Determinants of glycemic control among diabetes mellitus patients in a tertiary clinic in Gaborone, Botswana: findings and implications

Abstract

Background and aims: Glycemic control among patients with diabetes mellitus is associated with a marked reduction of both macrovascular and microvascular complications; however, glycemic control remains an elusive goal worldwide. The aim of this study was to determine factors associated with glycemic control among patients attending a tertiary clinic in Botswana as limited information to date. Methods: Cross-sectional study in a tertiary clinic in Gaborone, Botswana. Patients were recruited between 21 st July 2015 and 21 st September 2015. The majority of the randomly recruited patients (368/380-96.8%) had documentation of glycemic control (HbA1c) within three months of study recruitment and were subsequently included in the analysis. Glycemic control was categorized as desirable, suboptimal and poor if HbA1c was < 7%, 7-9% and > 9% respectively. Data was analyzed using SPSS for descriptive statistics including both bivariate and multinomial logistic regression. Ap-value < 0.05 was considered statistically significant. Results: The analyzed study population consisted of 258/368 (70.1%) females with a mean age (SD) of 56.7± 13.6 years. Means (SDs) for diabetes duration and glycated haemoglobin were 7.2± 7.1 years and 7.97± 2.02% respectively. Of the 368 patients, 136 (36.95%) and 132/368 (35.86%) had desirableand suboptimal glycemic control respectively. Older age, attending the clinic for more or equal to 3 years and not being on insulin were associated with both desirable and suboptimal glycemic control whereas duration of diabetes between 5-10 years was associated with poor glycemic control. Conclusions: The majority of patients had poor glycemic control. Older age and not being on insulin were associated with better glycemic control. The fact that patients on insulin had poor glycemic control calls for more research to determine timing of insulin initiations and dosing schedule factors as these will help toimprove overall glycaemic control in Botswana and elsewhere.

Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

“…FDCs have been developed to reduce the pill burden as well as potentially enhance adherence and outcomes in patients with T2DM [46,[210][211][212], with reduced pill burden along with improved effectiveness and reduced side-effects welcomed by patients [213]. Poor control of patients with T2DM is a concern especially among African countries [162,[214][215][216][217].…”

Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

“…This includes addressing sub-optimal management of patients with T2DM with currently only a minority of patients in SSA achieving glycemic control (Mwita et al, 2012;Sobngwi et al, 2012;Kibirige et al, 2014;Pinchevsky et al, 2015;Manne-Goehler et al, 2019). Glycemic control is improved though in specialist centers in SSA (Sobngwi et al, 2012;Mwita et al, 2019;Rwegerera et al, 2019). This reflects the fact that NCDs such as diabetes have been relatively neglected over the last decade across Africa in favor of infectious diseases including human immunodeficiency viruses (HIV), tuberculosis (TB), and malaria due to their burden (Atun et al, 2017;Pastakia et al, 2017;South African Lancet National Commission, 2019).…”

“…Treatment, including adherence to agreed guidelines for patients with T2DM, and subsequent patient adherence to prescribed medicines, are also generally sub-optimal in LMICs including Africa (Igbojiaku et al, 2013;Awodele and Osuolale, 2015;Fadare et al, 2015;Moosa et al, 2015;Sapkota et al, 2015;Elsous et al, 2017;Abate, 2019;Moosa et al, 2019). A number of factors appear responsible for poor control of T2DM including the age of patients, their lack of perception of the consequences of diabetes, forgetfulness regarding taking medication, adverse effects of the prescribed medicines, living in rural areas, affordability, and issues of motivation including family support (Adegbola et al, 2016;Abate, 2019;Dedefo et al, 2019;Mwita et al, 2019;Rwegerera et al, 2019). There are also concerns with the c o n c o m i t a n t m a n a g e m e n t o f h y p e r t e n s i o n a n d hypercholesterolemia along with controlling HbA1c in patients with T2DM in Africa (Gudina et al, 2011;Sobngwi et al, 2012;Mwita et al, 2019).…”

Prevalence and Factors Associated with Type 2 Diabetes Control in Sub-Saharan Africa: A Systematic Review and Meta-analysis

“…Five studies assessed the relationship between increasing age and glycaemic control [27,31,34,58,61], two found that it was negatively associated with glycosylated haemoglobin [31,61], and one that it was associated with good glycaemic control [58]. Older age was associated with poor glycaemic control in twelve studies [22,29,32,36,39,65,68,69,73,77,83,86]. Eight studies assessed the relationship between the female gender and glycaemic control [18,29,34,51,61,64,65,73], two studies found that the female gender was associated signi cantly with poor glycaemic control [18,34] versus one study that linked it to good glycaemic control [29].…”

“…Older age was associated with poor glycaemic control in twelve studies [22,29,32,36,39,65,68,69,73,77,83,86]. Eight studies assessed the relationship between the female gender and glycaemic control [18,29,34,51,61,64,65,73], two studies found that the female gender was associated signi cantly with poor glycaemic control [18,34] versus one study that linked it to good glycaemic control [29]. Male gender in respect of glycaemic control was assessed by eleven studies [27,31,39,44,58,66,75,77,83,85,87], two studies associated it with good glycaemic control [58,75], while two studies linked it to poor glycaemic control [27,87].…”