Prevalence of Diabetes and Pre-Diabetes in Routine Haemoglobin HBA1C Screening and Impacts on Outcomes Among Patients Undergoing Surgery for Trauma

Introduction: The global prevalence and incidence of diabetes is steadily rising in all populations particularly in low and middle income countries. According to the International Diabetes Foundation, in 2021, an estimated 716,000 adults in Uganda had diabetes and about 89% of Ugandans with diabetes are neither on medication nor aware of their status and therefore present to the health system with difficult to treat complications. In many cases, lack of data is the major barrier for setting up efficient programs for prevention and management of diabetes in diverse populations. Currently, there is a scarcity of data on the prevalence of diabetes among patients that undergo orthopaedic interventions for various disease conditions in Uganda. Methods: We performed a hospital based cross sectional cohort study at Kumi Orthopaedic Center. All individuals who had HBA 1C test done between 2018 to 2024 were included in the study. A self-formulated data abstraction tool was used to extract participants’ data from the hospital data base. Patients with HBA 1c levels less than 5.70% were classified as normal, those with levels between 5.70 to 6.49% were classified as pre-diabetic and those with levels greater than 6.50% or currently on diabetes treatment were classified as being diabetic. Results: A total of 1534 participants were included in this study. The majority were female 911(59.4%) while the males constituted 623(40.6%). The mean age of the participants was 55.0 years (SD±15.8) with majority aged between 40 to 59 years (45.6%). The prevalence of diabetes in this study was 17.5% and prediabetes was 25.0% with a general difference between male and females. The prevalence of patients with a history of known diabetes was 14.5% (39) among those categorized as diabetic according to levels of HbA1c. Having elevated systolic blood pressure was a statistically significant predictor for diabetes (OR 1.60 95% CI 1.14-2.34: P=0.007). There was a higher infection rate noted among patients with diabetes (5%) compared to those without diabetes (2.1%) following surgery for trauma. Conclusion: The prevalence of diabetes and pre-diabetes is high among patients seen at Kumi Orthopaedic Center and remains undiagnosed in an alarmingly high proportion of individuals. These findings high light the need for continuous monitoring/screening for diabetes among patients seeking orthopaedic care. There is also a need for large scale studies to accurately quantify the burden and identify effective interventions and treatment strategies across diverse hospital populations.