Epidemiology of Macrovascular and Microvascular Complications Among Patients With Diabetes Mellitus in Primary Care in Bahrain

TL;DR

This study examines how common diabetes-related complications are among patients in Bahrain's primary care and identifies risk factors like poor kidney function and foot ulcers.

Contribution

The study provides new insights into the prevalence and predictors of diabetes complications in Bahrain's primary care setting.

Findings

Neuropathy and retinopathy were the most common microvascular complications, while peripheral vascular disease and heart disease were leading macrovascular issues.

Higher cholesterol and lower kidney function predicted macrovascular complications, while type 2 diabetes and foot ulcers strongly predicted microvascular complications.

Abstract

Introduction

Although diabetes mellitus (DM) is a leading cause of cardiovascular complications, few studies have evaluated the epidemiology of these complications in primary care in Bahrain. Since data from primary care settings are particularly important, as most patients with diabetes are managed in this setting, this study aimed to determine the prevalence and predictors of diabetic complications among patients attending primary healthcare centers in Bahrain.

Methods

A cross-sectional study was conducted among adult patients with DM attending diabetic clinics in primary care centers across Bahrain. Demographic, clinical, and laboratory data, and diabetes complications were collected. Microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (stroke, acute coronary syndrome, peripheral arterial disease) complications were assessed. Descriptive and inferential analyses were performed.

Results

A total of 585 patients were enrolled, with a median age of 61±14 years. Most patients were males (n=326, 55.7%), had type 2 DM (n=566, 96.8%), and had uncontrolled diabetes (n=349, 59.7%). Approximately half of the patients (51.6%) had at least one diabetes-related complication. Neuropathy (n=158, 27.0%) and retinopathy (n=89, 15.2%) were the most frequent microvascular complications, while peripheral vascular disease (n=64, 10.9%) and ischemic heart disease (n=61, 10.4%) were the leading macrovascular complications. Multivariable analysis revealed that higher total cholesterol (OR=1.326, p=0.031) and lower estimated glomerular filtration rate, eGFR (OR=1.009, p=0.025) predicted macrovascular complications. Diabetic foot ulcers increased macrovascular complications by 14-fold (p<0.001). Predictors of microvascular complications included type 2 DM (OR=16.277, p=0.011), longer DM duration (OR=1.156, p<0.001), higher triglycerides (OR=1.222, p=0.045), dyslipidemia (p=0.036), and foot ulcers (27-fold; p=0.002).

Conclusion

Diabetic complications were prevalent among diabetic patients in Bahrain, especially those with impaired renal function, dyslipidemia, anemia, and foot ulcers. Early identification and management of these comorbidities is crucial to prevent diabetes-related complications.