Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis

OBJECTIVES

To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package).

RESULTS

A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control.

CONCLUSIONS

This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.

Glycemic control and its association with sleep quality and duration among type 2 diabetic patients

Background

Poor glycemic control is the current most important tragedy in type 2 diabetic patients. Sleep has a major modulatory effect on endocrine and metabolic function. Sleep disturbance is associated with increased circulating cortisol levels, sympathetic activity, and epinephrine secretion. These physiological conditions are directly or indirectly associated with glucose metabolism in our body cells. In Ethiopia, sleep pattern association with glycemic control level is not studied yet.

Objectives

To assess glycemic control and its association with sleep quality, sleep duration and napping among patients with type 2 diabetes mellitus in Felege Hiwot Comprehensive Referral and Specialized Hospital Northwest Ethiopia.

Method

An institutional-based cross-sectional study was conducted among 407 type 2 diabetes mellitus patients from July 1, 2020, to April 28, 2021, using a systematic random sampling technique. We drew 5 mL of blood from each patient before breakfast to determine their fasting blood sugar level. The Pittsburg Sleep Quality Index was used to assess patients' sleep quality, and the presence or absence of Obstructive Sleep Apnea was determined using the STOP-BANG questionnaire. Data were analysed using STATA version 14.1.variables with a P-value of <0.05 were considered statistically significant.

Results

Glycemic control was found to be poor in 54.05% of the study participants. Female sex, poor sleep quality, and short and long sleep durations were all significantly associated with impaired glycemic control. Being female increased the odds of poor glycemic control by 2.7 times (AOR = 2.7, 95% CI: 1.23, 6.15) compared to males. T2DM patients who had poor sleep quality had 3.3 times (AOR = 3.3, 95% CI (1.16, 9.37) higher odds of poor glycemic control compared to patients who had good sleep quality. The odds of having poor glycemic control among T2DM patients who were at low risk of OSA and intermediate risk of OSA were decreased by 96% (AOR = 0.03, 95% CI: 0.01, 0.12) and 86% (AOR = 0.14, 95% CI: 0.05, 0.43) compared to T2DM patients who were at high risk of OSA, respectively. T2DM patients who had short sleep duration (<6 hours) were 8.3 times (AOR = 8.3, 95% CI: 2.66-25.85) higher chances of poor glycemic control compared to patients who had average sleep duration. T2DM patients who had long sleep duration (>8 hours) increased the odds of poor glycemic control by 2.6 times (AOR = 2.6, 95% CI (1.12-6.04) compared to those who had average sleep duration. The chances of having poor glycemic control among T2DM patients who did not take the balanced diet recommended by their physician were increased by 3.8 times (AOR = 3.8 95% CI: 1.05-13.77).

Conclusion

The prevalence of poor glycemic control in T2DM patients was high. Poor sleep quality, both short and long sleep duration, and an intermediate or low risk of obstructive sleep apnea were statistically associated with poor glycemic control. Hence, good sleep quality and appropriate sleep duration are recommended to maintain glycemic control levels in the normal range.

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.

Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study

BACKGROUND

Poor glycemic control is one of the most determinant factors for type 2 diabetes-related morbidity and mortality. The proportion of type 2 diabetes mellitus patients with poor glycemic control remains high. Yet evidence on factors contributing to poor glycemic control remains scarce. The aim of this study is to identify determinants of poor glycemic control among type 2 diabetes mellitus patients at a diabetes mellitus clinic in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Determinants of Poor Glycemic Control among Type 2 Diabetes mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched Case-Control Study.

METHODS

A hospital-based case-control study was conducted from June to September 2020. Using convenience sampling techniques, a total of 90 cases and 90 controls with type 2 diabetes were recruited. The data were entered into Epidata version 4.6.0.2 and analyzed by Stata version 14. A multivariable logistic regression analysis was performed to assess the association between independent variables and glycemic control. Both 95% CI and p-value<0.05 were used to determine the level and significance, respectively.

RESULTS

The mean age ( ± standard deviations) for the cases and controls were 57.55± 10.42 and 61.03± 8.93% respectively. The determinants of poor glycemic control were age (Adjusted odd ratio (AOR)= 0.08; 95% CI= 0.02-0.33), inadequate physical exercise (AOR = 5.05; 95% CI = 1.99-11.98), presence of comorbidities (AOR = 5.50; 95% CI = 2.06-14.66), non-adherence to anti-diabetes medications (AOR= 2.76; 95% CI= 1.19-6.40), persistent proteinuria (AOR=4.95; 95% CI=1.83-13.36) and high-density lipoprotein less than 40 mg/dl (AOR=3.08; 95% CI= 1.30-7.31).

CONCLUSIONS

Age less than 65 years, inadequate physical exercise, presence of comorbidities, non-adherence to anti-diabetes medications, persistent proteinuria, and high-density lipoprotein less than 40 mg/dl were the determinants of poor glycemic control. Therefore, targeted educational and behavioral modification programs on adequate exercise and medication adherence should be routinely practiced. Furthermore, early guideline-based screening and treatment of comorbidities and complications is required to effectively manage diabetes mellitus.

Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis

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.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.

PURPOSE

To evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.

PATIENTS AND METHODS

This cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.

RESULTS

Out of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.

CONCLUSION

The proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients' self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.

The Relationships Among the Organizational Factors of a Tertiary Healthcare Center for Type 2 Diabetic Patients in Palestine

BACKGROUND

Diabetes prevalence at Palestine was 10%, with a rising fund crisis, and diabetes healthcare problems. There was a limited research concerning diabetes healthcare dimensions including organizational factors and their predictors.

OBJECTIVE

This study described patient characteristics and organizational factors, and assessed relationships among organizational factors of type 2 diabetes health care in Palestine.

METHODS

This study is a retrospective cross sectional study, recruited by convenience sampling method in 330 participants from a type 2 diabetes patients list. It was carried out at Ramallah, Palestine. The Statistical Package for Social Sciences (SPSS v 19) was used to analyze data on patient characteristics and organizational factors collected from personal interview and medical records review.

RESULTS

The results showed that 51.2% were males, and 88.5% had additional chronic diseases. Preventive healthcare and patient-healthcare professionals' relationship were the most prominent organizational factors in statistically significant relationships among organizational factors.

CONCLUSION

This study reflected the need for reviewing prescription mode, and educational programs that emphasize the diabetes self-care management and the health care providers' role that would be of great benefit in health outcomes further.

Nutrition quality of life associated with affective functioning among Omani patients with type 2 diabetes from primary health care

Diabetes requires challenging lifelong dietary management, affects quality of life and heightens the impact of affective functioning. The aim of this study was to investigate the relationship between Nutrition Quality of Life (NQOL) and affective functioning in a sample of Omani patients with type 2 diabetes. A sample of 149 adults with type 2 diabetes was conveniently recruited from seven Primary Health Centers (PHCs) during follow-up visits. Data were gathered via face-to-face interviews. Pearson correlation and χ2 test of independence were applied to examine associations at P < 0⋅05. Most patients had poor glycemic control (71⋅1 %), BMI ≥ 25 kg/m2 (85⋅2 %) and central obesity (75⋅8 %), and moderate (54⋅4 %) and poor (32⋅9 %) level of NQOL. Based on the Hospital Anxiety and Depression Scale (HADS), 16⋅1 and 23⋅5 % of the sample endorsed the presence of anxiety and depression, respectively. A significant negative correlation was found between NQOL and HADS (r -0⋅590, P = 0⋅000), anxiety (r -0⋅597, P = 0⋅000) and depression (r -0⋅435, P = 0⋅000). There was a significant association between NQOL and HADS, χ2 (2) = 38⋅21, P < 0⋅01 that was large, Cramer's V = 0⋅51. Also, there were significant associations (P < 0⋅01) between NQOL and HADS when controlling for HbA1c, BMI, waist circumference and HMNT that were moderately to largely strong, Cramer's V = 0⋅43-0⋅55. There is an evident association between NQOL and affective functioning in adults with type 2 diabetes. Further research is recommended to confirm these relationships and to guide intervention programmes at PHCs to help improve the general quality of life of such patients.

Validation of an instrument to measure adherence to type 2 diabetes management

Background Adherence to type 2 diabetes management is defined as the extent to which the behaviour of a person matches the one recommended by health care professionals. Control of this disease depends on adherence to diabetes management, which includes monitoring blood glucose levels, adopting a healthy diet, exercising, taking medication, quitting smoking, and undergoing psychosocial care and periodic check-ups. This can also prevent health complications and reduce medical costs. Objective The objective of this study is to validate a culturally appropriate instrument directed towards the Mexican population that measures a patient's level of adherence to their type 2 diabetes mellitus management. Method The study design was cross-sectional. The instrument was applied individually (face to face researcher-assisted survey) by a member of the team. The study sample included 200 participants, which were attended at an outpatient clinic. To evaluate the psychometric validity of the scale we calculated response frequencies, the discrimination of items for extreme groups, the validity, and the internal reliability. The scale of adherence for complete management in patients with type 2 diabetes includes disease monitoring, complication prevention, and social support using questions and answers based on the Likert scale, corresponding to the 5 stages of the transtheoretical model. Main outcome measure The validity and internal reliability of the instrument to measure adherence to type 2 diabetes management, which proved to be justifiable and reliable with a Cronbach's alpha of 0.92 and a total explained variance of 65.03%. Results The instrument was composed of 29 items and 6 factors: adherence to medical Cronbach's alpha = 0.92 and dietary treatment Cronbach's alpha = 0.88, change in dietary habits Cronbach's alpha = 0.89, adherence to physical activity and exercise Cronbach's alpha = 0.84, social support Cronbach's alpha = 0.79, and prevention of complications Cronbach's alpha = 0.70. The instrument obtained a content validity index (I-CVI) of 0.9. Conclusion The proposed instrument, which includes factors that measure adherence in type 2 diabetes mellitus patient's management, using the transtheoretical model of behaviour change to simultaneously identify patient motivation to change their lifestyle, is valid and reliable.

Predictors of poor glycemic control and level of glycemic control among diabetic patients in west Ethiopia

BACKGROUND

Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. This study aims to assess the level of glycemic control and factors contributing to uncontrolled glycemia among diabetic patients at the Nekemte Referral Hospital, West Ethiopia.

METHODS

A cross sectional study was conducted on diabetic patients attending the diabetes clinic of Nekemte Referral Hospital. A total of 252 study participants were included in the study. Data were collected by interviewing patients during hospital visits and reviewing respective databases. The association between dependent and independent variables was assessed using bivariable and stepwise multivariable logistic regression. A variable with a p-value < 0.05 was considered as an independent predictor. A patient's written informed consent was obtained after explaining the purpose and procedures of the study.

RESULTS

Mean age of the participants was 41.7 ± 17.6 years. The majority of the participants (67.1%) had poor knowledge about diabetes. The glycemic rate control was 40.5%; while more than half of the participants (59.5%) had poor glycemic control. On multivariable logistic analysis poor glycemic control was more likely to occur among unemployed (p < 0.001), patients with no family/social support (p = 0.024), duration of diabetes >10 years (p = 0.005), poor knowledge about diabetes (p = 0.012), taking insulin (p = 0.004) and taking metformin plus glibenclamide (p < 0.001).

CONCLUSION

A finding of this study revealed that a glycemic control of study participants was poor. Thus greater effort is needed to improve glycemic control. Health care professionals should work on improving the adherence to anti-diabetic medications of diabetic patients and knowledge of diabetic patients on diabetes by providing education to the patients during follow up to improve glycemic control.

Association between dental caries indicators and serum glycated hemoglobin-levels among patients with type 2 diabetes mellitus

Diabetes mellitus (DM) with poor glycemic control is often linked to oral manifestations. This study aimed to investigate the association between dental caries (DC) and glycated hemoglobin (HbA1c) among patients with type 2 DM (T2DM). A health center-based cross-sectional study was conducted comprising 91 eligible patients with T2DM (21 males and 70 females) with a mean age (± standard deviation) of 61.49 ± 9.71 years. A structured interview, screening for DM-related factors, and oral examination were performed. Serum HbA1c levels were used as an index for glycemic control. A comparison between patients with controlled T2DM, i.e., HbA1c ≤7.0% (n = 46), and uncontrolled T2DM, i.e., HbA1c >7.0% (n = 45), showed significant differences in mean values of decayed teeth (DT) (P = 0.045); missing teeth (P = 0.002); and decayed, missing, and filled teeth (DMFT) index (P < 0.001). Results of multiple linear regression analysis revealed that the number of DT was significantly correlated with serum HbA1c levels (95% confidence interval [CI] 0.173 to 0.972, P = 0.005). Furthermore, DMFT index values and serum HbA1c levels (95% CI 0.532 to 1.658, P < 0.001) showed a significant association. This study provides substantial evidence on the association between DC indicators and serum HbA1c levels.

The level of knowledge and attitude on insulin therapy in patients with diabetes mellitus in a teaching hospital of Southern India

Aim of the Study:

To assess the level of knowledge and attitude on insulin therapy in patients with diabetes mellitus in a teaching hospital.

Objectives:

1. To assess the level of knowledge and attitude on insulin therapy among patients with diabetes mellitus. 2. To find out the association between the knowledge and attitude on insulin therapy with the selected study variables.

Materials and Methods:

This is a nonexperimental, cross-sectional study. A total of 100 participants were recruited from the outpatients and inpatients attending the department of general medicine and general surgery. Adult male and female with diabetes mellitus receiving insulin injection and willing to participate in the study were included in the study. The data was collected using 20 structured questionnaires to assess the level of knowledge and modified 4 point Likert scale was used, which contains 10 statements to assess the level of attitude on insulin therapy by interview method.

Results:

It was observed from the results that the level of knowledge among the study participants was as follows: 4% of them had adequate knowledge, 44% had moderately adequate knowledge, and more than half (52%) of them had inadequate knowledge. The level of attitude among the study participants (27%) with diabetes mellitus had favorable attitude, more than half (69%) had moderately favorable attitude, and 4% had unfavorable attitude on insulin therapy. It is observed that there is no statistically significant correlation (r) =0.038, P = 0.707 between the level of knowledge and attitude on insulin therapy among patients with diabetes mellitus.

Conclusion:

This study showed that there was inadequate knowledge and unfavorable attitude among the diabetic patients regarding insulin therapy. The people with diabetes should receive ongoing need-based quality diabetic education by using innovative methods that is tailored to their needs, delivered by skilled healthcare providers.

Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes

Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is 'a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness'. Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM. Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalism and to identify which of the 3 subscales (emotional distress, spiritual coping and perceived self-efficacy) were associated with HbA1c. Results: The mean age of the participants was 58.24(SD = 13.48) and the majority were females (53.76%), while 32.73% of the sample had diabetes for more than 10 years. Fully adjusted multiple linear regression models showed that higher scores on diabetes fatalism and the emotional distress subscale (P = 0.018) were significantly associated with higher HbA1c values. In addition, having diabetes for more than 11 years (P = 0.05) and a higher number of diabetes complications (P < 0.001) were associated with higher HbA1c levels. However, advanced age (P = 0.055), female gender (P = 0.003), and diabetes education (P = 0.011) were significantly associated with lower HbA1c levels. Conclusion: This is the first study in the Arab region that identifies diabetes fatalism as an independent predictor of glycemic control among Lebanese. Future studies should further investigate this construct to guide interventions that can address it for better diabetes outcomes.

[Factors associated with medication non-adherence in patients with type 2 diabetes mellitus: The first Algerian survey]

BACKGROUND

Non-adherence in patients with type 2 diabetes is a frequent phenomenon with important impact in terms of management of this disease. The aim of this study was to assess the level of medication adherence and to identify the factors associated with non-adherence in type 2 diabetic patients.

METHODS

A cross-sectional study was conducted in type 2 diabetic patients at the endocrinology and diabetology department of University Medical Center of Sidi Bel Abbes (Algeria) in 2017. Medication adherence was determined using a morisky 8-Item medication adherence questionnaire. A logistic regression was used to identify factors associated with non-adherence.

RESULTS

The study enrolled 403 type 2 diabetic patients. The mean age was 60 years and sex-ratio was 0.8. Medication non-adherence rate was 31.3% (95% CI: 26.8-35.8%). The factors significantly associated with non-adherence in multivariate analysis were: health insurance status, self-monitoring of blood glucose, disease duration, education level and need for information on diabetes.

CONCLUSION

Our study had demonstrated a low adherence in patients with type 2 diabetes. The results suggest that implementation of a therapeutic education program could be important in management of diabetes.

Self-care practices regarding diabetes among diabetic patients in West Ethiopia

OBJECTIVE

To assess the self-care practices and associated factors among diabetic patients in West Ethiopia.

RESULTS

A total of 252 study participants were included in the study, of this 54.8% were male. Of the participants more than half 150 (59.5%) had poor glycemic control and 153 (60.7%) of the participants had good self-care. Majority of the study participants 209 (82.9%) had adequate foot care and more than half 175 (69.4%) and 160 (63.5%) had adequate dietary plan and exercise management respectively. However of the total diabetic patients only 38 (15.1%) had adequate blood glucose testing practices. On multivariable logistic analysis poor self-care practices were more likely to occur among male patients (AOR = 5.551, 95% CI = 2.055-14.997, p = 0.001), patients living in rural area (AOR = 5.517, 95% CI = 2.184-13.938, p < 0.001), patients with duration of diabetes < 6 years (AOR = 41.023, 95% CI = 7.373-228.257, p < 0.001), patients with no access for self-monitoring blood glucose (AOR = 9.448, 95% CI = 2.198-40.617, p = 0.003), patients with poor knowledge about diabetes (AOR = 67.917, 95% CI = 8.212-561.686, p < 0.001) and patients with comorbidities (AOR = 18.621, 95% CI = 4.415-78.540, p < 0.001).

Evaluation of medication adherence among Lebanese diabetic patients

Background:

Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications.

Objectives:

The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence.

Methods:

A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20.

Results:

Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively).

Conclusions:

Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence.

Prevalence, risk factors, and glycaemic control of type 2 diabetes mellitus in eastern Sudan: a community-based study

BACKGROUND

Diabetes mellitus (DM) constitutes a global health threat and burden, especially in developing countries. We conducted a cross-sectional study in Gadarif in eastern Sudan to evaluate the prevalence and glycaemic control of patients with type 2 diabetes mellitus (T2DM).

METHODS

We performed a cross-sectional community-based study. Data on blood glucose levels, and anthropometric, demographic and clinical history data were obtained.

RESULTS

Six hundred Sudanese adults with a mean (SD) age of 44.9 (16.5) years were enrolled. More than two-thirds (70.3%) of the study participants were women. The prevalence of T2DM, newly diagnosed T2DM and uncontrolled T2DM was 20.8%, 10.0% and 80.0%, respectively. Logistic regression analysis showed no significant association between education, marital status, body mass index, waist circumference and DM. However older age (AOR = 4.88, 95% CI = 3.09-7.70) and a family history of DM (AOR = 2.58, 95% CI = 1.59-4.20) were associated with T2DM.

CONCLUSION

The prevalence of T2DM is high among the Sudanese population, especially in older people and those with a family history of DM. The high prevalence of uncontrolled DM in this setting is another hidden burden.

Assessment of glycemic control in type 2 diabetes in the Eastern Sudan

Objectives

A cross-sectional study was conducted in Gadarif, eastern Sudan to assess glycaemic control among adult patients with type 2 diabetes in eastern Sudan. Poor glycaemic control was defined as HbA1c level of ≥ 7.0%. Questionnaire was used to gathered sociodemographic and clinical characteristics.

Results

A total of 339 patients (69.9% were women) were enrolled in the study. The mean age of the participants was 54.8 (12.8) years. Approximately more than two-thirds (n = 243, 71.7%) of the participants were using oral glucose control agents. A round one-fifth (22.1%) of the participants were using insulin and only 6.2% of them were using both insulin and oral glucose control agents. The rate of poor glycemic control was 71.9%. In logistic regression analyses, duration of diabetes, medications used, and the triglycerides were not associated with poor glycemic control. However, being unmarried (OR = 3.64, 95% CI 1.21–10.90), adding sugar to the drinks (OR = 1.84, 95% CI 1.11–3.05, P = 0.017) and high cholesterol level (OR = 1.01, 95% CI 1.01–1.02.) were associated with poor glycemic control. In summary the rate of uncontrolled type 2 diabetes mellitus was considerably high especially among being unmarried patients and patients who were adding sugar to the drinks.

Factors associated with glycemic control among diabetic adult out-patients in Northeast Ethiopia

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.

Association of diabetes-related self-care activities with glycemic control of patients with type 2 diabetes in Pakistan

OBJECTIVE

Association of various self-care activities on glycemic control of people with diabetes (PWD) in Pakistan is yet to be explored. The current study aimed to evaluate the association of various diabetes-related self-care activities with glycated hemoglobin (HbA1c) levels and to examine the predictive relationship of patients' demographic variables with their self-care activities.

PATIENTS AND METHODS

A cross-sectional study was conducted on adult PWD (N=218) who were diagnosed with type 2 diabetes mellitus of at least 1 year duration. Self-care activities were examined by using the Urdu version of Diabetes Self-management Questionnaire. Linear regression analysis was conducted to examine the significant predictors for diabetes-related self-care activities and glycemic control.

RESULTS

Mean age of the patients was 50.77±13.3 years. Poor glycemic control (HbA1c $7%) was observed in majority of the patients (83%). Linear regression analysis revealed that glucose management (β=-0.44; 95% CI -0.438, -0.209; P<0.001) was the strongest predictor for low levels of patients' HbA1c, followed by dietary control (β=-0.19; 95% CI -0.248, -0.018; P=0.024) and physical activity (β=-0.17; 95% CI -0.165, -0.023; P=0.010), respectively. Linear regression analysis showed that use of oral hypoglycemic agents only (β=-0.218; 95% CI -0.956, -0.200; P=0.003) and higher education level (β=0.204; 95% CI 0.138, 0.777; P=0.005) were significant predictors for higher scores of patients' self-care activities.

CONCLUSION

The findings support that PWD having better self-reported self-care activities achieve better glycemic control. Patients' self-care activities should be monitored on a regular basis, especially for those who are at risk of poor glycemic control.

Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China

OBJECTIVES

Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood.

METHODS

A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8^©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model.

RESULTS

Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51-2.15] and [OR =1.17, 95% CI =1.06-1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69-0.84] and [OR =0.82, 95% CI =0.73-0.92], respectively).

CONCLUSION

BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.