Abstract

Diabetes mellitus (DM) is associated with a high risk of morbidity and mortality from hypertension. Even though DM is a non-communicable disease, there is a paucity of data on hypertension, gastritis, and their associated risk factors among patients with DM. Therefore this study was aimed at determining the prevalence and associated factors of hypertension and gastritis in DM patients attending Buea Regional Hospital Diabetic Unit.

A hospital-based cross-sectional study was employed wherein 100 DM patients were recruited. Demographic data and data on associated risk factors were collected using structured questionnaires. Blood samples were collected and tested for H. pylori. Data were analyzed using SPSS version 20.

Results for categorical variables were presented using frequency tables and figures. Associations were tested using the chi-square test. Statistical significance was set at P < 0.05 for all statistics. The prevalence of hypertension and gastritis in DM were 50% and 42% respectively. It was revealed that having a family history of diabetes was the most prevalent risk factor while Tobacco was the least prevalent risk factor.

There was a statistical significance between family history of diabetes and hypertension (P=0.0035) and between physical activity and hypertension (p= 0.000). It was observed that antihypertensive drugs had a significant association with gastritis while drugs against gastritis did not have any significant association with hypertension (P=0.673).

The prevalence of hypertension and gastritis is high among diabetic patients. Having a family history of diabetes and/or being physically inactive are related to an increased risk of developing hypertension among DM patients. DM patients on anti-diabetic drugs are most likely to develop gastritis.

CHAPTER ONE

INTRODUCTION

1.1 Background

Diabetes mellitus is a heterogeneous metabolic disorder characterized by the presence of hyperglycemia due to impairment of insulin secretion, defective insulin action, or both. The chronic hyperglycemia of diabetes is associated with relatively specific long-term microvascular complications affecting the eyes, kidneys, and nerves, as well as an increased risk for cardiovascular disease (CVD). The diagnostic criteria for diabetes are based on thresholds of glycemic values that are associated with microvascular disease, especially retinopathy (ADA, 2012).

Diabetes mellitus is a multifactorial disease of considerable heterogeneity ( WHO, 2019). The disease is the most common chronic endocrine disorder, affecting an estimated 5%–10% of adults worldwide (Alqurashi et al, 2011). Predictions based on many studies have indicated a growing increase of diabetes mellitus, particularly in developing countries.

It is predicted that between 2010 and 2030, developed and developing countries will see a 20% and 69% increase, respectively, in the number of adults with diabetes (Shaw et al, 2010). The prevalence of diabetes among those aged 20–79 years may increase to 7.7%, constituting 439 million by 2030 (IDF, 2013). Many studies have shown that lifestyle modifications are effective in preventing obesity and diabetes in high-risk adults with impaired glucose tolerance (Zimmet et al, 2011).

Globally, the east Mediterranean Region has the second-highest prevalence of diabetes in terms of population. According to the World Health Organization (WHO), almost a quarter of the region’s population has diabetes in one form or another (Thelin and Holmberg, 2014).

Data from the Gulf revealed high prevalence rates of type 2 diabetes mellitus. The reported prevalence rates were 25.7%, 16.1%, and 21% in Bahrain, Oman, and Kuwait, respectively (Zimmet et al, 2011).

In Cameroon, the prevalence of diabetes in adults in urban areas is 6-8%, with as many as 805 people living with diabetes who are currently undiagnosed in the population. Further, according to data from Cameroon in 2002, only about a quarter of people with known diabetes actually had adequate control of their blood glucose levels. The burden of diabetes in Cameroon is not only high but is also rising rapidly. Data in Cameroonian adults over 10years (1994-2004) showed an almost 10-fold increase in diabetes prevalence (WDF, 2020).

Hypertension is defined as abnormally high blood pressure (more than 120/80 mm Hg) in the arteries.  A persistent increase in systemic arterial blood pressure is known as hypertension. Hypertension and diabetes mellitus are two of the most common diseases in Westernized, industrialized civilizations, and the frequency of both diseases increases with increasing age. An estimated 2.5to3 million Americans have both diabetes and hypertension.

Diabetes mellitus is associated with a considerably increased cardiovascular risk (Oster and Materson, 2012). The presence of hypertension in the diabetic individual markedly increases morbidity and mortality (Reaven and Hoffman, 2011) from data drawn from death certificates, hypertension has been implicated in 44% of deaths coded to diabetes, and diabetes is involved in 10% of deaths Coded to hypertension. It has been estimated that 35-75% of diabetic complications can be attributed to hypertension. In contrast, the absence of hypertension is the usual finding in long-term survivors of diabetes (Sower and Zemel, 2013).

The prevalence of hypertension in diabetic individuals appears to be approximately twofold that in the non-diabetic population (Reaven and Hoffman, 2011).  This is clearly the case for Type I diabetes and is probably valid for type II diabetes as well, although the relationship is somewhat more controversial with regard to the latter (Oster and Materson, 2012).

The presence of hypertension in patients with diabetes markedly enhances the development of macrovascular and microvascular disease in these individuals (Sun et al.; 2015).  Diabetic individuals with coexisting hypertension have a much greater prevalence of stroke and transient ischemic episodes than do normotensive diabetics.

Peripheral vascular disease is also increased in the presence of high blood pressure in diabetic patient. Both hypertension and diabetes mellitus are major independent risk factors for accelerated atherosclerosis and ischemic heart disease (Sun et al.; 2015).

Infection with Helicobacter pylori has been recognized as a public health problem worldwide (Bener et al, 2017) affecting approximately 50% of the world population and more prevalent in developing than the developed countries.

It is a common infection in diabetic patients who have inadequate metabolic control as such individuals are colonized by H. pylori infection in the gastric antrum, probably because of chemotactic factors such as tumor necrotic factors(TNF), interleukins- IL1, IL2, and IL8 are present in the gastric epithelium (Bener et al, 2017). These cytokines induce a number of changes in the epithelium that promote inflammation and epithelial damage thus leading to increased risk of aberrant repair giving the picture of gastric atrophy or epithelial metaplasia.

Diabetes mellitus has been reported to cause causes dyspepsia. Disordered gastrointestinal motor function is now recognized as a major cause of diabetes mellitus. Besides DM, H. pylori is also a well-established cause of dyspepsia. The incidence of Helicobacter pylori is increased in Diabetes mellitus (Suluja et al, 2013).

Delayed gastric emptying and antral dysmotility are important causes of dyspepsia in diabetes. The role of H. pylori infection in diabetic dyspepsia is mainly related to blood glucose concentration. Hyperglycemia may induce the infection by H. pylori or the silent infection may get reactivated and produce symptoms of dyspepsia in diabetes.

The prevalence of DM in Pakistan is 22%, (Jawad, 2012) the prevalence of H. pylori is 49% (Zaman, 2016) whereas the prevalence of H.pylori in diabetes mellitus is 66% (Damir et al, 2018). In Cameroon, diabetes prevalence was estimated at around 6% in 2018. This prevalence is increasing in the general population, rising from 2.0% in 1999 to 4.7% in 2002 and 5.8% in 2018 (J.J Bigna et al, 2018).

Infection to spiral rod-shaped gram-negative bacterium, Helicobacter pylori (H. pylori)  is associated with many gastrointestinal diseases including ulcer disease, gastroesophageal reflux disease, atrophic gastritis, and gastric cancer (Ali and Sarkis, 2015). H. pylori infection has been estimated in up to half of the world’s population and is mainly acquired in childhood by the feco-oral, or oral or gastro-oral routes (Ebule, 2016).

1. pylori infection has also been implicated in other non-gastrointestinal diseases like diabetes mellitus, ischemic heart disease, neurological disorder,  hypertension,  thyroiditis,  dermatological, rheumatological, and cerebrovascular disease. Diabetes mellitus (DM) is a common, chronic and progressive disease characterized by chronic hyperglycemia with disturbances in carbohydrate, fat, and protein metabolism resulting from either absolute or a  relative deficiency of insulin and/or action (Sherwal et al, 2014).

Chronic hyperglycemia in DM patients is associated with long-term damage, dysfunction, and failure of various organs including the eyes, kidneys, nerves, heart as well as blood vessels. H. pylori have been implicated in cardiovascular conditions, insulin resistance, and metabolic syndrome potentially mediated by elevations in inflammatory markers such as C-reactive protein (CRP) and Interleukin-6 (IL-6) (Pareek and Kannan, 2014).

1.2 Statement Of Problem

According to the 2017 report, International Diabetes Federation (IDF) estimates about 425 million adults in the world have Diabetes mellitus (DM). This figure is projected to increase to 629 million adults by 2045, which is a 45% increase.

Africa is estimated to have 15.9 million adults living with Diabetes mellitus which is a regional prevalence of 3.1%. The African continent has the greatest population of people with undiagnosed DM and global projections show that it will experience the greatest burden of DM of about 156% by 2045.

In Cameroon, Diabetes prevalence was estimated at about 6% in 2018. This prevalence is increasing in the general population, rising from 2.0% in 1999 to 4.7% in 2002 and 5.8 in 2018 but its association with health conditions like Hypertension and Gastritis is not fully established.

Since there are only a few studies in our country on the association of Hypertension and H. pylori in Diabetic patients, this study was conducted at the Buea Regional Hospital to collect information that will be used to slow down the increasing rate of Diabetes and it associated complications. This study focused on the Association of Hypertension and Helicobacter pylori infection in patients with type 2 diabetes mellitus and help in providing data that is useful in the field of medicines as well as epidemiology.

1.4 Hypothesis

1. pylori is significantly associated with hypertension in diabetic patients.

1.5 Research Objectives

1.5.1 General objective

To investigate the relationship between hypertension and gastritis in diabetic patients.

 1.5.2 Specific objectives

1. To determine the prevalence of gastritis associated with H pylori infection among diabetic patients.
2. To determine the prevalence of hypertension among diabetic patients.
3. To evaluate the association between risk factors for diabetes, and hypertension/gastritis.