Poor-Glycaemic-Control Prevalence and Determinants among Type 2 Diabetes Mellitus Patients Attending a Primary Health Care Setting in Central Kerala

Abstract

BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing quickly all over the world. In spite of effective treatment guidelines for type 2 diabetes, in majority of the people, the disease is poorly controlled with existing therapies. Glycaemic control is considered as the most important step for prevention of organ damage and other complications of diabetes. A study on the prevalence and determinants of poor glycaemic control can assist in understanding the expanse of this problems and the ways to address it. We wanted to study the prevalence and determinants of poor glycaemic control among adult patients with type II diabetes mellitus attending a primary health care setting. METHODS The cross-sectional study was conducted in the outpatient department of NCD clinic in a Primary health centre of Kerala for a period of six months. Two hundred and fifty individuals diagnosed with Type II DM for a year were recruited as study participants. The study participants were interviewed using a semi-structured questionnaire. Adherence to medication was assessed using The Morisky Medication Adherence Scale. Anthropometric measurements and blood pressures were recorded. HbA1c and RBS was measured using semi quantitative technique. Any patient with an HbA1c of more than 7 was defined as having poor glycaemic control. RESULTS 64.4 % of the participants had poor glycaemic control. Poor adherence to medication, fewer visits to doctor, lack of diet modification, frequent junk food consumption, higher body mass index and lack of exercise were found to be significantly associated with poor glycaemic control. CONCLUSIONS A focused approach targeting these modifiable risk factors, especially in primary care setting, has the potential to bring about better glycaemic control which can prevent and minimize the occurrence of diabetes complications. KEYWORDS Poor Glycaemic Control, Uncontrolled Diabetes, Diabetes Mellitus, HbA1c, Diabetes Complications

Effectiveness of a Non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial

“…The difference was significant with t = 6.4, p < 0.001. While the median drug adherence score remained at 1 ( 1 – 3 ) throughout the months of follow-up in the control group, the score improved to 3 ( 3 , 4 ) in the intervention group. GEE showed a significant change with β = 0.67, Wald chi-square = 8.0, degree of freedom = 1, p = 0.005.…”

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“…Non-communicable Disease (NCD) clinics are conducted every week at the health sub-centers (most peripheral and the first contact point between the primary health care system and the community) as a part of the NCD control program of the Government aiming at early detection, delivery of adequate health education to the patients and improving access for NCD care and drugs. However, the glycemic control among a large proportion of diabetic patients is reported to be low even among the patients who receive treatment (3)(4)(5). Understanding that primary care optimization is an effective tool toward the achievement of health system objectives (6), researches to develop contextually appropriate and resourcesensitive approaches at the primary care level become important to ensure glycemic control among patients with diabetes.…”