Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam

Abstract

BackgroundTanzania has recently experienced a significant rise in the burden of diabetes, and it is estimated that more than 400,000 people are living with diabetes. A major concern in the management of diabetes is the occurrence of diabetic complications that occur as a result of poor glycemic control. Identification of the factors associated with poor glycemic control is important in order to institute appropriate interventions for the purpose of improving glycemic control and prevention of chronic complications.AimThe aim of this study was to determine the level of glycemic control and explore the factors associated with poor glycemic control among patients with type 2 diabetes mellitus (T2DM).MethodologyA cross-sectional study was carried out at the diabetic clinics for T2DM patients at the national and municipal hospitals in Dar es Salaam. A total of 469 patients were enrolled over a period of 8 weeks from March 2013 to May 2013. Patients’ information such as sociodemographic characteristics, self-care management behaviors, and medication adherence were obtained through interviews. Blood pressure, weight, and height were measured during the day of the interview. All available last readings for fasting blood glucose (FBG) measurements, lipid profile, and other clinical characteristics were obtained from patients’ records.ResultsThe mean age of patients was 54.93 years. The majority (63.5%) of patients were females and only eight patients had records of lipid profile measurements. Out of 469 patients, 69.7% had FBG of ≥7.2 mmol/L, indicating poor glycemic control. Females aged between 40 years and 59 years had significantly higher poor glycemic control (76.1%) as compared with their male counterparts. Thirty-eight percent of patients had poor medication adherence, which was associated with poor glycemic control. The proportion of poor glycemic control increased with age. A significantly high proportion of poor glycemic control was observed in patients who had had the disease for more than 20 years since diagnosis. Factors associated with poor glycemic control included lack of health insurance, using more than one oral hypoglycemic agent, normal body mass index, obesity, and nonadherence to diabetic medications.ConclusionPatients in this study had generally poor glycemic control. From these findings it is recommended that diabetic patients should be routinely screened for lipid profile to determine levels of cholesterol, triglycerides, and low-density lipoproteins, which are risk factors for cardiovascular events. An education program should be developed to educate patients on the importance of medication adherence and weight management for better glycemic control.

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

“…However, they used low-density lipoprotein cholesterol (LDL-cholesterol) for lipid profile and HbA1c for glycemic control as well as a lower cutoff point for blood pressure assessment, which is different from us. In line with our finding, similar rate of poor glycemic control was reported from Tanzania (69.7%) [19]. However, we found slightly higher prevalence of poor glycemic control based on mean FPG (72.3%) and lower results according to HbA1c calculated from mean FPG (58.5%).…”

Evaluation of the elderly´s profile with diabetes mellitus in primary health care

“…About glycemic control, primordial in the prevention of chronic complications of diabetes, abnormal glucose was found in the study population, which support the data found in many studies performed with DM elderly [23,24].…”

“…An education program that emphasizes the importance of medication adherence, physical exercise and weight control would be a relevant basic benefit for improving glycemic control in this patients [24].…”

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence‐Based Practice

“…Self‐care behaviors are crucial to affect subsequent QoL. Cross‐sectional and longitudinal studies have also indicated self‐care behaviors are significantly negatively correlated with HbA1C levels (Egede, Gebregziabher, Echols, & Lynch, ; Kamuhabwa & Charles, ). In this work, however, the 6‐month self‐care behavior did not affect 12‐month HbA1C levels.…”