Browsing by Author "Nyirenda, Moffat"

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Gestational Diabetes (GDM) Does Not Predict Large Birthweight or Perinatal Death in a Relatively Untreated Population in Uganda: A Prospective Observational Cohort Study.
(Elsevier, 2021-05) Milln, Jack; Nakabuye, Betty; Natamba, Barnabas; Sekitoleko, Isaac; Mubiru, Michael; Namara, Arthur; Tumwesigire, Samuel; Tino, Salome; Wilja, Mandy; Kakande, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annettee; Webb, Emily; Nyirenda, Moffat
BACKGROUND The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recent evidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization's criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36–5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20–2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74–3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17–3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16–2.30). CONCLUSION Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Prevalence and Factors Associated with Overweight and Obesity Among Patients with Type 2 Diabetes Mellitus in Uganda—A Descriptive Retrospective Study
(BMJ Publishing Group , British Med Assoc House, Tavistock Square, London, England, Wc1h 9jr, 2020) Tino, Salome; Mayanja, Billy N; Mubiru, Michael Charles; Eling, Emmanuel; Ddumba, Edward; Kaleebu, Pontiano; Nyirenda, Moffat
Objectives To assess the prevalence and risk factors of overweight and obesity among type 2 diabetes mellitus (T2DM) patients in Uganda. Design Retrospective chart review. Setting This study was conducted in the outpatient’s T2DM clinic in St. Francis Hospital—Nsambya, Uganda between March and May 2017. Participants Type 2 diabetes patients registered in the diabetes clinic between July 2003 and September 2016. Outcome measures Overweight and obesity defined as body mass index (kg/m2) of 25.0–29.9 and obesity as 30.0 or higher. Results Of 1275T2DM patients, the median age was 54 (IQR: 44–65) years, 770 (60.40%) were females, 887 (69.6%) had hypertension, 385 (28%) had controlled glycaemia, 349 (27%) were obese, while 455 (36%) were overweight. Overweight/obesity were lower among men (OR: 0.45, 95%CI: 0.340 to 0.593, p≤0.001) and among patients aged ≥65 years (OR: 0.52, 95%CI: 0.350 to 0.770, p=0.001); patients who rarely ate fruits and vegetables (OR: 0.66, 95% CI: 0.475 to 0.921, p=0.014) but higher among patients of middle (OR: 1.83, 95%CI: 1.320 to 2.550, p≤0.001) and upper (OR: 2.10, 95%CI: 1.450 to 2.990, p≤0.001) socioeconomic status; on dual therapy (OR: 2.17, 95%CI: 1.024 to 4.604, p=0.043); with peripheral neuropathy (OR: 1.40, 95% CI: 1.039 to 1.834, p=0.026) and hypertension (OR: 1.70, 95% CI: 1.264 to 2.293, p≤0.001). Conclusions Overweight and obesity are high among T2DM patients in this population and may contribute significantly to poor outcomes of T2DM. Therefore, strategies to address this problem are urgently needed.