Study discovers risk factors of undiagnosed diabetes in Ghana

A study, “Risk factors for Undiagnosed Diabetes in Ghana,” by a team of researchers, says undiagnosed diabetes is a significant public health concern in Ghana.

The study’s findings underscore the need for comprehensive research to discover the disease prevalence

The study was led by Dr Thomas Hormenu, the Principal Investigator of Cardiometabolic Risk [CarMeR] Study and Cardiometabolic Epidemiology Research Laboratory (CERL), University of Cape Coast and supported by African Academy of Sciences under the African Postdoctoral Training Initiative (APTI) programme that delved into the risk factors of diabetes in Ghana.

Diabetes is a global health challenge, contributing to morbidity and mortality worldwide with the burden in the country, escalating, especially in an era of infectious diseases like COVID-19, HIV and tuberculosis.

The research deployed a model that accounts for hidden dynamics including demographic, socioeconomic, clinical, physical activity, and behavioural factors.

With increasing dietary changes in addition to high consumption of fast foods, sugar drinks, and physical inactivity, many people have become obese and develop insulin resistant, that is inability of the body to digest glucose.

Instructively, many cases remain undiagnosed, resulting in delayed interventions and heightened complications with understanding diabetes etiology in indigenous communities critical for early interventions for prevention and remission.

The goal of the study was to identify the prevalence and burden of undiagnosed diabetes and to ascertain the efficacy of lifestyle interventions on cardiometabolic parameters in newly diagnosed persons with diabetes and prediabetes.

The methodology of the study, utilised multiple community-based designs of cross-sectional scheme for Phase 1 to select 13 indigenous communities of 1,200 healthy individuals, who hitherto has not been diagnosed with diabetes aged 25-70 years in Cape Coast Metropolis, Ghana, and Randomised Controlled Trial (RCT) for the Phase 2 intervention.

Dr Hormenu said these methods were chosen because their combinations were ideals in detecting undiagnosed diabetes and prediabetes within the population for prompt attention.

“Although several studies have been conducted on diabetes in Ghana, this is the first time a Generalised Structural Equation Model (GSEM) was used to investigate the direct and indirect associated factors for undiagnosed diabetes to gain insights into direct and indirect factors as modifiable pathways that could help public health professionals to prevent diabetes.”

The results revealed several direct factors associated with diabetes, including waist circumference, body mass index (BMI), triglycerides (TG), systolic blood pressure (SBP) and the Gamm–Glutamyl Transferase (GGT) levels. 

Additionally, socio-demographic, socio-economic, and lifestyle factors indirectly influenced diabetes status, requiring attention to these factors for effective management.

Key findings

The study found overall diabetes prevalence of 8.8 per cent and prediabetes at 14.5 per cent using fasting plasma glucose (FPG), 2-hour glucose, FPG diagnosed 3.8 per cent diabetes, 14.4 per cent prediabetes.

In terms of sex, women were more likely than men to have prediabetes (15.33%) and diabetes (5.15%) and (12.62% and 1.24%, respectively).

Urban areas had the lowest prevalence of diabetes, while rural areas had the highest, followed by peri-urban areas. Based on FPG levels, the study discovered that gamma-glutamyl transferase (GGT) a measure of alcohol content in the blood, female sex, triglycerides (TG), body mass index (BMI), and systolic blood pressure (SBP) were all direct predictors of prediabetes and diabetes.

Several indirect factors were found to influence diabetes and prediabetes through waist circumference (WC): family history, being aged 35–55 years and 56–70 years, moderate and high socioeconomic status, and childhood overweight status.

Prediabetes and diabetes were also indirectly influenced by high BMI, which was also linked to inadequate physical activity, female sex, moderate and high socioeconomic position, market trading, high-density lipoprotein (HDL) cholesterol, and childhood overweight.

According to International Diabetes Federations (2019), 3 million Ghanaians are diagnosed with diabetes and currently about 60 per cent of persons living with the disease unaware or statistically, three out of every five adults may be moving with the disease.

Consistently increasing blood sugar may lead to prediabetes and a major fuel of diabetes in Africa with high prevalence of diabetes and prediabetes in the communities and most of these people unaware of the disease are high in rural communities, markets and among females.

The study suggests the need for increased community screening for early diagnosis and changes in dietary practices from reducing food portion sizes, shielding from junk foods, increase daily intake of fruits and vegetable, and increase physical activity recommended.

Dr Hormenu said: “The cardinal solution is the ‘Delay, Prevent and Improve’ approach to undiagnosed diabetes, where Delay and Prevent diabetes are carried through healthy life choices, and early screening and Improve life of those diagnosed through a community intervention.”

A pilot of the community intervention on Nutrition education message framing and digital self-regulated physical activity through smart watches and phones has recorded significant diabetes remission of 71 per cent.

The researchers recommend financial support and collaboration from the Ministry of Health, Ghana Health Service, and donor agencies to validate the findings expected to lead to inclusion of the intervention into clinical practice.

The study has a few limitations that are worth mentioning for further research, notably, the data on the risk factors were obtained from a cross-sectional survey and not an experimental approach, which implies that the study’s results show an association between the variables, rather than causality.

The study suggested that future studies use an experimental design, notwithstanding this, the findings are reliable and provide a solid foundation for policy development.

Source: GNA

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