Economic Burden of Diabetic Mellitus Among Patients on Follow-up Care in Hospitals of Southwest Shewa Zone, Central Ethiopia

Replenish Revenue by Low-Cost Medicines, an Institution-Specific Action to Improve Access to High-Cost Medicines Used for Chronic Illness in Ethiopia: Narrative Review

Background

Over one-quarter of the global population has no access to essential medicines. Improving access to medicines for chronic illness requires multi-level interventions. Nearly half of the people who need insulin cannot afford it.

Aim

To describe institution-specific interventions that can be applied to improve access to high-cost medicines used for chronic diseases without affecting revenue generated from pharmaceuticals.

Methods

A narrative review was conducted by using articles written in the English language from January 2000 to May 2020 and retrieved from PubMed/Medline, Embase, Cochrane Library, Scopus, Web of Science, and Google Scholar with the following systematic search query.

Results

Fifty-three studies were included. Most of the drugs used for the treatment of hypertension, diabetes, chronic asthma, and cancer are not available in adequate quantity. It requires more than 4 months' wage for a lowest-paid worker to buy one cycle of treatment for non-Hodgkin lymphoma, cervical cancer, or breast cancer in Ethiopia. The replenish revenue by low-cost medicines (RRLCM) model theoretically improved access to high-cost medicines. This model's steps include: (1) Estimate the number of patients who will take high-cost medicine for specific chronic diseases. (2) Estimate the amount of high-cost medicine required in a given period. (3) Calculate the markup-related change in revenue. (4) Select fast-moving items with better affordability in the supply chain. (5) Estimate revenue by modifying the markup of fast-moving items with better public affordability, and (6) calculate the difference and compare the markup-related revenue resulting from adjusting markups.

Conclusion

Medicines used for chronic diseases are neither available nor affordable. The RRLCM model has potential to improve affordability, pending empirical validation. Therefore, it is important to reform national drug policy in light of pricing and markup regulation system. Researchers, who are willing to work in the similar area should evaluate the applicability of RRLCM model in different set-ups.

Cost of diabetes mellitus and associated factors - an institutional cross-sectional study in Ghana

BACKGROUND

Diabetes mellitus, like many other chronic diseases, is costly to manage and poses a substantial economic burden on individuals directly and indirectly. In this paper, we studied the associations between cost of diabetes and socio-demographic characteristics.

METHODS

This was a cross-sectional cost-of-illness study that employed systematic random sampling. We collected data from 385 respondents at the Tamale Teaching Hospital of Ghana between June and August of 2023. Prevalence-based costing and the human capital approach were employed to arrive at total cost of illness. Regression analysis was used to find associations between sociodemographic characteristics of the respondents and the total cost of illness.

RESULTS

The mean total cost of diabetes mellitus per year is $290.44. Mean direct annual cost of illness per year is $159.70 representing 54.99% of the total cost while the mean indirect annual cost per patient is $130.72. Being male (B = 0.42, 95% CI 0.02-0.82; p = 0.039), living in an urban area (B = - 1.05 95% CI - 1.58 - - 0.53; p = 0.000), having a longer duration of illness (B = 0.04, 95% CI 0.003-0.07; p = 0.032), and having the complications of diabetic retinopathy (B = 0.42, 95% CI 0.02-0.82; p = 0.041) and stroke (B = 1.26, 95% CI 0.52-2.00; p = 0.001) were statistically significant in association with total cost of illness.

CONCLUSIONS

Various demographics with diabetes carry different dynamics in terms of cost burden. We recommend a tailored approach to care for individuals with diabetes mellitus and their families as a protection against catastrophic health care expenditure that could result from a high cost of illness.

Antidiabetic Medicines Utilisation During Pre-Pandemic, Pandemic and Post-Pandemic Period of COVID-19-Data for Bulgarian Population

BACKGROUND

Type 2 diabetes is a chronic disease with high global prevalence and significant social and economic burden. The pandemic affected patients' diagnostics and medicines dispensing. Diabetes was among the most-affected conditions during lockdown due to the limited resources and unaffordable medicines. The impact of the pandemic on utilisation and cost has not been thoroughly studied, which inspired us to conduct the current study.

OBJECTIVES

The study explored cost dynamics, changes in antidiabetic medicines utilisation, and public expenditure of pharmacotherapy in three periods: pre-pandemic (2018-2019), during the pandemic (2020-2021), and post-pandemic (2022-2023).

METHODS

It is a retrospective, observational, macroeconomic analysis. Reimbursed cost and utilisation were analysed as a crude sum and as indexes of the average value.

RESULTS

The result shows that five new INNs have been included in the Positive Medicines List (PML), two of these being fixed dose combinations (FDCs). During the pandemic, a slow tendency of increase of the crude sum of public expenditure was observed, followed by a sharp increase in the post-pandemic period. The public spending increased more than twice, and we found a 30,018,982 Euro growth. The highest public spending is found for dapagliflozine in post-pandemic vs. pandemic period (index = 1.67), as well as empagliflozin/metformin and dapagliflozine in pandemic vs. pre-pandemic period (index = 0.21). Total utilisation increases from 58.16 to 71.78 DDD/1000 inh/day during 2018-2023. The most significant rise of utilisation is found for canagliflozin (index = 0.68) pandemic vs. pre-pandemic and dapagliflozin (index = 3.66) post-pandemic vs. pandemic.

CONCLUSIONS

Analysis of the antidiabetic medicines market reveals the rising of reimbursed cost and utilisation in pre-, post-, and during the pandemic. In conclusion, organisation of the supply and financing of antidiabetic medicines was not affected during the pandemic.

Diabetic ketoacidosis treatment outcomes and its associated factors among adult patients with diabetes mellitus admitted to public hospitals in Nekemte Town, Ethiopia: a cross-sectional study

Background

Diabetic ketoacidosis (DKA) is a serious and acute complication of diabetes mellitus. In Ethiopia, the mortality associated with acute diabetes complications ranges from 9.8% to 12%. Despite this, there is limited information on the clinical outcomes of DKA in our study location. Therefore, this study aimed to assess the magnitude and associated factors of DKA treatment outcomes among adult patients with diabetes admitted to public hospitals in Nekemte Town, Ethiopia.

Objective

To assess the DKA treatment outcomes and their associated factors among adult patients with diabetes admitted to public hospitals in Nekemte Town.

Methods

A 5-year cross-sectional study was conducted using a systematic random sampling technique among 201 patients from 1 July to 31 August 2023. DKA treatment outcomes were assessed at discharge. Pharmacists collected data by reviewing patient charts using Kobo Toolbox software. The data were then exported to SPSS Version 27 for analysis. Both bivariable and multivariable logistic regression analyses were performed. Variables with a P-value < 0.25 in the bivariable logistic regression were entered into the multivariable regression analysis to control for potential confounders. An adjusted odds ratio with a 95% confidence interval was used to identify predictors of treatment outcomes. A P-value < 0.05 was considered significant in the multivariable analysis.

Result

Complete data was available for 201 patients admitted with DKA. The majority, 178 (88.6%), improved and were discharged. Independent predictors of DKA recovery were comorbidities [AOR: 3.45, 95% CI: 1.33, 9.72], admission Glasgow Coma Scale (GCS) score (<8) [AOR: 2.74, 95% CI: 1.02, 7.34], random blood glucose (RBS) (≥ 500) [AOR: 3.07 (95% CI: 1.12, 8.39)], and urine ketones (≥ +3) [AOR: 3.24, 95% CI: 1.18, 8.88].

Conclusion and recommendation

Most of the treated patients with DKA were discharged with improvement. Comorbidity, admission GCS, RBS, and urine ketones were independently associated with DKA recovery. In general, significant consideration should be given to DKA prevention, early detection, and appropriate hospital management.

Cost-of-illness study among patients with diabetes mellitus and coping mechanisms in Northern Ghana

Introduction

The increasing prevalence of diabetes globally imposes financial burden on individuals, societies and health systems. However, not much is known about the treatment costs of diabetes and the coping mechanisms patients adopt in seeking care in the northern part of Ghana. In this study, we assessed the annual direct, indirect and intangible costs of diabetes mellitus care and related coping mechanisms of patients at the Tamale Teaching Hospital's Diabetic Clinic.

Methods

This was a descriptive cross-sectional cost-of-illness study conducted between June and August 2023 among 385 patients with diabetes in the Tamale Teaching Hospital of Ghana. Participants were selected by systematic random sampling. Direct medical costs (summation of cost of medications, investigations and admissions) and direct non-medical costs (cost of food and water, and transportation during hospital visits) together made up direct costs per patient per year. Indirect costs (lost wages as a result of illness or hospital visits) were estimated using the human capital approach. Intangible costs were analysed using a 5-point Likert Scale. Cost-coping mechanisms were obtained from the perspectives of the participants.

Results

The mean direct cost per person per year was found to be US$159.70 (95% CI 126.70 to 193.04), with direct medical costs being on average US$186.04 and direct non-medical costs being on average US$15.59, while the mean indirect cost per person per year was US$130.72. Average total cost of illness per person per year was found to be US$290.44 (95% CI 248.64 to 334.70). The study participants often experienced intangible costs such as physical pain, easy fatiguability and diet changes as a result of diabetes and adopted a number of cost-coping mechanisms which included the use of savings, borrowing and reducing medication use.

Conclusion

The costs incurred for care of diabetes mellitus in Northern Ghana are substantial, especially in view of Ghana's low minimum wage which was US$1.35 in 2023. This results in the adoption of adverse-cost-coping mechanisms that can drive families into further poverty with detrimental effects on the treatment of diabetes.

Time to development of macrovascular complications and its predictors among type 2 diabetes mellitus patients at Jimma University Medical Center

BACKGROUND

Type 2 diabetes mellitus is a serious metabolic disease that is often associated with vascular complications. The increasing prevalence of type 2 diabetes mellitus poses significant public health challenges, particularly in Low and Middle-Income Countries where healthcare resources are often limited. In Africa, the burden of T2DM is rising rapidly, leading to a consequential increase in macrovascular complications such as cardiovascular disease and stroke. These complications not only affect the quality of life but also significantly contribute to morbidity and mortality among affected individuals. The main objective of this study was to assess the time to development of macrovascular complications and identify its predictors among type 2 diabetes mellitus patients in Jimma University medical center from 2018-2022.

METHODS

Institutional-based retrospective follow-up study was conducted in Jimma University Medical Center among newly diagnosed type 2 diabetes mellitus patient from 2018, to 2022. A systematic sampling technique was used to recruit 452 records of type 2 diabetes mellitus patients. The Kaplan-Meier curve and the log-rank tests were used to determine the time to macro-vascular complications, and evaluate the significant difference in survival probability among predictors respectively. The overall goodness of the Cox proportional hazard model was checked by Cox-Snell residuals. Bivariable and multivariable cox-proportional hazard regression were used to identify the association between the variables and survival time.

RESULTS

The median survival time to development of macro vascular complications was 24 months. Urban residence [(Adjusted hazard ratio = 2.02; 95% CI: (1.33, 3.05)], having hypertension at start of diabetic treatment [(AHR = 1.52; 95% CI: (1.06, 2.13)], baseline age ≥ 60 years [(AHR = 4.42; 95% CI: (1.72, 11.29)], having dyslipidemia at baseline [(AHR = 1.82; 95% CI: (1.13, 2.93)], High density lipoprotein cholesterol levels < 40 mg/dl [(AHR = 2.11; (1.16, 3.81)], triglycerides > 150 mg/dl [(AHR = 1.48; 95% CI:( 1.02, 2.13)], Hemoglobin A1C level > 7% [(AHR = 1.49; 95% CI: (1.04, 2.14)], and Oral hypoglycemic agents + insulin [(AHR = 2.73; 95% CI: (1.81, 4.09)] were the significant predictors of the time to development of macro vascular complications.

CONCLUSION

Findings in this study indicated that the median time to development of macro vascular complications among type 2 diabetes mellitus patients was 24 months. Baseline age category in years, residence, presence of hypertension, presence of dyslipidemia, High density lipoprotein-cholesterol level < 40 mg/dl, triglyceride > 150 mg/dl, HgbA1C > 7% at baseline, and medication regimens were identified as independent significant predictors of the time to development of macro vascular complications among type 2 diabetes mellitus patients. The findings call attention to the role of treatment regimens, particularly the use of combination therapies involving oral hypoglycemic agents and insulin, which were associated with increased hazards for complications. High incidence of macrovascular complications within a short follow-up period underscores the need for proactive, individualized care strategies in T2DM management. By focusing on early identification of at-risk patients and tailoring treatment plans accordingly, healthcare providers can potentially improve outcomes and reduce the burden of macro vascular complications in this population.

Out-of-pocket direct cost of ambulatory care of type 2 diabetes in Delhi: Estimates from the Delhi diabetes community-II (DEDICOM-II) survey

BACKGROUND & AIM

Much of the cost data from India is restricted to patients recruited purely from healthcare institutions and do not explore determinants. Therefore, the out of pocket expenditure for ambulatory diabetes care was evaluated in Delhi.

METHODS

The DEDICOM-II survey used a two-stage probability-proportionate-to-size(systematic) cluster design. Thirty clusters were chosen to recruit 25 to 30 subjects per area. We used questionnaires to estimate the direct out-of-pocket expenditure (OOPE) on drugs, investigations, consultation and travel, excluding hospitalization, and then analysed its determinants and impact on quality of care.

RESULTS

We enrolled 843 subjects with a mean age of 53.1 years. The annual direct OOPE on ambulatory care of diabetes was US$ 116.3 (95 % CI 93.8-138.9) or INR 8074.8 (95 % CI 6512.9-9636.7), corresponding to 3.6 %(95 % CI 2.9-4.3) of the yearly family income. The burden of expenses was disproportionately higher for those visiting private providers from lower-income groups(19.1 %). Duration of disease and treatment with insulin predicted higher annual OOPE while care at public facilities was less expensive. Cost was higher for those adhering to the recommended processes of care. Quality of care was better for institutional care and worse for alternative medicine or self-care.

CONCLUSIONS

The study provides representative estimates of the high cost of diabetes management in Delhi across the socio-economic and care provider spectra. Poorer patients suffer a high financial burden from diabetes, highlighting the need for enhancing equity in diabetes care.

Relationship of oral bacterial number with medical hospitalization costs in analysis of Diagnosis Procedure Combination database from single institution in Japan

Oral bacteria are known to be associated with perioperative complications during hospitalization. However, no presented reports have clarified the relationship of oral bacterial number with medical costs for inpatients. The Diagnosis Procedure Combination (DPC) database system used in Japan provides clinical information regarding acute hospital patients. The present study was conducted to determine the association of oral bacterial numbers in individual patients treated at a single institution with length of hospital stay and medical costs using DPC data. A total of 2369 patients referred by the medical department to the dental department at Hiroshima University Hospital were divided into the low (n = 2060) and high (n = 309) oral bacterial number groups. Length of hospital stay and medical costs were compared between the groups, as well as the associations of number of oral bacteria with Charlson comorbidity index (CCI)-related diseases in regard to mortality and disease severity. There was no significant difference in hospital stay length between the low (24.3 ± 24.2 days) and high (22.8 ± 20.1 days) oral bacterial number groups. On the other hand, the daily hospital medical cost in the high group was significantly greater (US$1456.2 ± 1505.7 vs. US$1185.7 ± 1128.6, P < 0.001). Additionally, there was no significant difference in CCI score between the groups, whereas the daily hospital medical costs for patients in the high group treated for cardiovascular disease or malignant tumors were greater than in the low number group (P < 0.05). Multivariate regression analysis was also performed, which showed that oral bacterial number, age, gender, BMI, cardiovascular disease, diabetes, malignant tumor, and hospital stay length were independently associated with daily hospitalization costs. Monitoring and oral care treatment to lower the number of oral bacteria in patients affected by cardiovascular disease or cancer may contribute to reduce hospitalization costs.

Access to essential medicines for diabetes care: availability, price, and affordability in central Ethiopia

BACKGROUND

Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia's public and private medicine outlets with respect to availability and affordability parameters.

METHODS

A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days' wages required by the lowest paid government worker (LPGW) to purchase a one month's supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices.

RESULTS

Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO's target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month's supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively.

CONCLUSIONS

There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Determinants of diabetic nephropathy among diabetic patients in Ethiopia: Systematic review and meta-analysis

INTRODUCTION

Diabetic nephropathy (DN) is a long-term kidney disease among diabetic patients. It is the leading cause of end-stage renal failure. In Ethiopia, DN affects the majority of diabetic populations, but there were inconsistent findings about the determinant factors across the studies.

METHODS

We have accessed studies using PubMed, Embase, EBSCO, Web of Science, OVID, and search engines including Google and Google Scholar published up to June 2023. The study populations were diabetic patients with nephropathy. The quality of each included article was assessed using the Newcastle-Ottawa quality assessment scale. The odds ratios of risk factors were pooled using a random-effect meta-analysis model. Heterogeneity was assessed using the Cochrane Q statistics and I-Square (I2). The publication bias was detected using the funnel plot and/or Egger's test (p< 0.05). Trim and fill analysis was carried out to treat the publication bias. The protocol has been registered with the reference number CRD42023434547.

RESULTS

A total of sixteen articles were used for this reviewed study. Of which, eleven articles were used for advanced age, ten articles for duration of diabetic illness, ten articles for poor glycemic control, and eleven articles for having co-morbid hypertension. Diabetic patients with advanced age (AOR = 1.11, 95% CI: 1.03-120, I2 = 0.0%, p = 0.488), longer duration of diabetic illness (AOR = 1.23, 95% CI = 1.05-1.45, I2 = 0.0%, p = 0.567), poor glycemic control (AOR = 2.57, 95% CI: 1.07-6.14; I2 = 0.0%, p = 0.996), and having co-morbid hypertension (AOR = 4.03, 95% CI: 2.00-8.12, I2 = 0.0%, p = 0.964) were found to be factors associated with DN.

CONCLUSIONS

The findings of the study revealed that diabetic patients with advanced age, longer duration of diabetic illness, poor glycemic control status, and co-morbid hypertension were the determinant factors of DN. Therefore, treatment of co-morbid hypertension and high blood glucose and regular screening of renal function should be implemented to detect, treat, and reduce the progression of DN. Furthermore, healthcare workers should give due attention to diabetes with advanced age and a longer duration of diabetes illness to prevent the occurrence of DN.

Combined untargeted and targeted lipidomics approaches reveal potential biomarkers in type 2 diabetes mellitus cynomolgus monkeys

BACKGROUND

The significantly increasing incidence of type 2 diabetes mellitus (T2DM) over the last few decades triggers the demands of T2DM animal models to explore the pathogenesis, prevention, and therapy of the disease. The altered lipid metabolism may play an important role in the pathogenesis and progression of T2DM. However, the characterization of molecular lipid species in fasting serum related to T2DM cynomolgus monkeys is still underrecognized.

METHODS

Untargeted and targeted LC-mass spectrometry (MS)/MS-based lipidomics approaches were applied to characterize and compare the fasting serum lipidomic profiles of T2DM cynomolgus monkeys and the healthy controls.

RESULTS

Multivariate analysis revealed that 196 and 64 lipid molecules differentially expressed in serum samples using untargeted and targeted lipidomics as the comparison between the disease group and healthy group, respectively. Furthermore, the comparative analysis of differential serum lipid metabolites obtained by untargeted and targeted lipidomics approaches, four common serum lipid species (phosphatidylcholine [18:0_22:4], lysophosphatidylcholine [14:0], phosphatidylethanolamine [PE] [16:1_18:2], and PE [18:0_22:4]) were identified as potential biomarkers and all of which were found to be downregulated. By analyzing the metabolic pathway, glycerophospholipid metabolism was associated with the pathogenesis of T2DM cynomolgus monkeys.

CONCLUSION

The study found that four downregulated serum lipid species could serve as novel potential biomarkers of T2DM cynomolgus monkeys. Glycerophospholipid metabolism was filtered out as the potential therapeutic target pathway of T2DM progression. Our results showed that the identified biomarkers may offer a novel tool for tracking disease progression and response to therapeutic interventions.

Economic burden and coping mechanisms by tuberculosis treatment supporters: a mixed method approach from Bono Region, Ghana

BACKGROUND

The Directly Observed Therapy Short Course (DOTS) strategy recommended by World Health Organization for tuberculosis control requires multiple clinic visits which may place economic burden on treatment supporters especially those with low socio-economic status. The End tuberculosis goal targeted eliminating all tuberculosis associated costs. However, the economic burden and coping mechanisms by treatment supporters is unknown in Ghana.

OBJECTIVES

The study determined the economic burden and coping mechanism by treatment supporters in Bono Region of Ghana.

METHODS

Cross-sectional study using mixed method approach for data collection. For the quantitative data, a validated questionnaire was administered to 385 treatment supporters. Sixty in-depth interviews with treatment supporters to elicit information about their coping mechanisms using a semi-structured interview guide for the qualitative data. Descriptive statistics, costs estimation, thematic analysis and bivariate techniques were used for the data analysis.

RESULTS

Averagely, each treatment supporter spent GHS 112.4 (US$21.1) on treatment support activities per month which is about 19% of their monthly income. Borrowing of money, sale of assets, used up saving were the major coping mechanisms used by treatment supporters. Highest level of education, household size, marital status and income level significantly influence both the direct and indirect costs associated with tuberculosis treatment support. The significant levels were set at 95% confidence interval and p < 0.05.

CONCLUSION

We concludes that the estimated cost and coping mechanisms associated with assisting tuberculosis patients with treatment is significant to the tuberculosis treatment supporters. If not mitigated these costs have the tendency to worsen the socio-economic status and future welfare of tuberculosis treatment supporters.

A comparative study to assess the use of chromium in type 2 diabetes mellitus

Diabetes mellitus is a prevalent endocrine disorder characterized by elevated blood glucose levels, often resulting in complications affecting multiple organs, such as retinopathy, nephropathy, and neuropathy. Among potential interventions, certain micronutrients, like chromium, have the potential to improve glycemic management. The potential of chromium to mitigate insulin resistance and enhance insulin sensitivity through cellular receptors underscores its significance. Conversely, insufficient dietary chromium intake could contribute to diabetes development. This research aimed to evaluate the impact of chromium supplementation among individuals with diabetes. In a single-blind randomized clinical trial, participants aged 40 to 60 years with uncontrolled diabetes were divided into two groups. The intervention group received a daily chromium supplement of 200 mcg and their regular diabetes medication regimen, while the control group received only medication. The follow-up period spanned four months, during which fasting blood sugar, HbA1c levels, and lipid profiles were assessed for both groups, followed by a comparative analysis. Patients had a mean age of 52.3±6.3 years. Males constituted only 47.5% of participants, and women were 52.5%. The initial HbA1c level at the start of the study for individuals receiving chromium was 10.4±2.4. Following the follow-up period, the average HbA1c level decreased significantly to 7.2±1.7, showing a statistically significant difference. Furthermore, there was a significant reduction in the mean fasting blood sugar levels, approaching normal levels. These results suggest a beneficial role of chromium supplementation in managing type 2 diabetes mellitus, contributing to improved glycemic control.

Prevalence of Glycemic Control and Factors Associated With Poor Glycemic Control: A Systematic Review and Meta-analysis

The primary method for preventing health and health-related problems in diabetic people is glycemic control. Numerous studies have documented the importance of glycemic control and the factors that influence it. However, the results are dispersed. This study sought to identify the prevalence of poor glycemic control and associated factors in Ethiopia. Findings will be crucial to reduce the burden of poor glycemic control. Comprehensive search was performed from databases: PubMed, Global Health, CINAHL, IRIS, and FSTA. Gray literature sources were also explored. This document was prepared based on the PRISMA flowchart. The protocol is registered in PROSPERO (ID: CRD42022296583). STATA software was used for data analyses and I2 test with Cochrane Q statistics, and forest plot were used to verify heterogeneity. When the I2 value was higher than 50% and the p-value was 0.05, heterogeneity was deemed significant. To confirm publication bias, a funnel plot with an Egger's regression test was performed. The factors related to poor glycemic control were reported using pooled odds ratios (POR) and a 95% confidence interval. In this study, 46 papers totaling 15 457 people were used to calculate the pooled estimates. It was determined that 32.6% (95% CI: 28.3, 36.9) and 61.92% (95% CI: 57.92, 65.92) of the subjects, respectively, had good and poor glycemic control. Being male protected against poor glycemic control, while poor diet adherence, lack of exercise, poor adherence to anti-diabetic medications, and smoking increased the likelihood of poor glycemic control. Lack of formal education, no family history of diabetes, lack of glucometer for blood glucose monitoring, comorbidity, being overweight and prolonged length of stay with diabetes all contributed to poor glycemic control. Ethiopia had a fairly high rate of poor glycemic control. The main determinants are lifestyle factors. Therefore, it is important to focus on behavioral interventions.