Differential management and associations of dyslipidaemia and hypertension by glycaemic status in urban South Africans

Authors

  • N Peer South African Medical Research Council, Cape Town, South Africa
  • L Kotzé-Hörstmann South African Medical Research Council, Cape Town, South Africa
  • J Hill South African Medical Research Council, Cape Town, South Africa
  • A-P Kengne South African Medical Research Council, Cape Town, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i3.1315

Keywords:

diabetes; dyslipidaemia; hypertension; care; management; lipids; cholesterol; blood pressure; Africa; high-risk

Abstract

Background. Dyslipidaemia and hypertension care have not been reported in large samples of community-based participants with known diabetes (KD) nor compared with individuals at high risk for diabetes.
Objectives. To describe the management and associations of dyslipidaemia and hypertension in adults with KD, newly diagnosed diabetes (NDD) and normoglycaemia.

Methods. This urban population-based cross-sectional study comprised participants with KD, NDD and normoglycaemia. Participants at high risk for diabetes but without KD underwent oral glucose tolerance tests; those who were subsequently classified as NDD or normoglycaemic were included in this study. Data collection comprised administered questionnaires, clinical measurements and biochemical analyses. Multivariable logistic regressions determined the associations with hypertension and dyslipidaemia management in separate models.

Results. Among 618 participants (82% women), aged median 58 years, there were 339 participants with KD, 70 with NDD and 209 with normoglycaemia. Prevalence of hypertension (BP ≥140/90 mmHg or on treatment) and dyslipidaemia (raised low-density lipoprotein cholesterol >3 mmol/L or on treatment) was highest in KD (89% and 83%) compared with NDD (64% and 74%) and normoglycaemia (66% for both) (p<0.001). Detected or known hypertension was highest in KD (97.4%), followed by NDD (88.9%) and normoglycaemia (80.3%). Among participants with known or detected hypertension, those with KD were most likely to be treated (90.2%) compared with NDD (77.5%) and normoglycaemia (74.5.%). Hypertension control among participants on treatment was highest in KD (69.5%) compared with NDD (51.6%) and normoglycaemia (61.0%). Participants with KD had significantly higher rates of previously detected dyslipidaemia (85.1%) compared with NDD (36.5%) and normoglycaemia (35.5%). KD participants were also more likely to be treated for their previously detected dyslipidaemia (85.4%) and to be controlled when on treatment (56.3%) compared with their counterparts (NDD: 63.2% and 33.3%, normoglycaemia: 61.2% and 43.3%, respectively). Diabetes control was poor; only 20% of those with KD had HbA1c <7%. In the regression models, compared with normoglycaemia, KD was associated with hypertension detection (odds ratio (OR) 6.91, 95% confidence interval (CI) 2.25 - 21.22) and control (OR 2.05, 95% CI 1.04 - 4.02). KD compared with normoglycaemia was associated with dyslipidaemia detection (OR 10.29, 95% CI 5.21 - 20.32) and treatment (OR 3.94, 95% CI 1.68 - 9.27). Sociodemographic and cardiovascular disease risk factors were generally not associated with hypertension or dyslipidaemia management.

Conclusion. Albeit that diabetes control was poor and required better management, dyslipidaemia and hypertension prevalence were higher and better managed in KD than NDD and normoglycaemia. Different approaches are required to improve glucose control in KD, better identify NDD and monitor and prevent diabetes in high-risk individuals. Also important would be to improve care of hypertension and dyslipidaemia in those without KD.

References

Pheiffer C, Pillay-van Wyk V, Turawa E, et al. Prevalence of type 2 diabetes in South Africa: A systematic review and meta-analysis. Int J Environ Res Public Health 2021;18(11):5686. https://doi. org/10.3390/ijerph18115868

Bradshaw D, Norman R, Pieterse D, Levitt NS. Estimating the burden of disease attributable to diabetes in South Africa in 2000. S Afr Med J 2007;97(8 Pt 2):700-706.

Peer N, Baatiema L, Kengne AP. Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: Current challenges and outlook for the future. Expert Rev Cardiovasc Ther 2021;19(2):129-140. https://doi.org10.1080/14779072.2021.1855975

Statistics South Africa. Mortality and causes of death in South Africa: Findings from death notification 2017. Pretoria: Stats SA, 2020.

Kengne AP, Amoah AG, Mbanya JC. Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation 2005;112(23):3592-3601. https://doi.org10.1161/ CIRCULATIONAHA.105.544312

Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005;112(20):3066-3072. https:// doi.org10.1161/CIRCULATIONAHA.105.539528.

Hill J, Peer N, Jonathan D, et al. Findings from community-based screenings for type 2 diabetes mellitus in at-risk communities in Cape Town, South Africa: A pilot study. Int J Environ Res Public Health 2020;17(8):2876. https://doi.org10.3390/ijerph17082876

World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO consultation. Geneva: WHO, 1999. https://doi.org10.1002/ (SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S

KuPW,SteptoeA,LiaoY,HsuehMC,ChenLJ.Acut-offofdailysedentarytimeandall-causemortalityin adults: A meta-regression analysis involving more than 1 million participants. BMC Med 2018;16(1):74. https://doi.org/10.1186/s12916-018-1062-2

World Health Organization. Obesity: Preventing and managing the global epidemic: Report of a WHO consultation. Geneva: WHO, 2000.

World Health Organization. Waist circumference and waist-hip ratio: Report of a WHO expert consultation, Geneva, 8 - 11 December 2008. Geneva: WHO, 2011.

Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutrition 2005;56(5):303-307. https://doi.org10.1080/09637480500195066

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018;39(33):3021-3104. https://doi.org10.1093/eurheartj/ehy339

Klug E, Raal FJ, Marais AD, et al. South African dyslipidaemia guideline consensus statement: 2018 update. A joint statement from the South African Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA). S Afr Med J 2018;108(11b):973-1000. https://doi. org/10.7196/SAMJ.2018.v108i11.13383

Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120(16):1640-1645. https://doi.org10.1161/CIRCULATIONAHA.109.192644

AnwerZ,SharmaRK,GargVK,KumarN,KumariA.Hypertensionmanagementindiabeticpatients. Eur Rev Med Pharmacol Sci 2011;15(11):1256-1263.

National Department of Health. Primary Care 101: Symptom-based integrated approach to the adult in primary care. Pretoria: NDoH, 2014.

Peer N, Steyn K, Lombard C, et al. Rising diabetes prevalence among urban-dwelling black South Africans. PloS ONE 2012;7(9):e43336. https://doi.org10.1371/journal.pone.0043336

Peer N, Steyn K, Lombard C, Gwebushe N, Levitt NS. A high burden of hypertension in the urban black population of Cape Town: The cardiovascular risk in black South Africans (CRIBSA) Study. PloS ONE 2013;8(11):e78567. https://doi.org10.1371/journal.pone.0078567

Peer N, Steyn K, Lombard C, Gaziano T, Levitt N. Alarming rise in prevalence of atherogenic dyslipidaemia in the black population of Cape Town: The cardiovascular risk in black South Africans (CRIBSA) study. Eur J Prev Cardiol 2014;21(12):1549-1556. https://doi.org10.1177/2047487313497865. Epub 2013 Jul 23

Puoane T, Tsolekile L, Sanders D, Parker W. Chronic non-communicable diseases. In: South African Health Review 2008. Durban: Health Systems Trust, 2008. http://www.hst.org.za/uploads/files/ chap5_08.pdf (accessed 24 July 2012).

Webb EM, Rheeder P, van Zyl DG. Diabetes care and complications in primary care in the Tshwane district of South Africa. Primary Care Diabetes 2015;9(2):147-154. https://doi.org10.1016/j. pcd.2014.05.002

Pillay S, Mahomed F, Aldous C. Diabetic patients served at a regional level hospital: What is their clinical picture? J Endocrin Metabol Diabetes. JEMDSA 2015;20(1):60-66. https://doi.org/10.1080/1 6089677.2015.1030856

Katz I, Schneider H, Shezi Z, et al. Managing type 2 diabetes in Soweto – the South African Chronic Disease Outreach Program experience. Primary Care Diabetes 2009;3(3):157-164. https://doi. org10.1016/j.pcd.2009.06.007

Webb EM, Rheeder P, Wolvaardt JE. The ability of primary healthcare clinics to provide quality diabetes care: An audit. Afr J Prim Health Care Fam Med 2019;11(1):e1-e6. https://doi.org10.4102/ phcfm.v11i1.2094

MasupeTK,NdayiK,TsolekileL,DelobelleP,PuoaneT.Redefiningdiabetesandtheconceptofself- management from a patient’s perspective: Implications for disease risk factor management. Health Educ Res 2018;33(1):40-54. https://doi.org10.1093/her/cyx077

Stadler JT, Lackner S, Morkl S, et al. Obesity affects HDL metabolism, composition and subclass distribution. Biomedicines 2021;9(3):242. https://doi.org10.3390/biomedicines9030242

Department of Health, South African Medical Research Council. South Africa Demographic and Health Survey 2016: Key Indicator Report. Pretoria: Statistics South Africa, 2017

Downloads

Published

2024-03-18

Issue

Section

Research

How to Cite

1.
Peer N, Kotzé-Hörstmann L, Hill J, Kengne A-P. Differential management and associations of dyslipidaemia and hypertension by glycaemic status in urban South Africans. S Afr Med J [Internet]. 2024 Mar. 18 [cited 2024 Apr. 21];114(3):e1315. Available from: https://samajournals.co.za/index.php/samj/article/view/1315

Similar Articles

1-10 of 256

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)