Chronic complications among patients with type 2 diabetes in Southern Ethiopia

Background Type 2 diabetes mellitus (T2DM) is a global health concern associated with complications that significantly impact patients’ quality of life and place significant burdens on healthcare systems. While the prevalence of T2DM is rising in Ethiopia, the scope and factors contributing to its complications remain understudied. Hence, this study aimed to assess the burden and identify associated factors of chronic complications among Type 2 diabetes mellitus patients attending Wolaita Sodo University Comprehensive Specialized Hospital in Southern Ethiopia.

A facility-based cross-sectional quantitative study was conducted from July 1 to August 30, 2024, involving 404 systematically sampled T2DM patients. Data on sociodemographic characteristics, clinical profiles, self-care practices, and chronic complications were collected through structured interviews and medical record reviews. Descriptive statistics summarized patient characteristics, while multivariable logistic regression identified factors associated with chronic complications. Results were reported as Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs), and a p-value < 0.05 was considered statistically significant.

A total of 404 type 2 Diabetes mellitus patients participated in the study, with a response rate of 97.58%. The mean age of participants was 44.80 ± 14.10 years, 41.09% had diabetes for more than 5 years, and 64.85% had suboptimal glycemic control. Among participants, 45.54% (95% CI: 40.61 - 50.54) had at least one chronic complication, and one in five had multimorbidity. The most common microvascular complications were peripheral neuropathy (14.85%) and nephropathy (9.65%), while macrovascular complications included congestive heart failure (14.11%) and cerebrovascular disorders (11.39%). Multivariable logistic regression identified older age (AOR = 2.74; 95% CI: 1.73, 4.37; p=0.002), female sex (AOR = 2.14; 95% CI: 1.12, 4.76; p=0.018), longer diabetes duration (AOR = 2.98; 95% CI: 1.41, 6.54; p<0.001), poor glycemic control (AOR = 2.02; 95% CI: 1.33, 3.09; p=0.032), hypertriglyceridemia (AOR = 2.00; 95% CI: 1.06, 3.80; p=0.001), high salt intake (AOR = 1.57; 95% CI: 1.06, 2.32; p=0.005), and physical inactivity (AOR = 1.75; 95% CI: 1.16, 2.64; p=0.025) as significant factors associated with chronic complications.

The study identified that nearly half of the T2DM patients experienced chronic complications, highlighting a need for improved prevention strategies. Targeted screening, regular monitoring of blood glucose and lipids, personalized counseling on diet and physical activity, and integrated chronic disease management should be prioritized to reduce the complications and improve health outcomes. Competing Interest Statement The authors have declared no competing interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We obtained ethical approval from the Institutional Review Board of Arba Minch University College of Medicine and Health Sciences (IRB/23166/2024) and informed consent from each participant after a clear explanation of the study objectives. For illiterate participants, trained data collectors read the information sheet and consent form aloud in their preferred language, and verbal consent was documented with a witness present. Confidentiality was maintained by omitting personal identifiers from the questionnaire, and all data were securely stored and accessible only to the research team. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes This version of the manuscript reflects substantial revisions made following peer review and editorial feedback received from PLOS ONE. Key updates include: Clarification of definitions: Terms such as chronic complications, multimorbidity, and hypertension have been explicitly defined to enhance clarity and consistency. Enhanced methods section: Detailed descriptions have been added on how clinical and behavioral variables (e.g., salt intake, physical activity, glycemic control using FBG levels) were measured and categorized. Updated statistical analysis: A more robust multivariable logistic regression model was applied, and adjusted odds ratios (AORs) with 95% CIs were reported. Confounder selection was explained, and p-values were added to all relevant tables. Refined results presentation: Data tables were reorganized for clarity and completeness, and findings were clearly linked to statistical outputs. Improved discussion: The discussion section was rewritten to better reflect the findings, integrate relevant literature, and avoid causal interpretations. Study limitations were expanded to include issues of design, bias, and generalizability. These changes aim to improve the clarity, methodological rigor, and interpretability of the study while preserving its core findings regarding the burden and determinants of chronic complications among T2DM patients in Southern Ethiopia. Data Availability The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Abbreviations - AOR - Adjusted Odds Ratio - BMI - Body Mass Index - COR - Crude Odds Ratio - DALYs - Disability-Adjusted Life Years - DM - Diabetes Mellitus - ESRD - End-Stage Renal Disease - IRB - Institutional Review Board - NCDs - Non-Communicable Diseases - SDGs - Sustainable Development Goals - T2DM - Type 2 Diabetes Mellitus - USD - United States Dollar - WHO - World Health Organization