Beyond blood pressure: carotid intima-media thickness uncovers subclinical atherosclerosis in normotensive adults with type 2 diabetes in Sub-Saharan Africa

BACKGROUND: Diabetes mellitus is strongly linked to a heightened risk of cardiovascular disease. Carotid intima-media thickness (CIMT) is increasingly utilized as a surrogate marker of atherosclerosis and cardiovascular disease risk. This study aimed to evaluate CIMT through high-resolution ultrasonography in adults with Type 2 diabetes and assess its potential association with selected clinical factors within a native Black African population. METHODOLOGY: An analytical cross-sectional study was conducted between November 2022 and February 2023 at the Diabetic Clinic of Mulago National Referral Hospital, Kampala, Uganda. One hundred normotensive adults with Type 2 diabetes were enrolled by consecutive sampling. CIMT was measured bilaterally at the common carotid artery using high-resolution Doppler ultrasonography. Clinical variables collected included age, sex, body mass index (BMI), glycated haemoglobin (HbA1c), fasting lipid profile, and diabetes duration. Multivariable Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPR). RESULTS: The mean age was 52.4 years (SD 11.2) and 62% of participants were female. The median diabetes duration was 10.0 years and the median HbA1c was 9.9% (IQR 7.8-10.9). Abnormal CIMT (> 0.9 mm) was found in 61% (61/100) of participants. On multivariable analysis, independent predictors of abnormal CIMT included age > 45 years (aPR 1.17, 95% CI 1.08-1.28), high LDL cholesterol (aPR 1.20, 95% CI 1.07-1.36), poor or very poor glycemic control (HbA1c > 8%; aPR 1.16, 95% CI 1.01-1.32), and diabetes treatment duration > 9 years (aPR 1.11, 95% CI 1.01-1.21). CONCLUSIONS: Among normotensive Ugandan adults with Type 2 diabetes, 61% had increased CIMT. Independent predictors were older age, poor glycemic control, high LDL cholesterol, and longer disease duration. CIMT assessment offers a simple, non-invasive adjunct for identifying subclinical atherosclerosis and may improve cardiovascular risk stratification in this population.