Poor Glycaemic Control and It’s Risk Factors Among Diabetes Patients in An Urban Area of Western India
DOI:
https://doi.org/10.55489/njcm.150120243602Keywords:
HBA1c, Body mass Index, Perceived stress, GPAQ, MET, Physical activityAbstract
Introduction: Diabetes is a major public health problem worldwide including India. Poor glycaemic control is a major risk factor for the development of diabetes-related complications. Hence, monitoring and achieving good glycaemic control is critical to reducing the risk of complications and improving outcomes in people with diabetes. This study conducted to determine the prevalence of poor glycaemic control and to identify the factors associated with poor glycaemic control.
Methodology: This cross-sectional descriptive study conducted in an urban area among those patients having diabetes since more than five years. All participants were interviewed and tested for HbA1c. Cases with good glycaemic control (HbA1c <7%) were compared with those with poor glycaemic control (HbA1c ≥7%). Multivariate analysis was conducted to find out independent determinants.
Results: Out of 632 cases, poor glycaemic control was found in 81.3% cases. Multivariate logistic regression indicated that living without a spouse (p 0.036), Female gender (p 0.032), MBI >23(kg/m2) (p <0.001), poor medication adherence (p 0.022), and high perceived stress level (p 0.011) were independent predictors of poor glycaemic control. More than 10 years duration of diabetes was found to be associated with good glycaemic control (p 0.016)
Conclusion: There are a high proportion of patients with poor glycaemic control. Higher BMI, poor drug adherence and higher stress level are independently associated with poor glycaemic control.
References
International Diabetes Federation. IDF Diabetes Atlas, 9th Edn. Brussels, Belgium; 2019.
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5) 2019-2021. India. Mumbai; 2021.
American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44(Suppl 1):S15-S33; Doi: https://doi.org/10.2337/dc21-S002 PMid:33298413
Vashist P, Senjam SS, Gupta V, et al. Prevalence of diabetic retinopahty in India: Results from the National Survey 2015-19. Indian J Ophthalmol 2021;69(11):3094; doi: 10.4103/IJO.IJO_1310_21. Doi: https://doi.org/10.4103/ijo.IJO_1310_21 PMid:34708747 PMCid:PMC8725073
Turner R. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352(9131):854-865; doi: 10.1016/S0140-6736(98)07037-8. Doi: https://doi.org/10.1016/S0140-6736(98)07037-8
Group TDC and CTR. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complica-tions in Insulin-Dependent Diabetes Mellitus. Doi: https://doi.org/10.1056/NEJM199309303291401 PMid:8366922
Afroz A, Ali L, Karim MN, et al. Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for opti-mization of management plan. Sci Rep 2019;9(1); Doi: https://doi.org/10.1038/s41598-019-46766-9 PMid:31308457 PMCid:PMC6629620
Manoharan D, Viswanathan V, Kumpatla S, et al. Knowledge and Outcome Measure of HbA1c Testing in Asian Indian Patients with Type 2 Diabetes from a Tertiary Care Center. Indian J Community Med 2010;35(2):290; Doi: https://doi.org/10.4103/0970-0218.66858 PMid:20922109 PMCid:PMC2940188
Anonymous. Perceived Stress Scale. n.d. Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft02889-000 [Last accessed: 5/21/2023].
Armstrong T, Bull F. Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health (Bangkok) 2006;14(2):66-70; Doi: https://doi.org/10.1007/s10389-006-0024-x
Borgharkar SS, Das SS, Surendra D, et al. Real-world evidence of glycemic control among patients with type 2 diabetes mellitus in In-dia: the TIGHT study. BMJ Open Diabetes Res Care 2019;7(1):e000654; Doi: https://doi.org/10.1136/bmjdrc-2019-000654 PMid:31413840 PMCid:PMC6673766
Kumar SP, Sandhya AM. A study on the glycemic, lipid and blood pressure control among the type 2 diabetes patients of north Kera-la, India. Indian Heart J 2018;70(4):482-485; Doi: https://doi.org/10.1016/j.ihj.2017.10.007 PMid:30170640 PMCid:PMC6116718
Najeeb SS, Joy TM, Sreedevi A, et al. Glycemic control and its determinants among people with type 2 diabetes mellitus in Ernakulam district, Kerala. Indian J Public Health 2022;66(Supplement):S80-S86; Doi: https://doi.org/10.4103/ijph.ijph_1104_22 PMid:36412480
Oluma A, Abadiga M, Mosisa G, et al. Magnitude and predictors of poor glycemic control among patients with diabetes attending pub-lic hospitals of Western Ethiopia. PLoS One 2021;16(2):e0247634; Doi: https://doi.org/10.1371/journal.pone.0247634 PMid:33630936 PMCid:PMC7906479
Jeon JY, Kim DJ, Ko SH, et al. Current status of glycemic control of patients with diabetes in Korea: The fifth Korea national health and nutrition examination survey. Diabetes Metab J 2014;38(3):197-203; Doi: https://doi.org/10.4093/dmj.2014.38.3.197 PMid:25003073 PMCid:PMC4083026
De Pablos-Velasco P, Parhofer KG, Bradley C, et al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: Data from the PANORAMA study. Clin Endocrinol (Oxf) 2014;80(1):47-56; Doi: https://doi.org/10.1111/cen.12119 PMid:23194193
Ford KJ, Robitaille A. How sweet is your love? Disentangling the role of marital status and quality on average glycemic levels among adults 50 years and older in the English Longitudinal Study of Ageing. BMJ Open Diabetes Res Care 2023;11(1); Doi: https://doi.org/10.1136/bmjdrc-2022-003080 PMid:36746526 PMCid:PMC9930545
International Diabetes Federation. Type 2 Diabetes. n.d. Available from: https://www.idf.org/aboutdiabetes/type-2-diabetes.html [Last accessed: 6/2/2023].
Joung IMA, Van De Mheen HD, Stronks K, et al. A longitudinal study of health selection in marital transitions. Soc Sci Med 1998;46(3):425-435; Doi: https://doi.org/10.1016/S0277-9536(97)00186-X PMid:9460823
Guner N, Kulikova Y, Llull J. Marriage and Health: Selection, Protection, and Assortative Mating. Eur Econ Rev 2018;104:138-166; Doi: https://doi.org/10.1016/j.euroecorev.2018.02.005 PMid:33132405 PMCid:PMC7597938
Sisodia RK, Chouhan M. The study of correlation between Body Mass Index and glycemic control-HbA1c in diabetes type 2 patients. International Journal of Advances in Medicine 2019;6(6):1788; Doi: https://doi.org/10.18203/2349-3933.ijam20195228
Chiero V, Das KC. Risk factors of Diabetes and its Comorbidities Among Elderly in India: Evidence from Longitudinal Aging Study (LASI). National Journal of Community Medicine 2023;14(01):10-17; Doi: https://doi.org/10.55489/njcm.140120232428
Alzaheb RA, Altemani AH. The prevalence and determinants of poor glycemic control among adults with type 2 diabetes mellitus in Saudi Arabia. Diabetes Metab Syndr Obes 2018;11:15-21; Doi: https://doi.org/10.2147/DMSO.S156214 PMid:29430192 PMCid:PMC5797462
Bae JP, Lage MJ, Mo D, et al. 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):212-220; Doi: https://doi.org/10.1016/j.jdiacomp.2015.11.016 PMid:26689451
Sheleme T, Mamo G, Melaku T, et al. Glycemic Control and its Predictors among Adult Diabetic Patients attending Mettu Karl Referral Hospital, Southwest Ethiopia: A Prospective Observational Study. Diabetes Ther 2020;11(8):1775-1794; Doi: https://doi.org/10.1007/s13300-020-00861-7 PMid:32583174 PMCid:PMC7376794
Martinez KE, Tucker LA, Bailey BW, et al. Expanded Normal Weight Obesity and Insulin Resistance in US Adults of the National Health and Nutrition Examination Survey. J Diabetes Res 2017;2017; Doi: https://doi.org/10.1155/2017/9502643 PMid:28812029 PMCid:PMC5547730
Nilsson PM, Theobald H, Journath G, et al. Gender differences in risk factor control and treatment profile in diabetes: a study in 229 swedish primary health care centres. Scand J Prim Health Care 2004;22(1):27-31; Doi: https://doi.org/10.1080/02813430310003264 PMid:15119517
Haghighatpanah M, Nejad ASM, Haghighatpanah M, et al. Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Melli-tus Patients with Complications. Osong Public Health Res Perspect 2018;9(4):167-174; Doi: https://doi.org/10.24171/j.phrp.2018.9.4.05 PMid:30159222 PMCid:PMC6110332
Demoz GT, Gebremariam A, Yifter H, et al. Predictors of poor glycemic control among patients with type 2 diabetes on follow-up care at a tertiary healthcare setting in Ethiopia. BMC Res Notes 2019;12(1); Doi: https://doi.org/10.1186/s13104-019-4248-6 PMid:30947749 PMCid:PMC6449968
Choe SA, Kim JY, Ro YS, et al. Women are less likely than men to achieve optimal glycemic control after 1 year of treatment: A multi-level analysis of a Korean primary care cohort. PLoS One 2018;13(5); Doi: https://doi.org/10.1371/journal.pone.0196719 PMid:29718952 PMCid:PMC5931663
Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev 2016;37(3):278-316; Doi: https://doi.org/10.1210/er.2015-1137 PMid:27159875 PMCid:PMC4890267
Kautzky-Willer A, Kosi L, Lin J, et al. Gender-based differences in glycaemic control and hypoglycaemia prevalence in patients with type 2 diabetes: results from patient-level pooled data of six randomized controlled trials. Diabetes Obes Metab 2015;17(6):533-540; Doi: https://doi.org/10.1111/dom.12449 PMid:25678212 PMCid:PMC6680342
Al-Qazaz HK, Sulaiman SA, Hassali MA, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm 2011;33(6):1028-1035; Doi: https://doi.org/10.1007/s11096-011-9582-2 PMid:22083724
Kirkman MS, Rowan-Martin MT, Levin R, et al. Determinants of adherence to diabetes medications: findings from a large pharmacy claims database. Diabetes Care 2015;38(4):604-609; Doi: https://doi.org/10.2337/dc14-2098 PMid:25573883 PMCid:PMC4370331
Duarte FG, Da Silva Moreira S, Almeida MDCC, et al. Sex differences and correlates of poor glycaemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela. BMJ Open 2019;9(3); Doi: https://doi.org/10.1136/bmjopen-2018-023401 PMid:30842107 PMCid:PMC6429715
Boels AM, Rutten G, Cleveringa F, et al. Insulin Therapy in Type 2 Diabetes Is Associated With Barriers to Activity and Worse Health Status: A Cross-Sectional Study in Primary Care. Front Endocrinol (Lausanne) 2021;12; Doi: https://doi.org/10.3389/fendo.2021.573235 PMid:33776906 PMCid:PMC7989698
Annor FB, Roblin DW, Okosun IS, et al. Work-related psychosocial stress and glycemic control among working adults with diabetes mellitus. Diabetes Metab Syndr 2015;9(2):85-90; Doi: https://doi.org/10.1016/j.dsx.2015.02.003 PMid:25818923
Walker RJ, Garacci E, Campbell JA, et al. The influence of daily stress on glycemic control and mortality in adults with diabetes. J Be-hav Med 2020;43(5):723-731; Doi: https://doi.org/10.1007/s10865-019-00109-1 PMid:31617047 PMCid:PMC7156304
Pan KY, Xu W, Mangialasche F, et al. Work-related psychosocial stress and the risk of type 2 diabetes in later life. J Intern Med 2017;281(6):601-610; Doi: https://doi.org/10.1111/joim.12615 PMid:28439925
Sui H, Sun N, Zhan L, et al. Association between Work-Related Stress and Risk for Type 2 Diabetes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. PLoS One 2016;11(8); Doi: https://doi.org/10.1371/journal.pone.0159978 PMid:27513574 PMCid:PMC4981307
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Yash Rajan, Anup Kharde, Hitesh Bhabhor, Jay Kakadiya, Kush Varsadiya, Aman Damor
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.