Assessment of a diabetes symptom screening checklist and associated factors of impaired fasting glucose among ART patients on Copperbelt province

Abstract

There has been some evidence that because of life saving combination Antiretroviral therapy (cART), people living with HIV are living longer and it is apparent that they are at an increased risk of developing non communicable diseases (NCD) including diabetes mellitus. Despite this recognition, not much effort has been directed to introduce interventions that would mitigate this scenario. The main objective of this study was to assess the validity of the diabetes symptoms screening checklist and associated factors of impaired fasting glucose among adult ART patients. This was a quantitative cross sectional study which employed systematic random sampling procedure on cART patients who had been in care for at least 2 years, aged 18 years and above in five selected health facilities of Copperbelt province from October to December 2015.Data was extracted using the diabetes symptoms screening checklist and a separate data collection form for records from patient files as secondary data. STATA version 14 was used to determine descriptive statistics in form of frequencies of social demographics and clinical characteristics of the study sample. Multivariate logistic regression was used to identify the best predictors of impaired fasting blood sugar.Sensitivity, Specificity,Positive Predictive Value and Negative Predictive Values were also calculated. Out of 272 ART patients who were screened for diabetes using the Chronic HIV Care Checklist, 80% had at least one symptom of diabetes mellitus. Among these, 43%, (95% CI: 37%-49%) had impaired random blood sugarand 15.3 % (95% CI: 11%- 20%) % had impaired fasting blood sugar greater than 6.1mmol/l. This study found sensitivity (80%), specificity (20.4%), Positive Predictive Value (18.2%), Negative Predictive Value (84.9%) and ROC value (0.75) for the Diabetes checklist. Among the factors found to be associated to Impaired fasting blood sugar were, Body Mass Index >30 (AOR 2.2, 95% CI: 1.7-7.8) , Baseline weight (AOR 1.07 95% CI: 1.01-1.13), Number of symptoms >3 ticked on the diabetes checklist (AOR 6.5 95% CI: 1.4-29.9%) and Age >45 (AOR 2.7 95% CI: 1.14-3.34) The results of this study suggests an increase in the magnitude of ART patients with impaired fasting glucose compared to what is reported in the general population, suggesting a high prevalence of diabetes among this population. The diabetes symptoms screening checklist was effective in correct classification of ART patients who had impaired fasting glucose from those who had normal fasting glucose levels and therefore should be used within ART settings. Being 45 years and above, having at least 3 symptoms of diabetes and also having a body mass index greater or equal to 30 are important factors associated with impaired fasting glucose. In view of this glycaemic makers and risk reduction strategies especially for obese and aging ART patients is highlighted. Therefore, there is need for integrated care for HIV/AIDS and diabetes mellitus within ART platforms because of high proportion of ART patients being symptomatic of diabetes mellitus as evidenced in this study.