Factors Associated With Poor Glycemic Control or Wide Glycemic Variability Among Diabetes Patients in Hawaii, 2006–2009

Abstract

IntroductionAlthough glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years.MethodsThis retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006. We conducted multivariable logistic regressions to examine factors related to sustained poor control, some glycemic variability, and wide glycemic variability during the next 3 years. Independent variables evaluated as possible predictors were age, sex, type of insurance coverage, morbidity, diabetes duration, history of cardiovascular disease, and number of medications.ResultsLonger duration of diabetes, being under age 35, and taking 15 or more medications were significantly associated with sustained poor glycemic control. Preferred provider organization and Medicare (vs health maintenance organization) enrollees and patients with high morbidity were less likely to have sustained poor glycemic control. Wide glycemic variability was significantly related to being younger than age 50, longer duration of diabetes, having coronary artery disease, and taking 5 to 9 medications per year.ConclusionResults indicate that duration of diabetes, age, number of medications, morbidity, and type of insurance coverage are risk factors for sustained poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Patients younger than age 50 and those with a history of coronary heart disease should be warned of the health risks of wide glycemic variability.

Achievements of Diabetes Goals and Their Determinants in Type 2 Diabetic Patients Attending Outpatient Diabetic Clinic in Northern Ethiopia

“…In accordance with our result, Assunção et al and Juarez et al also found significant association between longer duration of diabetes and poor glycemic control [30, 31]. This association may be due to the decreases in β -cell function and insulin secretion as the disease progresses over time.…”

Glycemic Control and it’s Associated Factors in Type 2 Diabetic Patients in Suhul Hospital, Northwest Tigray, Ethiopia

“…In this study, 36.5% of participants achieved good glycemic control. The present study is consistent with a study reported from Mekelle, Tigray [9], Jimma [10], Addis Ababa [11], and Hawaii [12]. The present finding is higher than a study reported from jimma [13].…”

Work-related psychosocial stress and glycemic control among working adults with diabetes mellitus

“…Although stress is highly personalized and its perception can vary depending on personality type, interpretation of life events and cultural context [58], the nature of some occupations may be more stressful than others. Similarly, length of time since DM onset has been directly related to glycemic control [59] so we recognize the need to have included these two variables but they were not available. Secondly, participants were enrollees of the HMO and results may not be generalizable to uninsured patients, those in other health insurance system or patients in other geographic locations.…”