Cytomorphological characteristics of cervical scrape from controlled and uncontrolled diabetes mellitus patients attending tertiary healthcare, Kenya.

Abstract

Background: Globally, the concurrence of diabetes mellitus and cervical cancer among women is compounded and increasing health burden. Furthermore, the incidence and prevalence of both diseases are increasing, particularly in Middle and Low-income countries. In Kenya, 19.7 % of new cancer cases among women is attributed to cervical cancer. While diabetes causes metabolic disorders and immune alterations that may promote persistent high-risk Human Papilloma virus infection, the magnitude of cervical cytomorphological abnormalities among diabetes women in Kenya remains unclear.

Aim: To determine the cytomorphological characteristics of cervical scrape samples obtained from patients with controlled and uncontrolled diabetes mellitus who visited the Kitale County Hospital, Kenya.

Methodology: This prospective, hospital-based analytical cross-sectional study was conducted between April 2023 and June 2024. A total of 156 patients with diabetes (n=156) between the ages of 18 and 65 years were enrolled. Alcohol fixed cervical smears were processed using Papanicolaou staining method. The findings were reported using the 2014 Bethesda system for reporting cervical cytology. Images were captured for cytomorphological abnormalities using X20 mobile camera. Rstudio 4.2.2 (2024-10-31 ucrt) software was used to analyze data. Mann-Whitney U test was used to compare distributions of laboratory characteristics between controlled and uncontrolled diabetes. Fisher's exact test was performed to explore associations between diabetes control and cytomorphological abnormalities. Chi-square tests were performed to determine relationship between diabetes control and presence of cervical abnormalities. Logistic regression was performed to assess the relationship between glycemic levels and presence of cytomorphological abnormalities.

Results: Out of 156 cases, cytomorphological abnormalities were reported in 63.5%. Negative for Intraepithelial lesion or Malignancy accounted for 84.0% while 16% were cervical intraepithelial lesions. Non-neoplastic abnormalities/infections were recorded in 48.1% of study participants. The study showed that there is statistically significant difference in the central tendency of age between controlled and uncontrolled diabetes Mellitus [95% CI= 2.0-10.0, p=0.001]. There was statistical significance association between reproductive status and presence of cervical infections [OR=2.18, 95% CI= 1.15 - 4.18, p=0.016]. There was no significant association between diabetes control and occurrence of cervical cytomorphological abnormalities [OR=1.47, 95% CI=0.76-2.86, p=0.704]. While a unit increase in HBA1c was associated with (1.12) times higher odds of cytomorphological abnormality, it was not statistically significant [OR=1.12, CI=-0.11-0.245, p=0.080].

Conclusion: The current study points both groups of patients with controlled and uncontrolled diabetes mellitus are at higher risk of cervical cytomorphological abnormalities. Further, glycemic control showed no significant association with occurrence of cervical cytomorphological abnormalities.