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Chetoui A, Kaoutar K, Elmoussaoui S, Boutahar K, El Kardoudi A, Chigr F, Najimi M. Prevalence and determinants of poor glycaemic control: a cross-sectional study among Moroccan type 2 diabetes patients. Int Health 2022; 14:390-397. [PMID: 31957782 PMCID: PMC9248056 DOI: 10.1093/inthealth/ihz107] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/29/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes remains poorly controlled in a high proportion of diabetes patients. This study examines the prevalence of poor glycaemic control and associated factors in type 2 diabetes patients in the Beni-Mellal Khenifra region in Morocco. METHODS A cross-sectional survey was conducted in 2017 among 1456 diabetes patients attending primary health centres. Demographic and clinical data were collected through face-to-face interviews using structured and pre-tested questionnaires. Anthropometric measurements, including body weight, height and waist circumference were taken using standardized techniques and calibrated equipment. Glycaemic control was assessed in terms of the glycated haemoglobin (HbA1c) level and poor glycaemic control was defined as HbA1c ≥7% and a level <7% reflects good glycaemic control. RESULTS Of the total participants, 66.3% had poor glycaemic control. Bivariate analysis showed that sex (p=0.010), education level (p=0.013), body mass index (p=0.048), duration of diabetes (p<0.0001) and type of therapeutic regimen (p<0.0001) were significantly associated with HbA1c level. However, multiple logistic regression analyses revealed that only a longer duration of diabetes (OR 1.525 [95% confidence interval {CI} 1.183-1.967], p=0.001) and receiving insulin therapy alone (OR 1.589 [95% CI 1.157-2.183], p=0.004) or a combination of oral antidiabetics with insulin (OR 2.554 [95% CI 1.786-3.653], p<0.001) were significantly associated with inadequate glycaemic control. CONCLUSIONS Despite the particularities of the region, the findings about glycaemic control and its cross-sectionally associated factors are in line with findings from other regions of Morocco. In this subgroup, the longer duration of diabetes and insulin treatment could constitute a cause leading to poor glycaemic control. However, inverse causality cannot be excluded.
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Affiliation(s)
- Ahmed Chetoui
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
| | - Kamal Kaoutar
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
| | - Soufiane Elmoussaoui
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
- Mohamed VI Hospital University, PO.BOX:2360, Avenue Ibn Sina, Marrakesh, Morocco
| | - Kaltoum Boutahar
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
| | - Abdesslam El Kardoudi
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
| | - Fatiha Chigr
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
| | - Mohamed Najimi
- Biological Engineering Laboratory, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Mghila, PO.BOX:523, 23000, Beni Mellal, Morocco
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Agarwal AA, Jadhav PR, Deshmukh YA. Prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients. J Basic Clin Pharm 2014; 5:79-83. [PMID: 25278671 PMCID: PMC4160724 DOI: 10.4103/0976-0105.139731] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Despite the availability of efficacious anti-diabetic drugs, which act by different mechanisms to reduce the blood-glucose, the majority of people with diabetes on anti-diabetic drug therapy, have poor glycemic control and diabetic vascular complications. AIM AND OBJECTIVES The aim was to study the prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients attending tertiary care teaching hospital in Navi Mumbai. MATERIALS AND METHODS A prospective, cross-sectional, observational survey was carried out in 100 patients of diabetes mellitus attending diabetes outpatient/medicine outpatient departments, to assess their prescribing pattern of anti-diabetic drugs, and their blood-glucose level was measured by Accu-Chek Active glucometer to determine their glycemic control. RESULTS Average number of anti-diabetic drugs per prescription was 1.4. Sulfonylureas were the most commonly prescribed class, but metformin (biguanide) was the commonest prescribed individual drug among oral hypoglycemic agents (OHA). Fixed dose combination of biguanide and sulfonylurea was prescribed commonly. Monotherapy dominated over polytherapy and there was a higher percentage of use of insulin in Type 2 diabetics. Only 41% of patients on anti-diabetic therapy had optimal glycemic control. The association between anti-diabetic therapy along with lifestyle modification and glycemic control was statistically significant (P = 0.0011). CONCLUSIONS OHAs still dominate the prescribing pattern, but there was a shifting trend toward the use of insulin preparations in the management of Type 2 diabetes mellitus. In achieving optimal glycemic control, the efficacy of the anti-diabetic drugs was only 41%; therefore intensification of current drug treatment as well as planning multiple drug interventions with lifestyle modification is necessary.
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Affiliation(s)
- Akshay A Agarwal
- Department of Pharmacology, MGM Medical College, Navi Mumbai, Maharashtra, India
| | - Pradeep R Jadhav
- Department of Pharmacology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Yeshwant A Deshmukh
- Department of Pharmacology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
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Ismail-Beigi F, Lombardero MS, Escobedo J, Genuth S, Green J, Massaro E, Mooradian AD, Ovalle F, Whitehouse F, Zonszein J. Determinants of successful glycemic control among participants in the BARI 2D trial: a post-hoc analysis. J Diabetes Complications 2014; 28:101-9. [PMID: 23478173 PMCID: PMC4156479 DOI: 10.1016/j.jdiacomp.2013.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/25/2013] [Accepted: 01/30/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control. RESEARCH DESIGN AND METHODS In a 2×2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone. Successful long-term glycemic control (success) was defined by simultaneously meeting 1) a mean HbA1c level of <7.0% after each participant's third year of follow-up period, and 2) adherence with medications only from the assigned glycemic treatment arm during >80% of the BARI 2D follow-up. The association between baseline variables and success was determined using unadjusted and adjusted logistic regression models. RESULTS 1917 participants (962 IP and 955 IS participants) had sufficiently long follow-up and data for this analysis. Among these IP and IS participants, 235 and 335 participants met both criteria of success, respectively (p<0.001). Those not on insulin at entry had higher odds of success (OR 2.25; CI 1.79-2.82) when treated with IS versus IP medications, irrespective of baseline HbA1c levels. Younger age, shorter duration of T2DM, and lower HbA1c at baseline were also each independently associated with higher success when treated with IS versus IP medications. CONCLUSION Patients similar to those in the BARI 2D trial may have a higher chance of achieving success with IS versus IP medications if they are younger, have shorter duration of T2DM, have lower HbA1c levels, have moderate or strenuous physically activity, and are not on insulin. In contrast, increasing age, longer duration of T2DM, higher HbA1c, and insulin therapy are associated with increased chance of success if treated with IP medications.
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Affiliation(s)
- Faramarz Ismail-Beigi
- Department of Medicine, Case Western Reserve University and Cleveland VA Medical Center, Cleveland, OH, USA.
| | | | - Jorge Escobedo
- Clinical Research Center. Regional Hospital No. 1. Mexican Institute of Social Security. Gabriel Mancera 222, Col. del Valle. 03100 Benito Juarez, DF. Mexico
| | - Saul Genuth
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jennifer Green
- Department of Medicine, Division of Endocrinology, Duke University Medical Center and Durham VA Medical Center, Durham, NC, USA
| | - Elaine Massaro
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando Ovalle
- Department of Medicine, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL, USA
| | - Fred Whitehouse
- Division of Endocrinology, Diabetes and Bone and Mineral Diseases, Henry Ford Health System, Detroit, MI, USA
| | - Joel Zonszein
- Albert Einstein College of Medicine, Montefiore Clinical Diabetes Center, Bronx, NY, USA
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Nagrebetsky A, Griffin S, Kinmonth AL, Sutton S, Craven A, Farmer A. Predictors of suboptimal glycaemic control in type 2 diabetes patients: the role of medication adherence and body mass index in the relationship between glycaemia and age. Diabetes Res Clin Pract 2012; 96:119-28. [PMID: 22261095 DOI: 10.1016/j.diabres.2011.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/24/2011] [Accepted: 12/01/2011] [Indexed: 12/30/2022]
Abstract
AIMS To analyse predictors of glycaemic control including medication adherence and body mass index (BMI) in UK general practice patients with sub-optimally controlled type 2 diabetes. METHODS Baseline demographic, health- and treatment-related measures were evaluated as predictors of one year glycaemic control defined separately as HbA(1c)≤ 7.5% and a continuous measure of HbA(1c) concentration, using multivariate regression models. Significant predictors were adjusted for objectively assessed medication adherence and BMI. RESULTS One-year HbA(1c) concentration was associated with baseline HbA(1c) (p<0.001), BMI (p=0.02), and inversely associated with age (p=0.007) and objectively assessed adherence. Adherent patients had one-year (adjusted) HbA(1c) concentration 0.65% (95% CI -1.04, -0.25; p=0.001) lower than nonadherent. Odds ratios (95% CI) of HbA(1c)≤ 7.5% for 10-year higher age were 1.63 (1.08, 2.45); for adherent compared to non-adherent patients 1.89 (0.84, 4.25); for patients receiving >5 compared to ≤ 5 medications 0.32 (0.13, 0.76); and for each 1% increment in baseline HbA(1c) 0.48 (0.31, 0.73). CONCLUSIONS The lower HbA(1c) achieved from greater adherence to glucose lowering treatment is comparable to that achieved with additional medication. Relationships between older age and better glycaemic control are not explained by better adherence, but may partly relate to lower BMI.
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Mendes ABV, Fittipaldi JAS, Neves RCS, Chacra AR, Moreira ED. Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol 2010; 47:137-45. [PMID: 19655083 PMCID: PMC2859160 DOI: 10.1007/s00592-009-0138-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 07/14/2009] [Indexed: 12/21/2022]
Abstract
Diabetes is a significant public health burden on the basis of its increased incidence, morbidity, and mortality. This study aimed to estimate the prevalence of inadequate glycaemic control and its correlates in a large multicentre survey of Brazilian patients with diabetes. A cross-sectional study was conducted in a consecutive sample of patients aged 18 years or older with either type 1 or type 2 diabetes, attending health centres located in ten large cities in Brazil (response rate = 84%). Information about diabetes, current medications, complications, diet, and satisfaction with treatment were obtained by trained interviewers, using a standardized questionnaire. Glycated haemoglobin (HbA(1c)) was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA(1c) > or = 7 were considered to have inadequate glycaemic control. Overall 6,701 patients were surveyed, 979 (15%) with type 1 and 5,692 (85%) with type 2 diabetes. The prevalence of inadequate glycaemic control was 76%. Poor glycaemic control was more common in patients with type 1 diabetes (90%) than in those with type 2 (73%), P < 0.001. Characteristics significantly associated with improved glycaemic control included: fewer years of diabetes duration, multi professional care, participation in a diabetes health education program, and satisfaction with current diabetes treatment. Despite increased awareness of the benefits of tight glycaemic control, we found that few diabetic patients in Brazil met recommended glycaemic control targets. This may contribute to increased rates of diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes.
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Affiliation(s)
| | | | - Raimundo Celestino Silva Neves
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710 Brazil
| | | | - Edson Duarte Moreira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710 Brazil
- Clinical Research Center, Charitable Works Foundation of Sister Dulce, Av. Bonfim 161, Salvador, 40415-006 Brazil
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Alberti H, Boudriga N, Nabli M. Primary care management of diabetes in a low/middle income country: a multi-method, qualitative study of barriers and facilitators to care. BMC FAMILY PRACTICE 2007; 8:63. [PMID: 17996084 PMCID: PMC2186326 DOI: 10.1186/1471-2296-8-63] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 11/09/2007] [Indexed: 12/02/2022]
Abstract
BACKGROUND The management of patients with diabetes mellitus is complex. Some research has been done in developed countries to attempt to determine the factors that influence quality of care of patients with diabetes: Factors thus far postulated are usually categorised into patient, clinician and organisational factors. Our study sought to discover the main barriers and facilitators to care in the management of diabetes in primary care in a low/middle income country. METHODS A qualitative study, based on reflexive ethnography using participant observation, semi-structured interviews of clinicians (10) and group interviews with paramedical staff (4) and patients (12) in three purposively sampled health centres, along with informal observation and discussions at over 50 other health centres throughout Tunisia. A content analysis of the data was performed. RESULTS Over 400 potential barriers or facilitators to care of patients with diabetes in primary care in Tunisia emerged. Overall, the most common cited factor was the availability of medication at the health centre. Other frequently observed organisational factors were the existence of chronic disease clinics and clinicians workload. The most commonly mentioned health professional factor was doctor motivation. Frequently cited patient factors were financial issues, patient education and compliance and attendance issues. There were notable differences in the priority given to the various factors by the researcher, physicians, paramedical staff and the patients. CONCLUSION We have discovered a large number of potential barriers and facilitators to care that may potentially be influencing the care of patients with diabetes within primary care in Tunisia, a low/middle income country. An appreciation and understanding of these factors is essential in order to develop culturally appropriate interventions to improve the care of people with diabetes.
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Affiliation(s)
- Hugh Alberti
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, UK, NE2 4AA
| | - Nessiba Boudriga
- DSSB (Direction du Soins de Santé de Base), 31 Rue Khartoum, Tunis, Tunisia
| | - Mounira Nabli
- DSSB (Direction du Soins de Santé de Base), 31 Rue Khartoum, Tunis, Tunisia
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