126
VOLUME 11 NUMBER 3 • SEPTEMBER 2014
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Prevalence and determinants of electrocardiographic
abnormalities in sub-Saharan African individuals with
type 2 diabetes
ANASTASE DZUDIE, SIMEON-PIERRE CHOUKEM, ABDOUL KADIR ADAM, ANDRE PASCAL KENGNE,
PATRICIA GOUKING, MESMIN DEHAYEM, FÉLICITÉ KAMDEM, MARIE SOLANGE DOUALLA,
HENRY ACHU JOKO, MARIELLE EPACKA EWANE LOBE, YVES MONKAM MBOUENDE, HENRY LUMA,
JEAN CLAUDE MBANYA, SAMUEL KINGUE
Correspondence to: Anastase Dzudzie
Department of Internal Medicine, Buea Faculty of Health Sciences, and
Department of Internal Medicine, Douala General Hospital, Cameroon
e-mail:
Department of Internal Medicine, Buea Faculty of Health Sciences, Cameroon
Simeon-Pierre Choukem
Félicité Kamden
Solange Doualla
Henry Achu Joko
Marielle Epacka Ewane Lobe
Yves Monkam Mbouende
Henry Luma
Université des Montagnes, Bangangte, Cameroon
Abdoul Kadir Adam
Department of Medicine, University of Cape Town and
Medical Research Council, Cape Town, South Africa
Pascal Kengne
Diabetes and Endocrine Service, Yaoundé Central Hospital
and Faculty of Medicine, Cameroon
Patricia Gouking
Mesmin Dehayem
Jean Claude Mbanya
Department of Internal Medicine, Yaoundé Faculty of
Medicine, Cameroon
Solange Doualla
Henry Luma
Jean Claude Mbanya
Samuel Kingue
Previously published in
Cardiovasc J Afr
2012;
23
(10): 533
S Afr J Diabetes Vasc Dis
2014;
11
: 126–130
Abstract
Aim:
This study assessed the prevalence and determinants
of electrocardiographic abnormalities in a group of type
2 diabetes patients recruited from two referral centres in
Cameroon.
Methods:
A total of 420 patients (49%men) receiving chronic
diabetes care at the Douala General and Yaoundé Central
hospitals were included. Electrocardiographic abnormalities
were investigated, identified and related to potential
determinants, with logistic regressions.
Results:
The mean age and median duration of diagnosis
were 56.7 years and four years, respectively. The main electro-
cardiographic aberrations (prevalence %) were: T-wave
abnormalities (20.9%), Cornell product left ventricular
hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart
disease (13.6%), conductiondefects (11.9%),QTcprolongation
(10.2%) and ectopic beats (4.8%). Blood pressure variables
were consistently associated with all electrocardiographic
abnormalities. Diabetes-specific factors were associated
with some abnormalities only.
Conclusions:
Electrocardiographic aberrations in this popula-
tion were dominated by repolarisation, conduction defects
and left ventricular hypertrophy, and were more related to
blood pressure than diabetes-specific factors.
Keywords:
diabetes mellitus, sub-Saharan Africa, Cameroon,
ECG, cardiovascular disease
A major threat to the health of diabetes subjects is cardiovascular
disease (CVD), which currently accounts for about threequarters of
all deaths in diabetes patients in major populations and settings.
1
Attempts to maintain cardiovascular health in diabetics include: (1)
routine prescription of medications with proven beneficial effects on
cardiovascular health, such as statins and aspirin; (2) investigation
and treatment of individuals with abnormal levels of modifiable
risk factors; (3) monitoring of individuals for infra-clinical changes,
which are indicators of future high risk for cardiovascular events, or
those with lessadvanced stages of diabetes, whose course could be
modified through early intervention.
2
The electrocardiogram (ECG) is widely used for monitoring.
3
ECG changes appear early in the course of diabetes, and usually
include alterations such as sinus tachycardia, QTc prolongation, QT
dispersion, changes in heart rate variability, ST–T changes, and left
ventricular hypertrophy. These changes and others, detected with
the use of a resting ECG, often together with an exercise ECG, are
used to detect silent ischaemia, assess prognosis and predict future
risk. Because the ECG is a non-invasive and relatively easy test to
perform, it is used in the series of investigations conducted as part
of the annual clinical evaluation of people with diabetes around
the world.
3
The use of this modality however varies substantially, guided
essentially by the availability of ECG machines and the cost of such
investigations. As a result, the regional office of the International
Diabetes Federation (IDF) for Africa recommends ECG monitoring
in diabetes only at the secondary or tertiary level of the healthcare
system where facilities for performing an ECG are more readily
available.
4
Therefore in sub-Saharan Africa, the majority of patients with
diabetes who receive care in primary healthcare facilities do not have
