The magnitude of chronic diabetes complications and its associated factors among diabetic patients attending the general hospitals in Tigray region, Northern Ethiopia

**Background:** Diabetes is a major global public health challenge, causing significant morbidity, mortality, and healthcare costs. In Ethiopia, 4.7% of the population (3.0 million) had diabetes in 2021. Chronic complications such as hypertension, retinopathy, nephropathy, and neuropathy are common but understudied, especially in lower-level healthcare facilities. Most prior Ethiopian research focused on tertiary hospitals or high-risk inpatients, limiting generalizability. This study aimed to assess the magnitude of chronic diabetes complications and associated factors among type 2 diabetes (T2D) outpatients in general hospitals in the Tigray region.

**Methods:** A multi-centre cross-sectional study was conducted from September 2019 to January 2020 in 10 randomly selected public general hospitals in Tigray. A total of 1,158 T2D patients (response rate 99.14%) were enrolled via systematic random sampling. Data were collected using an interviewer-administered questionnaire, medical record review, and physical measurements (blood pressure, BMI). Chronic complications were diagnosed based on standard criteria (e.g., hypertension: SBP ≥140 mmHg and/or DBP ≥90 mmHg or antihypertensive use; eye disease: ophthalmologist report; kidney disease: albuminuria or elevated creatinine). Multivariable logistic regression identified factors associated with complications, with p<0.05 considered significant.

**Key Results:** The mean age was 55.9 years (SD ±11.9); 54% were male, 72.3% urban, 50.5% had no formal education, and 76.5% had BMI <25 kg/m². Overall, 54% (95% CI: 51.35–57.10) of participants had at least one chronic complication. Among those, 10.5% had one complication, 16.9% had two, and 26.8% had more than two. Macrovascular complications: hypertension 27% (95% CI: 24.71–29.85), peripheral vascular disease 9.13% (95% CI: 7.49–10.81), coronary artery disease 3.28% (95% CI: 2.25–4.30), cerebrovascular disease 4.31% (95% CI: 3.14–5.49). Microvascular complications: eye disease 22.62% (95% CI: 20.21–25.03; including retinopathy 9%, cataract 5%, glaucoma 8%, blindness 1%), kidney disease 19.17% (95% CI: 16.90–21.44; microalbuminuria 9%, macroalbuminuria 4%, high creatinine 6%), peripheral neuropathy 11% (95% CI: 8.84–12.39), foot ulcer 4.14% (95% CI: 2.99–5.29). Factors independently associated with higher odds of complications: age ≥61 years (AOR=3.00; 95% CI: 1.73–5.26), insulin plus oral hypoglycemic agent use (AOR=2.20; 95% CI: 1.18–4.27), diabetes duration ≥5 years (AOR=1.56; 95% CI: 1.18–2.05), pill burden ≥4/day (AOR=1.63; 95% CI: 1.23–2.15), SBP ≥140 mmHg (AOR=3.13; 95% CI: 2.25–4.35), DBP ≥90 mmHg (AOR=1.39; 95% CI: 1.06–1.81). Protective factors: government employment (AOR=0.48; 95% CI: 0.26–0.90), antiplatelet drug use (AOR=0.29; 95% CI: 0.16–0.52), antidyslipidemia drug use (AOR=0.54; 95% CI: 0.35–0.84).

**Clinical Implications:** This study reveals a high burden of chronic diabetes complications (54%) in general hospital settings in Northern Ethiopia, with hypertension, eye disease, and kidney disease being most prevalent. The findings underscore the need for routine screening and integrated management of complications, especially in older patients, those with longer diabetes duration, and those on combination therapy or with high pill burden. The protective effect of antiplatelet and antidyslipidemia medications suggests potential benefits of broader cardiovascular risk management. Limitations include the cross-sectional design (cannot infer causation), lack of HbA1c and lipid profile data, and potential underdiagnosis due to limited diagnostic resources at general hospitals. Future longitudinal studies are needed to establish causal pathways and evaluate intervention strategies.