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Akale M, Tadesse T, Arega B. Assessment of Quality of Diabetic Care in Teaching Hospitals in Ethiopia: In Comparison to International Guidelines. Diabetes Metab Syndr Obes 2024; 17:691-700. [PMID: 38352233 PMCID: PMC10863472 DOI: 10.2147/dmso.s441764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background Comprehensive high quality of care is critical in preventing diabetic complications and improving quality of life. This needs compliance with guidelines and focused therapy. There is no data in Ethiopia evaluating the quality of diabetes care using standard guidelines (American diabetic association and international diabetic federation) as a reference. Methods A cross-sectional study was conducted at Yekatit 12 Hospital Medical College (YHMC) to assess the process and outcome quality indicators of diabetic patients. Data were collected from outpatient clinics between May and July 2022 over a period of 3 months. Diabetic patients with at least one year since diagnosis were selected using systematic random sampling. Both the process and outcome of diabetic quality care indicators were measured and compared with standard guidelines (ADA and IDF). Both descriptive statistics and logistic regression were used for data analysis. The P-value <0.05 was used as statistical significance. Results About 250 diabetic patients with a mean age of 53±15 were included. The majority were type 2 diabetes mellitus (83.2%). HbA1c was determined for 128 (51.2%) patients with the recent mean value of 8±1.6. Only 52 (40.6%) of patients achieved target HbA1c. Annual comprehensive feet examination, urine albuminuria test, and retinal examination were done for 54 (21.6%), 52 (20.8%), and 122 (48.8%), respectively. Single marital status (AOR = 5.76; 95% CI; 1.02-32.36) P = 0.047, determining HbA1c level at least twice a year (AOR = 6.27; 95% CI; 2.18-17.73) P = 0.001, and medication adherence (AOR = 7.1; 95% CI; 2.61-19.01)P = 0.001, were significantly associated with good glycemic control. Conclusion The overall quality of diabetic care was found suboptimal both in process and outcome quality indicators. Thus, awareness creation about quality indicators for caregivers, compliance with guidelines, wise resource utilization, and cooperation with different stakeholders like hospital management teams, and government officials is needed.
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Affiliation(s)
- Mengesh Akale
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Tirhas Tadesse
- Department of Public Health, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Balew Arega
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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Lengeiya F, Mathenge S, Ojola P. Relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetic medications: a cross-sectional study. Pan Afr Med J 2024; 47:37. [PMID: 38586073 PMCID: PMC10998250 DOI: 10.11604/pamj.2024.47.37.41815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction type 2 Diabetes mellitus is a chronic metabolic disease with devastating effects on patients and results in numerous healthcare challenges in terms of its management and the cost burden among the affected. Successful management involves maintaining optimal glycemic control to prevent complications, with adherence to antidiabetic medications playing a crucial role in achieving this objective. Additionally, maintaining a healthy electrolyte balance is key for overall well-being and physiological function. However, the correlation between glycated hemoglobin and electrolyte balance remains under investigated, particularly in patients with suboptimal adherence. The aim of this research was to study the relationship between glycated hemoglobin and electrolytes among diabetic patients with poor adherence to antidiabetic medications. Methods this study was conducted at Samburu County Referral Hospital in Samburu County, Kenya. We employed a descriptive cross-sectional design focusing on adult diabetic patients aged 18 years and above who had visited the diabetic clinic over a three-month period. To evaluate their adherence levels, we employed a Morisky Medication Adherence Scale-8. Seventy-two diabetic patients who got adherence level scores of < 6 were categorized as having low adherence and their blood samples were collected for measuring glycated hemoglobin levels and electrolytes levels particularly potassium, sodium, calcium, magnesium, phosphorus and chloride. Relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetics was determined using Karl Pearson correlation. Results among the study participants, the lowest hemoglobin A1C (HbA1c) level recorded was 5.1% while the highest was 15.0% and the majority (41.7%) fell within the HbA1c range of 5-7%. A high proportion of individuals (58.3%) with poor adherence to antidiabetics had elevated HbA1c levels, indicating poor glycemic control. The correlations observed between glycated hemoglobin and electrolytes which included magnesium, sodium, chloride, calcium and phosphorus was r= -0.07, -0.32, -0.05 -0.24 and -0.04 respectively. Conclusion this study concluded that there is a relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetics. A statistically significant negative correlation was observed between glycated hemoglobin and calcium level (r=-0.2398 P ≤0.05) and also sodium (r=-0.31369 P≤0.05). A negative correlation (P≥0.05) was observed between phosphorus, magnesium, chloride and potassium with HbA1c levels though not statistically significant.
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Affiliation(s)
- Francis Lengeiya
- Department of Medical Laboratory Sciences, Kenyatta University, Nairobi, Kenya
| | | | - Patroba Ojola
- Department of Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya
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Tusubira AK, Ssinabulya I, Kalyesubula R, Nalwadda CK, Akiteng AR, Ngaruiya C, Rabin TL, Katahoire A, Armstrong-Hough M, Hsieh E, Hawley NL, Schwartz JI. Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001777. [PMID: 38079386 PMCID: PMC10712841 DOI: 10.1371/journal.pgph.0001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda. METHODS Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants' healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient's conditions. RESULTS Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (P<0.0001). Participants with DM or HTN/DM were more frequently educated about their health condition(s), dietary habits, and weight management than those with only HTN. Specifically, education about their conditions yielded adjusted odds ratios (aOR) of 5.57 for DM-only and 4.12 for HTN/DM. Similarly, for diet, aORs were 2.77 (DM-only) and 4.21 (HTN/DM), and for weight management, aORs were 3.62 (DM-only) and 4.02 (HTN/DM). Medication adherence was notably higher in DM-only participants (aOR = 2.19). Challenges in self-care were significantly more reported by women (aOR = 2.07) and those above 65 years (aOR = 5.91), regardless of their specific condition(s). CONCLUSION Compared to rural Ugandans with HTN-only, participants with DM had greater utilization of healthcare services, exposure to self-care education, and adherence to medicine and self-monitoring behaviors. These findings should inform ongoing efforts to improve and integrate NCD service delivery in rural SSA.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, California, United States of America
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, United States of America
- Department of Epidemiology, School of Global Public Health, New York University, New York, United States of America
| | - Evelyn Hsieh
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Yeheyis T, Hoyiso D, Ekubazgi KW, Chura GK, Alemayehu Y. The Pattern of Initial Presentation of Diabetes, Treatment Outcome and Its Predictors Among Diabetic Pediatrics Attended Service at Selected Public Hospitals of Southern Ethiopia: A Multi-Center Study. Risk Manag Healthc Policy 2023; 16:2485-2495. [PMID: 38024493 PMCID: PMC10676097 DOI: 10.2147/rmhp.s437361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Diabetes mellitus is the most common metabolic disorder in the pediatric population. Globally the incidence of diabetes increased from 11.3 million (95% UI 10.6-12.1) in 1990 to 22.9 million (21.1-25.4) in 2017, with a 102.9% increase and there was a 3% increase in diabetes mortality rates by age between 2000 and 2019. Objective This study aims to assess the pattern of initial presentation of pediatric diabetes mellitus, treatment outcome, and its predictors among pediatrics who attended service at selected public hospitals in southern Ethiopia from 2015 to 2019. Methods A cross-sectional study was conducted among 422 randomly selected pediatrics from October 1st, 2021 to December 30, 2021, and participants were selected randomly from 8 randomly selected public hospitals in southern Ethiopia after proportional to client flow allocation of samples. Data was extracted from clients' charts using a data extraction checklist. Statistical Package for Social Sciences (SPSS) version 24, and logistic regression analysis were applied to determine the presence of an association between dependent and independent variables, and significance was declared at p-value <0.05. Results In this study, most (74.6%) of the pediatrics initially presented with Diabetic ketoacidosis (DKA). This study found that Two-thirds (67.1%) of the respondents in the study had a good treatment outcome. In this study residence, presenting signs and symptoms; poly symptoms and weight loss, history of hospitalization, and comorbidity were predictors of treatment outcome of pediatric diabetes mellitus. Conclusion Diabetes mellitus with Diabetic ketoacidosis is the predominant pattern of initial presentation in the study. The magnitude of poor treatment outcomes of diabetes mellitus among pediatrics in this study is high and unacceptable Residence, signs, and symptoms at initial presentation, history of hospitalization, and comorbidity were found to be significant independent predictors of treatment outcome of pediatric diabetes mellitus.
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Affiliation(s)
- Tomas Yeheyis
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dawit Hoyiso
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kinfe Woldu Ekubazgi
- School of medicine, College of Medicine and health sciences, Hawassa University, Hawassa, Ethiopia
| | - Gemechu Kediro Chura
- Department of Nursing, College of medicine and health sciences, Meda Welabu University, Shashemene, Ethiopia
| | - Yonas Alemayehu
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Onyango JT, Namatovu JF, Besigye IK, Kaddumukasa M, Mbalinda SN. Social support from family, associated factors and relationship with glycemic control among diabetic patients in Uganda: a cross-sectional study. Pan Afr Med J 2023; 45:72. [PMID: 37663636 PMCID: PMC10474808 DOI: 10.11604/pamj.2023.45.72.38256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/10/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction social support from family members in diabetes management is a predictor of optimal glucose control. There is limited evidence of the relationship in Uganda. The objective was to determine association of social support from family and glycemic control, and association of social demographic and clinical characteristics with family support among diabetic patients in eastern Uganda. Methods this was a cross-sectional study involving 405 adult patients attending diabetic clinics between May 2021 and June 2021. Socio-demographics, clinical characteristics, social support from family, and glycemic control data were collected. Descriptive statistics were done and associations were determined using Pearson chi-square and Fisher´s exact tests. Generalized linear model was used to determine independent association with social support from family. Results the mean age was 52 years, (60%) were female, majority (49.4%) were 45-64 years old. Perceived social support from family (PSS-fa) and good glucose control were found in; (95.3%) and (20.99%) respectively. PSS-fa was associated with good glucose control. Financial contribution from family members to cost of care, cohesion among family members in support of care, being (married/cohabiting) and monthly income ≥28 USD were associated with PSS-fa. Factors independently associated with PSS-fa were; female gender, financial contribution to cost of care and cohesion among family in support of care. Conclusion social support from family was associated with good glycemic control. Factors associated with PSS-fa were; female gender, financial contribution from family to cost of care and cohesion among family in support of care.
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Affiliation(s)
- Jude Tadeo Onyango
- Department of Family Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda
| | | | | | - Mark Kaddumukasa
- Department of Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda
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Kibirige D, Chamba N, Andia-Biraro I, Kilonzo K, Laizer SN, Sekitoleko I, Kyazze AP, Ninsiima S, Ssekamatte P, Bongomin F, Mrema LE, Olomi W, Mbunda TD, Ntinginya NE, Sabi I, Sharples K, Hill P, Te Brake L, VandeMaat J, vanCrevel R, Critchley JA. Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e060786. [PMID: 36351737 PMCID: PMC9644326 DOI: 10.1136/bmjopen-2022-060786] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes. METHODS We systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the prevalence of five diabetes complications. RESULTS In total, 109 studies with a total of 63 890 participants (53.3% being females) were included in the meta-analysis. Most of the studies were conducted in Eastern African countries (n=44, 40.4%). The pooled proportion of attainment of an optimal HbA1c, BP and LDLC goal was 27% (95% CI 24 to 30, I2=94.7%), 38% (95% CI 30 to 46, I2=98.7%) and 42% (95% CI 32 to 52, I2=97.4%), respectively. The pooled prevalence of diabetic peripheral neuropathy, retinopathy, diabetic nephropathy, peripheral arterial disease and foot ulcers was 38% (95% CI 31 to 45, I2=98.2%), 32% (95% CI 28 to 36, I2=98%), 31% (95% CI 22 to 41, I2=99.3%), 19% (95% CI 12 to 25, I2=98.1%) and 11% (95% CI 9 to 14, I2=97.4%), respectively. CONCLUSION Attainment of optimal diabetes treatment goals, especially HbA1c, in adult patients with type 2 diabetes in Africa remains a challenge. Diabetes complications, especially diabetic peripheral neuropathy and retinopathy, are highly prevalent in adult populations with type 2 diabetes in Africa.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Lubaga Hospital, Kampala, Uganda
| | - Nyasatu Chamba
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunomudation and Vaccines, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Sweetness Naftal Laizer
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Isaac Sekitoleko
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew Peter Kyazze
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sandra Ninsiima
- Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Lucy Elauteri Mrema
- Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | - Willyhelmina Olomi
- Department of Medical Statistics, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | - Theodora D Mbunda
- Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | | | - Issa Sabi
- Department of Paediatrics and Child Health, NIMR-Mbeya Medical Research Programme, Mbeya, Tanzania
| | - Katrina Sharples
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Lindsey Te Brake
- Department of Pharmacology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Josephine VandeMaat
- Department of Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Reinout vanCrevel
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
- University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
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Kidie AA, Ayal BG, Ayele T, Fentie EA, Lakew AM. Poor glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia, 2020: facility-based cross sectional retrospective study design. Sci Rep 2022; 12:15664. [PMID: 36123389 PMCID: PMC9485249 DOI: 10.1038/s41598-022-19909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Diabetes mellitus is a global public health problem. Glycemic control is a major public health problem. Diabetes results from elevated levels of glycaemia such as increased glucose and glycated hemoglobin, and controlling glycaemia is an integral component of the management of diabetes. Glycemic control in children is particularly difficult to achieve. Identifying determinants of poor glycemic control is important for early modification of diabetic related end organ damages. This study was aimed to assess the status of glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia. Facility-based cross sectional retrospective cohort study design was used and this study was conducted from September, 2015 to February, 2018. Simple random sampling was used to select 389 samples. Data were collected using an extraction checklist. Data were entered into Epi-data − 4.6, and analyzed using Stata-16. Finally, multivariable binary logistic regression was done. Poor glycemic control was more common among pediatric patients 39.3% (95% CI 34.6, 44.3). Treatment discontinuation (AOR 2.42, 95% CI 1.25, 4.69), age (AOR 1.15, 95% CI 1.03, 1.28) and treatment dose (AOR 0.96, 95 CI 0.92, 0.99) were significantly associated with poor glycemic control. Prevalence of poor glycemic control was high. Patient’s age, history of treatment discontinuation and dose of treatment were the significant contributing factors to poor glycemic control. These need to be addressed to attain the objective of adequate glycemic control.
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Affiliation(s)
- Atitegeb Abera Kidie
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia.
| | | | - Tiruneh Ayele
- Department of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Abera RG, Demesse ES, Boko WD. Evaluation of glycemic control and related factors among outpatients with type 2 diabetes at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMC Endocr Disord 2022; 22:54. [PMID: 35249547 PMCID: PMC8898656 DOI: 10.1186/s12902-022-00974-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The goals of glycemic management for patients with diabetes are to prevent or delay complications and optimize quality of life. However, in clinical practice, the recommended glycemic control target is difficult to achieve. Therefore, it is important to identify factors that influence the outcomes of glycemia to improve the quality of diabetic management. The study aimed to evaluate the level and factors associated with glycemic control among type 2 diabetic outpatients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. METHODS A hospital-based cross-sectional study was conducted among systematically selected 325 patients with type 2 diabetes who attended diabetic clinics at Tikur Anbessa Specialized Hospital. Pretested, structured, and interviewer-administered questionnaires were used to collect sociodemographic and diabetes-related information from March 1 to May 30, 2021. HbA1c was used to assess glycemic control according to the HbA1c target of < 7% ('good' control) as recommended by the American Diabetes Association for non-pregnant adults. The HbA1c level in the range of 7-8% was defined as 'inadequate' control and 'poor' at levels > 8%. Data entry and analysis were performed using SPSS v26. Multivariate logistic regression analysis was used to identify determinants of glycemic control. RESULTS The median level of HbA1c of the participants was 8.4% (IQR 6.8-10.1). And approximately three-quarters (73.8%) of the patients had inadequate and poor glycemic control (HbA1c ≥ 7%). Older age (AOR: 2.46, 95% CI: 1.28-6.01), DM duration of > 10 years (AOR: 3.15, 95% CI: 2.22-6.54), insulin therapy (AOR: 3.07, 95% CI: 2.10-6.12), poor diet compliance (AOR: 1.97, 95% CI: 1.28-3.52) and failure to set goals for glycemic control (AOR: 3.42, 95% CI: 2.17-5.97) were factors associated with inadequate and poor glycemic control. CONCLUSIONS The study revealed that a significant number of diabetic patients had inadequate and poor glycemic control levels. And this was associated with older age, longer duration of DM, insulin therapy, poor diet compliance, and failure to set control goals. This requires a focus on the associated factors identified and tailored management mechanisms to maintain good glycemic control.
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Affiliation(s)
- Rodas Getachew Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Eyouel Shimeles Demesse
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wako Dedecha Boko
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Niwaha AJ, Rodgers LR, Greiner R, Balungi PA, Mwebaze R, McDonald TJ, Hattersley AT, Shields BM, Nyirenda MJ, Jones AG. HbA1c performs well in monitoring glucose control even in populations with high prevalence of medical conditions that may alter its reliability: the OPTIMAL observational multicenter study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002350. [PMID: 34535465 PMCID: PMC8451306 DOI: 10.1136/bmjdrc-2021-002350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/22/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The utility of HbA1c (glycosylated hemoglobin) to estimate glycemic control in populations of African and other low-resource countries has been questioned because of high prevalence of other medical conditions that may affect its reliability. Using continuous glucose monitoring (CGM), we aimed to determine the comparative performance of HbA1c, fasting plasma glucose (FPG) (within 5 hours of a meal) and random non-fasting glucose (RPG) in assessing glycemic burden. RESEARCH DESIGN AND METHODS We assessed the performance of HbA1c, FPG and RPG in comparison to CGM mean glucose in 192 Ugandan participants with type 2 diabetes. Analysis was undertaken in all participants, and in subgroups with and without medical conditions reported to affect HbA1c reliability. We then assessed the performance of FPG and RPG, and optimal thresholds, in comparison to HbA1c in participants without medical conditions thought to alter HbA1c reliability. RESULTS 32.8% (63/192) of participants had medical conditions that may affect HbA1c reliability: anemia 9.4% (18/192), sickle cell trait and/or hemoglobin C (HbC) 22.4% (43/192), or renal impairment 6.3% (12/192). Despite high prevalence of medical conditions thought to affect HbA1c reliability, HbA1c had the strongest correlation with CGM measured glucose in day-to-day living (0.88, 95% CI 0.84 to 0.91), followed by FPG (0.82, 95% CI 0.76 to 0.86) and RPG (0.76, 95% CI 0.69 to 0.81). Among participants without conditions thought to affect HbA1c reliability, FPG and RPG had a similar diagnostic performance in identifying poor glycemic control defined by a range of HbA1c thresholds. FPG of ≥7.1 mmol/L and RPG of ≥10.5 mmol/L correctly identified 78.2% and 78.8%, respectively, of patients with an HbA1c of ≥7.0%. CONCLUSIONS HbA1c is the optimal test for monitoring glucose control even in low-income and middle-income countries where medical conditions that may alter its reliability are prevalent; FPG and RPG are valuable alternatives where HbA1c is not available.
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Affiliation(s)
- Anxious J Niwaha
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Lauren R Rodgers
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Rosamund Greiner
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Priscilla A Balungi
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Raymond Mwebaze
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Timothy J McDonald
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Moffat J Nyirenda
- NCD Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- NCD Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angus G Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
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Tusubira AK, Nalwadda CK, Akiteng AR, Hsieh E, Ngaruiya C, Rabin TL, Katahoire A, Hawley NL, Kalyesubula R, Ssinabulya I, Schwartz JI, Armstrong-Hough M. Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda. Ann Glob Health 2021; 87:86. [PMID: 34458110 PMCID: PMC8378074 DOI: 10.5334/aogh.3308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings. Objective We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda. Methods Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes. Results Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities. Conclusion Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients' social support networks.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY USA
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11
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Shiferaw WS, Akalu TY, Desta M, Kassie AM, Petrucka PM, Assefa HK, Aynalem YA. Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:1941-1949. [PMID: 33039936 DOI: 10.1016/j.dsx.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Diabetic retinopathy is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of glycemic control on the risk of diabetic retinopathy, but the results remain inconclusive. Therefore, this meta-analysis was performed to determine the association between glycated hemoglobin A1C levels and diabetic retinopathy in Africa. METHODS A systematic search was performed using the PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library from inception to June 11, 2020, for observational studies addressing the association of hemoglobin A1c levels with diabetic retinopathy. The I2 statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size (OR) and respective 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was used to determine the effect of a single study on the overall estimation. All statistical analyses were performed using STATA™ Version 14 software. RESULT A total of 23 articles with 18,099 study participants were included in this meta-analysis. In the present review, when HbA1c was analyzed as a categorical variable, poor glycemic control (HbA1c >7%) was associated with an increased risk of diabetic retinopathy when compared with good glycemic control (OR = 1.25; 95% CI; 1.14, 1.38). Similarly, when HbA1c was analyzed as a continuous variable, a higher HbA1c was associated with an increased risk of diabetic retinopathy (MD: 0.42, 95% CI; 0.11, 0.98). CONCLUSION Our meta-analysis indicated evidence for poor glycemic control as an independent risk factor for the development of diabetic retinopathy in patients with diabetes mellitus. Therefore, the authors suggest that clinicians should advise their patients with diabetes to maintain their HbA1c levels within the normal range.
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Affiliation(s)
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, Ethiopia
| | | | | | - Hilina Ketema Assefa
- Department of Nursing, College of Health Science, Debre Berhan University, Ethiopia
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Debre Berhan University, Ethiopia
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Balogun WO, Uloko AE, Owolabi MO. Atypical Diabetes Presentations in Sub-Saharan Africa Classification Puzzle and Possible Role of Precision Medicine. West Afr J Med 2020; 37:574-582. [PMID: 33058135 PMCID: PMC11250995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Precision in the diagnosis and classification of diabetes mellitus, a complex heterogeneous disease is increasingly required to achieve treatment goals and prevent complications. Several reviews over decades have not completely solved the diabetes classification puzzle. African clinicians are sometimes confronted with the difficulty of classifying a newly diagnosed diabetes patient presenting atypically. These unusual presentations fall into those with diagnosis of either clinical type 1 or 2 diabetes but having some diagnostic and/or therapeutic features at variance with what are seen in the Western nations, those with tropical diabetes and those known as ketosis-prone type 2 diabetes (KPD). Reports from many African countries indicate that patients do not fit the classic pattern seen in the Western nations. In recent times, there has been groundswell of pressures and proposed models to evolve a more accurate classification of diabetes and the recent 2019 WHO diabetes classification seems to have acknowledged and accommodated these concerns. Perhaps advances in genomic knowledge could help with precision in diabetes classification, especially in Africa. This review seeks to highlight the challenges often encountered with classifying diabetes patients in Africa, and proffer suggestions on the way forward including possible benefit from advances in molecular genomics.
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Affiliation(s)
- W O Balogun
- Department of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria. PMB 5116 Ibadan, Nigeria
| | - A E Uloko
- Department of Medicine, Aminu Kano Teaching Hospital Kano, Bayero University Kano, Kano, Nigeria
| | - M O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria. PMB 5116 Ibadan, Nigeria
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Sheleme T, Mamo G, Melaku T, Sahilu T. Glycemic Control and its Predictors among Adult Diabetic Patients attending Mettu Karl Referral Hospital, Southwest Ethiopia: A Prospective Observational Study. Diabetes Ther 2020; 11:1775-1794. [PMID: 32583174 PMCID: PMC7376794 DOI: 10.1007/s13300-020-00861-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The current estimate is that 463 million people worldwide have diabetes. In 2017, an estimated 5 million (9.9%) deaths worldwide among adults were caused by diabetes. The burden of disease associated with uncontrolled diabetes is substantial in terms of mortality and cardiovascular disease. The aim of this study was to assess glycemic control level and its predictors among adult patients with diabetes. METHODS A prospective observational study was conducted among patients with diabetes during follow-up at an ambulatory clinic of Mettu Karl referral hospital from 15 April to 09 August 2019. The consecutive sampling method was used to collect data, following which the data were entered into Epidata manager version 4.4.2 and exported to the SPSS version 24.0 statistical software package for analysis. Logistic regression analysis was performed to identify predictors of poor glycemic control. Variables whose significance level was < 0.05 (p value) were considered to be predictors of poor glycemic control. RESULTS A total of 330 diabetic patients were included in the study, among whom 240 (72.7%) had poor glycemic control. The predictors of poor glycemic control in the multivariate logistic regression analysis were overweight [adjusted odds ratio (AOR) 4.07; 95% confidence interval (CI) 1.60, 10.36; p = 0.003], obesity (AOR 4.39; 95% CI 1.59, 12.14; p = 0.004), higher estimated glomerular filtration rate (eGFR) (AOR 2.34; 95% CI 1.23, 4.44; p = 0.010), type 1 diabetes (AOR 3.22; 95% CI 1.58, 6.55; p = 0.001), poor diet adherence (AOR 6.95; 95% CI 3.63, 13.32; p < 0.001) and non-adherence to medications (AOR 5.82; 95% CI 2.77, 12.26; p < 0.001). CONCLUSION Almost three-quarters of the study population of diabetic patients had poorly controlled blood sugar. Overweight, obesity, higher eGFR, type 1 diabetics, poor adherence to diet recommendation and non-adherence to medications were independent predictors of poor glycemic control. Educational strategies should focus on improving adherence to the recommended diet and medication(s), achieving weight control and optimizing glycemic control.
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Affiliation(s)
- Tadesse Sheleme
- Department of Pharmacy, College of Public Health and Medical Science, Mettu University, Mettu, Ethiopia.
| | - Girma Mamo
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tamiru Sahilu
- Department of Pharmacy, College of Health Science, Assosa University, Assosa, Ethiopia
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Blum J, Chaney M, Mudji J, Mfungwa JAK, Rice T, Labhardt ND. Glycaemic control among patients with type 2 diabetes followed in a rural African primary care setting - A reality check in the Democratic Republic of Congo. Prim Care Diabetes 2020; 14:139-146. [PMID: 31455548 DOI: 10.1016/j.pcd.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/21/2019] [Accepted: 08/02/2019] [Indexed: 01/04/2023]
Abstract
AIMS The aim of this study was to assess diabetes control in adult patients with type II diabetes and to evaluate its association with socio-economic characteristics in rural the Democratic Republic Congo (DRC). METHODS We recruited patients ≥18 years in care for type II diabetes in a hospital in rural DRC. Socio-economic status, medical history and diabetes control were assessed through a structured questionnaire, a physical examination and laboratory tests, such as fasting glucose, HbA1c, serum creatinine and urine analysis. Uni- and multivariate logistic regression was used to assess for patient factors associated with diabetes control. RESULTS 319 diabetic patients (212 men, 107 women) were enrolled. The target threshold of HbA1c level at 7.0% or below was met by 17.8% (19/107) of female and 12.3% (26/212) of male patients. The fasting plasma glucose level was <7.0mmol/l in 28.9% (31/107) and 36.3% (77/212) of women and men, respectively. Among participants with a fasting glucose <7.0mmol/l only 32.4% (35/108) had an HbA1c at 7.0% or below. None of the assessed socio-economic or lifestyle factors were predictive of diabetes control. CONCLUSIONS In this study among diabetic patients in care at a rural hospital in DRC, less than one out of five had an HbA1c ≤7.0%. Fasting plasma glucose at study visit had poor correlation with HbA1c, only a third of patients with a fasting glucose level <7mmol/l had an HbA1c ≤7.0%.
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Affiliation(s)
- Johannes Blum
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland
| | - Matthew Chaney
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland
| | - Junior Mudji
- Hôpital Evangélique de Vanga, Democratic Republic of Congo
| | | | - Timothy Rice
- Hôpital Evangélique de Vanga, Democratic Republic of Congo; School of Medicine, Saint Louis University, St. Louis, MO, United States
| | - Niklaus Daniel Labhardt
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland.
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15
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Kalain A, Omole OB. Lifestyle advice, processes of care and glycaemic control amongst patients with type 2 diabetes in a South African primary care facility. Afr J Prim Health Care Fam Med 2020; 12:e1-e6. [PMID: 32242428 PMCID: PMC7136806 DOI: 10.4102/phcfm.v12i1.2163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The influence of processes of diabetes care on glycaemic control is understudied in primary health care (PHC). AIM To explore the influence of lifestyle advice, drug regimen and other processes of care on glycaemic control. SETTING Johan Heyns Community Health Centre, Vanderbijlpark, South Africa. METHODS In a cross-sectional study involving 200 participants with type-2 diabetes, we collected information on sociodemography, comorbidity, processes of diabetes care, drug regimen and receipt of lifestyle advice. Anthropometric measures and glycosylated haemoglobin (HbA1c) were also determined. RESULTS Participants' mean age was 57.8 years and most were black people (88%), females (63%), overweight or obese (94.5%), had diabetes for 10 years (67.9%) and hypertension as comorbidity (98%). Most participants received lifestyle advice on one of diet, exercise and weight control (67%) and had their blood pressure (BP) checked (93%) in the preceding 12 months. However, 2% had any of HbA1c, weight, waist circumference or body mass index checked. Glycaemic control (HbA1c 7%) was achieved in only 24.5% of participants. Exclusive insulin or oral drug was prescribed in 5% and 62% of participants, respectively. Compared to insulin monotherapy, participants on combined metformin and insulin or metformin, sulphonylurea and insulin were less likely to have glycaemic control. Comorbid congestive cardiac failure (CCF) significantly increased the likelihood of glycaemic control. CONCLUSION There is substantial shortcomings in the implementation of key processes of diabetes care and glycaemic control. Strategies are needed to prompt and compel healthcare providers to implement evidence-based diabetes guidelines during clinic visits in South African PHC.
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Affiliation(s)
- Aswin Kalain
- Division of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Gebreyohannes EA, Netere AK, Belachew SA. Glycemic control among diabetic patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2019; 14:e0221790. [PMID: 31454396 PMCID: PMC6711596 DOI: 10.1371/journal.pone.0221790] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/14/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Ethiopia recorded the highest numbers of people with diabetes in Africa. It is not uncommon for diabetic patients to have poor glycemic control leading to a number of complications. The aim of this systematic review and meta-analysis is to evaluate the level of glycemic control among diabetic patients in Ethiopia by combining the studies from the existing literature. Materials and methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was employed to plan and conduct this review. A comprehensive electronic-based literature search was conducted in the databases of MEDLINE, HINARI, GOOGLE SCHOLAR, and SCIENCEDIRECT. Open meta-analyst software was used to perform meta-analyses. Proportions of good glycemic control among diabetic patients was calculated. Odds ratio was also calculated to check the presence of statistically significant difference in glycemic control among patients with type 1 and type 2 diabetes. Results A total of 22 studies were included in the final analysis. Meta-analysis of 16 studies showed that only one-third of patients [34.4% (95% CI: 27.9%-40.9%), p<0.001] achieving good glycemic control based on fasting plasma glucose measurements. Similar to the studies that used fasting plasma glucose, the rate of good glycemic control was found to be 33.2% [(95% CI: 21.8%-44.6%), p<0.001] based on glycosylated hemoglobin measurements. There was no statistically significant difference in the rates of glycemic control between patients with type 1 and type 2 diabetes (p = 0.167). Conclusion High proportion of diabetic patients were unable to achieve good glycemic control. There was no difference in glycemic control among type 1 and type 2 diabetic patients.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia
- * E-mail:
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia
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Leulseged TW, Ayele BT. Time to optimal glycaemic control and prognostic factors among type 2 diabetes mellitus patients in public teaching hospitals in Addis Ababa, Ethiopia. PLoS One 2019; 14:e0220309. [PMID: 31365544 PMCID: PMC6668794 DOI: 10.1371/journal.pone.0220309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/12/2019] [Indexed: 11/18/2022] Open
Abstract
AIM To estimate time to first optimal glycaemic control and identify prognostic factors among type 2 diabetes mellitus (T2DM) patients attending diabetes clinic of public teaching hospitals in Addis Ababa, Ethiopia. METHODS A retrospective chart review study was conducted at diabetes clinic of Addis Ababa's public teaching hospitals among a randomly selected sample of 685 charts of patients with T2DMwho were on follow up from January 1, 2013 to June 30, 2017. Data was collected using data abstraction tool. Descriptive statistics, Kaplan Meier plots, median survival time, Log-rank test and Cox proportional hazard survival models were used for analysis. RESULTS Median time to first optimal glycaemic control among the study population was 9.5 months. Factors that affect time to first optimal glycaemic control were age group (HR = 0.635, 95% CI: 0.486-0.831 for 50-59 years, HR = 0.558, 95% CI: 0.403-0.771for 60-69 years and HR = 0.495, 95% CI: 0.310-0.790 for > = 70 years), diabetes neuropathy (HR = 0.502, 95% CI: 0.375-0.672), more than one complication (HR = 0.381, 95% CI: 0.177-0.816), hypertension (HR = 0.611, 95% CI: 0.486-0.769), dyslipidemia (HR = 0.609, 95% CI: 0.450-0.824), cardiovascular disease (HR = 0.670, 95% CI: 0.458-0.979) and hospital patient being treated (HR = 1.273, 95% CI: 1.052-1.541). CONCLUSIONS Median time to first optimal glycaemic control among T2DM patients is longer than expected which might imply that patients are being exposed to more risk of complication and death.
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Affiliation(s)
- Tigist W. Leulseged
- Department of Internal medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Birhanu T. Ayele
- Divison of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Extent and Predictors of Poor Glycaemic Control among Elderly Pakistani Patients with Type 2 Diabetes Mellitus: A Multi-Centre Cross-Sectional Study. ACTA ACUST UNITED AC 2019; 55:medicina55010021. [PMID: 30658518 PMCID: PMC6358768 DOI: 10.3390/medicina55010021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/03/2018] [Accepted: 01/09/2019] [Indexed: 01/03/2023]
Abstract
Objectives: This study aimed to explore the relationship between glycaemic control and factors that may influence this among elderly type 2 diabetes mellitus (T2DM) patients in Lahore, Pakistan. Methods: This descriptive, cross-sectional study was conducted at the Jinnah and Sir Ganga Ram Hospitals, Lahore using convenience sampling techniques between 1 December 2015 and 28 February 2016. The sample consisted of elderly (>65 years) T2DM patients. Glycaemic values and patient characteristics were obtained from medical charts. Consenting patients were interviewed to complete the Barthel Index, Lawton Instrumental Activities of Daily Living Scale, Clinical Frailty Scale, Iowa Pain Thermometer Scale, Geriatric Depression Scale, Montreal Cognitive Assessment tool, Mini Nutritional Assessment Scale—Short Form and Self Care Inventory—Revised Version. Multiple logistic regression analysis was carried out to determine the predictors of poor glycaemic control. Results: A total of 490 patients were approached and 400 agreed to participate. Overall, nearly one-third (32.2%, n = 129) of patients had glycated haemoglobin (HbA1c) at the target level. Fasting and random plasma glucose levels were within the target range to much the same extent; (36.8%, n = 147) and (27%, n = 108), respectively. HbA1c levels were also higher in patients with co-morbidities (67.4%, n = 229) with diabetes-related complications (73.5%, n = 227). Significant predictors of impaired glycaemic control (HbA1c) included poor diabetes self-care (adjusted odds ratio (AOR) 0.96; 95% confidence interval (CI) 0.95, 0.98), not being prescribed oral hypoglycaemic agents (OHA) (AOR 6.22; 95% CI 2.09, 18.46), regular hypoglycaemic attacks (AOR 2.53; 95% CI 1.34, 4.81) and falling tendency (AOR 0.19; 95% CI 0.10, 0.36). Conclusions: Poor glycaemic control prevailed among the majority of elderly Pakistani diabetic patients in this study. Triggering factors of poor glycaemic control should be taken into consideration by the healthcare professionals in targeting multifaceted interventions to achieve good glycaemic control.
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Asmelash D, Abdu N, Tefera S, Baynes HW, Derbew C. Knowledge, Attitude, and Practice towards Glycemic Control and Its Associated Factors among Diabetes Mellitus Patients. J Diabetes Res 2019; 2019:2593684. [PMID: 31089472 PMCID: PMC6476031 DOI: 10.1155/2019/2593684] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/20/2018] [Accepted: 02/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a metabolic disorder of multiple etiologic factors characterized by chronic hyperglycemia with disturbance of carbohydrate metabolism. It can play the vital role in the cause of morbidity and mortality through continued clinical consequence. Therefore, good knowledge, attitude, and practices of glycemic control are necessary in promoting care, in enhancing better therapeutic outcomes, and in the prevention and management of diabetes complications. METHODS A cross-sectional study design was conducted to determine knowledge, attitude, and practice towards glycemic control and its associated factors. Diabetic patients who were attending the University of Gondar Hospital from March to May 2018 were included in the study. The data was collected using questionnaires, and individuals that can fulfill our inclusion criteria were selected by a simple random sampling technique. SPSS version 20 was used for descriptive and logistic regression analysis, and finally, the variables were summarized and presented using tables and graphs. RESULTS Of the total 403 participants, 216 (53.6%) were males and 176 (43.7%) were illiterate. Of the total, 250 (62%) had good knowledge, 271 (67.2%) had a good attitude, and 300 (74.4%) had good practice towards glycemic control. In multivariate logistic regression, occupational status and marital status were significantly associated with the knowledge of participants towards glycemic control. Occupational status, educational status, and marital status were significantly associated with attitude and practice towards glycemic control. CONCLUSION More than half of the participants had good knowledge, attitude, and practice towards glycemic control. Occupational status and marital status were significantly associated with knowledge, attitude, and practice towards glycemic control.
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Affiliation(s)
- Daniel Asmelash
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Netsanet Abdu
- Department of Medical Laboratory Sciences, School of Biomedical and Laboratory Sciences, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Samson Tefera
- Department of Medical Laboratory Sciences, School of Biomedical and Laboratory Sciences, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Wondifraw Baynes
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Cherie Derbew
- Department of Medical Laboratory Sciences, School of Biomedical and Laboratory Sciences, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
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Wan W, Skandari MR, Minc A, Nathan AG, Winn A, Zarei P, O'Grady M, Huang ES. Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial. Diabetes Care 2018; 41:1227-1234. [PMID: 29650803 PMCID: PMC5961392 DOI: 10.2337/dc17-1821] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/27/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the societal cost-effectiveness of continuous glucose monitoring (CGM) in patients with type 1 diabetes (T1D) using multiple insulin injections. RESEARCH DESIGN AND METHODS In the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial, 158 patients with T1D and HbA1c ≥7.5% were randomized in a 2:1 ratio to CGM or control. Participants were surveyed at baseline and 6 months. Within-trial and lifetime cost-effectiveness analyses were conducted. A modified Sheffield T1D policy model was used to simulate T1D complications. The main outcome was cost per quality-adjusted life-year (QALY) gained. RESULTS Within the 6-month trial, the CGM group had similar QALYs to the control group (0.462 ± 0.05 vs. 0.455 ± 0.06 years, P = 0.61). The total 6-month costs were $11,032 (CGM) vs. $7,236 (control). The CGM group experienced reductions in HbA1c (0.60 ± 0.74% difference in difference [DiD]), P < 0.01), the daily rate of nonsevere hypoglycemia events (0.07 DiD, P = 0.013), and daily test strip use (0.55 ± 1.5 DiD, P = 0.04) compared with the control group. In the lifetime analysis, CGM was projected to reduce the risk of T1D complications and increase QALYs by 0.54. The incremental cost-effectiveness ratio (ICER) was $98,108 per QALY for the overall population. By extending sensor use from 7 to 10 days in a real-world scenario, the ICER was reduced to $33,459 per QALY. CONCLUSIONS For adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control, CGM is cost-effective at the willingness-to-pay threshold of $100,000 per QALY, with improved glucose control and reductions in nonsevere hypoglycemia.
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Affiliation(s)
- Wen Wan
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - M Reza Skandari
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Alexa Minc
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Aviva G Nathan
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Aaron Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI
| | - Parmida Zarei
- Section of General Internal Medicine, University of Chicago, Chicago, IL
| | - Michael O'Grady
- National Opinion Research Center, University of Chicago, Chicago, IL
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Chicago, IL
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Fiseha T, Alemayehu E, Kassahun W, Adamu A, Gebreweld A. Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia. BMC Res Notes 2018; 11:316. [PMID: 29776447 PMCID: PMC5960206 DOI: 10.1186/s13104-018-3423-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/10/2018] [Indexed: 12/16/2022] Open
Abstract
Objective The aim of this study was to determine the status of glycemic control and identify factors associated with poor glycemic control among diabetic out-patients. Results A hospital based cross-sectional study was conducted among randomly selected 384 (126 type 1 and 258 type 2) diabetic adults attending a hospital in Northeast Ethiopia from January 1 to April 30, 2017. Of the total participants, 70.8% had poor status of glycemic control (defined as mean fasting blood glucose level above 130 mg/dl). In the multivariate analysis, rural residence (AOR = 2.61, 95% CI 1.37–4.96), low educational level (AOR = 7.10, 95% CI 2.94–17.17) and longer duration of diabetes (AOR = 2.20, 95% CI 1.18–4.08) were significantly associated with increased odds of poor glycemic control. Moreover, merchants (AOR = 3.39, 95% CI 1.16–9.96) were significantly more likely to have poor glycemic control compared to government employee. Diabetic patients receiving oral anti-diabetics (AOR = 5.12, 95% CI 2.10–12.52) or insulin (AOR = 3.26, 95% CI 1.26–8.48) were more likely to be poorly controlled. These results highlight the needed for appropriate management of patients focusing on associated factors identified for poor glycemic control to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Science, College of Health & Medical Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wongelawit Kassahun
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aderaw Adamu
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Lumu W, Kampiire L, Akabwai GP, Kiggundu DS, Kibirige D. Statin therapy reduces the likelihood of suboptimal blood pressure control among Ugandan adult diabetic patients. Ther Clin Risk Manag 2017; 13:215-221. [PMID: 28260908 PMCID: PMC5325131 DOI: 10.2147/tcrm.s120423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hypertension is one of the recognized risk factors of cardiovascular diseases in adult diabetic patients. High prevalence of suboptimal blood pressure (BP) control has been well documented in the majority of studies assessing BP control in diabetic patients in sub-Saharan Africa. In Uganda, there is a dearth of similar studies. This study evaluated the prevalence and correlates of suboptimal BP control in an adult diabetic population in Uganda. PATIENTS AND METHODS This was a cross-sectional study that enrolled 425 eligible ambulatory adult diabetic patients attending three urban diabetic outpatient clinics over 11 months. Data about their sociodemographic characteristics and clinical history were collected using pre-tested questionnaires. Suboptimal BP control was defined according to the 2015 American Diabetes Association standards of diabetes care guideline as BP levels ≥140/90 mmHg. RESULTS The mean age of the study participants was 52.2±14.4 years, with the majority being females (283, 66.9%). Suboptimal BP control was documented in 192 (45.3%) study participants and was independently associated with the study site (private hospitals; odds ratio 2.01, 95% confidence interval 1.18-3.43, P=0.01) and use of statin therapy (odds ratio 0.5, 95% confidence interval 0.26-0.96, P=0.037). CONCLUSION Suboptimal BP control was highly prevalent in this study population. Strategies to improve optimal BP control, especially in the private hospitals, and the use of statin therapy should be encouraged in adult diabetic patients.
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Affiliation(s)
- William Lumu
- Department of Medicine and Diabetes/Endocrine Unit, Mengo Hospital
| | | | | | | | - Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
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