Glycemic control among patients with type 2 diabetes at a primary health care center in Oman

Metabolic syndrome and pharmacotherapy outcomes in patients with type 2 diabetes mellitus

Background

Metabolic syndrome is a group of metabolic abnormalities that increase predisposition to several diseases including ischemic heart disease and diabetes mellitus. The study aimed to investigate metabolic syndrome among patients with type-2 diabetes mellitus (DM), and its impact on pharmacotherapy outcomes.

Methods

An observational cross-sectional study was performed on 910 patients with type-2 DM between June and December 2023. Fasting blood sugar, triglycerides, high-density lipoproteins (HDL), blood pressure, and abdominal obesity were measured. Metabolic syndrome was identified according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Pharmacotherapy outcomes were assessed according to American Association of Clinical Endocrinologists and American Diabetes Association guidelines using the ability to achieve adequate glycemic control and normal levels of blood pressure and fasting plasma lipoproteins.

Results

In total, 87.5% of type-2 DM patients had metabolic syndrome; the prevalence increased with age and was higher among females. Metabolic syndrome showed the following distribution of risk factors: insulin resistance (100%), low HDL (95.3%), elevated blood pressure (83%), triglycerides dyslipidemia (80.1%), and abdominal obesity (62.5%). Majority of the patients had either 5 or 4 risk factors of metabolic syndrome. The most common comorbidities were dyslipidemia (97.7%) and hypertension (83%). Treatment outcomes were insufficient where adequate glycemic control was only achieved in 12% of type-2 DM patients, and proper management of comorbid dyslipidemia and hypertension was achieved in 29% and 40.9% of patients, respectively. Adequate blood pressure control was less achieved in patients with metabolic syndrome (34.4%) than those without metabolic syndrome (77.2%). Similarly, dyslipidemia was less controlled in patients with metabolic syndrome (26.9%) than in those without metabolic syndrome (47.3%).

Conclusion

Pharmacotherapy outcomes were inadequate for most patients with type-2 diabetes mellitus. Adopting early preventive and therapeutic interventions for metabolic syndrome is advised to improve treatment outcomes of the comorbid dyslipidemia and hypertension.

The Association Between Glycated Hemoglobin (HbA1c) Level and Vitamin D Level in Diabetes Mellitus Patients: A Cross-Sectional Study

BACKGROUND

Prior research has established noteworthy correlations between inadequate glycemic management and a multitude of problems in individuals diagnosed with diabetes mellitus (DM).

METHODS

This is a cross-sectional retrospective study that was conducted at the Jeddah Center for the Care of Diabetes and Blood Pressure Patients, Jeddah, Kingdom of Saudi Arabia. The medical records of patients diagnosed with DM between 2015 and 2022 were identified and reviewed for the purpose of this study. Pearson correlation coefficient was used to examine the correlation between glycated haemoglobin (HbA1c) and vitamin D levels. Multiple linear regression analysis was applied to identify the association between HbA1c and vitamin D levels.

RESULTS

A total of 152 patients were included in this study. The mean HbA1c level for the patients in this study was 8.2% (SD: 1.7). The median vitamin D level for the patients was 20.9 ng/ml (interquartile range (IQR): 13-30.4). More than half of the patients (n= 92; 60.5%) were found to have vitamin D insufficiency. Pearson correlation coefficient identified that there is an inverse correlation between the level of HbA1c and vitamin D level (r= -0.21 (95%CI -0.36 to -0.06; p-value= 0.007). Multiple linear regression analysis (adjusting for age and type of DM) identified that poor glycaemic control has a negative association with vitamin D level (regression coefficient (B) = -0.027; 95%CI -0.053 to - 0.001; p-value= 0.039).

CONCLUSION

Poor glycaemic control is associated with vitamin D deficiency in DM patients. It is recommended that patients with DM adhere to their medications and maintain a healthy lifestyle in order to manage their condition. This will improve their overall health, specifically their vitamin D status.

Impact of telemedicine on glycemic control in type 2 diabetes mellitus during the COVID-19 lockdown period

BACKGROUND

The lockdown at the start of coronavirus disease 2019 (COVID-19) pandemic in Saudi Arabia (March 2020 to June 2020) shifted routine in-person care for patients with type 2 diabetes mellitus (T2DM) to telemedicine. The aim of this study was to investigate the impact telemedicine had during this period on glycemic control (HbA1c) in patients with T2DM.

METHODS

4,266 patients with T2DM were screened from five Ministry of National Guard Health Affairs hospitals in the Kingdom of Saudi Arabia. Age, gender, body mass index (BMI), HbA1c (before and after the COVID-19 lockdown), duration of T2DM, comorbidities and antidiabetic medications data were obtained. Mean and standard deviation of differences in HbA1c were calculated to assess the impact of telemedicine intervention. Correlations between clinically significant variances (when change in the level is ≥0.5%) in HbA1c with demographics and clinical characteristic data were determined using chi square test.

RESULTS

Most of the participants were Saudis (97.7%) with 59.7% female and 56.4% ≥60 years of age. Obesity was 63.8%, dyslipidemia 91%, and hypertension 70%. Mean HbA1c of all patients slightly rose from 8.52% ± 1.5% before lockdown to 8.68% ± 1.6% after lockdown. There were n=1,064 patients (24.9%) whose HbA1c decreased by ≥0.5%, n =1,574 patients whose HbA1c increased by ≥0.5% (36.9%), and n =1,628 patients whose HbA1c changed by <0.5% in either direction (38.2%). More males had significant improvements in glycemia compared to females (28.1% vs 22.8%, p<0.0001), as were individuals below the age of 60 years (28.1% vs 22.5%, p<0.0001). Hypertensive individuals were less likely than non-hypertensive to have glycemic improvement (23.7% vs 27.9%, p=0.015). More patients on sulfonylureas had improvements in HbA1c (42.3% vs 37.9%, p=0.032), whereas patients on insulin had higher HbA1c (62.7% vs 56.2%, p=0.001). HbA1c changes were independent of BMI, duration of disease, hyperlipidemia, heart and kidney diseases.

CONCLUSION

Telemedicine was helpful in delivering care to T2DM patients during COVID-19 lockdown, with 63.1% of patients maintaining HbA1c and improving glycemia. More males than females showed improvements. However, the HbA1c levels in this cohort of patients pre- and post-lockdown were unsatisfactorily high, and may be due to in part lifestyle, age, education, and hypertension.

The relationship between self-care activities, social support, and glycemic control in primary healthcare patients with type 2 diabetes

Objective

Egyptian studies in assessing the relationship between diabetes self-care, social support, and glycemic control in primary healthcare (PHC) are limited. Therefore, this study aimed to assess this relationship, and to evaluate the associated factors of diabetes self-care, social support, and glycemic control in Egyptian PHC patients with type 2 diabetes (T2DM).

Methods

A cross-sectional study was conducted on 320 T2DM patients at four PHC settings in Port Said city, affiliated with the General Authority of Healthcare. A semi-structured questionnaire was used to collect data, including demographic characteristics, socioeconomic status scale, disease profile, the Arabic versions of the Summary of Diabetes Self-Care Activities, and the received social support scales. Data were collected from January 2020 to June 2020.

Results

Diabetes self-care activities, and self-monitoring of blood glucose had a very weak negative correlations with glycated hemoglobin (HbA1c) levels (rho = - 0.125, p = 0.025, rho = - 0.112, p = 0.044, respectively). Receiving social support on following a meal correlated positively and very weakly with HbA1c levels (rho = 0.145, p = 0.010). Hardly positive correlation was found between receiving emotional support on feelings about diabetes, and following a specific diet (rho = 0.169, p = 0.002). Diabetes self-care activities were positively associated with higher education levels, and elevated BMI. Received social support was negatively associated with having coronary artery disease, and marital status e.g. divorced and widow. Increased age, and female gender were the predictors of good glycemic control.

Conclusion

Diabetes self-care activities were linked with reduced HBA1c levels. Further studies are needed to evaluate the buffering effect of social support on glycemic outcomes in PHC patients with T2DM.

Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis

Aims

To examine the patient‐related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries.

Design

A systematic review and meta‐analysis.

Data Sources

A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer‐reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified.

Review Methods

Extracted data were analysed using Review Manager 5.4.

Results

The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self‐management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006).

Conclusion

These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.

Illness perception, medication adherence and glycemic control among primary health-care patients with type 2 diabetes mellitus at Port Said City, Egypt

Aims

Despite the availability of a wide selection of antidiabetic treatments, many patients with type 2 diabetes mellitus (T2DM) still do not have controlled glucose levels. This study aimed to assess illness perception, medication adherence, and glycemic control among primary care attendees with T2DM.

Methods

A cross-sectional study was conducted between July 2019 and November 2020. A random sample of 265 Egyptian T2DM patients were enrolled from primary health-care settings in Port Said, Egypt. Data on socio-demographic characteristics, lifestyle habits, and diabetic medical history were collected using a semi-structured questionnaire. The Brief Illness Perception Questionnaire (B-IPQ) was used to assess diabetes perception, whereas the 8-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate medication adherence.

Results

There was a significant difference in B-IPQ scores between different groups of the patients in terms of diabetic medications, complications, and glycemic control (p < 0.05). There was a significant difference in MMAS-8 score found between different groups of the patients in terms of disease duration, family history of T2DM, and glycemic control (p < 0.05). Further, there was a significant difference in HbA1c score found between different groups of patients in terms of disease duration, medications, complications, and family history of T2DM (p < 0.05). Higher BMI, a positive family history of T2DM, patients who take insulin, high illness perception, and poor medication adherence were the factors associated with higher HbA1c level.

Conclusion

Higher HbA1c levels were linked to a higher BMI, a positive family history of T2DM, insulin users, high illness perception, and poor medication adherence.

A systematic review of factors associated with uncontrolled diabetes and meta-analysis of its prevalence in Saudi Arabia since 2006

The study aims to systematically review the literature for risk factors associated with poor glycaemic control among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia (SA) and conducts a meta-analysis of its prevalence. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we searched the Scopus, PubMed, PsycINFO, Web of Science, and CINAHL Plus databases from May to November 2018. The search terms were T2DM, glycaemic control, and SA. The inclusion criteria include the following: observational studies which were conducted in T2DM patients in SA reporting prevalence or/and personal, psychological or behavioural predictors in papers published after 2006. Articles were assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool. Studies included in the meta-analysis defined uncontrolled T2DM as glycated haemoglobin ≥7% (53 mmol/mol), and reported results were based on a random-effects model. Eighteen of the following articles (3 retrospective cohort studies, 1 case-control study, and 14 cross-sectional studies) were included. The quality of the studies (high: 2; moderate: 7, and low: 9) varied. The pooled prevalence of uncontrolled T2DM in SA was 77.7% (95% CI, 71.2-84.2). In the included studies, the most consistent predictors of poor glycaemic control were longer diabetes duration, lack of self-efficacy, and low knowledge of diabetes. However, significant variations in research designs were observed across the studies. A national diabetes prevention and treatment program is needed to lessen the burden of diabetes in SA. Future studies should address the personal, psychological, and behavioural factors of poor glycaemic control in SA at national level.

Diabetic Complications and Factors Affecting Glycemic Control Among Patients With Type II Diabetes Mellitus Attending the Chronic Illness Clinics at Tabuk, Saudi Arabia

Background Diabetes mellitus (DM) is one of the most common diseases worldwide and affects many patients all over the globe. Diabetic complications vary between microvascular and macrovascular, affecting a wide range of organs and systems in the body. Understanding, determining, and in return, preventing such factors is essential to alleviate the quality of life of diabetic patients. Therefore, we aim to determine the poor glycemic control and the factors associated with it in our diabetes population. Methods This is a retrospective study where data was reviewed for all patients with Type II DM (T2DM) who attended the chronic illness clinic at King Khaled Hospital in Tabuk. We included patients aged ≥ 18 years, of Saudi nationality, and residents of the Tabuk region. Any patient not satisfying all the inclusion criteria was excluded from the current study. Diagnosis with diabetes was made according to the American Diabetes Association guidelines, 2020. Patients' demographic data, medical history, and social and lifestyle history were extracted from records. In addition, age, body mass index (BMI), drugs (insulin vs. oral hypoglycemic agents), duration of the disease, lipid profile, and other comorbidities were also extracted from the files. A p-value of <0.05 was selected as the statistically significant level in all tests. Results A total of 697 patients were included in the current study, with a mean age of 58.2±11.6 years. The mean glycosylated hemoglobin (HbA1c) of the study participants was 8.4±1.7%, and their fasting blood sugar (FBS) level was 9.9±3.9 mmol/l. With HbA1c cut-off at 7%, the overall prevalence of poor glycemic control was 81.5% (565/693). A higher prevalence of poor glycemic control was reported among study participants with higher DM duration (p=0.002). Diabetes complications were found in 208 (29.8%) of the study participants, where microvascular complications were present in 140 patients, and microvascular ones were found in 102. In the logistic regression model, older patients were less prone to poor glycemic control (OR=0.98; 95% CI=0.96-0.99; p=0.010). In addition, longer disease duration was a predictive factor of poor glycemic control (OR=1.05; 95% CI=1.02-1.08; p=0.003). Furthermore, the usage of combined insulin and tablet treatments were associated with a higher risk of poor glycemic control when compared to insulin only treatments (OR=4.65; 95% CI=1.55-13.94; p=0.006). Conclusion The results of this study indicate a high prevalence rate of poor glycemic control among Saudi patients, which is higher than previous reports have shown. More interest should be given to awareness programs with regard to promoting self-control protocols for the disease.

Glycemic control in Kuwaiti diabetes patients treated with glucose-lowering medication

BACKGROUND

Diabetes is prevalent in Kuwait. We aimed to assess the level of glycemic control in Kuwaiti adults with diabetes.

METHODS

The World Health Organization's STEPS non-communicable disease risk factor survey was conducted in Kuwait in 2014. Participants' demographics, medical history, physical measurements and blood biochemistry were assessed. A total of 2561 Kuwaiti men and women aged 18-69 years completed all three survey steps. Glycemic control in 278 individuals with diabetes who were on glucose-lowering medication was determined using the US National Institutes of Health guidelines of fasting plasma glucose (FPG) ≤7.2mmol/l and the American Diabetes Association guidelines of glycated hemoglobin (HbA1c) <7% (53mmol/mol).

RESULTS

Adequate glycemic control in people with drug-treated diabetes was 34.5% when determined by HbA1c, 37.8% when determined by FPG level, and 24.5% when both criteria were met. Mean body-mass index and fasting serum triglycerides were significantly higher and serum high-density lipoprotein-cholesterol significantly lower in individuals with an inadequate glycemic control than in those with adequate control. Women with diabetes were almost twice as likely to have inadequate HbA1c levels as men with diabetes (OR, 1.9, [95% CI, 1.03, 3.5]).

CONCLUSIONS

Glycemic control in Kuwaiti adults with treated diabetes is low. A systemic, multi-disciplinary public health approach is needed to improve diabetes education and adherence to treatment.

Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period

BACKGROUND

This study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period.

METHODS

A total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3-12 months.

RESULTS

Patients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m² and presence of hypertension were associated with a decreased risk of poor glycemic control.

CONCLUSION

Using data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.

Organisational and individual characteristics associated with glycaemic control among patients with type 2 diabetes: cross-sectional study in China

OBJECTIVE

There is a high prevalence of poor glycaemic control among patients with type 2 diabetes (T2DM) in China. This study aimed to explore both organisational and individual characteristics associated with glycaemic control among patients with T2DM.

DESIGN

Cross-sectional survey.

SETTING

Shandong Province, China.

PARTICIPANTS

The participants were 2166 patients with T2DM and 337 healthcare providers from 36 urban communities and 36 rural villages in Shandong Province.

PRIMARY AND SECONDARY OUTCOME MEASURES

Multistage stratified sampling procedures were used to measure demand-side individual demographic, clinical and self-management characteristics, and supply-side organisational characteristics, and the status of glycaemic control. Multilevel logistic regression analysis was performed to assess key determinants of glycaemic control.

RESULTS

Only 42.8% of the patients with T2DM achieved good glycaemic control. Age, income, hypertension and self-efficacy were significantly positive predictors of optimal glycaemic control, while duration of diabetes, antidiabetic drugs and monitoring of blood glucose were significantly negative predictors of that. Private VCs (OR=0.48, 95% CI 0.29 to 0.82, p<0.01) and lack of healthcare providers (OR=0.69, 95% CI 0.53 to 0.89, p<0.01; OR=0.71, 95% CI 0.52 to 0.98, p<0.05) were significantly negative predictors of optimal glycaemic control, while diabetes knowledge level of healthcare providers (OR=1.36, 95% CI 1.02 to 1.83, p<0.05; OR=1.45, 95% CI 1.00 to 2.10, p<0.05) and kinds of antidiabetic drugs (OR=1.37, 95% CI 0.97 to 1.93, p<0.1; OR=1.46, 95% CI 1.07 to 2.00, p<0.05) were significantly positive predictors of that.

CONCLUSIONS

Glycaemic control was suboptimal among patients with T2DM in China. The determinants of failing to achieve good glycaemic control included both organisational and individual characteristics. Potential interventions that target patients, providers and the healthcare organisations should be taken to improve the glycaemic control and health outcome among patients with T2DM.

Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan

AIMS

The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.

The Status of Metabolic Control in Patients With Type 2 Diabetes Attending Dasman Diabetes Institute, Kuwait

Purpose: To evaluate metabolic control in patients with type 2 diabetes at Dasman Diabetes Institute (DDI, Kuwait), a specialist diabetes clinic and research center, and to investigate its association with patient demographics and clinical characteristics. Methods: Data from 963 patients with type 2 diabetes were retrospectively collected from the Knowledge Based Health Records maintained at DDI for patients who attended DDI during 2011-2014. The collected data included patient demographics, clinical characteristics, and anti-diabetic medications. Student's t-test was used to evaluate the differences in mean values between poor and good glycemic control groups. Categorical variables were assessed using chi-square analysis with Fisher's exact test for small data sets. Results: The patients' mean age was 53.0 ± 9.5 years with equal number of males and females. Females (34.4 ± 7.2 kg/m²) had a higher mean body mass index than males (32.1 ± 6.4 kg/m²). The mean fasting blood glucose and HbA1c levels were 9.6 ± 3.8 mmol/L and 8.5 ± 1.8%, respectively. Dyslipidemia (46%) and hypertension (40%) were the most common comorbidities, whereas nephropathy (36%) and neuropathy (35%) were the most common diabetic complications. The most commonly used anti-diabetic medication was metformin (55%). Factors significantly associated with poor glycemic control (HbA1c level ≥ 7%) included insulin use; neuropathy or foot ulcers as diabetic complications; and elevated systolic blood pressure and total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and fasting blood glucose levels. Factors significantly associated with good glycemic control included metformin use and elevated high-density lipoprotein cholesterol level. The proportion of patients with good glycemic control (HbA1c level < 7%) was 29.5%. A large proportion of the patients with poor glycemic control were only administered monotherapy drugs, and two-thirds of the patients were obese. Further, the American Diabetes Association (ADA) recommendations for blood pressure and LDL cholesterol level were met (62 and 63%, respectively) by follow-up year 4. Conclusion: The therapeutic management of type 2 diabetes in Kuwait is suboptimal. Therapeutic strategies should ensure better adherence to ADA guidelines, evaluate the high obesity rates, and adherence to lifestyle recommendations by patients, and continually promote diabetes education and self-empowerment.

Glycaemic control for people with type 2 diabetes in Saudi Arabia - an urgent need for a review of management plan

BACKGROUND

The aim of this study was to assess inadequate glycaemic control and its associated factors among people with type 2 diabetes in Saudi Arabia.

METHODS

A cross-sectional study design was used. Adults with type 2 diabetes attending diabetes centres in Riyadh, Hofuf and Jeddah cities were interviewed and their anthropometrics were measured. Their medical records were also reviewed to collect information related to recent lab tests, medications, and documented comorbidities. Multivariable logistic regression were used for data analysis.

RESULTS

A total of 1111 participants were recruited in the study. Mean age was 57.6 (±11.1) years, 65.2% of the participants were females, and mean HbA1c was 8.5 ± 1.9%. About three-fourths of participants had inadequate glycaemic control (≥ 7%). Multivariable analysis showed that age ≤ 60 years, longer duration of diabetes, living in a remote location, low household income, low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, low adherence to medication, and using injectable medications were independent risk factors for inadequate glycaemic control.

CONCLUSIONS

Inadequate glycaemic control is prevalent among people with type 2 diabetes in Saudi Arabia. In order to improve glycaemic control diabetes management plan should aim at controlling the modifiable risk factors which include low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, and low adherence to medications.

Challenges in the management of Type 2 Diabetes among native women in the United Arab Emirates

AIM

To investigate Type 2 Diabetes mellitus (T2DM) management in native female patients in the United Arab Emirates (UAE).

METHODS

Ninety women from the outpatient diabetes clinic at Tawam Hospital, UAE, were interviewed face-to-face about how they manage their disease, using a structured questionnaire. Clinical values of the patients were extracted from medical records.

RESULTS

The mean age of the women was 57.5 (SD: 12.7) years and half of them were illiterates. Two-third of the participants had hypertension and/or high cholesterol. A majority reported to have received information about lifestyle modification but admitted low physical activity and unhealthy diet. Mean weight and BMI were 80.0 (SD: 17.2) kg and 33.5 (SD: 6.3) kg/m², respectively. Although the majority were taught how to measure blood glucose, 46% considered self-measurement difficult. Oral antihyperglycemic drugs were used by 96% of participants, and 31% were also taking injections. Forty-nine percent had HbA1c values below 7% and the average was 7.7% (range: 4.9-14.1). Two-third had systolic blood pressure (SBP) and low-density lipoprotein (LDL) values within the target range.

CONCLUSION

Despite major challenges in T2DM management among native female patients in UAE, this study shows that one in two patients had an overall glycemic control that was acceptable.

Patient-Related Determinants of Glycaemic Control in People with Type 2 Diabetes in the Gulf Cooperation Council Countries: A Systematic Review

The aim of this systematic review is to assess patient-related factors affecting glycaemic control among people with type 2 diabetes in the Arabian Gulf Council countries. MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases were searched from their date of inception to May 2016. Two researchers independently identified eligible studies and assessed the risk of bias. A total of 13 studies met the inclusion criteria. One study was population based, six recruited participants from multiple centres, and the remaining were single centred. The majority of the studies were of low to moderate quality. Factors associated with poor glycaemic control include longer duration of diabetes, low level of education, poor compliance to diet and medication, poor attitude towards the disease, poor self-management behaviour, anxiety, depression, renal impairment, hypertension, and dyslipidaemia. Healthcare providers should be aware of these factors and provide appropriate education and care especially for those who have poor glycaemic control. Innovative educational programs should be implemented in the healthcare systems to improve patient compliance and practices. A variation in the results of the included studies was observed, and some potentially important risk factors such as dietary habits, physical activity, family support, and cognitive function were not adequately addressed. Further research is needed in this area.

The prevalence and determinants of poor glycemic control among adults with type 2 diabetes mellitus in Saudi Arabia

BACKGROUND

Although the prevalence of type 2 diabetes mellitus (T2DM) is rising sharply in Saudi Arabia, data on glycemic control, crucial to reducing diabetes mellitus complications, remain scarce. This study therefore investigated glycemic control status and the factors influencing poor glycemic control among adult T2DM patients in Saudi Arabia.

METHODS

This cross-sectional study examined 423 T2DM patients at a diabetic center in Tabuk, Saudi Arabia between September 2016 and July 2017. Glycemic levels were measured via fasting blood glucose (FBG) levels, and "poor glycemic control" was defined as FBG >130 mg/dL. Poor glycemic control's risk factors were identified using a logistic regression.

RESULTS

In the sample, 74.9% of the patients had poor blood glycemic control. Logistic regression revealed that T2DM patients had an increased chance of poorly controlled diabetes if they had family histories of diabetes (adjusted odds ratio [AOR] =7.38, 95% CI 4.09-13.31), longer diabetic durations (AOR =2.33, 95% CI 1.14-4.78 for 5-10 years and AOR =5.19, 95% CI 2.50-10.69 for >10 years), insufficient physical exercise (AOR =19.02, 95% CI 6.23-58.06), or were overweight (AOR =3.79, 95% CI 2.00-7.18), or obese (AOR =5.35, 95% CI 2.72-12.59).

CONCLUSION

A high proportion of the sampled patients had poor glycemic control, therefore, health care professionals should manage the associated risk factors to limit disease complications and improve the health of patients with diabetes.

Glycaemic control in Sudanese individuals with type 2 diabetes: Population based study

BACKGROUND

Diabetes mellitus (DM) is a major health problem in Sudan and is a leading cause of morbidity and mortality. The objective of this study was to determine the prevalence of glycaemic control among individuals with type 2 diabetes across different cities in Sudan.

METHODS

Individuals with type 2 diabetes attending selected diabetes centres in Sudan, who had been on treatment for DM for at least one year and volunteered to participate were included. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic and life style characteristics. Lipid profile and glycosylated hemoglobin were tested by calibrated laboratory methods. Blood pressure, Body mass index (BMI) and waist circumference were measured. Chi squared and logistic regression were used as statistical methods.

RESULTS

A total of 387 individuals with T2DM were included in this study (50.4% males and 49.6% females). The glycemic control indicator (HbAIc>7) was poor in 85% of patients. Factors associated with poor glycemic control were prolonged duration of diabetes (p=0.03), high plasma triglyceride (p=0.02), low high density lipoprotein (HDL) level (p=0.04) and low glomerular filtration rate (GFR) (P=0.01). Logistic regression analysis showed that low GFR is independent factor with poor diabetes control.

CONCLUSION

High prevalence of uncontrolled diabetes (85%) is noted in Sudanese individuals with type 2 diabetes.

Five-year comparison of diabetic control between community diabetic center and primary health-care centers

CONTEXT

Hyperglycemia is the most important factor for development of complications. A high level of hemoglobin A1c (HbA1c) is linked with such complications of diabetes.

AIMS

The aim of this study was to compare diabetic care between community diabetic center (CDC) and primary health centers.

SETTINGS AND DESIGN

This was a retrospective cohort study conducted at King Abdulaziz Medical City for National Guard Health Affairs at Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

Data were retrieved from electronic medical records for diabetes mellitus Type 2 patients who were treated at two settings: CDCs and primary healthcare.

STATISTICAL ANALYSIS USED

SPSS (V21) was used to analyze the univariate and bivariate analysis, Student's t-test for continuous variables and Chi-square test for binary variables were used. P value was set as statistically significant if it is <0.05.

RESULTS

The mean difference for HbA1c from first to last visits increased significantly +0.2 ± 1.67 with P = 0.002 while the low-density lipoprotein (LDL) on the other way around improved by decrease of -0.159 ± 0.74 and P < 0.000. Body mass index (BMI) among the sample increased by +0.134 ± 1.57 with no significant, P = 0.078. Among the sample, 39.5% improved their HbA1c while 56.8% deteriorated and 3.6% of the samples' readings remain the same. 55.3% of the sample improved in LDL and 52.4% in the high-density lipoprotein while 53.7% improved in triglycerides. The BMI was improved among 43.4% of diabetic patients.

CONCLUSIONS

The 5-year management of diabetic patients failed to improve the A1c or BMI, at both CDC and primary health-care centers.

Characteristics of Registered Diabetics in Dhank Province in the Sultanate of Oman

OBJECTIVE

The aim of this study was to estimate the prevalence of registered diabetics and describe the clinical and epidemiological characteristics of patients with type 2 diabetes mellitus (T2DM) in three primary health care centers in the Dhank province of Oman.

METHODS

This cross-sectional study included 567 individuals aged > 20 years old. Clinical data were obtained retrospectively from physical registers and electronic clinical records.

RESULTS

Of the total 567 patients with T2DM (age-stratified prevalence = 10.2%), 44.8% were men. The mean age of the patients was 55.8±15.6, and they had a mean body mass index (BMI) of 29.7±6.0. Diabetes duration was 5.9±4.0 years. Overall, 28.4% of the patients had glycated hemoglobin values < 7%. The percentages of patients who did not reach the recommended targets for high-density lipoprotein (HDL) (< 1.0 mmol/L), low-density lipoprotein (LDL) (> 2.59 mmol/L) and triglycerides (TG) (< 1.69 mmol/L) were 63.3%, 60.0%, and 34.6%, respectively. Almost half of all patients (43.40%) had a BMI > 30. Obesity and overweight were more prevalent in patients in the 30-59 age group compared to patients aged < 30 or > 60 years (p < 0.001). Almost all patients (93%) had an estimated Glomerular Filtration Rate (eGFR) of more than 60 mL/min/1.73m(2). The number of patients diagnosed with T2DM aged < 60 years has been increasing gradually from 2008 to 2015 compared to those > 60 years (p = 0.017). Patients were managed by lifestyle measures (14.2%), oral hypoglycemic agents (one or two; 50%), and insulin therapy (35.7%).

CONCLUSIONS

The prevalence of registered T2DM patients in Dhank is less than the national figure. This may be due to the location of Dhank as a border province. Further qualitative studies are recommended to elaborate on the factors that lead to poor glycemic control.

Glycaemic control and associated factors among patients with diabetes at public health clinics in Johor, Malaysia

OBJECTIVES

To determine the prevalence of glycaemic control and factors associated with poor glycaemic control [glycosylated haemoglobin (HbA1c) ≥6.5%] among patients with type 2 diabetes treated in public health clinics in Johor, Malaysia.

STUDY DESIGN

Cross-sectional study.

METHODS

A review of all patients aged over 18 years and with a diagnosis of type 2 diabetes for >1 year. The National Diabetic Registry was used as the database for attendees at public health clinics in Johor Bahru between January and December 2013. A required sample of 660 was calculated, and a random sampling method was applied to acquire patient information across the 13 public health clinics in Johor Bahru. All relevant information (e.g. HbA1c, type of treatment and other parameters for glycaemic control) were abstracted from the registry.

RESULTS

Sixty-eight percent of 706 patients had HbA1c >6.5%, and mean HbA1c was 7.8%. Younger patients (72.3%) had poorer glycaemic control than older patients (63.0%), and most patients with poor glycaemic control were obese (79.2%). Approximately 31.7% of patients did not achieve the target blood pressure <130/80 mmHg, and 58.5% did not achieve the target lipid profile. Multiple logistic regression analysis revealed that age (<60 years), sex (male), duration of diabetes (>5 years), body mass index (obese), type of treatment (diet therapy vs combination therapy) and abnormal lipid profile were significantly associated with increased odds of HbA1C >6.5%.

CONCLUSIONS

More than half (68%) of the patients with diabetes had HbA1c >6.5%. This highlights the importance of providing organized care to manage patients with diabetes in the primary care setting, such as weight reduction programmes, proper prescribing treatment, and age- and gender-specific groups to ensure good glycaemic control.