Proportion and Potential Risk Factors of Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus: Experience of a Tertiary Center in Baghdad, Iraq, 2020
DOI:
https://doi.org/10.32007/jfacmedbagdad.6622070Keywords:
Risk Factors, Glycemic Control, Type 2 Diabetes MellitusAbstract
Background: Diabetes Mellitus is the most prevalent metabolic disorder worldwide. Effective diabetes self-management and keeping the Glycosylated hemoglobin level within the normal range could decrease the burden on the health system by reducing hospital admissions and diabetic complications, lowering the financial strain on the health system.
Objective: To recognize the potential risk factors of poor glycemic control in patients having type 2 Diabetes Mellitus in Baghdad, Iraq.
Patients and Methods: This cross-sectional study was conducted in the Diabetes and Endocrine Center at Al-Kindy Teaching Hospital, Baghdad, Iraq, from June to November 2020. The total number of the study's participants was 234. Based on the cutoff point of glycosylated hemoglobin of 7, the patients with glycosylated hemoglobin of ≥7 were considered uncontrolled, and those with glycosylated hemoglobin of <7 were considered controlled.
Results: The proportion of cases with uncontrolled diabetes was 68.4% (160). The remaining 74 patients had controlled diabetes. Age, sex, marital status, and employment status were not significantly associated with the control status (P>0.05). The binary analysis showed a significant association observed between the control status and level of education (P=0.001), income (P=0.001), presence of comorbidities (P=0.028), positive family history (P=0.03), dyslipidemia (P=0.001), cholesterol level (P=0.002), high triglyceride level (P=0.001), and low-density lipoprotein-cholesterol level (P=0.025). The smoking status, body mass index, and high-density lipoprotein-cholesterol level were not significantly associated with the control status (P>0.05). The disease characteristics, including the disease duration, fasting blood glucose, type of medication, self-monitoring, healthy diet, physical activity, and medication adherence, were significant factors (P<0.001). The multivariate regression method showed that dyslipidemia, FBS≥130, physical inactivity, and poor medication adherence were significant predictors for uncontrolled DM (P-value = 0.03, 0.001, 0.03, and 0.043, respectively).
Conclusion: The most important potentially modifiable risk factors for poor diabetes control were dyslipidemia, physical inactivity, and poor adherence to the management protocol. Enhancing the education of patients and their healthcare providers on these factors is crucial to improving the patients’ control status.
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References
Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine (United Kingdom). 2019; 47(1):22–7. https://doi.org/10.1016/j.mpmed.2018.10.004
Zhou B, Lu Y, Hajifathalian K, Bentham J, Di Cesare M, Danaei G, et al. Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. The Lancet. 2016; 387(10027):1513–30. URL
Ong SE, Kai Koh JJ, Toh SAES, Chia KS, Balabanova D, McKee M, et al. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS One. 2018; 13 (3); e0195086. https://doi.org/10.1371/journal.pone.0195086
Ho AYK, Berggren I, Dahlborg-Lyckhage E. Diabetes empowerment related to Pender’s Health Promotion Model: a meta-synthesis. Nurs Health Sci. 2010; 12(2):259–67. https://doi.org/10.1111/j.1442-2018.2010.00517.x
Ahola AJ, Groop PH. Barriers to self-management of diabetes. Diabet Med. 2013; 30(4):413–20. https://doi.org/10.1111/dme.12105
Cheng LJ, Wang W, Lim ST, Wu VX. Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review. J Clin Nurs.; 28(9–10):1433–50. https://doi.org/10.1111/jocn.14795
Aboudi S Al, Lami F, Maliki A Al. Prevalence and Determinants of Depression among Diabetic Patients, Babel Province, Iraq, 2013-2014. JFac Med Baghdad. 2014; 56(4). https://doi.org/10.32007/med.1936/jfacmedbagdad.v56i4.15
Tawfeeq AS. Prevalence and risk factors of diabetic retinopathy among Iraqi patients with type 2 diabetes mellitus. Iraqi Journal of Community Medicine. 2015; 28(1). URL
Pinchevsky Y, Butkow N, Raal FJ, Chirwa T, Rothberg A. Demographic and Clinical Factors Associated with Development of Type 2 Diabetes: A Review of the Literature. Int J Gen Med [Internet]. 2020; 13: 121. https://doi.org/10.2147/IJGM.S226010
Diabetes Facets & Figures/ International Diabetes Federation URL
Iacobucci G. Diabetes: Missed routine checks are causing premature deaths in England, charity warns. BMJ. 2023;381:1070. https://doi.org/10.1136/bmj.p1070
2015 STEPS Country report Iraq. URL
Saud A Bin Rakhis Sr, AlDuwayhis NM, Aleid N, AlBarrak AN, Aloraini AA. Glycemic Control for Type 2 Diabetes Mellitus Patients: A Systematic Review. Cureus. 2022; 14(6). https://doi.org/10.7759/cureus.26180
Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care. 2020 ; 44(1):258–79. https://doi.org/10.2337/dci20-0053.
Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLoS One. 2018; 13(3):e0194127. https://doi.org/10.1371/journal.pone.0194127
Kayar Y, Ilhan A, Kayar NB, Unver N, Coban G, Ekinci I, et al. Relationship between the poor glycemic control and risk factors, life style and complications. Biomed. Res. 28(4). URL
Alqarni AM, Alrahbeni T, Al Qarni A, Al Qarni HM. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia – a cross-sectional survey. Patient Prefer Adherence. 2019; 13: 63. https://doi.org/10.2147/PPA.S176355
Figueira ALG, Boas LCGV, Coelho ACM, Freitas MCF de, Pace AE. Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus. Rev Lat Am Enfermagem. 2017; 25(0). https://doi.org/10.1590/1518-8345.1648.2863
Bae JP, Lage MJ, Mo D, Nelson DR, Hoogwerf BJ. Obesity and glycemic control in patients with diabetes mellitus: Analysis of physician electronic health records in the US from 2009-2011. J Diabetes Complications. 2016;30(2):212–20. URL
Alzaheb RA, Altemani AH. Prevalence and Associated Factors of Dyslipidemia Among Adults with Type 2 Diabetes Mellitus in Saudi Arabia. Diabetes Metab Syndr Obes. 2020;13:4033–40. https://doi.org/10.2147/DMSO.S246068
Abdelmoneim I, Al-Homrany M A. Health education in the management of diabetes at the primary health care level: is there a gender difference? East Mediterr Health J. 2002; 8(1):18–23. https://doi.org/10.26719/2002.8.1.18
American Diabetes Association. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S193–202. https://doi.org/10.2337/dc20-S015
Jialal I, Singh G. Management of diabetic dyslipidemia: An update. World J Diabetes. 2019; 10(5):280–90. https://doi.org/10.4239/wjd.v10.i5.280
Bi Y, Zhu D, Cheng J, Zhu Y, Xu N, Cui S, et al. The status of glycemic control: A cross-sectional study of outpatients with type 2 diabetes mellitus across primary, secondary, and tertiary hospitals in the Jiangsu province of China. Clin Ther . 2010 ; 32(5):973–83. https://doi.org/10.1016/j.clinthera.2010.05.002
Pokharel DR, Khadka D, Sigdel M, Yadav NK, Acharya S, Kafle R, et al. Prevalence and pattern of dyslipidemia in Nepalese individuals with type 2 diabetes. BMC Res Notes. 2017;10(1):1–11. https://doi.org/10.1186/s13104-017-2465-4
Iqbal J, Al Qarni A, Hawwari A, Alghanem AF, Ahmed G. Metabolic Syndrome, Dyslipidemia and Regulation of Lipoprotein Metabolism. Curr Diabetes Rev. 2017 Jul 24; 14(5):427–33. https://doi.org/10.2174/1573399813666170705161039
Hirano T. Pathophysiology of Diabetic Dyslipidemia. J Atheroscler Thromb. 2018; 25(9):771–82. http://doi.org/10.5551/jat.RV17023
Mansour AA, Alibrahim NTY, Alidrisi HA, Alhamza AH, Almomin AM, Zaboon IA, et al. Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period. Diabetes Metab Syndr. 2020; 14(3):265–72. https://doi.org/10.1016/j.dsx.2020.03.008
Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: A review. Int J Health Sci (Qassim). 2017; 11(2):65.URL
Kang Y, Hur Y. Medication Adherence and Its Associated Factors in Laotians with Type 2 Diabetes Mellitus. Clin Nurs Res. 2020; 29(5):331–8. https://doi.org/10.1177/1054773819849349
Vanroy J, Seghers J, Bogaerts A, Devloo K, De Cock S, Boen F. Short- and long-term effects of a need-supportive physical activity intervention among patients with type 2 diabetes mellitus: A randomized controlled pilot trial. PLoS One . 2017 ; 12(4):e0174805. https://doi.org/10.1371/journal.pone.0174805
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