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

Abstract

BackgroundPoor 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 StudyMethodsA 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.ResultsThe 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).ConclusionsAge 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.

Predictors of hypertension among diabetic patients in the Ejisu municipality of Ghana

“…Similarly, the study outcome of Cheneke, et al 67 found that even though the study participants were on diabetes treatment, the majority of them were found to have poor glycemic control. Similar studies in the sub-Saharan Africa context by Govender, et al, 68 and Legese, et al, 69 have shown that poor fasting blood glucose and haemoglobin A1C status have been found among diabetic patients. Again, we found that 40.8% of the study participants in our research recorded high total cholesterol levels with a little below half recording high triglyceride levels above 1.71mmol/L.…”

Factors contributing to glycaemic control in an urban population of adults living with type 2 diabetes in Cameroon: A community-based cross-sectional study

“…In addition, our study observed poor glucose control in patients with poor dietary adherence, physical activity adherence, and medication adherence, a finding also observed in Bangladesh (Afroz et al, 2019) and Ethiopia (Legese et al, 2023). The Ethiopian study was a hospitalbased cross-sectional study involving 180 adults living with type 2 diabetes attending a diabetic clinic in Gondar town near Addis Abba, as opposed to our study which was community-based.…”

“…Additionally, lifestyle factors, including excess alcohol intake, smoking, physical inactivity, unhealthy diet, and educational level (Dubale et al, 2023;Chetoui et al, 2019;Bitew et al, 2023;Demoz et al, 2019;Legese et al, 2023), are predictive of a patient's blood glucose level. For example, a study by Abdullah et al (2019), aimed to determine predictors of good glycemic control among patients with type 2 diabetes in rural Malaysia, found that shorter diabetes duration was a predictor of good glycemic control.…”

“…Nevertheless, these factors have been identified in industrialized nations, and it is unclear whether these same factors or other determinants influence glucose control levels in settings with limited resources, such as Cameroon. This is particularly important given that differences in age, ethnicity, religion, culture, socioeconomic status (IDF, 2021), education, lifestyle, and diabetes duration (Chetoui et al, 2019;Bitew et al, 2023;Legese et al, 2023) may lead to disparities in glucose control levels. In Cameroon, there is limited data on the factors associated with glucose control among people living with type 2 diabetes.…”

Adherence to diabetes diet and glycemic control among type 2 diabetes mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia: a health facility based unmatched case-control study.

“…The sample size was calculated by considering the following assumptions for unmatched case control study in Epi info version 7.2.6.0 software using the following assumptions: 95% Con dence level (probability of committing α error) to be 1.96 ,90% power (probability of rejecting a true difference), control to case ratio of 2:1, and proportion of main exposure variable (persistent proteinuria among controls to be 14.4% with its adjusted odds ratio of 3.96 from previous studies (29) yielding the largest sample size of 153 ( 102 controls and 51 cases ). However, we included two additional controls and one case at spot during data collection and analyzed data from 156(104 controls and 52 cases ).Although, we considered the exposure variables such as adherence to diabetes diet and medication, physical exercise and comorbidities to estimate the sample size, they yielded less sample size for this study.…”