revised 29 January 2013; accepted 5 February 2013

ABSTRACT

Introduction: Diabetes mellitus type 2 is a grow-

ing threat in developing countries already bur-

dened with high levels of infectious disease.

Screening the general population has debatable

advant a ges. This s tudy aims to de termine whether

spouses of patients with diabetes mellitus have

higher random blood glucose (RBG) levels as

well as the benefit of RBG testing as a targetted

screening tool. Methodology: The survey em-

ployed a cross-sectional comparative study of

spouses’ of diabetics and non-diabetics attend-

ing the general out-patient department of the La-

gos State University Teaching Hospital (LASUTH),

Ikeja. A modified WHO STEPS Surveillance In-

strument and a one-touch Glucometer were

used to collect data. Blood pressures and BMI

were measured and correlated to blood glucose

levels. Results: Prevalence of high RBG was

found to be 7% among spouses of diabetics and

3.3% among spouses of non-diabetic patients.

Mean RBG was 5.57 mmol/L and 7.7 mmol/L

within the age group 40 - 49 years and 50 - 59

years respectively among spouses of diabetic

patients compared to 5.4 mmol/L and 5.5 mmol/L

within the same age group among the spouses

non-diabetics. S pouses of patients with diabetes

mellitus had higher systolic and diastolic blood

pressures and BMI comp ared to spo uses of non-

diabetics. Conclusion: Being male, married to a

diabetic patient, lower educational levels and

higher body mass index are significantly asso-

ciated with higher random blood glucose in the

spouses of diabetic patients. Random blood

glucose measurements are an effective screen-

ing tool and spouses of diabetic patients can

benefit from targeted screening in controlled

clinical settings.

Keywords: Diabetes Mellitus Type 2;

Non-Communicab le Disease; Rando m Blood

Glucose Levels; Glucose Intolerance; Body Mass

Index; Blood Pressure

1. INTRODUCTION

Diabetes mellitus type 2 is a growing threat in devel-

oping countries already burdened with high morbidity

and mortality rates from infectious diseases, maternal

and infant health concerns and weak ineffective health

systems [1,2]. Analysis of the g lobal and region al burden

of non-communicable diseases shows that almost half the

disease burden in developing countries is from non-

communicable diseases, with 15 to 59 year olds facing a

30% greater risk of death from an NCD than their coun-

terparts in the developed world [3]. In Nigeria there has

been an increase in the prevalence of diabetes mellitus

from 0.39% reported in a hospital population in 1963, to

6.8% in 2003 which is comparable to global estimated

prevalence of 6.4%, with the largest proportion of in-

crease occurring in developing countries [4-6]. Overall

about 1.05 million people are diabetic in Nigeria and

most of these are type II. Urban communities had a

higher over all prevalence of diabetes mellitus (3.3%)

when compared with rural communities (2.6%). The

burden of diabetes in Nigeria is expected to increase

even further [5].

The rising prevalence of diabetes mellitus cannot be

linked only to the genetic factors of ageing populations.

Environmental factors of obesity, diet and physical activ-

ity have a major influence. Various studies have exam-

ined the effect of environmental influences versus ge-

netic factors in twins and cohabiting couples in morbid-

ities such as coronary disease, cancer, hypertension and

depression [7-13].

*Key findings: a statistically significant 7% of spouses of diabetic

atients had random blood glucose levels ove

11 mmol/L, compared

to 3.3% of spouses in the comparative group. It was also observed that

spouses of non-diabetic patients had statistically significantly lower

systolic and diastolic blood pres s ures.

G. L. Yahaya et al. / Open Journal of Preventive Medicine 3 (2013) 58-63 59

Screening for disease in the general population is ap-

propriate when certain condition s are met with regards to

representing a public health burden with known patho-

physiology and a defined, asymptomatic preclinical stage

when the disease can be diagnosed by reliable acceptable

tests.

Diabetes meets many of the conditions for screening,

which is cost-effective if done as a systematic process.

Community screening is usually poorly targeted , tends to

test those at low risk (the worried well) and those already

diagnosed. However, in developing countries, there is

benefit to be obtained from case detection using oppor-

tunistic events where there is clinical evidence of risk

fa ctors [14 ,15]. The cost-effectiveness of targeted scr een-

ing of people attending clinics has been shown to have

benefits of being able to institute preventive and thera-

peutic measures to reduce the impact of more serious

complications [16,17]. The use of fasting blood glucose

(FBG) and 2-hour blood glucose (2-hBG) have com-

monly been used as screening for type 2 diabetes melli-

tus especially for making the definitive diagnosis of dia-

betes in patients that h ave pr esen ted with th e typical triad

of polyuria, polyphagia and polydipsia. However, the use

of random blood glucose levels has the advantage of not

requiring a special time of day or trained personnel and

can therefore be quickly used to screen [18]. This study

set out to determine whether spouses of patients with

type 2 diabetes mellitus are at risk of developing higher

levels of random blood glucose and the value of random

blood glucose testing as a screening tool for spouses of

identified diabetic patien ts.

2. METHODOLOGY

This was a cross-sectional comparative study carried

out in the general out-patients department (GOPD) of the

Lagos State University Teaching Hospital. One thousand

four hundred and sixty two patients attending the outpa-

tients’ clinic were divided into 2 groups based on the

sampling formula using a prevalence rate of 2.2% [4].

Respondents of the first group was made up of spouses

of known diabetics aged 30 years and over who had been

diagnosed previously and were attending the GOPD for

regular follow-up. The second group was made up of the

spouses of other patients attending GOPD who neither

had diabetes mellitus nor had been diagnosed with same

at the time of recruitment. For this study, spouses re-

ferred to a married couple aged 30 years and above, of

opposite genders living at the same address, with the

same surname [11].

The WHO STEPS questionnaire was administered to

each respondent after verbal and written consent had

been obtained. The questionnaire examined socio-demo-

graphic and socio-economic data, knowledge of diabetes

mellitus; its risk factors and management, lifestyle risk

perception and behaviour of the respondents of both

groups.

Diabetic patients were those who had previously been

diagnosed by having had two fasting blood glucose lev-

els of >7.0 mmol/L, but who did not require insulin for

management and had not had ketonuria in the previous

six months. All respondents were measured for weight,

height and truncal circumferences. The body mass index

(BMI) and waist-hip (W-H) ratios were calculated and

random blood glucose levels were clinically determined.

Blood pressure was measured as three supine readings

taken at 5 minute intervals. Diastolic pressure was meas-

ured as Korotkoff phase 5.

Data was collated and analyzed using SPSS version 14

and presented as means (±SD) and/or medians (range)

where relevant. Differences in variables between the two

groups was examined using Student’s t test, and χ2

(Chi-Square) was used to examine the discrete variables.

Statistical significance was determined at P < 0.05.

3. RESULTS

Of the 1462 patients recruited into the study, 62 eith er

did no t consent to contin ue in the study, wer e lost to fol-

low-up, or could not be reached at the addresses pro-

vided. Their data were used to establish the contiguity of

the groups but were not included in the final statistical

analysis. There was some statistical difference in the

socio demographic characteristics between the two

groups. More spouses were females and more spouses of

diabetics were aged 60 and over. Significantly more

spouses of non-diabetics earned over N30,000 ($200) a

month. Over a third of the respondents of both groups

lived within walking distance (Table 1).

Seventy two respondents had random blood glucose

levels over 11 mmol/L, of which significantly more than

hal f ( 4 9 /7 2) were spouses of diabetic patients (P > 0. 00 1 ) .

It was also observed that spouses of non-diabetic patients

had statistically significantly lower systolic and diastolic

blood pressures (P > 0.001). Waist-hip ratios measured

were high in both groups, but significantly lower in the

group of spouses of non-diabetics (P = 0.027) (Table 2).

Random blood glucose levels in spouses of diabetic

patients showed statistically significant association with

increasing age, being male and higher income brackets

(P > 0.001). Two-thirds of respondents in both groups

had body mass indices (BMI) over 30, and this was sig-

nificantly more prevalent among spouses of diabetic pa-

tients (Table 3).

4. DISCUSSION

This study shows that spouses of diabetic patients are

twice as likely to have higher than normal random blood

glucose levels compared to spouses of patients that did

G. L. Yahaya et al. / Open Journal of Preventive Medicine 3 (2013) 58-63

Table 1. Socio-demographic characteristics of respondents.

Variables Spouses of the diabetics N (%) Spouses of Non-diabetics N (%) X

2 P

Age (years)

30 - 39 169 (24.1) 110 (15.7)

40 - 49 24 (3.4) 134 (19.1)

50-59 151 (21.6) 160 (22.9)

60 and above 356 (50.9) 296 ( 42.2) 94.84 0.00**

Sex

Males 332 (47.4) 335 (47.6)

Females 368 (52.6) 365 ( 52.4) 0.872 0.03**

Religion

Christianity 489 (69.9) 484 (69. 1)

Islam 172 (24.6) 167 (23.9)

Traditional Religion 39 (5.6) 49 (7.0) 1.24 0.54

Education

No formal education 190 (27.1) 194 (27.7)

Primary School 260 (37.1) 250 (35.7) 4.9 0.17

Secondary 212 (30.3) 233 (33.3)

University 38 (5.4) 23 (3.3)

Family income per month

Less than N10,0001 267 (38.1) 140 (20.0)

N10,001 to N20,000 191 (27.3) 135 (19.3)

N20,001 to N30,000 124 (17.7) 210 (30.0)

Above N30,000 118 (16.9) 215 (30.7) 102.5 0.00**

Nearness to health care faci li t y

Walking distance 256 (36.6) 275 (39.3)

5 km 140 (20.0) 140 (20.0)

10 km 159 (22.7) 145 (20.7)

15 km 145 (20.7) 140 (20.0) 1.41 0.70

*Computed on the basis of daily incomes of $2 at rate of $1 to N150.

Table 2. Random blood glucose levels in spouses of diabetic and non-diabetic patients.

RBG (mmol/L) Spouse s of diabetics Spouses of non-diabetics P

N (%) N (%)

<11.1 651 (93.0) 677 (96.7)

>11.1 49 (7.0) 23 (3.3) 0.0016**

Blood pressure measurements & W-H ratio

Systolic BP (mmHg) 129.8 ± 13.1 112 ± 10.1 0.000***

Diastolic BP (mmHg) 81.2 ± 8.3 76.1 ± 6.1 0.000***

Waist-Hip Ratio 0.99 ± 0.13 0.97 ± 0.11 0.027***

*Computed on the basis of daily incomes of $2 at rate of $1 to N150.

G. L. Yahaya et al. / Open Journal of Preventive Medicine 3 (2013) 58-63 61

Table 3. Correlates of random blood glucose levels of spouses of diabetic and non-diabetic patients.

Spouses of diabetics RBG (mmol/L) Spouses of non-diabetics RB G (mmol/L)

N (%) N (%) P N (%) N (%) X 2 P

<11.1 >11.1 <11.1 >11.1

Age

30 - 39 159 (22.7) 10 (1.4) 105 (15) 5 (0.7) 0.25 0.62

40 - 49 15 (2.1) 9 (1.3) 129 (18.4) 5 (0.7) 28.74 0.0000**

50 - 59 138 (19.7) 13 (1.9) 155 (22.1) 5 (0.7) 4.29 0.04*

>60 339 (48.4) 17 (2.4) 288 (41.1) 8 (1.1) 1.88

Sex

Males 324 (46.3) 23 (3.3) 542 (77.4) 15(2.14) 8.22 0.004**

Females 327 (46.7) 26 (3.7) 135 (19.3) 8 (1.14) 0.55 0.48

Education

No Formal Education 165 (23.5) 25 (3.5) 187 (26.7) 7 (1.0) 11.46 0.0007**

Primary 244 (34.6) 16 (2.3) 241 (33.4) 9 (1.3) 4.12 0.004**

Secondary 207 (29.6) 5 (0.7) 229 (32.7) 4 (0.6) 9.20 0.002**

University 35 (5.0) 3 (0.4) 0.000** 20 (2.9) 3 (0.4) 0.43

Family Income Per month

Less than 10,000 237 (33.6) 30 (4.3) 134 (19.1) 1(1.9) 0.58

10,001 - 20,000 183 (26.1) 8 (1.1) 121 (17.3) 5 (0.7) 0.32

20,001 - 30,000 119 (17.0) 5 (0.7) 0.007** 207 (29.3) 3 (0.4) 2.26

Above 30,000 112 (16.0) 6 (0.9) 215 (30.7) 2 (0.3) 5.68 0.02**

Body Mass Index

18 - 24.9 167 (23.9) 5 (0.7) 163 (23.3) 4 (0.6) 0.00 0.96

25 - 29.9 30 (4.3) 11 (1.6) 44 (6.3) 5 (0.7) 3.66 0.06

>30 454 (64.6) 35 (5.0) 0.0000** 470 (67.1) 14 (2.0) 9.25 0.0023**

*Computed on the basis of daily incomes of $2 at rate of $1 to N150.

not have diabetes. The findings were very similar to others

who also noted that age, sex, BMI and waist circum-

ference did not have any significant influence on the

findings [19]. The phenomenon of spousal concordance

has been demonstrated in spouses of patients of hyper-

tension who were found to have higher tendencies to

themselves develop hypertension [7] and diabetes [10]

for reasons attributed to both spouses living in environ-

mentally similar situations. The finding of higher blood

pressure and BMI mirrored other studies [11] and this

was significant. In view of the finding that a significant

proportion of spouses of diabetic patients lived on less

than $2 a day (less than N10,000 per month), setting the

random blood glucose cut-off point at 11 mmol/L, pre-

sented the financial advantage to patients of immediately

instituting preventive and therapeutic measures in those

patients are definite risk of microvascular complications.

[20] Lower departures from normal have the opportunity

to be evaluated using FBG and OGTT. Research evi-

dence has consistently shown that early targetted treat-

ment of diabetes mellitus and conditions known to be

risk factors can significantly decrease the development

and/or progression of chronic complications [21-25].

In consonance with studies done to screen for gesta-

tional diabetes mellitus, the use of random blood glucose

testing was shown to have the same sensitivity and

specificity as traditional risk factors and offer a measure

of cost-effectiveness in reducing the tendency to develop

cardiovascular complications [26-28]. Spouses of dia-

betic patients have a greater tendency to higher random

G. L. Yahaya et al. / Open Journal of Preventive Medicine 3 (2013) 58-63

blood glucose levels and can benefit from targeted ran-

dom blood glucose testing as part of a 2-stage screening

process that affords them the opportunity to discuss the

results and management options with a primary care pro-

vider in a clinical setting. Research is needed to deter-

mine whether the extra years of treatment that individu-

als will receive if screening determines their pre-diabetic

state will result in significantly improved diabetes related

cardiovascula r out comes in a cost-effe ct i ve manner.

5. KEY MESSAGES

• Spouses of diabetic patients with a greater tendency

to higher random blood glucose levels can benefit from

targetted screening in a clin ical setting.

• Random blood glucose measurements are an effec-

tive screening tool in controlled clinical setting s.

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