Factors associated with poor glycemic control among patients with Type 2 diabetes

https://doi.org/10.1016/j.jdiacomp.2008.12.008Get rights and content

Abstract

Objectives

Determine factors associated with poor glycemic control among Jordanian patients with Type 2 diabetes.

Methods

A systematic random sample of 917 patients was selected from all patients with Type 2 diabetes over a period of 6 months in 2008. A prestructured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviours, medication adherence, barriers to adherence, and attitude towards diabetes. Weight, height, and waist circumferences were measured. All available last readings of hemoglobin A1c (HbA1c), fasting blood sugar measurements and lipid were abstracted from patients' records. Poor glycemic control was defined as HbA1c ≥7%.

Results

Of the total 917 patients, 65.1% had HbA1c ≥7%. In the multivariate analysis, increased duration of diabetes (>7 years vs. ≤7years) (OR=1.99, P≤.0005), not following eating plan as recommended by dietitians (OR=2.98, P≤.0005), negative attitude towards diabetes, and increased barriers to adherence scale scores were significantly associated with increased odds of poor glycemic control.

Conclusion

The proportion of patients with poor glycemic control was high, which was nearly comparable to that reported from many countries. Longer duration of diabetes and not adherent to diabetes self-care management behaviors were associated with poor glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence to treatment regimen would be of great benefit in glycemic control.

Introduction

Diabetes mellitus is a major cause of morbidity and mortality. In a recent study in Jordan, the age-standardized prevalence of diabetes mellitus (DM) and impaired fasting glucose were 17.1% and 7.8%, respectively (Ajlouni, Khader, Batieha, Ajlouni, & EL-khateeb, 2008). In the Arab region, the overall prevalence of DM in the Kingdom of Saudi Arabia is 23.7% among people with age between 30 and 70 years (Al-Nozha et al., 2004). The prevalence of diabetes in the United Arab Emirates, Bahrain, and Kuwait were 20.1%, 14.9% and 12.8%, respectively (International Diabetes Foundation, 2003).

Several large clinical trials have demonstrated that tight blood glucose control correlates with a reduction in the microvascular complications of diabetes (The Diabetes Control and Complications Trial Research Group, 1993, UK Prospective Diabetes Study (UKPDS) Group, 1998). The American Diabetes Association (ADA) has designated HbA1c level of <7% as a goal of optimal blood glucose control (American Diabetes Association, 2003), and the American Association of Clinical Endocrinologist has further recommended HbA1c level of <6.5% (The American Association of Clinical Endocrinologists medical guidelines for the management of diabetes mellitus, 2002). Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications (Saadine et al., 2002, Stratton et al., 2000, UK Prospective Diabetes Study (UKPDS) Group, 1998), high proportion of patients remain poorly controlled (Karter et al., 2005). Poor and inadequate glycemic control among patients with Type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes (Koro, Bowlin, Bourgeois, & Fedder, 2004).

In clinical practice, optimal glycemic control is difficult to obtain on a long-term basis because the reasons for poor glycemic control in Type 2 diabetes are complex (Wallace & Matthews, 2000). Both patient- and health care provider-related factors may contribute to poor glycemic control (Rhee et al., 2005, Wallace & Matthews, 2000). This study was conducted to determine factors associated with poor glycemic control among patients with Type 2 diabetes who attended the National Center for Diabetes, Endocrinology, and Genetics (NCDEG) in Jordan.

Section snippets

Participants

A systematic random sample (every third patient) of 917 patients was selected from all patients with Type 2 diabetes who attended NCDEG over a period of 6 months in 2008. In systematic random sampling, a number within the sampling interval was chosen. We chose a random number between 1 and 10 using random number tables. Then every third person aged 18 years or above following the first number chosen was selected each day for the whole study period. Participants were informed about the objective

Participants' characteristic

This study included a total of 917 patients (455 men and 462 women) with Type 2 DM aged between 24 and 84 years, with a mean (S.D.) of 57.4 (9.6) years. Only 11% of patients were illiterate. More than half of the patients (68.5 %) were not employed. About 19.7% were current smoker. Their clinical, anthropometric, and relevant characteristics are shown in Table 1. About 62.3% of patients were on oral antidiabetic agents, 32.0% of patients were on combination of oral antidiabetic agents and

Discussion

This study estimated the proportion of patients with Type 2 diabetes who did not achieve target level of HbA1c in NCDEG. Poor glycemic control (HbA1c >7%) was present in 65.1% of patients. In Kuwait, 66.7% of the studied population had HbA1c ≥8% (Al-Sultan & Al-Zanki, 2005). In Saudi Arabia, only 27% of the patients reached target level of glycemic control (Akbar, 2001). In Pakistan (Habib & Aslam, 2003), 46.7% of patients had HbA1c >7.5%. In Trinidad, 85% had HbA1c >7% (Ezenwaka & Offiah, 2001

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