Prevalence, Morbidity and Mortality of Diabetes Mellitus in 9009 Adult Patients over 12 Years in the Internal Medicine Department of the Bouaké University Hospital

Abstract

Introduction: Diabetes mellitus, which is steadily increasing in sub-Saharan Africa, leads to disabling complications and premature death. We conducted a study in African hospitals with the aim of investigating the morbidity and mortality of diabetes in terms of its prevalence and associated factors. Meth ods: This was a cross-sectional, analytical study conducted in the Internal Medicine Department of Bouake University Hospital from January 2010 to December 2021 (12 years), covering 9009 diabetic patient records (aged 16 and over) in consultation and hospitalization. The diagnosis of diabetes was based on criteria from the American Diabetes Association (ADA 2024). The variables included sociodemographic data, comorbidities, cardiovascular risk factors, diabetes characteristics, complications, therapeutic and outcome parameters, and mortality analysis (only in hospitalized patients). We used EPI INFO 7 software for data analysis (p < 0.05). Results: The average age was 47.27 ± 11.8 years (28 - 42), the sex ratio was 0.83, and the average blood glucose level was 2.5 g/l (0.35 - 9.13). The prevalence in hospitalization was 10.1% and 29% in consultation. Familial diabetes was noted in 17% of cases, unknown in 54.2% of cases, and mainly type 2 (78.7%). Prevalence curves generally declined over 12 years. The main factor associated was hypertension (34.7%). Complications were metabolic (85%), dominated by ketoacidosis (94.7%), infectious such as pneumonia (26.5%) and diabetic foot (26.4%). There were also macroangiopathies (16%) such as strokes (52%), silent myocardial ischemia (28%), and microangiopathies (11.1%). Diabetes was fatal in 10.5% of cases, with diabetes-related mortality at 5.8% and diabetes-specific in-hospital mortality at 1.1%. Mortality had been increasing since 2018 and was associated with factors such as age over 50 (50 - 59 years: p: 0.0018; OR: 1.8 [1.26 - 2.6] and ≥60 years: p: 0.006; OR: 1.76 [1.19 - 2.6]), hypertension (p: 0.03; OR: 1.79 [1.07 - 3]), smoking (p < 0.001; OR: 3.74 [2 - 7]), dyslipidemia (p: 0.04; OR: 1.56 [1.04 - 2.34]), infections (p: 0.047; OR: 2.44 [1.05 - 5.6]), macroangiopathy (p < 0.001; OR: 4.7 [2.94 - 7.5]) and microangiopathy (p < 0.001; OR: 5.44). Women were associated with death (OR: 2.34). Conclusion: The prevalence and mortality of diabetes were high and increasing. Factors associated with mortality included infections, macroangiopathies, and microangiopathies, Hence the importance of targeted screening of people at risk, adult members of the families of each diabetic patient, and finally multidisciplinary care, especially preventive care for diabetic patients.