Level of sustained glycemic control and associated factors among patients with diabetes mellitus in Ethiopia: a hospital-based cross-sectional study

Abstract

Solomon Mekonnen Abebe,1 Yemane Berhane,2 Alemayehu Worku,3 Shitaye Alemu,1 Nebiyu Mesfin1 1University of Gondar, College of Medicine and Health Sciences, School of Medicine, Gondar, Ethiopia; 2Addis Continental Institute of Public Health, Addis Ababa, Ethiopia; 3School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia Background: The level of sustained glycemic control in patients with diabetes mellitus (DM) is a major determinant of the occurrence of both acute and chronic complications. However, information about the level of glycemic control among patients in the follow-up care at the University of Gondar Referral Hospital is scanty. The study assessed the degree of glycemic control and associated factors among diabetic patients in the study area. Method: A hospital-based cross-sectional study was conducted at the University of Gondar Referral Hospital. All diabetic patients aged ≥18 years who visited the Diabetes Clinic in January and February 2013 for follow-up medical evaluation and medication participated in the study. Patients with glycosylated hemoglobin test (HbA1c) of ≥7% were classified as having a poor level of glycemic control. Propensity score was used to estimate the treatment effect. Multivariable logistic regression analysis was applied to determine the associated factors. Result: Two hundred and fifty three (64.7%) of the 391 diabetic patients included in the study had a poor level of glycemic control, as evidenced by HbA1c ≥7%. Poor glycemic control was much higher among Type 1 patients (82.9%) compared with Type 2 patients (57.5%). Being on insulin treatment (AOR =2.51; 95% CI =1.25, 5.04) and reporting poor medication adherence (AOR =3.19; 95% CI =1.76, 5.80) were found to be associated with poor glycemic control among Type 2 DM patients. High waist circumference was inversely associated with a poor level of glycemic control in Type 1 DM patients (AOR =0.05; 95% CI =0.01, 0.85). Conclusion: The proportion of diabetic patients with a poor level of glycemic control is high. We recommend a comprehensive intervention to improve the overall treatment adherence with special attention to DM patients receiving insulin. Keywords: glycemic control, HbA1c, waist circumference, diabetes mellitus, BMI