Challenges And Factors Associated With Poor Glycemic Control Among Type 2 Diabetes Mellitus Patients At Nekemte Referral Hospital, Western Ethiopia

Prevalence of and factors associated with suboptimal glycemic control among patients with type 2 diabetes mellitus attending public hospitals in the Greater Male' Region, Maldives: a hospital-based cross-sectional study

BACKGROUND

Suboptimal glycemic control of type 2 diabetes mellitus (T2DM) which is defined as having HbA1c greater than 7% is a major public health problem in several countries, including the Maldives. The study aimed to estimate the prevalence and determine factors associated with suboptimal glycemic control among T2DM patients.

METHODS

A hospital-based cross-sectional was applied to collect data from T2DM patients who attended public hospitals in the Greater Male' Region, Maldives where were one of the highest reports of T2DM and suboptimal glycemic control cases in the country between January to March 2023 by a validated questionnaire and anthropometric measurements. Five (5) ml blood specimens were collected to measure the glycated hemoglobin (HbA1c) level. Univariable and multivariable logistic regressions were employed to determine factors associated with suboptimal glycemic control of T2DM at a significant level of α = 0.05.

RESULTS

A total of 341 participants were recruited for the study: 65.7% were female, 42.5% were aged 40-60 years, and 42.2% were married. The overall prevalence of suboptimal glycemic control was 50.7%. Ten variables were found to be associated with suboptimal glycemic control in multivariable logistic regression. Those aged 40-60 years (AOR = 3.35, 95% CI = 1.78-6.30), being single (AOR = 2.53, 95% CI = 1.21-5.30), preparation of food using more than three tablespoons of cooking oil (AOR = 2.78, 95% CI = 1.46-5.28), preparation of food with more than three tablespoons of sugar (AOR = 2.55, 95% CI = 1.31-4.93), no exercise (AOR = 2.04, 95% CI = 1.15-3.61), DM diagnosed with more than twenty years prior (AOR = 2.59, 95% CI = 1.34-4.99), obese body mass index (BMI) (AOR = 3.82, 95% CI = 1.75-8.32), high total cholesterol (AOR = 2.43, 95% CI = 1.36-4.35), high triglycerides (AOR = 3.43, 95% CI = 1.93-6.11), and high-level stress (AOR = 2.97, 95% CI = 1.48-5.93) were having a greater odds of having suboptimal glycemic control than those who did not have these characteristics.

CONCLUSION

A large proportion of T2DM patients in the Greater Male' Region fail to control their blood glucose. Effective public health interventions should be introduced, especially interventions focused on reducing cooking oil and sugar in daily cooking practices, encouraging regular exercise, and maintaining cholesterol levels, particularly for those diagnosed with diabetes mellitus for more than 20 years prior.

Effectiveness of Family-Based Diabetes Management Intervention on Glycated Haemoglobin Among Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Glycated hemoglobin (HbA1c) control is a crucial goal in the management of type 2 diabetes mellitus (T2DM), requiring lifelong commitment and family support. This study aimed to assess the effectiveness of family-based diabetes management intervention on HbA1c among adults with T2DM.

METHODS

From inception up to 2022, a comprehensive literature search was conducted across PubMed, ProQuest, Scopus, CORE, and the Cochrane Library. The quality of studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Effect sizes were calculated using standard deviations (SD), while the degree of heterogeneity was evaluated using the Higgins I2 test. Subgroup analyses were performed to explore factors contributing to sources of heterogeneity among trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed, and the protocol was registered with PROSPERO CRD42022384034.

RESULTS

A total of 18 randomized controlled trials (RCTs) involving 2815 participants indicated that family-based diabetes management intervention had a statistically significant impact on improving HbA1c (Mean Difference [MD] = -.47; 95% Confidence Interval [CI]: -.64 to -.30, p < .001) with a moderate level of heterogeneity (I2 = 59%). Subgroup analysis indicated that family-based diabetes management intervention among adults with T2DM in developing regions was more effective in improving HbA1c levels compared to developed countries.

CONCLUSION

Family-based diabetes management interventions improved HbA1c. Further research is required to develop diabetes management strategies with a family focus that clearly defines the family's involvement.

Insulin therapy among diabetic patients in rural communities of Sub-Saharan Africa: a perspective review

In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.

Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis

Introduction

Prior primary studies have examined the prevalence and factors associated with glycaemic control among patients with type 2 diabetes mellitus, but studies with evidence-based synthesis of the primary data remained unknown. Hence, we aimed to determine the prevalence of poor glycemic control and identify determinants of poor glycemic control in patients with type 2 diabetes in Ethiopia.

Methods

We performed searches in the online databases of PubMed, Google Scholar, Scopus, Science Direct, and the Cochrane Library. Microsoft Excel was used to extract data, and STATA statistical software (v. 16) was used for analysis. Publication bias was explored by forest plots, Begg's rank test, and Egger's regression test. To check for heterogeneity, I2 was computed. Subgroup analysis was conducted based on region and publication year. In addition, the pooled odds ratio for associated factors was calculated.

Results

Out of 1,045 studies assessed, 23 studies were included fulfilling our inclusion criteria. In all, 6,643 individuals were enrolled in the study. It was estimated that 61.11% of type 2 diabetes patients had poor glycemic control (95% CI, 57.14-65.19). The subgroup analysis by study region and publication year revealed that the highest prevalence was observed in the Addis Ababa region (68.57%) and studies published before 2019 (61.76%), respectively. Poor glycemic control was associated with older age > 50 years (AOR = 2.12; 95% CI: 1.27-2.97), not attending formal education (AOR = 3.60; 95% CI: 2.75, 4.46), having diabetes for longer duration (10 years; AOR = 2.57; 95% CI: 1.65-3.49), having comorbidity (AOR = 2.43; 95% CI: 2.05-2.80), and low adherence to diabetes management (AOR = 3.67; 95% CI: 2.41-4.92).

Conclusion

Our findings indicate a high prevalence of poor glycemic control among people with type 2 diabetes in Ethiopia. Being older, not attending formal education, having a longer duration of diabetes, having comorbidity, and having low adherence to diabetes management were all associated. Therefore, we recommend health organizations implement measures to monitor and control patients' blood glucose levels. Patient education and training of healthcare professionals could serve as a short-term strategy to achieve adequate glycemic control.

Systematic review registration

PROSPERO, identifier CRD42022349792, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349792.

The mediating effect of self-efficacy on the relationship between social support and medication adherence in adults with type 2 diabetes

Objective

To evaluate the status of medication adherence in diabetic patients and its effective factors.

Methods

A cross-sectional descriptive study was conducted with 170 diabetic patients in Iran. Participants were assessed for medication adherence, self-efficacy, and social support. Descriptive statistics, bivariate analyses, and multiple stepwise regression were conducted to explore predictors for medication adherence.

Results

Regression analysis showed that 48% of medication adherence changes stemmed from the four variables including social support, self-efficacy, income, and education levels, (R2adj = 0.480, F = 39.943, p < 0.001). According to the model, the highest effects were related to income level (β = 0.332, t = 5.493, p ⩽ 0.001) and self-efficacy (β = 0.330, t = 4.789, p ⩽ 0.001), respectively. Based on the final model, only the social support variable showed no significant relationship with adherence (β = 0.002, t = 0.032, p = 0.947).

Conclusion

Social support and self-efficacy were related to medication adherence in diabetic patients, and social support can improve medication adherence in patients with diabetes by affecting self-efficacy. Healthcare workers who interact with individuals with diabetes should take into account the factors mentioned above when designing health promotion interventions to address the needs of these individuals.

Frequency and correlates of poor glycemic control in patients with type 2 diabetes at Jimma Medical Centre, Ethiopia: a cross-sectional study

Introduction

the majority of studies in Ethiopia determine the prevalence of glycemic control employed by fasting blood sugar (FBS), which is impacted by a variety of factors. Hence, the purpose of this study was to assess the status of glycemic control using HbA1c and its correlates in patients with type 2 diabetes in Southwest Ethiopia.

Methods

a cross-sectional study was employed among 124 T2 diabetes mellitus (DM) patients at Jimma Medical Center (JMC), Southwest Ethiopia. HbA1c and FBS were estimated using the Cobas 6000 analyzer. The body mass index (BMI) and waist-to-hip ratio were calculated as the standard formula. Data were analyzed by SPSS version 25. Logistic regression analysis was employed to identify independent risk factors associated with poor glycemic control of DM patients.

Results

males comprised 63.7% (n=79) of the total respondents. The mean age of aOR: 2.21, 95% CI 1.13, 4.34; p = 0.01f participants was 51.84 ± 11.6 years; 60.5% (n=75) of T2 DM patients were in poor glycemic control (HbA1c ≥ 7%). In multivariate logistic regression analysis, BMI of ≥ 30, (aOR: 2.21, 95% CI 1.13, 4.34) increased waist-to-hip ratio (aOR: 1.63, 95% CI 0.82, 2.18), high systolic blood pressure (aOR: 1.52, 95% CI 1.11, 6.23), high FBS (aOR: 1.61, 95% CI 1.00, 4.12), and longer duration of DM (aOR: 1.23, 95% CI 0.87, 1.88) were associated with poor glycemic control.

Conclusion

the level of poor glycemic control in the study population is high. Obesity and/or overweight, central obesity, systolic hypertension, and fasting blood sugar levels were all associated with poor glycemic control in T2 DM patients.

Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine

BACKGROUND

Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020.

AIMS

This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs.

METHODS

A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant.

RESULTS

More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration.

CONCLUSION

This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.

Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

BACKGROUND

Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa.

METHOD

A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I² statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger's test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

RESULTS

Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes.

CONCLUSION

The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting.KEY MESSAGESThere was a high prevalence of overweight and obesity among the type 2 diabetes patients.Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients.Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.

Dietary practice and associated factors among type 2 diabetic patients attending chronic follow-up in public hospitals, central Ethiopia, 2022

BACKGROUND

Diabetes Mellitus (DM) is affecting numerous Ethiopian populations regardless of environmental and social status. Diabetic people all over the world are commonly urged to acquire a healthy eating habit, which necessitates lifelong changes in food habits, beliefs, and meal patterns. Dietary management is considered one of the cornerstones of diabetes care, as it is an important component of the overall treatment plan. Choosing and following a healthy diet is important for everyone, especially people with diabetes.

OBJECTIVE

This study aims to assess dietary practices and associated factors among type 2 diabetes patients in the west Shewa Zone, Oromia Regional State, Ethiopia, in 2022.

METHODS

A hospital-based cross-sectional study design was conducted in West Shewa Zone public hospitals among 421 randomly selected type 2 diabetic patients from February 1 to March 30, 2022. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Descriptive, bivariate, and multivariate binary logistic regression analyses were done using SPSS.

RESULTS

In this study, about 35.6% (95% CI: 30.9-39.9) of type 2 diabetes patients had good dietary practices. Diabetes knowledge (AOR 9 2; 95% CI 4.4-19.4), food-secured households (AOR 3.3; 95% CI 1.6-6.9), high self-efficacy (AOR 6.6; 95% CI 3.2-13.9), diabetes diet information from healthcare professionals (AOR 2.9; 95% CI 1.3-6.4), complete dietary change (AOR = 2.3; 95% CI 1.1-4.8), and female gender (AOR 3.6; 95% CI 1.6-8.1) were independent predictors of good dietary practice.

CONCLUSION

The proportion of patients with type 2 diabetes, who attended follow-up at West Shawa Public Hospitals and practiced good dietary habits, was low. Patients' household food insecurity, diabetes knowledge, self-efficacy, source of information on the diabetic diet, complete dietary change after diabetes diagnosis, and gender were all significantly associated with type 2 diabetic patients' dietary practices. Thus, promoting the provision of continuous, modified, and comprehensive education and advice on the importance of diabetes self-management, particularly adherence to dietary recommendations, is fundamental to decreasing the burden of diabetes complications and massive health expenses among diabetic patients.

Perspectives for glycaemic control in type 2 diabetes in Kinshasa, Democratic Republic of the Congo

Glycaemic control is a significant problem in the Democratic Republic of the Congo (DRC), the perspectives associated with glycaemic control are not fully known as previous studies rarely explored patients' perspectives and lived experiences. This qualitative study described the perspectives regarding glycaemic control among persons with type 2 diabetes in Kinshasa, DRC. A total of 23 participants were purposively selected in seven health centres in Kinshasa. In-depth interviews were used for data collection. The study used a phenomenology approach, and deductive, constructionist and thematic analysis. Data analysis was performed using the MAXQDA 2022. Five themes were identified as perspectives for glycaemic control in Kinshasa: financial constraints, limited social and relational support, difficulties with lifestyle changes, beliefs and practices about diabetes and ability to adapt for caring for the illness. Themes were integrated using social cognitive theory. Participants expressed that they were unable to achieve better glycaemic control due to financial constraints, limited social and relational support and difficulty in changing their lifestyle. Their beliefs and practices about diabetes also constituted a barrier. Our results showed that lack of adequate funding is a major determinant of glycaemic control and therefore it is crucial to integrate a consistent and reliable funding system for care of people living with diabetes. Persons with diabetes must be empowered to successfully adapt to the requirements of diabetes care. In this process, support for people living with type 2 diabetes is also essential and should involve their families as well as healthcare providers.

Factors associated with glycemic control and diabetes complications in a group of Saudi patients with type 2 diabetes

Poor glycemic control is a risk factor for micro and macrovascular complications of diabetes. The aim of this study was to assess the prevalence and factors related to suboptimal glycemic control and diabetes complications in a group of patients with type 2 diabetes mellitus (T2DM). This cross-sectional descriptive study conducted in Al Qassim region, Saudi Arabia. Two hundred patients with T2DM were enrolled. Demographic, social, and self-care behavior data were collected. A thorough clinical evaluation was done. Glycated hemoglobin, lipid, and kidney profile results were recorded. Mann-Whitney test was used to compare different groups. For comparing categorical data, Chi-square (χ2) test was performed. Multivariate logistic regression analyses used to detect predictors of poor glycemic control and macrovascular and microvascular complications. The median age of patients was 58 years, and 62% of them were males. Only 22.5% of patients had glycated hemoglobin <7%. Forty-four patients (22%) had evidence of macrovascular complications. Retinopathy, neuropathy, and nephropathy were found in 42.5%, 32.5%, and 12%, respectively. Longer diabetes duration was significantly associated with poor glycemic control (OR = 1.006, P < .005). The age of the patients was independently associated with macrovascular complications (OR = 1.050, P = .029). Hyperlipidemia was significantly associated with neuropathy (OR = 0.229, P = .043) and retinopathy (OR = 12.887, P = .003). Although physical activity was lower in patients with suboptimal glycemic levels (P = .024), cardiovascular disease (P = .030), neuropathy (P < .001), retinopathy (P < .001), and nephropathy (P = .019), multivariate analysis showed that it was only independently associated with neuropathy (OR = 0.614, P = .001). The prevalence of suboptimal glycemic control is high in the studied population. Effective health measures are urgently needed to stop diabetes complications, especially retinopathy and neuropathy. Elderly people with long durations of diabetes, and lower physical activity should be the focus of the interventions. Tailored exercise programs are particularly needed for better diabetes control and for the prevention of complications in patients with T2DM.

Prevalence and predictors of type 2 diabetes complications: a single centre observation

Background

Diabetes complications are a major burden on persons living with diabetes and the health care systems.

Objectives

The study assessed the glycemic control, prevalence and predictors of type 2 diabetes complications among patients in a healthcare centre.

Methods

Two hundred adults who had type 2 diabetes in a general hospital were recruited for the study. Cross-sectional and retrospective surveys were used to determine prevalence, number and types of complications in the patients. SPSS version 21 was used for descriptive analysis and Chi-square (p<0.05).

Results

A total of 200 (100%) respondents participated in the study and 97 (48.5%) had poor glycemic control. Mean number of complications per patient was 2.48 ± 1.22. Number of complications per person and type of complications were significantly associated with Age (p = 0.000 and p = 0.000, respectively), Gender (p = 0.008 and p = 0.031, respectively) and Occupation (p=0.000 and p=0.006, respectively). Marital status (p = 0.032) and years of diagnosis (p=0.021) were also associated with type of complications. The majority of patients 64 (32.0%) were admitted in the previous year for diabetes-related complications. Majority 159 (79.5%) had ≥ 2 number of complications from the observed 497 complications.

Conclusions

Poor glycemic control and high prevalence of complications were observed. Also, socio-demographic characteristics were likely predictors of number and type of complications. These findings are essential for improved planning and prioritizing of diabetes care.

Changes in trends and patterns of glycaemic control at Ghana's National Diabetes Management and Research Centre during the era of the COVID-19 pandemic

BACKGROUND

Maintaining optimal glycaemic control (GC) delays the onset and progression of diabetes-related complications, especially microvascular complications. We aimed to establish the trend and pattern of GC, and its associated factors in persons living with diabetes (PLWD), and to examine the influence of COVID-19 on GC.

METHODS

A retrospective study involving secondary data from 2,593 patients' physical records from the National Diabetes Management and Research Centre (NDMRC) in Accra, extracted from 2015-2021. Growth rate of GC was assessed, and ordinal logistic and Poisson models weighted with Mahalanobis distance matching within propensity caliper were adopted to assess the impact of COVID-19 pandemic on GC. Stata 16.1 was utilized and the significant value set as p≤0.05.

RESULTS

GC pattern indicated a steady deterioration ranging from 38.6% (95%CI = 34.5-42.9) in 2015 to 69.2% (95%CI = 63.5-74.4) in 2021. The overall growth from 2015-2021 was 8.7%. Being a woman and increasing diastolic pressure significantly increase the likelihood of poor glycaemic control (PGC) by 22% and 25%, respectively compared with their respective counterparts [aOR(95%CI = 1.01-1.46 and 1.25(1.10-1.41), respectively]; whilst lower age increased the risk of PGC throughout the years. We found that risk of PGC during the era of COVID-19 was approximately 1.57(95%CI = 1.08-2.30) times significant, whilst the adjusted prevalence ratio (aPR) of PGC during the era of COVID-19 was approximately 64% significantly higher than the era without COVID-19 (aPR = 1.64, 95%CI = 1.10-2.43).

CONCLUSION

GC worsened from 2015-2021, especially during the COVID era. Younger age, uncontrolled blood pressure and/or being a woman were associated with PGC. The NDMRC and other centres that provide specialist healthcare in resource-limited settings, must determine the factors that militate against optimal service delivery in the era of the COVID-19 pandemic, and implement measures that would improve resilience in provision of essential care in the face of shocks.

Depression and determinants among diabetes mellitus patients in Ethiopia, a systematic review and meta-analysis

INTRODUCTION

Primary studies have estimated the prevalence of depression and its determinants among diabetes patients. However, studies synthesizing this primary evidence are limited. Hence, this systematic review aimed to determine the prevalence of depression and identify determinants of depression among diabetes in Ethiopia.

METHODS

This systematic review and meta-analysis included a search of PubMed, Google Scholar, Scopus, Science Direct, PsycINFO, and Cochrane library. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Data were pooled using a random-effects model. Forest plots, and Egger's regression test were all used to check for publication bias. Heterogeneity (I)² was computed. Subgroup analysis was done by region, publication year, and depression screening instrument. In addition, the pooled odds ratio for determinants was calculated.

RESULTS

Sixteen studies, including 5808 participants were analyzed. The prevalence of depression in diabetes was estimated to be 34.61% (95% CI: 27.31-41.91). According to subgroup analysis by study region, publication year, and screening instrument, the highest prevalence was observed in Addis Ababa (41.98%), studies published before 2020 (37.91%), and studies that used Hospital Anxiety and Depression Scale (HADS-D) (42.42%,) respectively. Older age > 50 years (AOR = 2.96; 95% CI: 1.71-5.11), being women (AOR = 2.31; 95% CI: 1.57, 3.4), longer duration with diabetes (above 5 years) (AOR = 1.98; 95% CI: 1.03-3.8), and limited social support (AOR = 2.37; 95% CI: 1.68-3.34), were the determinants of depression in diabetic patients.

CONCLUSION

The results of this study suggest that the prevalence of depression in diabetes is substantial. This result underscores the importance of paying particular attention to prevent depression among diabetes. Being older, not attending formal education, longer duration with diabetes, having comorbidity, and low adherence to diabetes management were all associated. These variables may help clinicians identify patients at high risk of depression. Future studies focusing on the causal association between depression and diabetes are highly recommended.

Glycemic control and diabetes complications among adult type 2 diabetic patients at public hospitals in Hadiya zone, Southern Ethiopia

BACKGROUND

Diabetes is one of the biggest worldwide health emergencies of the 21st century. A major goal in the management of diabetes is to prevent diabetic complications that occur as a result of poor glycemic control. Identification of factors contributing to poor glycemic control is key to institute suitable interventions for glycemic control and prevention of chronic complications.

METHODS

A hospital-based cross-sectional study was conducted among 305 adult type 2 diabetic patients at public hospitals in Hadiya zone from March 1-30, 2019. The study participants were selected by systematic sampling technique. Data were collected using a pretested structured questionnaire and patient chart review; anthropometric and blood pressure measurements were taken. Multivariable logistic regression analysis was used to identify factors associated with poor glycemic control. Adjusted odds ratios (AOR) with respective 95% Confidence Interval (CI) and p < 0.05 were used to set statistically significant variables.

RESULTS

Out of 305 diabetic patients, 222 (72.8%) were found to have poor glycemic control. Longer duration of diabetes (5-10 years) [AOR = 2.24, 95% CI: 1.17-4.27], lack of regular follow-up [AOR = 2.89, 95% CI: 1.08-7.71], low treatment adherence [AOR = 4.12, 95% CI: 1.20-8.70], use of other alternative treatments [AOR = 3.58, 95% CI: 1.24-10.36], unsatisfactory patient physician relationship [AOR = 2.27, 95% CI: 1.27-4.04], and insufficient physical activity [AOR = 4.14, 95% CI: 2.07-8.28] were found to be independent predictors of poor glycemic control. Diabetes Mellitus (DM) complications were slightly higher among participants with poor glycemic control (39.2%), duration of DM 10 and above years (41.9%), low medication adherence (48.5%), taking oral anti-diabetics (54.3%), and DM patients having unsatisfactory patient provider relationship (72.4%).

CONCLUSION

A significant proportion of diabetic patients had poor glycemic control and DM complications. Therefore, appropriate interventions are required to maintain optimal glycemic control and prevent the development of life-threatening complications among DM patients.

Factors associated with poor glycemic control among adult patients with type 2 diabetes mellitus in Gamo and Gofa zone public hospitals, Southern Ethiopia: A case-control study

BACKGROUND

Diabetes mellitus is a serious global public health problem that affects the whole life of people in terms of their biological, psychological, and social effects. Complications and death from diabetes occur from poorly controlled blood glucose levels. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess factors associated with poor glycemic control among type2 diabetes patients in public hospitals of Gamo and Gofa zone southern, Ethiopia, 2021.

METHODS

An institution-based unmatched case-control study was employed among 312 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identify factors associated with poor glycemic control using IBM SPSS version 25. The strength of association was assessed by using an Adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULT

Factors associated with poor glycemic control based on multivariable analysis were, having comorbidity (AOR = 2.35, 95% CI (1.39-3.95)), adhering to dietary recommendations (AOR = 0.31, 95% CI (089-0.51)), poor social support (AOR = 3.31, 95% CI (1.59-6.85)), physical exercise (AOR = 1.86 95% CI (1.11-3.12)), and having poly-pharmacy (AOR = 2.83, 95% CI (1.39-5.74)).

CONCLUSION AND RECOMMENDATION

This study indicated a significant association of comorbidity, physical exercise, poly-pharmacy, low social support, and adherence to dietary recommendations with poor glycemic control. We suggest that the health care providers and concerned bodies encourage patients to have regular check-ups and work on providing necessary social support.

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

The primary method for preventing health and health-related problems in diabetic people is glycemic control. Numerous studies have documented the importance of glycemic control and the factors that influence it. However, the results are dispersed. This study sought to identify the prevalence of poor glycemic control and associated factors in Ethiopia. Findings will be crucial to reduce the burden of poor glycemic control. Comprehensive search was performed from databases: PubMed, Global Health, CINAHL, IRIS, and FSTA. Gray literature sources were also explored. This document was prepared based on the PRISMA flowchart. The protocol is registered in PROSPERO (ID: CRD42022296583). STATA software was used for data analyses and I2 test with Cochrane Q statistics, and forest plot were used to verify heterogeneity. When the I2 value was higher than 50% and the p-value was 0.05, heterogeneity was deemed significant. To confirm publication bias, a funnel plot with an Egger's regression test was performed. The factors related to poor glycemic control were reported using pooled odds ratios (POR) and a 95% confidence interval. In this study, 46 papers totaling 15 457 people were used to calculate the pooled estimates. It was determined that 32.6% (95% CI: 28.3, 36.9) and 61.92% (95% CI: 57.92, 65.92) of the subjects, respectively, had good and poor glycemic control. Being male protected against poor glycemic control, while poor diet adherence, lack of exercise, poor adherence to anti-diabetic medications, and smoking increased the likelihood of poor glycemic control. Lack of formal education, no family history of diabetes, lack of glucometer for blood glucose monitoring, comorbidity, being overweight and prolonged length of stay with diabetes all contributed to poor glycemic control. Ethiopia had a fairly high rate of poor glycemic control. The main determinants are lifestyle factors. Therefore, it is important to focus on behavioral interventions.

Physical activity can improve diabetes patients' glucose control; A systematic review and meta-analysis

Background

Glycemic control is vital to patient care, and it is still the most important treatment goal for reducing organ damage and other complications associated with diabetes. Physical activity is one of the factors that affects glycemic management. Therefore, the aim of this systematic review and meta-analysis was to find, evaluate, and synthesize the best available information on the link between physical exercise and glycemic control in Ethiopian diabetes patients.

Methods

Pubmed, Science Direct, Google Scholar and African Journals Online were the databases searched. In addition, gray literature were explored. All papers chosen for inclusion in the review underwent a thorough critical appraisal utilizing the Joanna Briggs Institute's standardized critical appraisal instruments (JBI critical appraisal checklist-2017). For statistical analysis and descriptive synthesis, quantitative articles were combined. The Odds ratio and their 95% confidence intervals were generated. Papers that were of excellent quality but lacked the main outcome (physical activity) for meta-analysis were subjected to descriptive synthesis.

Results

The finding of this meta-analysis showed diabetes patients who were physically active had controlled their blood glucose levels by 2.4 times compared to their counter (Odds ratio = 2.40, 95% Confidence Interval = 1.57,3.69). The duration of disease was found to be the most commonly reported predictor for poor glycemic control followed by dietary habits, patients' sex and age.

Conclusion

Physical activity, which is a simple and inexpensive therapy for diabetes patients, can help them control their blood glucose levels. Patients with diabetes who have had it for a long time should be aware of the need of regular physical activity in maintaining blood glucose control.

A Mixed Methods Multicenter Study on the Capabilities, Barriers, and Opportunities for Diabetes Screening and Management in the Public Health System of Southern Ethiopia

Background

More than half of diabetics' in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia.

Methods

We applied a mixed methods study. To assess the healthcare systems' capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly.

Results

Our study findings indicated that there were good opportunities and encouraging capabilities like government commitment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system's structural problems, skilled professionals' inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and evaluation mechanisms have been hampering the service delivery at the system level. While service unaffordability, low awareness level, and lifestyle modification problems were the main challenges at the patient level. Furthermore, outdated paper-based medical record documentation, frequent essential drug stock-outing, essential laboratory service interruptions, and none-use of some available services like HbA1c have been contributing to the barriers.

Conclusion

Despite favorable capabilities available, diabetes management in southern Ethiopia has been struggling with solvable structural defects, poor service delivery and inaccessibility, and patients' poor lifestyle modification. Therefore, public health system restructuring, optimum financing, computerization of medical records documentation, and health system and patient capacity building are strongly recommended interventions to tackle the problem at the grass-root level.

Waist-to-hip circumference and waist-to-height ratio could strongly predict glycemic control than body mass index among adult patients with diabetes in Ethiopia: ROC analysis

Background

Poorly controlled blood glucose is prevalent and contributes to the huge burden of diabetes related morbidity, and central obesity has a great role in the pathogenesis of diabetes and its adverse complications, which could predict such risks, yet evidence is lacking. Hence, this paper is to evaluate the predictive performance of central obesity indices for glycemic control among adult patients with diabetes in eastern Ethiopia.

Methods

A survey of 432 randomly chosen patients with diabetes was conducted using a pretested questionnaire supplemented by chart review, anthropometrics, and biomarkers by trained data collectors. The poor glycemic control was assessed using a fasting blood glucose (FBS) level of above 130 and/or an HgA1c level above 7%. Weight, height, waist circumference (WC), and hip circumference (HC) were measured under standard procedures and we calculated waist-to-hip circumference ratio (WHR) and waist-to-height ratio (WHtR). The receiver operating characteristics curve was used to assess the predictive performance of obesity indices for glycemic control using area under the curve (AUC) and corresponding validity measures.

Results

A total of 432 (92%) patients with diabetes were enrolled with a mean age of 49.6 (±12.4) years. The mean fasting blood glucose level was 189 (±72) mg dl-1 where 330 (76.4%) (95% CI: 74.4–78.4%) and 93.3% of them had poor glycemic control based on FBS and HgA1c, respectively. WC (AUC = 0.90; 95% CI: 0.85–0.95), WHR (AUC = 0.64; 95% CI: 0.43–0.84), and WHtR (AUC = 0.87; 95% CI: 0.83–0.94) have a higher predictive performance for poor glycemic control at cut-off points above 100 cm, 0.95, and 0.62, respectively. However, obesity indices showed a lower predictive performance for poor glycemic control based on FBS. Body mass index (BMI) had a poor predictive performance for poor glycemic control (AUC = 0.26; 95% CI: 0.13–0.40).

Conclusions

Poor glycemic control is a public health concern and obesity indicators, typically WC, WHR, and WHtR, have a better predictive performance for poor glycemic control than BMI.

Level of dietary adherence and determinants among type 2 diabetes population in Ethiopian: A systemic review with meta-analysis

BACKGROUND

The beneficial effect of the dietary practice is significant reduction in the risk of developing diabetes related complication. Dietary practice among type 2 diabetes is not well-implemented in Ethiopia. Up to now, in the nation, several primary observational studies have been done on dietary adherence level and its determinants among type 2 diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap.

METHODS

A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization- Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion dietary adherence among type2 diabetes and the odds ratios of risk factors favor to dietary adherence after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42020149475.

RESULTS

We included 19 primary studies (with 6, 308 participants) in this meta-analysis. The pooled proportion of dietary adherence in the type 2 diabetes population was 41.05% (95% CI: 34.86-47.24, I2 = 93.1%). Educational level (Pooled Odds Ratio (POR): 3.29; 95%CI: 1.41-5.16; I2 = 91.1%), monthly income (POR: 2.50; 95%CI: 1.41-3.52; I2 = 0.0%), and who had dietary knowledge (POR: 2.19; 95%CI: 1.59-2.79; I2 = 0.0%) were statistically significant factors of dietary adherence.

CONCLUSION

The overall pooled proportion of dietary adherence among type 2 diabetes in Ethiopia was below half. Further works would be needed to improve dietary adherence in the type 2 diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and dietary education according to diabetes recommended dietary guideline.

Prevalence of Obesity and Cardiovascular Risk Factors Among Type 2 Diabetes Mellitus Patients in Al-Khobar, Saudi Arabia

BACKGROUND

The prevalence of obesity has grown significantly worldwide. It is considered a major cardiovascular risk factor among type II diabetes mellitus (T2DM) patients.

OBJECTIVES

The main objective of this study is to determine the prevalence of obesity in patients with T2DM at King Fahd University Hospital (KFUH), Al-Khobar, and to assess the relationship between T2DM and cardiovascular risk factors with body mass index (BMI) and waist to hip ratio (WHR).

METHODS

A retrospective, cross-sectional study, included T2DM patients from the Internal Medicine department at KFHU. The investigators recorded patient demographics (age and gender), weight (kg), height (cm), body mass index (Kg/m²), waist and hip circumference (cm), smoking status, physical activity, blood pressure measurements (mmHg) and laboratory results of fasting blood glucose (FBG), glycated haemoglobin (HbA1c) and lipid profile.

RESULTS

Among 346 patients, the prevalence of obesity and overweight was 62.4% and 27.2%, respectively. The relationship between BMI and demographic data including age and gender was statistically significant (P<0.05). The correlation between the BMI with cardiovascular risk factors including smoking, physical activity and WHR found to be statistically significant (P<0.05).

CONCLUSION

Our study showed that obesity and overweight affect 89.6% of patients with T2DM. Therefore, it is important to take into consideration weight control strategies to effectively manage diabetic patients.

Protocol: Developing a framework to improve glycaemic control among patients with type 2 diabetes mellitus in Kinshasa, Democratic Republic of the Congo

In Kinshasa, Democratic Republic of the Congo (DRC), between 68–86% of patients with type 2 diabetes present with poor glycaemic control leading to increased risk of complications and high cost of care. Identifying the factors driving glycaemic control is essential for better management. There is lack of data on factors associated with poor glycaemic control and targeted interventions in the DRC. This study aims to determine the factors associated with type 2 diabetes control and develop an appropriate intervention package in Kinshasa. The study will comprise of three sub-studies as follows: the first sub-study being a concurrent parallel mixed-methods cross-sectional study to determine factors driving poor glycaemic control among patients in Kinshasa. A total of 614 patients will be invited to participate in a cross-sectional study and respond to standardized questionnaires. A minimum of 20 purposively selected patients will participate in the qualitative study that will involve in-depth interviews about their perspectives on glycaemic control. In the quantitative study, multivariable logistic regression will be performed to determine factors associated with glycaemic control, after identifying the confounding factors. In the qualitative study, thematic analysis will be performed. Findings of the quantitative and qualitative studies on factors that are associated with glycaemic control will be triangulated. And allow to conduct the second sub-study, a qualitative inquiry with a minimum of 20 healthcare providers and 20 patients, selected purposively, to explore their perspectives about potential interventions to improve glycaemic control. At the last, the findings of both sub-studies will be subjected to an anonymous electronic three-round process Delphi study involving 25 stakeholders on the intervention package to develop a framework to optimise glycaemic control in Kinshasa. The implementation of the intervention package will occur after the completion of this study with expected substantial impact on the patients, healthcare providers, and health system.

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

BACKGROUND

There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.

METHODS

We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I².

RESULTS

A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6-32.9). The glycaemic control prevalence ranged from 10-60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.

CONCLUSION

Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

Diabetes self-management and its associated factors among patients with diabetes in central Vietnam: A cross-sectional study

Objective

Diabetes self-management (DSM) enables maintenance of optimal individualized glycemic control for patients with diabetes through comprehensive lifestyle, medication adherence, and self-monitoring glucose level. This study aimed to evaluate DSM and to find associated factors among Vietnamese diabetes patients by using the Vietnamese version of Diabetes Self-Management Instrument (DSMI).

Methods

A cross-sectional study was conducted at a single hospital in the central Vietnam. DSM was assessed using the DSMI. The participant’s socio-demographic and clinical features were obtained through face-to-face interviews and medical records. Multivariate linear regression was used to determine independent factors associated with total DSMI.

Results

The mean total DSM score based on DSMI self-administered questionnaire scores was 88.4 ± 22.1, with a range of 47 to 140. The mean self-integration, self-regulation, interaction with health professionals, self-monitoring blood glucose, and adherence to the prescribed regime were 24.8, 22.3, 21.6, 10.2, and 9.5, respectively. 48.1% of DM patients had good HbA1c control. Sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activities were factors independently predictive of DSMI total score.

Conclusion

This study emphasizes that the DSM situation is seen to be average among DM patients with mean DSMI score 88.4 ± 22.1 and sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activities were independently predictive factors of DSMI total score. This evidence suggests that there is a need to enhance the effectiveness of DSM education programs among diabetic patients.

Self-care practice and glycemic Control among type 2 diabetes patients on follow up in a developing country: a prospective observational study

Purpose

The main goal of managing diabetes is to achieve glycemic control. However, the glycemic level of most diabetic patients is shown to be poorly controlled mainly due to poor adherence to self-care practices. This study aims to assess the level of self-care practice and glycemic control among type 2 diabetes patients on follow up in a resource limited country.

Methods

A four-month prospective observational study was conducted among type 2 diabetes patients from February 1 to May 30, 2021. Data was collected using a data abstraction checklist and structured questionnaire. The data was entered into Epidata version 4.4.6 and analyzed with SPSS version 26. Glycemic control and its predictors were determined using binary logistic regression. P-value less than 0.05 was considered as statistically significant.

Results

A total of 138 patients were included in the study. Nearly three-fourths (74.6%) of patients had poor glycemic control and the majority of patients had poor self-care practice. 78.3%, 98.6%, 96.4%, and 55.8% of patients had poor adherence to diet, exercise, self-monitoring of blood glucose, and medications respectively. Importantly, 85(79%), 102(75%), 99(74.4%), and 65(84.4%) patients with poor adherence to diet, physical activity, self-monitoring of blood glucose, and antidiabetic medications had poor glycemic control. On multivariate logistic regression, BMI (AOR 4.1, CI:1.20-14.11, p = 0.024) and drug adherence (AOR 3.08, CI:1.22-7.08, p = 0.017) were factors associated with poor glycemic control.

Conclusions

A higher proportion of patients had low-level of self-care practice and poor glycemic control. This highlights the need to improve patients' awareness about the importance of self-care practice to maintain good glycemic control and prevent adverse outcomes associated with the disease.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-00995-4.

Predictors of blood glucose change and microvascular complications of type 2 diabetes mellitus patients in Felege Hiwot and Debre Markos referral hospital, North West Ethiopia

BACKGROUND

Microvascular complications lead to disability, dependency, and accelerated morbidity and mortality. This study aimed to identify predictors of blood glucose change and time to microvascular complications among patients with type 2 diabetes.

METHODS

A retrospective cohort study was conducted among type 2 diabetes mellitus patients enrolled between December 2014 and December 2015 at Felege Hiwot and Debre Markos Referral Hospital. A total of 318 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Microvascular Complications in Type 2 Diabetes Mellitus Patients.

RESULTS

The prevalence of microvascular complications in Type 2 diabetes patients was 26.3%, 95%confidence interval(CI):(21.5, 31.1). Of which, half of the patients developed a microvascular complication after 30 months from the onset of the follow-up. The significant predictors of developing microvascular complication were positive proteinurea (adjusted hazard ratio (AHR) = 1.418, 95%CI: 1.080, 1.861), Serum creatinine (AHR = 3.704, 95%CI: 1.992, 6.887), Weight (AHR = 1.058, 95%CI: 1.023, 1.094), and log fasting blood glucose(log(FBS))(AHR = 1.013, 95%CI: 1.010, 1.015). The predictors of fasting blood glucose progression were higher baseline FBS(est(estimate) = 0.002,95%CI:0.0018, 0.0022), Systolic blood pressure (SBP) (est = 0.003, 95%CI: 0.002, 0.004), diastolic blood pressure (DBP) (est = 0.002, 95%CI: 0.0002, 0.004), and age (est = 0.003, 95%CI: 0.001, 0.004).

CONCLUSION

The progression of the fasting blood glucose level for rural patients was faster than for urban patients. Patients having higher baseline FBS, previous hypertension history, higher SBP, higher DBP, older age, and fewer visits to the hospital have a relatively more progressive change in blood sugar levels. Patients having higher triglyceride levels, positive proteinuria, higher fasting blood sugar, higher weight, and a lesser number of hospital visits have a higher risk of developing a complication. In response to this finding, an aggressive intervention that targets to prevent microvascular complications is required.

Health literacy and behaviors influencing blood sugar level control among type 2 diabetes patients in primary care units, Thailand: A cross-sectional study

Background: Type 2 Diabetes Mellitus (T2DM) remains a significant cause of death globally. In addition, T2DM is among the top five chronic diseases which leads to mortality in the Thai population. Patients with T2DM need a wide self-management protocol.  However, patients with low health literacy experience difficulty in recognizing health-related information and have difficulties in expressing their status to health care providers, resulting in poor self-management which results in worsening of the health condition. This study aimed to identify the health literacy among patients with type 2 diabetes to determine its association between factors with blood sugar level control in the patients who are treated in primary care units. Methods: A total of 605 subjects were randomly selected from four districts of Nakhon Ratchasima Province, Northeastern Thailand. Data were collected using a structured questionnaire and a review of their charts. A descriptive statistical analysis was used to describe characteristics of the subjects. In addition, multiple logistic regression was used for the association to estimate effect sizes in terms of an odds ratio with the 95% confidence interval. Results: Of the total 605 respondents, 90.90% of the subjects had a sufficient level of health literacy about diabetes. The present study found the subjects who had sufficient health literacy were significantly associated with blood sugar level control (Adjusted Odds Ratio, (AOR)=2.27; 95% CI: 1.10-4.74; p =0.026). A strongly significant association with blood sugar level control was found with diet behaviors (AOR = 9.71; 95% CI: 5.98-15.77; p<0.001) and exercise behaviors (AOR = 14.50; 95% CI: 8.66-24.27; p<0.001). Conclusions: Health literacy on the changing health related behaviors among the T2DM patients is significantly associated with controlling blood sugar level. Hence, health practitioners should enhance the health literacy on self-care among T2DM patients which will help to control T2DM in an effective manner.

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

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.

Poor glycemic control and its associated factors among diabetes patients attending public hospitals in West Shewa Zone, Oromia, Ethiopia: An Institutional based cross-sectional study

Purpose

Diabetes mellitus (DM) is increasing at an alarming rate throughout the world and its complications of has become a major public health concern in all countries. Glycemic control is the most important predictor for DM related complications and deaths. However information on glycemic control remains scarce in Ethiopia including our study area. Hence, the aim of this study was to assess the magnitude and factors associated with poor glycemic control among diabetic outpatients at West Shewa public Hospitals, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from June 01 to September 30, 2020. Poor glycemic control was assessed by glycated hemoglobin level and a systematic random sampling method was employed to select participants. An interviewer-administered structured questionnaire was used and the data entered into Epi data version 3.1 and exported into SPSS version 22 for analysis. Logistic regression was conducted to identify predictors of poor glycemic control. A p-value of <0.05 was considered statistically significant.

Results

A total of 390 participants were involved in the study with mean age of 46.45 (±15.6) years. The study finding showed that the prevalence of poor glycemic control was found to be 63.8%. Age of ≥50 years (AOR = 2.77; 95% CI: 0.15,0.85), being single (AOR = 2.55; 95% CI: 0.179,.857), having high low-density lipoprotein cholesterol (AOR = 3.44; 95% CI: 1.65, 7.12), being female gender (AOR = 2.4; 95%CI: 0.31,0.816), alcohol intake (AOR = 1.88; 95% CI: 1.135, 3.1) and presence of diabetic peripheral neuropathy (AOR = 1.24; 1.1,1.39) were associated with poor glycemic control.

Conclusion

About two-thirds of participants had poor blood glucose control. Increased age, high low-density lipoprotein cholesterol, family history of diabetes, being single, being female, diabetic peripheral neuropathy and alcohol intake were associated with poor glycemic control. Hence, effort should be made towards reducing these factors among DM patients by the concerned body.

Nondisclosure of Medical Related Information by Persons with Type 1 and Type 2 Diabetes Mellitus to Their Healthcare Providers: Do Different Patterns Exist?

PURPOSE

The doctor-patient relationship is often challenged by complex communication issues and nondisclosure of important related medical information, especially in diabetes management. Very little information is known about diabetic patient nondisclosure to their doctors. The present study evaluated the prevalence of nondisclosure of information by persons with type 1 and type 2 diabetes mellitus to healthcare providers and its associated factors among the Saudi population, as well as the differences between persons with type 1 and type 2 diabetes mellitus.

METHODS

A cross-sectional study targeting persons with type 1 and type 2 diabetes mellitus was conducted at King Saud University Medical City, Saudi Arabia, Riyadh. An online self-administered questionnaire was used to collect data.

RESULTS

A total of 285 participants were included in the study (155 [54.4%] and 130 [45.6%] type 1 and 2 diabetic patients, respectively). Having an unhealthy diet (25.3%, n = 72), not regularly exercising (23.5%, n = 67), hiding some glucose readings (23.2%, n = 65), and not following instructions for weight loss (22.8%, n = 44) were the most common types of nondisclosed information among diabetic patients. The nondisclosure of information was significantly higher among type 2 patients (29.2%) than type 1 diabetic patients (18.7%) in terms of not participating in regular exercise (p = 0.018). Similarly, the nondisclosure of information was significantly higher among persons with type 1 diabetes compared to persons with type 2 diabetes in terms of hiding some glucose readings (p < 0.001) and not disclosing hyperglycemia (p = 0.011).

CONCLUSION

Nondisclosure of important related medical information among diabetic patients to their healthcare providers is prevalent among the Saudi population. Furthermore, the types and causes of nondisclosed information differ among persons with type 1 and type 2 diabetes mellitus.

The occurrence of urinary tract infection and determinant factors among diabetic patients at Dessie Referral Hospital, South Wollo, Northeast Ethiopia

Introduction:

Diabetic patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. Urinary tract infections cause considerable disorders in diabetic patients, and if complicated, can cause renal failure. In Ethiopia, the magnitude of diabetes mellitus-associated urinary tract infections increased from 7.1% in 2005 to 33.9% in 2019. The successful management of patients suffering from urinary tract infections in diabetic patients depends upon the identification of risk factors. This study aimed to determine the magnitude and factors affecting the urinary tract infections among diabetic patients which enable professionals to prevent infections and manage them effectively.

Methods:

Hospital-based cross-sectional study was conducted with 365 diabetic patients selected by systematic sampling technique from March to April 2020. Data were collected by trained BSc nurses via face-to-face interview and patient chart review. Urine microscopy was done to diagnose urinary tract infections. Data were coded and entered using Epi data version 3.1 and exported to Statistical Package of Social Sciences version 26 for analysis. Variables with p-value < 0.25 in bivariable logistic regression were included multivariable logistic regression and variables with a p-value < 0.05 were considered statistically significant.

Results:

The magnitude of urinary tract infections was 22.3% (95% confidence interval: 18–27). The odds of being infected by urinary tract infections were significantly higher in diabetic females (adjusted odds ratio: 2.46; 95% confidence interval: 1.40–4.32), duration of diabetes mellitus diagnosis of ⩾5 years (adjusted odds ratio: 1.98; 95% confidence interval: 1.05–3.72), with comorbidity (adjusted odds ratio: 4.87; 95% confidence interval: 2.76–8.59) and khat chewer (adjusted odds ratio: 1.84; 95% confidence interval: 1.04–3.24) compared with their counter.

Conclusion and recommendation:

Urinary tract infections were high among diabetic patients. Predictors like sex, duration of diagnosis, comorbidity, and khat chewer were found to be associated with urinary tract infections. Improvement of the regular screening of patients with diabetes mellitus for urinary tract infections will provide more effective measures in prevention and management.

Poor glycemic control and associated factors in diabetic people attending a reference outpatient clinic in Mato Grosso, Brazil

OBJECTIVES

To identify the proportion of poor of glycemic control and associated factors among people with type 2 diabetes attending a regional reference outpatient clinic in Mato Grosso (Brazil).

METHODS

This is a cross-sectional quantitative study based on data from medical records of 338 people with type 2 diabetes who attend a state reference outpatient clinic in Mato Grosso (Brazil). Information on glycemic control, sociodemographic factors, lifestyle and clinical conditions was collected.

RESULTS

The prevalence of elevated glycated hemoglobin was 47.34%. In the Poisson multiple regression model analysis with robust variance, poor glycemic control was significantly associated (p<0.05) with the following factors: insulin use (Prevalence Ratio -PR = 2.03), fasting glucose ≤70 and ≥100 mg/dL (PR = 2.0), postprandial glucose ≥180 mg/dL (PR = 1.76), no physical activity (PR = 1.62), the interaction between age group ≤59 years and the time of disease diagnosis >10 years (PR = 1.58), and presence of arterial hypertension (PR = 0.79).

CONCLUSIONS

Most users of the reference outpatient clinic with type 2 diabetes had poor glycemic control associated with risk factors that alter glycated hemoglobin and negatively affect the achievement of established glycemic levels.

Association of glycemic control and anthropometric measurement among type 2 diabetes mellitus: a cross-sectional study

Introduction

Maintaining good glycemic control is the main therapeutic target for diabetes mellitus (DM) patients. Nevertheless, due to complex factors, the majority of patients worldwide persist poorly controlled. Hence the study was conducted to determine the association of anthropometric measurement and other factors with glycemic control among type 2 DM patients.

Methods

An institutional-based cross-sectional study was conducted among 366 type 2 DM patients from October-1 to November 30/2019. Data were collected by a pre-tested structured questionnaire and data abstraction format. The collected data were edited in Epi-data-4.4.1.0 and exported to SPSS-25 for analysis. The degree of association was assessed using logistic regression analysis and expressed in terms of p value and odds ratio with a 95%CI. p value < 0.05 was considered statistically significant.

Results

Of the total 366 participants, (66.1%) had poor glycemic control. Increased waist circumference (AOR 2.37, 95% CI 1.28-4.40 for overweight and AOR 3.31, 95% CI 1.28-8.58 for obesity), long duration of DM (AOR 2.12, 95% CI 1.14-3.95 for 5-10 years and AOR 5.67, 95% CI 1.76-11.30 for > 10 years), occupation (AOR 3.74, 95% CI 1.94-7.23 for government employee and AOR 4.90, 95% CI 2.19-10.94 for private employee), and family history of DM (AOR 1.93, 95% CI 1.08-3.43), were significantly associated with poor glycemic control.

Conclusion

Nearly two-thirds of study participants had poor glycemic control. Increased waist circumference, long duration of DM, occupational status, and family history of DM were independently associated with poor glycemic control. Therefore, type 2 DM patients with these identified factors should be strictly monitored to maintain good glycemic control.

Knowledge and behavior changes in clinician after training of partnership for Diabetes Control in Indonesia

BACKGROUND AND AIMS

One of the main determinants of successful diabetes management is the quality of healthcare provider including general practitioner and internist which can be increased through medical training. This study aimed to describe the changes of clinician's knowledge and behavior of comprehensive diabetes management training program around Indonesia.

METHOD

We conducted a three-day training program for general practitioners and internists for 3.5 years, 2013 to 2016. All clinicians invited as voluntary participant to send their patient data from medical record. Each participant was expected to submit a minimum of 25 type 2 diabetes (T2DM) set patient data before and 6 months after training program to analyze the impact of program in physician knowledge and behavior related to diabetes management.

RESULT

120 of 489 voluntary participants submitted completed baseline data with 4676 patient data. Meanwhile, only 32 participants that submitted completed data of 6 months before after training with 886 patient data. Most of parameters were improve before and after program. The greatest and lowest improvement were on A1c measurement (21%) and smoking assessment (2%).

CONCLUSION

Intensive seminar and training was not enough to empower diabetes management. This research might push the creation of clinical practice program that were tailored to each care facilities and integrated within routine care aimed at continual improvement of its healthcare worker.

Magnitude and predictors of poor glycemic control among patients with diabetes attending public hospitals of Western Ethiopia

BACKGROUND

Diabetes is one of the most prevalent non-communicable diseases globally, which rapidly is increasing in developing countries. Ethiopia is also facing growing morbidity and mortality related to diabetes complications. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess the magnitude and predictors of poor glycemic control among diabetic patients in western Ethiopia.

METHODS

The cross-sectional study design was employed on a sample of 423 diabetic patients. A systematic random sampling method was employed. An interviewer-administered structured questionnaire was used. The data entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p-<0.25 in bivariate were entered into multivariate analysis. The multivariable logistic regressions were used to determine predictors' poor glycemic control by considering the Adjusted Odds Ratio at CI 95% and the significance level was set at p <0.05.

RESULTS

The magnitude of poor glycemic control was 64.1%. Being females (AOR = 1.684,95%CI = 1.066,2.662), duration of diabetes >8years (AOR = 2.552,95%CI = 1.397, 4.665), presence of diabetes complication (AOR = 2.806,95%CI = 1.594,4.941), negligence of blood glucose test at home (AOR = 1.720, 95%CI = 1.078, 2.743), poor self-care behavior (AOR = 1.787, 95%CI = 1.083,2.959) and poor self-efficacy (AOR = 1.934, 95%CI = 1.078,3.469) were significant predictors of poor glycemic control.

CONCLUSION

The proportion of poor glycemic control was high which was nearly comparable to that reported from many countries. This could be due to factors that were significantly associated with poor glycemic control like lack of home blood glucose test, increased duration of diabetes, presence of diabetes complications, poor self-efficacy, and poor self-care behaviors. Each were significant independent predictors of poor glycemic control. Thus, we recommend patients with diabetes and health care providers enhancing self-monitoring practices, and preventing potential complications should be a priority concern to improve blood glucose levels. Further studies are also recommended to explore important factors which were not identified by the current study.

Factors Associated with Glycaemic Control among Diabetic Patients Managed at an Urban Hospital in Hanoi, Vietnam

Type 2 diabetes (T2DM) epidemic is rising in Vietnam. Identifying associated factors with glycaemic control in patients with T2DM is vital to improve treatment outcomes. This study is aimed at examining the uncontrolled glycaemic level of patients with type 2 diabetes (T2DM) at an urban hospital in Hanoi, Vietnam, and determining associated factors. An observational longitudinal cohort survey was performed among T2DM patients. Glycaemic control was evaluated by using the HbA1c level ≥ 6.5% or fasting blood glucose level ≥ 7.5 g/mmol. Information about sociodemographic, clinical, and behavioral characteristics was collected. Multivariate mixed-effects logistic regression was employed to identify associated factors with control glycaemic level conditions. Among 189 T2DM patients, 70.4% had an uncontrolled glycaemic level. A higher number of comorbidities were associated with a lower likelihood of having uncontrolled glycaemic levels (OR = 0.71, p < 0.001, 95%CI = 0.52 − 0.98). Meanwhile, a higher body mass index (OR = 1.15, p < 0.05, 95%CI = 1.02 − 1.29), higher initial HbA1C (OR = 3.75, p < 0.01, 95%CI = 2.59 − 5.44), and higher initial fasting blood glucose levels (OR = 1.57, p < 0.01, 95%CI = 1.29 − 1.90) were positively associated with a higher risk of uncontrolled glycaemic levels. This study reveals that poor glycaemic control was common among T2DM patients in the urban hospital in Vietnam. Findings underlined the need for appropriate management strategies to control glycaemic levels and weight in this population.

Poor Glycemic Control and Its Contributing Factors Among Type 2 Diabetes Patients at Adama Hospital Medical College in East Ethiopia

BACKGROUND

Poor glycemic control is a major public health issue among patients with type 2 diabetes mellitus and a significant risk factor for the progression of diabetic complications. This study aimed to assess the magnitude and contributing factors of poor glycemic control among type 2 diabetes patients on follow-up at Adama Hospital Medical College (AHMC) in East Ethiopia.

METHODS

A cross-sectional study was conducted among 245 type 2 diabetes patients on follow-up at AHMC from March 1 to 30, 2020. All type 2 diabetes patients on follow-up at AHMC and fulfilling the inclusion criteria were included in the study. The data were collected through face-to-face interviews using structured questionnaires and reviewing the patient chart. The data were entered and analyzed using SPSS version 21. The level of significance was declared at a p-value of <0.05.

RESULTS

Of the 245 type 2 diabetes patients included in the study, 157 (64.1%) had poor glycemic control. The factors associated with poor glycemic control were being male (AOR = 2.28, 95% CI [1.24-4.21]), not attending formal education (AOR = 3.12, 95% CI [1.53-6.35]), monthly income of <136 USD (AOR = 2.14, 95% CI [1.17-3.91]), overweight (AOR = 2.60, 95% CI [1.32-5.10]) and obesity (AOR = 3.44, 95% CI [1.44-8.21]), and chewing khat (AOR = 2.77, 95% CI [1.04-7.33]).

CONCLUSION

The proportion of poor glycemic control among type 2 diabetes patients at AHMC was remarkably high. Therefore, more effort should be taken to strengthening and disseminating health education programs for diabetes patients at each follow-up visit on the importance of achieving optimal body weight, avoiding khat chewing, and maintaining regular physical exercise to prevent and mitigate the complications resulting from poor glycemic control.

Transcutaneous application of the gaseous CO2 for improvement of the microvascular function in patients with diabetic foot ulcers

INTRODUCTION

Microvascular function is impaired in patients with diabetes mellitus (DM) and is involved in numerous DM complications. Several microvascular-supporting interventions have been proposed of which the transcutaneous application of gaseous CO₂ (hereinafter CO₂ therapy) is one of the most promising. The aim of present study was to determine the effect of repeated CO₂ therapies on the cutaneous microvascular function in DM patients with diabetic foot ulcers.

METHODOLOGY

A total of 42 subjects with at least one chronic diabetic foot ulcer were enrolled in the study. They were divided into the experimental group (21 subjects aged 64.6 ± 11.6 years) that underwent 4-week-long treatment with transcutaneous application of gaseous CO₂ (hereinafter CO₂ therapies), and the placebo group (21 subjects aged 65.0 ± 10.7 years) that underwent 4-week-long placebo treatment with transcutaneous application of air. Before the first and after the last treatment in both groups, laser Doppler (LD) flux in foot cutaneous microcirculation, heart rate, and arterial blood pressure measurements were carried out during rest and local thermal hyperaemia (LTH) provocation test.

RESULTS

In the experimental group the following statistically significant changes were observed after the completed treatment 1) increased mean relative powers of LD flux signals during rest in the frequency bands related to NO-independent endothelial (0.07 ± 0.055 vs. 0.048 ± 0.059, p = 0.0058), NO-mediated endothelial (0.154 ± 0.101 vs. 0.113 ± 0.108, p = 0.015), and neurogenic (0.17 ± 0.107 vs. 0.136 ± 0.098, p = 0.018) activity; 2) decreased resting LD flux (35 ± 29 PU vs. 52 ± 56 PU; p = 0.038); and 3) increased peak LD flux as a function of baseline during LTH (482 ± 474%BL vs. 287 ± 262%BL, p = 0.036); there were no statistically significant changes observed in the placebo group. No systemic effects were observed in none of the two groups by means of mean values of heart rate and arterial blood pressure.

CONCLUSIONS

Repeated CO₂ therapies improves the microvasular function in DM patients without any systemic side effects.

Is Telenursing an Effective Method to Control BMI and HbA1c in Illiterate Patients Aged 50 Years and Older With Type 2 Diabetes? A Randomized Controlled Clinical Trial

Introduction: Telenursing is a simple method to provide and maintain nursing care for patients with chronic illness such as diabetes. This study aimed to determine the effectiveness of telenursing on body mass index (BMI) and glycosylated hemoglobin (HbA1c) in illiterate patients aged 50 years and older with type 2 diabetes.

Methods: A randomized controlled clinical trial was performed. Sixty patients with type 2 diabetes who referred to Aligoodarz diabetes clinic (Lorestan, Iran) were randomly assigned to the intervention and control group. Each patient was assessed before and after intervention for the following clinical parameters: HbA1c by Drew-DS5 analyzer and weight by scale (Sahand BMI electronic scale /Iran). All patients received diabetes self-care training for 3 days before the study. Telephone follow ups were applied in intervention group for 12 weeks. The data were analyzed using chi-square, paired t test and independent t test by SPSS11.

Results: Results showed statistically significant decrease in BMI at the end of the training from 29.28 (3.29) to 28.35 (3.37) kg/m 2 and statistically significant decrease in HbA1c from 8.96 (1.24) to 7.56 (0.71) in the intervention group. The effect size base on Cohen’s formula for BMI and HbA1c was Cohen’s d = 2.85, effect size r = 0.81 and Cohen’s d = 2.04, effect size r = 0.71, respectively.

Conclusion: The findings indicate that nurse-led telephone follow up can increase adherence from treatment program and has beneficial effects on HbA1c and BMI in illiterate patients aged 50 years and older with type 2 diabetes.