diabetes especially diabetes mellitus ( dm ) has become a disease of concern for both developed and developing countries [ 1 , 2 ] . in adults , the prevalence of dm worldwide was estimated to be 8.3% in 2011 and is expected to rise to 9.9% by the year 2030   largely due to the global obesity epidemic and other factors .
a dm prevalence of 8% has been reported in europe and the us [ 5 , 6 ] . in sub - saharan africa
reported prevalence varies widely ( benin 3% ; mauritania 6% ; cameroon 6.1% ; congo 7.1% ; zimbabwe 10.2% ; democratic republic of congo 14.5% ) .
type 2 diabetes mellitus ( type 2 dm ) has been shown to be the most common form of diabetes in sub - saharan africa [ 9 , 10 ] constituting 9095% .
type 2 dm has been shown to be associated with obesity . abdominal obesity / central obesity measured by either waist circumference ( wc ) or
waist - to - hip ratio ( whr ) has been shown to be strongly associated with diabetes and other chronic diseases than general obesity measured by bmi [ 1315 ] .
it is established that abdominal obesity is associated with decreased glucose tolerance , alterations in glucose insulin homeostasis , reduced metabolic clearance of insulin , and decreased insulin - stimulated glucose disposal .
some 31% of adults in tamale , ghana , are centrally obese and this has been related to advanced age , low physical activity , female gender , urban environment , high income , distorted perception of weight status , and tertiary education [ 12 , 1621 ] . with contrasting prevalence , severe complications , and public health significance , a study on the prevalence of abdominal obesity and its predictors in type 2 dm patients are remarkably scarce .
understanding the burden of abdominal obesity and its associated factors is pertinent in guiding diagnosis , management , and prevention of dm in sub - saharan africa .
the objective of this study was to determine the prevalence of abdominal obesity ( measured by wc ) in a sample of type 2 dm patients .
furthermore , we examined the demographic , clinical , and anthropometric determinants of increasing waist circumference in this same sample .
three hundred ( 300 ) previously diagnosed diabetes patients attending the diabetes clinic of the tamale teaching hospital in tamale , ghana , were recruited for this cross - sectional study in 2013 . as described elsewhere ,
all previously diagnosed diabetes patients that sought for care from the hospital 's diabetes clinic , during the study period , were eligible to participate in the study .
three hundred and twenty - one participants were approached ; 300 of them consented to the study , yielding a response rate of 93.5% .
the study was approved by the ethics committee of the university for development studies , school of medicine and health sciences , ghana .
participants aged  30 years , who have clinical determined type 2 dm based on the who criteria , and who have duration of diabetes of at least 1 year were qualified to participate in the study .
participants aged < 30 years and pregnant and lactating mothers were excluded from the study . also participants with a history of heart failure , type 1 dm , myocardial infarction , acromegaly , hypothyroidism , hypogonadism , and any other chronic diseases , patients on prolonged steroid use , and those who were on active drug treatment for obesity at the time of admission were excluded from the study .
waist circumference ( wc ) was measured midway between the inferior angle of the ribs and the suprailiac crest .
both measurements were measured to the nearest 1  cm using a nonstretchable fibre - glass measuring tape ( butterfly , china ) . during both measurements
, participants stood in an upright position , with arms relaxed at the side , feet evenly spread apart , and body weight evenly distributed in accordance with the who expert consultation report on waist circumference and waist - to - hip ratio . abdominal obesity was determined as a waist circumference > 102  cm in men and > 88  cm in women according to the world health organization cut - off points and risk of metabolic complications for waist circumference .
clinical variables such as systolic blood pressure ( sbp ) and diastolic blood pressure ( dbp ) and fasting plasma glucose ( fpg ) values were taken from the personal health record files of the diabetic patients .
elevated blood pressure denoted a mean bp  140/90  mmhg and/or documented antihypertensive treatment .
impaired fasting glycaemia ( ifg ) was defined as fpg  6.1  mmol  l .
sociodemographic data such as gender , age , and duration of diabetes were also obtained from the patients .
all data were entered into microsoft excel 2007 and analysed using graphpad prism version 5 ( graphpad software , san diego , california , usa , http://www.graphpad.com ) and the pasw statistics 18 for windows .
continuous data were analyzed using student 's t - test whilst categorical variables were analyzed using fisher 's exact test using graphpad prism version 5 .
a forward : lr method of multiple linear regression models was used to determine the predictors of wc .
all correlation and multiple linear regression analyses were done using pasw statistics 18 for windows . in all statistical tests ,
mean waist circumference was found to be 95.99  cm and significantly higher in women than in men .
the prevalence of abdominal obesity was found to be 77.0% and significantly higher in women than in men ( p < 0.001 ) .
average systolic blood pressure ( sbp ) and diastolic blood pressure ( dbp ) of the participants were 122.8  16.16  mmhg and 84.5  13.83  mmhg .
men had higher mean sbp ( p = 0.015 ) and dbp ( p = 0.001 ) than women . over 70% of both men and women
were found to have uncontrolled diabetes . among the participants with uncontrolled diabetes , 29.9% ( n = 69 ) had impaired fasting glycaemia and 70.1% ( n = 162 ) had hyperglycaemia .
significantly ( p = 0.008 ) , the mean age of the women ( 57.22  12.32 years ) in this study was higher than men ( 52.83  10.85 years ) . the mean duration of diabetes among the participants was found to be 5.23  5.00 years in which men had a higher mean duration than women . as seen in table 2 ,
significantly , wc correlated positively with whr ( r = 0.56 , p < 0.01 ) , age ( r = 0.50 , p < 0.01 ) , and gender ( r = 0.36 , p < 0.01 ) . the multiple linear regression models in table 3 show the relative contribution of predictor variables of wc . explaining 14% of the variance in wc in step 1 , gender was a significant predictor of wc . in step 2 , gender was no longer a significant predictor of wc , but whr ( b = 0.43 , p < 0.01 ) , age ( b = 0.40 , p < 0.01 ) , and fpgl ( b = 0.14 , p < 0.01 ) were significant predictors of wc .
this cross - sectional study from tamale , ghana , among type 2 dm patients attending an outpatient clinic shows a high prevalence of central obesity and a relatively low prevalence of elevated blood pressure .
parameters that significantly predicted increasing waist circumference were gender , age , fpg , whr , and wc .
this is higher than the central obesity prevalence of 31.2% reported among an apparently healthy population of civil servants in tamale , ghana .
our findings however concur with the central obesity prevalence of 75% in a hospital - based study of diabetes patients in kumasi , ghana , and 68.1% among diabetes patients in southern india .
this is not surprising since obesity has been shown to be a significant risk factor for diabetes especially in type 2 dm [ 13 , 14 ] .
this is lower than the 63.0% reported among diabetes patients in kumasi , ghana , 54.2% among diabetes patients in benin city , nigeria , 66.4% in a cameroonian type 2 diabetic population , and 50% of the diabetes patients in kenya .
the differences could be due to variations in definitions of hypertension , population characteristics , and ethnic variations . in a univariate analysis
this was confirmed by our correlation and multiple linear regression models in which the female gender strongly predicted whr and wc in a positive direction .
several studies have reported findings that are in agreement with the association between the female gender and obesity among diabetics [ 3033 ] .
a similar relationship has also been reported in cross - sectional studies among apparently healthy populations [ 18 , 3436 ] . in identifying factors that influenced wc , our correlation and multiple linear regression models revealed whr , age , and fpg as independent predictors of wc in a positive direction .
as reported in several studies , a positive relationship was found between age and wc making age a strong predictor of wc (  = 0.40 , 95% ci = 0.400.64 , p < 0.01 ) [ 12 , 3739 ] . in agreement with our findings ,
wc significantly predicted the levels of blood glucose in a cross - sectional study in a sample of 5,882 adults from the us 19992004 national health and nutrition examination survey . in a population - based survey of the prevalence of diabetes and
correlates in an urban slum in a community in nairobi , kenya , ayah et al . found that persons with diabetes were twice as likely to have an elevated wc ( or 2.3 ; 95% ci 1.24.6% ) and whr ( or 2.1 ; 95% 1.13.9% ) . increased intra - abdominal adipose tissue is the most clinically relevant type of body fat that is associated with metabolic complications and adverse health effects including hyperinsulinemia and type 2 dm [ 4244 ] .
this indicates the negative influence of increasing wc on blood glucose levels . in the management of diabetes to maintain blood glucose levels , emphasis should be placed on regularly measuring and monitoring abdominal and central adiposity using a simple and inexpensive measure like wc .
fpg and blood pressure values were obtained secondarily from the personal health files of the diabetes patients .
although all care was taken to record the values to minimize errors , misreporting might have occurred .
predictors of increasing whr and wc were the female gender , age , and fpg . a relatively low prevalence of elevated blood pressure was found .
 type 2 diabetes mellitus ( type 2 dm ) has become a disease of public health concern worldwide . 
 obesity and elevated blood pressure have been shown to be comorbidities of type 2 dm . in this cross - sectional study in tamale , ghana , we determined the prevalence of abdominal obesity among type 2 dm patients . 
 furthermore , we examined the demographic , clinical , and anthropometric predictors of increasing waist circumference in this population . 
 three hundred type 2 dm patients attending the outpatient diabetes clinic of the tamale teaching hospital , ghana , were recruited for the study . 
 waist circumference ( wc ) and hip circumferences were measured appropriately . 
 systolic blood pressure ( sbp ) and diastolic blood pressure ( dbp ) and fasting plasma glucose ( fpg ) were taken from the personal health record files of patients . 
 demographic data were obtained . 
 pearson correlation and multiple linear regression models were employed to identify predictors of increasing wc . 
 the prevalence of abdominal obesity was 77.0% and was significantly higher in women than in men . 
 a positive correlation was observed between waist - to - hip ratio ( whr ) and wc ( r = 0.56 , p < 0.001 ) , female gender ( r = 0.73 , p 
 < 0.001 ) , and age ( r = 0.20 , p 
 < 0.001 ) . 
 a high prevalence of abdominal obesity was observed . 
 predictors of increasing wc were gender , age , fpg , and whr . 
1. Background
2. Materials and Methods
3. Results
4. Discussion
5. Conclusion