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

Sendekie, Ashenafi Kibret; Belachew, Eyayaw Ashete; Dagnew, Ephrem Mebratu; Netere, Adeladlew Kassie

doi:10.1136/bmjopen-2022-065250

Cited by 5 publications

(7 citation statements)

References 28 publications

(54 reference statements)

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“…This is consistent with the previous studies [17][18][19]. In line with the previous studies [8,15,27,33], there was also a significant difference in the incidence of hypoglycemic episodes including rate of sever hypoglycemia between NPH and premixed insulin regimens, which hypoglycemic episodes were more likely to occur in patients treated with premixed insulinbased regimens compared with patients treated with NPH insulin regimens. The finding might be justified that the regular insulin component of the premixed insulin is more likely to be responsible for hypoglycemic episodes because of its short acting effects.…”

Section: Discussionsupporting

confidence: 92%

Hypoglycemic events and glycemic control effects between NPH and premixed insulin in patients with type 2 diabetes mellitus: A real-world experience at a comprehensive specialized hospital in Ethiopia

2022

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Background Though initiation of insulin results in a significant change in glycemic levels, treating patients without significant hypoglycemic events remains difficult in diabetes patients initiated with different insulin-based regimens. This study assessed the association of hypoglycemic incidence and glycemic control between NPH and premixed insulin regimens in patients with type 2 diabetes mellitus (T2DM). Methods This was a retrospective observational study in patients with T2DM who were treated with insulin-based therapy from 2015 to 2020 at the University of Gondar Comprehensive Specialized hospital. Average fasting blood glucose (FBG) between NPH and premixed insulin regimens was compared using an independent t-test. The Association of NPH and premixed insulin regimens with hypoglycemic incidences and glycemic control was examined by a logistic regression model. P < 0.05 was statistically significant. Results From 405 participants, more than half (55.3%) were males with a mean age of 59.2(±9.1) years. Baseline mean HbA1C and FBG levels were 12.73(±1.1) % and 347.7(±48.5) mg/dl, respectively. Within a one-year follow-up period of insulin initiation, the rate of hypoglycemia was 13.1%. The incidence of hypoglycemia was significantly higher in patients initiated with premixed insulin compared with NPH insulin regimens (P < 0.001). After one year of insulin initiation, HbA1C decreased from 12.7 to 7.6 and from 12.8 to 7.3% and FBG levels decreased from 347.5 to 160.7 and from 348.2 to 147.3 mg/dl following initiation of NPH and premixed insulin, respectively. Patients treated with premixed-based insulin were found more likely to achieve target FBG compared with patients treated with NPH insulin regimens after one year of initiation (P = 0.02). Conclusion Premixed insulin-based regimen has found to have a higher hypoglycemic incidence, but a better level of glycemic control compared to NPH insulin-based therapy. Therefore, patients initiated with premixed insulin need to be highly vigilant and motivated to recognize the symptoms of hypoglycemia.

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Section: Discussionsupporting

confidence: 92%

Hypoglycemic events and glycemic control effects between NPH and premixed insulin in patients with type 2 diabetes mellitus: A real-world experience at a comprehensive specialized hospital in Ethiopia

2022

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“…The magnitude of pooled poor glycemic control is lower than the findings of individual studies conducted in Saudi Arabia (74.6%, 74.9%), 90 , 91 Kenya (65.1%), 92 Bangladesh (82%), 93 India (78.2%), 15 Morocco 66.3%, 94 and Dares Salaam (69.7%) 95 as well as a recent finding in Ethiopia where 72.5% patients with T2DM have poor glycemic control. 96 However, it is lower than the findings in China and Zimbabwe, where 57.3% 97 and 58.2% 98 of diabetic patients had poor glycemic control, respectively. The differences in the sample size, study population, and reference points indicating glycemic control may be associated with differences in the elucidation of these discrepancies.…”

Section: Discussionmentioning

confidence: 68%

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

Bitew

Alemu

Jember

et al. 2023

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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.

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“…These findings indicate that patients who practice SMBG can obtain direct feedback regarding their blood glucose and may use that information to adjust their management and lifestyle modifications. The earlier findings also showed that practicing SMBG results in good glycaemic control,33 50 which in turn can help patients maintain their HRQoL. As a result, because SMBG is an important tool for improving patient self-management and clinicians may use it to guide management interventions, patients may be encouraged to use it, share their testing results with physicians and the clinicians may then act to make management decisions 51 52.…”

Section: Discussionmentioning

confidence: 98%

“…Additionally, obesity causes increased levels of fatty acids and inflammation, leading to insulin resistance, which in turn can result in poor glycaemic control and compromised HRQoL in patients. The earlier study also disclosed that patients with obesity were found to have poor glycaemic control, 33 which in turn could result in poor HRQoL. Health weight can prevent the progression of diabetes by improving blood glucose, blood pressure and lipid profiles that reduce the risk of complications, which in turn can maintain the HRQoL of patients at the optimum level.…”

Section: Discussionmentioning

confidence: 99%

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Health-related quality of life and its determinants among patients with diabetes mellitus: a multicentre cross-sectional study in Northwest Ethiopia

et al. 2023

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ObjectivesThis study assessed the health-related quality of life (HRQoL) and its determinants in patients with diabetes.Design and settingAn institutional-based multicentre prospective cross-sectional study design was conducted in diabetes follow-up clinics of selected hospitals in Northwest Ethiopia from April to July 2022.ParticipantsAll eligible adult patients with diabetes at the selected facilities.Main outcome measuresHRQoL was measured using EuroQol 5-dimensions 5-levels (EQ-5D-5L) and the EuroQol-Visual Analogue Scales (EQ-VAS) instruments. A lower EQ-5D-5L utility mean score for each dimension and/or an overall lower utility score of EQ-5D-5L and EQ-VAS scores are intended to show poor HRQoL. Linear regression analysis was used to identify the association of HRQoL and other variables.ResultsOut of the 422 samples approached, 402 (95.3%) participated in the study. Most of the participants (>85%) reported having moderate-to-severe problems in all five EQ dimensions. The overall EQ-5D-5L utility and EQ-VAS scores were 0.56 (±0.11) and 56.7 (±10.1), respectively. A higher body mass index (BMI) (p < 0.001), a higher number of medications (p = 0.037), a high level of blood glucose (p < 0.001), the presence of comorbidities and/or complications (p = 0.031), hypoglycaemia (p = 0.043) and taking insulin (p < 0.001) were associated with worsened HRQoL, whereas practicing self-monitoring of blood glucose (p = 0.002) and taking aspirin (p = 0.008) had a significant association with increased HRQoL.ConclusionThis study concluded that the HRQoL of patients was compromised in all five measuring dimensions. The EQ-5D-5L utility and EQ-VAS scores were far lower than other findings. Clinical and medication-related variables, such as a higher BMI, a higher number of medications, the presence of comorbidities and/or complications, hypoglycaemia and insulin use were associated with poor HRQoL in patients with diabetes. As a result, interventions should be individualised and focused on determinant factors.

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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

Cited by 5 publications

References 28 publications

Hypoglycemic events and glycemic control effects between NPH and premixed insulin in patients with type 2 diabetes mellitus: A real-world experience at a comprehensive specialized hospital in Ethiopia

Hypoglycemic events and glycemic control effects between NPH and premixed insulin in patients with type 2 diabetes mellitus: A real-world experience at a comprehensive specialized hospital in Ethiopia

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

Health-related quality of life and its determinants among patients with diabetes mellitus: a multicentre cross-sectional study in Northwest Ethiopia

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