Magnitude and predictors of poor glycemic control among patients with diabetes attending public hospitals of Western Ethiopia

Prevalence of and factors associated with suboptimal glycemic control among patients with type 2 diabetes mellitus attending public hospitals in the Greater Male' Region, Maldives: a hospital-based cross-sectional study

BACKGROUND

Suboptimal glycemic control of type 2 diabetes mellitus (T2DM) which is defined as having HbA1c greater than 7% is a major public health problem in several countries, including the Maldives. The study aimed to estimate the prevalence and determine factors associated with suboptimal glycemic control among T2DM patients.

METHODS

A hospital-based cross-sectional was applied to collect data from T2DM patients who attended public hospitals in the Greater Male' Region, Maldives where were one of the highest reports of T2DM and suboptimal glycemic control cases in the country between January to March 2023 by a validated questionnaire and anthropometric measurements. Five (5) ml blood specimens were collected to measure the glycated hemoglobin (HbA1c) level. Univariable and multivariable logistic regressions were employed to determine factors associated with suboptimal glycemic control of T2DM at a significant level of α = 0.05.

RESULTS

A total of 341 participants were recruited for the study: 65.7% were female, 42.5% were aged 40-60 years, and 42.2% were married. The overall prevalence of suboptimal glycemic control was 50.7%. Ten variables were found to be associated with suboptimal glycemic control in multivariable logistic regression. Those aged 40-60 years (AOR = 3.35, 95% CI = 1.78-6.30), being single (AOR = 2.53, 95% CI = 1.21-5.30), preparation of food using more than three tablespoons of cooking oil (AOR = 2.78, 95% CI = 1.46-5.28), preparation of food with more than three tablespoons of sugar (AOR = 2.55, 95% CI = 1.31-4.93), no exercise (AOR = 2.04, 95% CI = 1.15-3.61), DM diagnosed with more than twenty years prior (AOR = 2.59, 95% CI = 1.34-4.99), obese body mass index (BMI) (AOR = 3.82, 95% CI = 1.75-8.32), high total cholesterol (AOR = 2.43, 95% CI = 1.36-4.35), high triglycerides (AOR = 3.43, 95% CI = 1.93-6.11), and high-level stress (AOR = 2.97, 95% CI = 1.48-5.93) were having a greater odds of having suboptimal glycemic control than those who did not have these characteristics.

CONCLUSION

A large proportion of T2DM patients in the Greater Male' Region fail to control their blood glucose. Effective public health interventions should be introduced, especially interventions focused on reducing cooking oil and sugar in daily cooking practices, encouraging regular exercise, and maintaining cholesterol levels, particularly for those diagnosed with diabetes mellitus for more than 20 years prior.

Risk factors for suboptimal glycemic control in pediatrics with type 1 diabetes mellitus: a cross-sectional study

The objective of this research is to analyze the influence of various factors on glycemic control in pediatrics with type 1 diabetes mellitus (T1DM). The study, a cross-sectional analysis, involved 221 T1DM patients below 18 years old who visited our clinic between 2011 and 2020, predating the COVID-19 outbreak. Out of the initial pool, 204 participants were chosen based on specific criteria. By computing odds ratios and 95% confidence intervals, we determined the correlation between these factors and achieving optimal glycemic control (HbA1c < 7.5%). Of the 204 individuals, 55.9% (113 patients) were female. The average age at diagnosis was 6.93 ± 3.9 years. Mean HbA1c (A1C) level of optimal and suboptimal groups were 6.97, 95% CI 6.84 to 7.1 and 8.86, 95% CI 8.68 to 9.03, respectively (p-value < 0.001). Fifty patients had optimal glycemic control and 154 people experienced suboptimal glycemic control during the follow-up that the prevalence of each of them was 24.51, 95% CI 18.7 to 31 and 75.49, 95% CI 68.99 to 81.22, respectively. In the assessment of risk factors associated with suboptimal glycemic control, patients aged 10-14 years had the highest likelihood of experiencing suboptimal glycemic control (crude odds ratio [COR] 3.12, 95% CI 1.04 to 9.3), followed by duration of diabetes (COR 2.85, 95% CI 1.2 to 6.8), which both were significant. By utilizing multivariable logistic regression analysis, a noteworthy finding emerged. It was revealed that patients aged 10-14 years exhibited a significant association with suboptimal glycemic control, [adjusted odds ratio (AOR) 4.85, 95% CI 1.32 to 17.7]. Additionally, a statistically significant correlation was identified between individuals with a body mass index (BMI) falling within the ≥ 95th percentile category and suboptimal glycemic control, Cramer's V = 0.21, p-value = 0.01. Our research has revealed a significant correlation between patients aged 10-14 years and obese individuals (BMI ≥ 95th) with suboptimal glycemic control. It is crucial to consider these factors as they can offer valuable insights during diagnosis, highlighting the increased risk of long-term suboptimal glycemic control.

Frequency and correlates of poor glycemic control in patients with type 2 diabetes at Jimma Medical Centre, Ethiopia: a cross-sectional study

Introduction

the majority of studies in Ethiopia determine the prevalence of glycemic control employed by fasting blood sugar (FBS), which is impacted by a variety of factors. Hence, the purpose of this study was to assess the status of glycemic control using HbA1c and its correlates in patients with type 2 diabetes in Southwest Ethiopia.

Methods

a cross-sectional study was employed among 124 T2 diabetes mellitus (DM) patients at Jimma Medical Center (JMC), Southwest Ethiopia. HbA1c and FBS were estimated using the Cobas 6000 analyzer. The body mass index (BMI) and waist-to-hip ratio were calculated as the standard formula. Data were analyzed by SPSS version 25. Logistic regression analysis was employed to identify independent risk factors associated with poor glycemic control of DM patients.

Results

males comprised 63.7% (n=79) of the total respondents. The mean age of aOR: 2.21, 95% CI 1.13, 4.34; p = 0.01f participants was 51.84 ± 11.6 years; 60.5% (n=75) of T2 DM patients were in poor glycemic control (HbA1c ≥ 7%). In multivariate logistic regression analysis, BMI of ≥ 30, (aOR: 2.21, 95% CI 1.13, 4.34) increased waist-to-hip ratio (aOR: 1.63, 95% CI 0.82, 2.18), high systolic blood pressure (aOR: 1.52, 95% CI 1.11, 6.23), high FBS (aOR: 1.61, 95% CI 1.00, 4.12), and longer duration of DM (aOR: 1.23, 95% CI 0.87, 1.88) were associated with poor glycemic control.

Conclusion

the level of poor glycemic control in the study population is high. Obesity and/or overweight, central obesity, systolic hypertension, and fasting blood sugar levels were all associated with poor glycemic control in T2 DM patients.

Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2022, cross-sectional study

INTRODUCTION

Diabetes foot deformity is among the major causes of diabetic foot ulceration, resulting in lower limb amputation. However, the study on the distribution of foot deformity and its risk factor among diabetic patients in Ethiopia is limited. This study determined the overall prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.

METHODS

Hospital-based cross-sectional study was conducted among 392 diabetic patients using a systematic random sampling technique at Debre Markos Comprehensive Specialized Hospital. Data were collected by pre-tested, semi-structured questionnaires and diabetic foot assessment format. Multivariable binary logistic regression was used to determine the association between dependent and independent variables. Adjusted odds ratios (AOR) with their 95% confidence interval (CI) were used to determine the strength of the association, and a variable with a p-value < 0.05 was statistically significant factors of diabetes foot deformity.

RESULT

The overall prevalence of foot deformity was 33.4% [95% CI: 28.9-38.3]. In the final logistic regression analysis, rural residency [AOR = 2.64, 95% CI: 1.31, 5.31], poor glycemic control [AOR = 2.41; 95% CI: 1.34, 4.33], diabetes duration ≥ 10 years [AOR = 2.74; 95% CI: 1.50, 5.02], inadequate footwear [AOR = 2.11; 95% CI: 1.17, 3.82] and presence of peripheral neuropathy [AOR = 8.21; 95% CI: 4.54, 14.84] were statistically significant associated factors with diabetes foot deformity.

CONCLUSION

The prevalence of foot deformity among adult diabetic patients was high. It is recommended to incorporate foot deformity screening in routine diabetic patient follow-ups especially for those with poor glycaemic control, rural residency, long diabetes duration, inadequate footwear, and diabetic peripheral neuropathy.

The Pattern of Initial Presentation of Diabetes, Treatment Outcome and Its Predictors Among Diabetic Pediatrics Attended Service at Selected Public Hospitals of Southern Ethiopia: A Multi-Center Study

Background

Diabetes mellitus is the most common metabolic disorder in the pediatric population. Globally the incidence of diabetes increased from 11.3 million (95% UI 10.6-12.1) in 1990 to 22.9 million (21.1-25.4) in 2017, with a 102.9% increase and there was a 3% increase in diabetes mortality rates by age between 2000 and 2019.

Objective

This study aims to assess the pattern of initial presentation of pediatric diabetes mellitus, treatment outcome, and its predictors among pediatrics who attended service at selected public hospitals in southern Ethiopia from 2015 to 2019.

Methods

A cross-sectional study was conducted among 422 randomly selected pediatrics from October 1st, 2021 to December 30, 2021, and participants were selected randomly from 8 randomly selected public hospitals in southern Ethiopia after proportional to client flow allocation of samples. Data was extracted from clients' charts using a data extraction checklist. Statistical Package for Social Sciences (SPSS) version 24, and logistic regression analysis were applied to determine the presence of an association between dependent and independent variables, and significance was declared at p-value <0.05.

Results

In this study, most (74.6%) of the pediatrics initially presented with Diabetic ketoacidosis (DKA). This study found that Two-thirds (67.1%) of the respondents in the study had a good treatment outcome. In this study residence, presenting signs and symptoms; poly symptoms and weight loss, history of hospitalization, and comorbidity were predictors of treatment outcome of pediatric diabetes mellitus.

Conclusion

Diabetes mellitus with Diabetic ketoacidosis is the predominant pattern of initial presentation in the study. The magnitude of poor treatment outcomes of diabetes mellitus among pediatrics in this study is high and unacceptable Residence, signs, and symptoms at initial presentation, history of hospitalization, and comorbidity were found to be significant independent predictors of treatment outcome of pediatric diabetes mellitus.

Evaluation of coupling coordination development between digital economy and green finance: Evidence from 30 provinces in China

The convergence of China's digital economy and green finance holds great significance for fostering a sustainable and high-quality developmental path. However, existing studies have not explored the coupling coordination development between these two crucial subsystems. To bridge this gap, this paper employs a modified coupling coordination degree (CCD) model to assess and affirm the coupling coordination degree between the digital economy and green finance across 30 provinces in China from 2015-2021. Based on degree results, provinces are classified into three clusters by using K-means and hierarchical clustering algorithm. Our findings unveil that the current level of coupling coordination development in China is at a primary coordination stage. Although regional disparities significantly exist, the overall level of coordination remains steadily increasing, with the eastern region outperforming the western region. Additionally, we determine that the COVID-19 pandemic's disruption on the coupling coordination development of these systems has been limited. This research sheds light on the evolution of coupling systems and offers practical recommendations for strengthening the coordinated development of the digital economy and green finance.

Prevalence and Associated Factors of Hypertension Among Adults in Gurage Zone, Southwest Ethiopia, 2022

Introduction

Hypertension affects over a billion people worldwide, making it a major public health problem. The problem is significant in both developed and developing countries. However, studies are scarce in developing countries such as Ethiopia.

Objectives

This study aimed to assess the prevalence of hypertension and its associated factors at the community level, in South Ethiopia.

Methods

A cross-sectional study design was employed on a sample of 680 participants in the study from April 1 to June 30, 2022. An interview administer was conducted using a standardized and pretested questionnaire was employed. The Epi data 3.1 versions were used to enter data and then exported into SPSS version 23 for analysis. All variables in the multivariable logistic analysis were a candidate with a bi-variable at p < .25. The multivariable logistic regressions were performed to determine the predictors of hypertension, and the significance level was established with p < .05.

Results

There were a total of 635 participants and the response rate was 93.4%. The prevalence of hypertension was found to be 22.0% [95% CI; 19.1-25.4]. The mean age of the participants was 40.8 ± 12.88 years. Being older age (AOR: 1.95; 95%CI; 1.13-3.36), family history [AOR: 2.65, 95%; CI (1.29-5.45)], eating animal fat [AOR: 0.21, 95%; CI (0.08-0.52)], smoking cigarettes [AOR: 4.06, 95%; CI (2.24-7.36)] and had poor knowledge about hypertension [AOR: 2.69, 95%; CI (1.61-4.49)] were significantly associated with raised blood pressure.

Conclusions

Hypertension was prevalent in one out of every five study participants. Older age, family history of hypertension, animal fat intake, cigarette smoking, and lack of knowledge were found to be significant factors for hypertension. To address the burden of hypertension, health care practitioners should provide broad health education, routine screening, and promotion of recommended lifestyle measures.

Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study

BACKGROUND

Poor glycemic control is one of the most determinant factors for type 2 diabetes-related morbidity and mortality. The proportion of type 2 diabetes mellitus patients with poor glycemic control remains high. Yet evidence on factors contributing to poor glycemic control remains scarce. The aim of this study is to identify determinants of poor glycemic control among type 2 diabetes mellitus patients at a diabetes mellitus clinic in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Determinants of Poor Glycemic Control among Type 2 Diabetes mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched Case-Control Study.

METHODS

A hospital-based case-control study was conducted from June to September 2020. Using convenience sampling techniques, a total of 90 cases and 90 controls with type 2 diabetes were recruited. The data were entered into Epidata version 4.6.0.2 and analyzed by Stata version 14. A multivariable logistic regression analysis was performed to assess the association between independent variables and glycemic control. Both 95% CI and p-value<0.05 were used to determine the level and significance, respectively.

RESULTS

The mean age ( ± standard deviations) for the cases and controls were 57.55± 10.42 and 61.03± 8.93% respectively. The determinants of poor glycemic control were age (Adjusted odd ratio (AOR)= 0.08; 95% CI= 0.02-0.33), inadequate physical exercise (AOR = 5.05; 95% CI = 1.99-11.98), presence of comorbidities (AOR = 5.50; 95% CI = 2.06-14.66), non-adherence to anti-diabetes medications (AOR= 2.76; 95% CI= 1.19-6.40), persistent proteinuria (AOR=4.95; 95% CI=1.83-13.36) and high-density lipoprotein less than 40 mg/dl (AOR=3.08; 95% CI= 1.30-7.31).

CONCLUSIONS

Age less than 65 years, inadequate physical exercise, presence of comorbidities, non-adherence to anti-diabetes medications, persistent proteinuria, and high-density lipoprotein less than 40 mg/dl were the determinants of poor glycemic control. Therefore, targeted educational and behavioral modification programs on adequate exercise and medication adherence should be routinely practiced. Furthermore, early guideline-based screening and treatment of comorbidities and complications is required to effectively manage diabetes mellitus.

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.

Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices

Nigeria struggles to reframe its traditional acute-care disease approach to health care to accommodate rising needs for chronic disease care. This interpretive descriptive study explored Nigerian healthcare providers' (HCPs) perspectives, experiences, and practices related to self-management support (SMS). Observational and experiential data were gathered from 19 HCPs at two urban hospitals in Southeastern Nigeria (seven physicians, four nurses, five dietitians/nutritionists, and three health educators). There were four themes: (a) compliance-oriented medical model, (b) SMS as advice, informal counseling, and education, (c) navigating the sociocultural terrain, and (d) workarounds. Nigerian HCPs perspectives and SMS practices were characterized by attempts to foster compliance with healthcare instructions within a traditional biomedical model. Participants enhanced patient support using specific strategies to bypass structural system obstacles. These findings demonstrate the need to reevaluate the current understanding of SMS in Nigeria and its practice.

Physical activity can improve diabetes patients' glucose control; A systematic review and meta-analysis

Background

Glycemic control is vital to patient care, and it is still the most important treatment goal for reducing organ damage and other complications associated with diabetes. Physical activity is one of the factors that affects glycemic management. Therefore, the aim of this systematic review and meta-analysis was to find, evaluate, and synthesize the best available information on the link between physical exercise and glycemic control in Ethiopian diabetes patients.

Methods

Pubmed, Science Direct, Google Scholar and African Journals Online were the databases searched. In addition, gray literature were explored. All papers chosen for inclusion in the review underwent a thorough critical appraisal utilizing the Joanna Briggs Institute's standardized critical appraisal instruments (JBI critical appraisal checklist-2017). For statistical analysis and descriptive synthesis, quantitative articles were combined. The Odds ratio and their 95% confidence intervals were generated. Papers that were of excellent quality but lacked the main outcome (physical activity) for meta-analysis were subjected to descriptive synthesis.

Results

The finding of this meta-analysis showed diabetes patients who were physically active had controlled their blood glucose levels by 2.4 times compared to their counter (Odds ratio = 2.40, 95% Confidence Interval = 1.57,3.69). The duration of disease was found to be the most commonly reported predictor for poor glycemic control followed by dietary habits, patients' sex and age.

Conclusion

Physical activity, which is a simple and inexpensive therapy for diabetes patients, can help them control their blood glucose levels. Patients with diabetes who have had it for a long time should be aware of the need of regular physical activity in maintaining blood glucose control.

Epidemiology of Poor Glycaemic Control among Patients with Type 2 Diabetes Mellitus in Terengganu State of Malaysia

Background: Type 2 diabetes mellitus (T2DM) is among the most common non-communicable diseases worldwide and Malaysia. Poor glycaemic control among T2DM patients lead to serious life-long complications. Therefore, it is imperative to study the prevalence of poor glycaemic control and its risk factors to facilitate public health physicians and clinicians in developing the best strategies to optimize glycaemic control among T2DM patients. Materials and Methods: A comparative cross-sectional study between groups of good glycaemic control and poor glycaemic control was conducted among type 2 diabetes mellitus (T2DM) patients who fulfilled study criteria in Terengganu state of Malaysia. Eligible samples in the National Diabetes Registry registered from 1st January 2021 until 31st December 2021 were included into the study. Descriptive statistics, simple and multiple logistic regressions were employed for data analysis. Result: A total of 17,165 samples were recruited in the descriptive part of the study. The prevalence of patients with poor glycaemic control in Terengganu state was 65.3% (95% CI: 0.62, 0.67). In the inferential part of the study, a total 3,700 samples were randomly selected. Multivariable analysis using multiple logistic regression revealed age, duration of diabetes, body mass index, cigarette smoking, presence of retinopathy and presence of hypertension were the significant factors associated with poor glycaemic control among T2DM patients in Terengganu state with an adjusted odds ratio (AOR) of 0.95 (95%CI:0.94, 0.96); p<0.001), AOR 1.15 (95%CI:1.13, 1.17; p<0.001), AOR 1.03 (95%CI:1.01, 1.04; p<0.001), AOR 1.45 (95%CI:1.01, 2.10; p=0.047), AOR 1.32 (95%CI:1.01, 1.73; p=0.043) and AOR 1.39 (95%CI:1.16, 1.67; p<0.001) respectively. Conclusion: Strategies focusing on the identified risk factors may improve diabetes mellitus management and avert life-long diabetic complications.

Poor glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia, 2020: facility-based cross sectional retrospective study design

Diabetes mellitus is a global public health problem. Glycemic control is a major public health problem. Diabetes results from elevated levels of glycaemia such as increased glucose and glycated hemoglobin, and controlling glycaemia is an integral component of the management of diabetes. Glycemic control in children is particularly difficult to achieve. Identifying determinants of poor glycemic control is important for early modification of diabetic related end organ damages. This study was aimed to assess the status of glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia. Facility-based cross sectional retrospective cohort study design was used and this study was conducted from September, 2015 to February, 2018. Simple random sampling was used to select 389 samples. Data were collected using an extraction checklist. Data were entered into Epi-data − 4.6, and analyzed using Stata-16. Finally, multivariable binary logistic regression was done. Poor glycemic control was more common among pediatric patients 39.3% (95% CI 34.6, 44.3). Treatment discontinuation (AOR 2.42, 95% CI 1.25, 4.69), age (AOR 1.15, 95% CI 1.03, 1.28) and treatment dose (AOR 0.96, 95 CI 0.92, 0.99) were significantly associated with poor glycemic control. Prevalence of poor glycemic control was high. Patient’s age, history of treatment discontinuation and dose of treatment were the significant contributing factors to poor glycemic control. These need to be addressed to attain the objective of adequate glycemic control.

Rate of glycaemic control and associated factors in patients with type 2 diabetes mellitus treated with insulin-based therapy at selected hospitals in Northwest Ethiopia: a multicentre cross-sectional study

OBJECTIVES

This study was aimed to determine the level of glycaemic control and associated factors in patients with type 2 diabetes mellitus (T2DM) treated with insulin-based therapy.

DESIGNS

Institutional-based multicentre cross-sectional study design was employed to conduct this study.

SETTINGS

The diabetes follow-up clinics of selected hospitals in Northwest Ethiopia.

PARTICIPANTS

Adult patients with T2DM treated with insulin-based therapy at the selected hospitals who met the eligibility criteria were the study participants.

MAIN OUTCOME MEASURES

Good glycaemic control; when fasting blood glucose (FBG) level ranged from 70 to 130 mg/dL, and FBG <70 and >130 mg/dL was considered poor glycaemic control. A logistic regression model was used to identify determinants of poor glycaemic control. A p<0.05 at 95% CI was statistically significant.

RESULTS

Of 403 study participants, 54.8% were males with a mean age of 55.03±10.8 years. Though patients with T2DM were treated with insulin-based therapy, most of the participants (72.5%) could not achieve the target FBG. The overall mean FBG was 177.1±54.3, and far from the target glucose level. Patients who could not practise self-monitoring of blood glucose were found more likely to have poor glycaemic control compared with those who practised self-monitoring (p<0.001). Whereas patients who had a normal body mass index (p=0.011) and who were treated with premixed insulin-based therapy (p=0.04) were found less likely to have poor glycaemic control compared with patients with obesity and who received NPH insulin based-regimens, respectively.

CONCLUSION

This study demonstrated that a significant proportion of the study samples could not achieve glycaemic targets and the average blood glucose was far higher than the recommended glycaemic target level. Insulin initiation and titration, considering the determinants of glycaemic control, could be recommended to achieve target glycaemic levels.

Poor glycemic control and its associated factors among diabetes patients attending public hospitals in West Shewa Zone, Oromia, Ethiopia: An Institutional based cross-sectional study

Purpose

Diabetes mellitus (DM) is increasing at an alarming rate throughout the world and its complications of has become a major public health concern in all countries. Glycemic control is the most important predictor for DM related complications and deaths. However information on glycemic control remains scarce in Ethiopia including our study area. Hence, the aim of this study was to assess the magnitude and factors associated with poor glycemic control among diabetic outpatients at West Shewa public Hospitals, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from June 01 to September 30, 2020. Poor glycemic control was assessed by glycated hemoglobin level and a systematic random sampling method was employed to select participants. An interviewer-administered structured questionnaire was used and the data entered into Epi data version 3.1 and exported into SPSS version 22 for analysis. Logistic regression was conducted to identify predictors of poor glycemic control. A p-value of <0.05 was considered statistically significant.

Results

A total of 390 participants were involved in the study with mean age of 46.45 (±15.6) years. The study finding showed that the prevalence of poor glycemic control was found to be 63.8%. Age of ≥50 years (AOR = 2.77; 95% CI: 0.15,0.85), being single (AOR = 2.55; 95% CI: 0.179,.857), having high low-density lipoprotein cholesterol (AOR = 3.44; 95% CI: 1.65, 7.12), being female gender (AOR = 2.4; 95%CI: 0.31,0.816), alcohol intake (AOR = 1.88; 95% CI: 1.135, 3.1) and presence of diabetic peripheral neuropathy (AOR = 1.24; 1.1,1.39) were associated with poor glycemic control.

Conclusion

About two-thirds of participants had poor blood glucose control. Increased age, high low-density lipoprotein cholesterol, family history of diabetes, being single, being female, diabetic peripheral neuropathy and alcohol intake were associated with poor glycemic control. Hence, effort should be made towards reducing these factors among DM patients by the concerned body.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.

PURPOSE

To evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.

PATIENTS AND METHODS

This cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.

RESULTS

Out of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.

CONCLUSION

The proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients' self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.

An Interpretive Description of Sociocultural Influences on Diabetes Self-Management Support in Nigeria

The purpose of this study is to explore how Nigeria’s social and cultural environment influences professional diabetes self-management support practices. This interpretive descriptive study is based on two diabetes clinics in southeastern Nigeria. Nineteen healthcare providers, including nurses, were purposely selected and engaged in participant observation and interviews. Concurrent data generation and analysis facilitated iterative constant comparative analysis. Findings show significant factors influencing diabetes self-management support include belief in the supernatural origin of diabetes, individual–family interdependence, myths and limited understanding of diabetes, lack of health insurance, poverty, and the rigidity of a hierarchical acute care model of diabetes services. Thus, there is an urgent need to adapt diabetes self-management support strategies to fit people’s contexts. By doing so, specific challenges in the healthcare system can directly be addressed while capitalizing on identified strengths and adapting select strategies that constructively foster person-centered and culturally appropriate care.

Poor Self-Care Practices and Being Urban Resident Strongly Predict Chronic Complications Among Patients with Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study

BACKGROUND

Diabetes, together with its complications, has a considerable negative influence on people's quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤0.05.

RESULTS

One or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications.

CONCLUSION

The burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.

The Impact of Telemonitoring on Improving Glycemic and Metabolic Control in Previously Lost-to-Follow-Up Patients with Type 2 Diabetes Mellitus: A Single-Center Interventional Study in the United Arab Emirates

BACKGROUND

Telemonitoring (TM), mobile-phone technology for health, and bluetooth-enabled self-monitoring devices represent innovative solutions for proper glycemic control, compliance and monitoring, and access to providers.

OBJECTIVE

In this study, we evaluated the impact of TM devices on glycemic control and the compliance of 38 previously lost-to-follow-up (LTFU) patients with type 2 diabetes mellitus (T2DM).

METHODS

This was an interventional single-center study that randomly recruited LTFU patients from the Dubai Diabetes Center (DDC), UAE. After contact and recruitment by phone, patients had an initial visit at which they were provided with home-based TM devices. A follow-up visit was conducted three months later.

RESULTS

The mean HbA1c decreased significantly from 10.3 ± 1.9% at baseline to 7.4 ± 1.5% at the end of follow-up, with a mean difference (MD) of -2.9% [95% CI: -3.6 to -2.2]. The percentage of patients with HbA1c <7% was 50% after three months. Home-based blood sugar monitor devices showed a significant reduction in fasting blood glucose (FBG) after three months (MD = -40.1 mg/dL, 95% CI: -70.8 to -9.3). A significant reduction was observed in terms of body weight after three months (MD = -1.3 kg, 95% CI: -2.5 to -0.08). The mean number of days the participants used a device was the highest for portable pill dispensers (86.5 ± 22.8 days), followed by a OneTouch® blood glucose monitor (72.9 ± 23.5 days).

CONCLUSIONS

TM led to significant improvements in overall diabetes outcomes, including glycemic control and body weight, indicating its effectiveness in a challenging population of T2DM patients who had previously been lost to follow-up.

Rate of glycemic control and associated factors among type two diabetes mellitus patients in Ethiopia: A cross sectional study

Objective

To assess the rate of glycemic control and associated factors among type 2 diabetes mellitus patients at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia.

Methods

A cross-sectional study was conducted from 13 May to 16 August 2019. Type 2 diabetic patients on follow up at Dilchora Referral Hospital who fulfilled the inclusion criteria of the study were included. Systematic random sampling was used to select study participants. Data was collected by a face-to-face interview and review of medical records. The primary outcome was the level of blood glucose during three consecutive visits. Poor glycemic control was defined as a blood sugar level of more than 154 mg/dL based on the average of measurements from three consecutive visits. Multivariate logistic regression analysis was used to identify determinants of glycemic control.

Result

A total of 394 participants responded to the interview and were included in the final analysis. The overall prevalence of poor glycemic control was 45.2% (95%CI: 40.6%-50.0%). Patients who were on oral anti-diabetic drug plus insulin had more than two times greater chance of poor glycemic control than patients on oral anti-diabetic drug alone: 2.177(95%CI:1.10–4.29). The odds of poor glycemic control in patients who did not understand the pharmacist’s instructions was two times higher than patients with good understanding of instructions 1.86(95%CI: 1.10–3.13). Patients who had poor level of practice were found to have poor glycemic control: 1.69(95% CI: 1.13–2.55).

Conclusion

The overall prevalence of poor glycemic control was high among type 2 diabetes patients. Oral anti-diabetic drugs in combination with insulin, lack of understanding of pharmacist’s advice, and poor practice of diabetic patients were significant factors of poor glycemic control. Pharmacists should reassure the understanding of patients before discharge during counseling. Optimization of the dose of antidiabetic medications and combination of oral hypoglycemic agents should be considered.