Predictors of Glycaemic control among Adults attending a diabetic Outpatient clinic in a Tertiary hospital, Tanzania: A cross sectional study

Authors

  • Msafiri Mweng’emeke
  • Deogratius Bintabara
  • Alex Ernest
  • Bonaventura C.T Mpondo

DOI:

https://doi.org/10.4314/tmj.v28i2.226

Keywords:

Type 2 diabetes, Glycaemic control, Tanzania

Abstract

Background

The burden of diabetes mellitus is increasing worldwide and especially so in developing countries. Poor control of diabetes mellitus is associated with the development and progression of many chronic diseases. Proper glycaemic control is important to prevent the development and progression of these complications. In this study, we aimed at assessing the status of glycaemic control and identifying predictors of good glycaemic control among patients with diabetes mellitus type 2 attending an outpatient clinic in Kilombero district, Tanzania.

Methods

This study was a prospective, clinic based, cross-sectional study conducted between August and October 2014 at the St. Francis Referral Hospital diabetic outpatient clinic in Ifakara. A systematic, random sample of 221 patients was enrolled for the study. Socio-demographic and clinical characteristics were collected using a structured questionnaire and a data-collecting tool was used to record the laboratory and clinical measurements. Fasting blood glucose was measured in all patients and the level of ?7.2mmol/dl was considered good glycaemic control. Logistic regression was used to assess association between different variables and glycaemic control.

Results

Out of the 221 patients involved in the study, 65 (29.4%) had good glycaemic control. Factors associated with good glycaemic control included having received diabetes education (OR [95% CI] = 13.8 [5.95-31.9], p = < 0.001), engaging in regular physical exercise (OR [95% CI] = 5.26 [1.95-14.2], p=0.001), having health insurance (OR [95% CI] = 2.44 [1.08-5.49], P = 0.03) and the use of monotherapy (OR [95% CI] = 7.24 [1.70-30.8], p= 0.007). Duration of diabetes, age and BMI were not associated with glycaemic control in this study.

Conclusion

The majority of patients had poor glycaemic control in this population. Health care resource allocation to diabetes and counseling patients to engage in physical activity are important to improve glycaemic control in type 2 diabetic patients.

References

Aspray TJ, Mugusi F, Rashid S, Whiting D, Edwards R, Alberti KG UN. Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living. Trans R Soc Trop Med Hyg [Internet]. 2000 Dec [cited 2015 Jan 3];94(6):637–44. Available from: http://www.sciencedirect.com/science/article/pii/S0035920300902165

Diabetes in Tanzania 2014 [Internet]. International Diabetes Federation. 2014 [cited 2015 Jan 31]. Available from: http://www.idf.org/membership/afr/tanzania

Rekkedal G. [WHO world health report 1997]. Tidsskr Sykepl [Internet]. 1997 May 20 [cited 2015 Jan 31];85(9):37–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9483095

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care [Internet]. 2004 May [cited 2014 Jul 10];27(5):1047–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15111519

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ [Internet]. 2000 Aug 12 [cited 2015 Jan 31];321(7258):405–12. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27454&tool=pmcentrez&rendertype=abstract

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med [Internet]. 1993 Sep 30 [cited 2014 Jul 22];329(14):977–86. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8366922

Group UPDS (UKPDS). Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet [Internet]. 1998 Sep 12 [cited 2015 Jan 23];352(9131):854–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9742977

Del Prato S, Felton A-M, Munro N, Nesto R, Zimmet P, Zinman B. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract [Internet]. 2005 Dec [cited 2015 Jan 31];59(11):1345–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16236091

Benoit SR, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with Type 2 diabetes: a longitudinal study. BMC Public Health [Internet]. 2005 Apr 17 [cited 2015 Jan 3];5:36. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1090595&tool=pmcentrez&rendertype=abstract

Ahmad NS, Islahudin F, Paraidathathu T. Factors associated with good glycemic control among patients with type 2 diabetes mellitus. J Diabetes Investig [Internet]. 2014 Sep [cited 2014 Dec 5];5(5):563–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4188115&tool=pmcentrez&rendertype=abstract

Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009. Prev Chronic Dis [Internet]. 2012 Jan [cited 2015 Jan 3];9:120065. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3475506&tool=pmcentrez&rendertype=abstract

Kamuhabwa AR, Charles E. Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam. Drug Healthc Patient Saf [Internet]. 2014 Jan [cited 2014 Dec 18];6:155–65. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4216043&tool=pmcentrez&rendertype=abstract

Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications [Internet]. 2010 Jan [cited 2015 Jan 3];24(2):84–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19282203

American Diabetes Association. Standards of medical care in diabetes--2009. Diabetes Care [Internet]. 2009 Jan 1 [cited 2014 Dec 17];32 Suppl 1(Supplement_1):S13–61. Available from: http://care.diabetesjournals.org/content/32/Supplement_1/S13.full/Standards-of-Medical-Care-in-Diabetes-2009#ref-31

Lerman-Garber I, López-Ponce A, Murcio Flores RA, Brito-Córdova GX, Velasco-Pérez ML, Villa AR, et al. Comparing easy and accessible parameters of glycemic control in type 2 diabetes. Rev Invest Clin [Internet]. 2001 Jan [cited 2015 Feb 1];53(6):518–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11921524

Edo AE, Akhuemokhan K. Relationships between hemoglobin A 1c and spot glucose measurements in Nigerians with type 2 diabetes mellitus. Niger J Clin Pract [Internet]. 2012 Jan [cited 2015 Feb 1];15(1):23–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22437083

Arai K, Hirao K, Matsuba I, Takai M, Matoba K, Takeda H, et al. The status of glycemic control by general practitioners and specialists for diabetes in Japan: a cross-sectional survey of 15,652 patients with diabetes mellitus. Diabetes Res Clin Pract [Internet]. 2009 Mar [cited 2015 Feb 2];83(3):397–401. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19124170

Kobayashi M, Yamazaki K, Hirao K, Oishi M, Kanatsuka A, Yamauchi M, et al. The status of diabetes control and antidiabetic drug therapy in Japan--a cross-sectional survey of 17,000 patients with diabetes mellitus (JDDM 1). Diabetes Res Clin Pract [Internet]. 2006 Aug [cited 2015 Feb 2];73(2):198–204. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16621117

Reisig V, Reitmeir P, Döring A, Rathmann W, Mielck A. Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey. Int J Public Health [Internet]. 2007 Jan [cited 2015 Feb 2];52(3):158–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17958282

Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S. Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002. Clin Ther [Internet]. 2006 Mar [cited 2014 Dec 18];28(3):388–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16750453

Rothenbacher D, Rüter G, Saam S, Brenner H. Younger patients with type 2 diabetes need better glycaemic control: results of a community-based study describing factors associated with a high HbA1c value. Br J Gen Pract [Internet]. Royal College of General Practitioners; 2003 May 1 [cited 2015 Jan 3];53(490):389–91. Available from: /pmc/articles/PMC1314599/?report=abstract

McPherson ML, Smith SW, Powers A, Zuckerman IH. Association between diabetes patients’ knowledge about medications and their blood glucose control. Res Social Adm Pharm [Internet]. 2008 Mar [cited 2014 Dec 15];4(1):37–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18342821

Al-Qazaz HK, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm [Internet]. 2011 Dec [cited 2014 Dec 16];33(6):1028–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22083724

Kalyango JN, Owino E, Nambuya AP. Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors. Afr Health Sci [Internet]. 2008 Jun [cited 2015 Jan 3];8(2):67–73. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2584325&tool=pmcentrez&rendertype=abstract

Melikian C, White TJ, Vanderplas A, Dezii CM, Chang E. Adherence to oral antidiabetic therapy in a managed care organization: a comparison of monotherapy, combination therapy, and fixed-dose combination therapy. Clin Ther [Internet]. 2002 Mar [cited 2015 Jan 3];24(3):460–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11952029

Motahari-Tabari N, Ahmad Shirvani M, Shirzad-E-Ahoodashty M, Yousefi-Abdolmaleki E, Teimourzadeh M. The effect of 8 weeks aerobic exercise on insulin resistance in type 2 diabetes: a randomized clinical trial. Glob J Health Sci [Internet]. 2015 Jan [cited 2015 Feb 2];7(1):34118. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25560330

Sukla P, Shrivastava SR, Shrivastava PS. A longitudinal study to assess the impact of exercise on clinical, biochemical, and anthropometric parameters among the type 2 diabetes patients of South India. Avicenna J Med [Internet]. 2015 Jan [cited 2015 Jan 28];5(1):16–20. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4296392&tool=pmcentrez&rendertype=abstract

Lumb A. Diabetes and exercise. Clin Med [Internet]. 2014 Dec [cited 2015 Feb 2];14(6):673–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25468857

Umpierre D, Ribeiro PAB, Kramer CK, Leitão CB, Zucatti ATN, Azevedo MJ, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA [Internet]. 2011 May 4 [cited 2015 Jan 30];305(17):1790–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21540423

Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA [Internet]. 2001 Sep 12 [cited 2015 Feb 2];286(10):1218–27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11559268

Quah JHM, Liu YP, Luo N, How CH, Tay EG. Younger adult type 2 diabetic patients have poorer glycaemic control: a cross-sectional study in a primary care setting in Singapore. BMC Endocr Disord [Internet]. 2013 Jan [cited 2015 Feb 2];13:18. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3674913&tool=pmcentrez&rendertype=abstract

Rothman RL, Mulvaney S, Elasy TA, VanderWoude A, Gebretsadik T, Shintani A, et al. Self-management behaviors, racial disparities, and glycemic control among adolescents with type 2 diabetes. Pediatrics [Internet]. 2008 Apr [cited 2015 Feb 2];121(4):e912–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18381520

Harris MI. Racial and ethnic differences in health care access and health outcomes for adults with type 2 diabetes. Diabetes Care [Internet]. 2001 Mar [cited 2015 Jan 20];24(3):454–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11289467

Blaum CS, Velez L, Hiss RG, Halter JB. Characteristics related to poor glycemic control in NIDDM patients in community practice. Diabetes Care [Internet]. 1997 Jan [cited 2015 Feb 2];20(1):7–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9028685

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Published

2016-07-27

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Original Research

How to Cite

Predictors of Glycaemic control among Adults attending a diabetic Outpatient clinic in a Tertiary hospital, Tanzania: A cross sectional study. (2016). Tanzania Medical Journal, 28(2), 109-127. https://doi.org/10.4314/tmj.v28i2.226

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