Multidomain Autonomic Dysfunction assessed with COMPASS-31 among patients with type 2 diabetes in Zanzibar: prevalence and associated factors.
8 affiliations
- 1Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania. [email protected].
- 2School of Health and Medical Sciences, Department of Physiology, State University of Zanzibar (SUZA), Zanzibar, Tanzania. [email protected].
- 3School of Nursing and Midwifery, Aga Khan University, Dar-es-Salaam, Tanzania.
- 4Zanzibar Agricultural and Livestock Research Institute, Zanzibar, Tanzania.
- 5Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar-es- Salaam, Tanzania.
- 6Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
- 7Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania.
- 8Research Center for Health through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Abstract
Background
Autonomic dysfunction is an important but frequently under-recognized complication of type 2 diabetes mellitus (T2DM), particularly in settings where objective autonomic testing is not routinely available. The Composite Autonomic Symptom Score-31 (COMPASS-31) provides a practical symptom-based approach for assessing autonomic dysfunction across multiple domains. This study compared socioeconomic, lifestyle, and clinical characteristics among adults with T2DM in Zanzibar according to COMPASS-31-defined autonomic dysfunction and examined factors associated with its presence.Methods
This hospital-based cross-sectional study included 665 adults with T2DM attending the diabetes clinic at Mnazi Mmoja Hospital, Zanzibar. Autonomic symptoms were assessed using COMPASS-31, including the orthostatic intolerance, gastrointestinal, and bladder domains. Participants were classified as having autonomic dysfunction when they met the prespecified threshold for dysfunction in at least one assessed domain. Cardiovascular autonomic neuropathy (CAN) was assessed separately using standardized cardiovascular autonomic reflex tests performed with an automated CAN Analyzer and was not included in the COMPASS-31 composite outcome. Modified Poisson regression with robust variance estimation was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs).Results
Overall, 309 participants (46.5%) had COMPASS-31-defined autonomic dysfunction. Orthostatic intolerance was the most common domain, affecting 271 participants (40.8%), followed by gastrointestinal dysfunction in 177 (26.6%) and urinary dysfunction in 123 (18.5%). Separately, 305 participants (45.9%) met the analyzer-based criteria for CAN. In the multivariable analysis, autonomic dysfunction was more prevalent among participants without a family history of diabetes (aPR = 1.37, 95% CI: 1.16-1.61; p < 0.001), those with diabetes duration of ≥ 10 years (aPR = 1.45, 95% CI: 1.14-1.75; p < 0.001), those not using oral hypoglycemic agents (aPR = 1.66, 95% CI: 1.39-1.97; p < 0.001), and those who rarely consumed vegetables or consumed one portion per day (aPR = 1.79, 95% CI: 1.37-2.34; p < 0.001).Conclusion
Approximately half of the adults with T2DM in this tertiary-care population had COMPASS-31-defined autonomic dysfunction. Higher prevalence was associated with no family history of diabetes, longer diabetes duration, non-use of oral hypoglycemic agents, and lower vegetable intake. These findings highlight the potential value of symptom-based autonomic assessment and support further prospective research to better understand the clinical and lifestyle factors associated with autonomic dysfunction among adults with T2DM in Zanzibar.
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BibTeX
@article{haji2026multidomain,
title = {{Multidomain Autonomic Dysfunction assessed with COMPASS-31 among patients with type 2 diabetes in Zanzibar: prevalence and associated factors.}},
author = {Hassan Thabit Haji and Ramla Muhidin Ali and Ahmed Gharib Khamis and Kaushik Ramaiya and Patricia Munseri and Fredirick L Mashili},
journal = {Cardiovascular diabetology. Endocrinology reports},
year = {2026},
month = oct,
doi = {10.1186/s40842-026-00340-1},
url = {https://europepmc.org/article/MED/42902341},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Multidomain Autonomic Dysfunction assessed with COMPASS-31 among patients with type 2 diabetes in Zanzibar: prevalence and associated factors.
AU - Hassan Thabit Haji
AU - Ramla Muhidin Ali
AU - Ahmed Gharib Khamis
AU - Kaushik Ramaiya
AU - Patricia Munseri
AU - Fredirick L Mashili
PY - 2026
DA - 2026/10/21
JO - Cardiovascular diabetology. Endocrinology reports
DO - 10.1186/s40842-026-00340-1
UR - https://europepmc.org/article/MED/42902341
AB - Background Autonomic dysfunction is an important but frequently under-recognized complication of type 2 diabetes mellitus (T2DM), particularly in settings where objective autonomic testing is not routinely available. The Composite Autonomic Symptom Score-31 (COMPASS-31) provides a practical symptom-based approach for assessing autonomic dysfunction across multiple domains. This study compared socioeconomic, lifestyle, and clinical characteristics among adults with T2DM in Zanzibar according to COMPASS-31-defined autonomic dysfunction and examined factors associated with its presence.Methods This hospital-based cross-sectional study included 665 adults with T2DM attending the diabetes clinic at Mnazi Mmoja Hospital, Zanzibar. Autonomic symptoms were assessed using COMPASS-31, including the orthostatic intolerance, gastrointestinal, and bladder domains. Participants were classified as having autonomic dysfunction when they met the prespecified threshold for dysfunction in at least one assessed domain. Cardiovascular autonomic neuropathy (CAN) was assessed separately using standardized cardiovascular autonomic reflex tests performed with an automated CAN Analyzer and was not included in the COMPASS-31 composite outcome. Modified Poisson regression with robust variance estimation was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs).Results Overall, 309 participants (46.5%) had COMPASS-31-defined autonomic dysfunction. Orthostatic intolerance was the most common domain, affecting 271 participants (40.8%), followed by gastrointestinal dysfunction in 177 (26.6%) and urinary dysfunction in 123 (18.5%). Separately, 305 participants (45.9%) met the analyzer-based criteria for CAN. In the multivariable analysis, autonomic dysfunction was more prevalent among participants without a family history of diabetes (aPR = 1.37, 95% CI: 1.16-1.61; p < 0.001), those with diabetes duration of ≥ 10 years (aPR = 1.45, 95% CI: 1.14-1.75; p < 0.001), those not using oral hypoglycemic agents (aPR = 1.66, 95% CI: 1.39-1.97; p < 0.001), and those who rarely consumed vegetables or consumed one portion per day (aPR = 1.79, 95% CI: 1.37-2.34; p < 0.001).Conclusion Approximately half of the adults with T2DM in this tertiary-care population had COMPASS-31-defined autonomic dysfunction. Higher prevalence was associated with no family history of diabetes, longer diabetes duration, non-use of oral hypoglycemic agents, and lower vegetable intake. These findings highlight the potential value of symptom-based autonomic assessment and support further prospective research to better understand the clinical and lifestyle factors associated with autonomic dysfunction among adults with T2DM in Zanzibar.
SN - 3059-4057
ER -