Cytomorphological characteristics of cervical scrape from diabetes mellitus patients attending tertiary healthcare, Kenya

Abstract Background: Globally, the concurrence of diabetes mellitus and cervical cancer among women is compounded health burden of increasing magnitude. Further, there is an increasing incidence and prevalence of both diseases, 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. Early detection and appropriate treatment of cervical abnormalities among diabetes women effectively prevents invasive cases, increases life expectancy and minimizes the socioeconomic burden associated with concurrence of cervical intraepithelial lesions with diabetes. Aim: To determine the cytomorphological characteristics in cervical scrape samples obtained from patients with diabetes mellitus attending Kitale County Hospital, Kenya. Methodology: This was a prospective, hospital-based analytical cross-sectional study conducted between April 2023 to May 2024. A total of 158 diabetes patients(n=158) between the age of 18 and 65 years were consented. Cervical samples were collected and processed using Pap stain. The cervical cytomorphological 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. Means and standard deviations for symmetric distributions were calculated, while for asymmetric distributions, medians and interquartile ranges. Mann-Whitney U test was used to compare distributions of laboratory characteristics between controlled and uncontrolled diabetes. Chi-square were performed to compare proportions. 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(HBA1c) and presence of cytomorphological abnormalities. Results: Out of 156 cases, Cytomorphological abnormalities were reported in 63.5%. Negative for Intraepithelial lesion or Malignancy (NILM) 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 study points to a higher prevalence of cervical cytomorphological abnormalities among diabetes mellitus women. Both controlled and uncontrolled diabetes mellitus patients are at higher risk of cervical cytomorphological abnormalities. Further, diabetes control showed no significant association with occurrence of cervical cytomorphological abnormalities.