Abstract
AimsTo assess the determinants of glycaemic control among patients with Type 2 diabetes mellitus (T2DM) presenting at the Greater Accra Regional Hospital, Ghana.MethodsThe study employed semi-structured questionnaires and review of clinical records of patients 16 years and above with Type 2 Diabetes.ResultsThe mean age of participants was 56.6 ± 13.8 years, with majority (71.6%) being females. A total of 161 (59.4%) of patients had poor glycaemic control (HbA1c ≥8.1%; 95% CI: 53.6 to 65.3%). Poor glycaemic control was significantly associated with high body mass index of the patient (AOR 13.22; 95% CI: 1.95 to 89.80), having only elementary education (AOR 5.22, 95% CI 2.12–12.86, p<0.0001) and being on insulin therapy (AOR 2.88; 95% CI: 1.05 to 7.88). On the other hand, seldom coffee intake (AOR: 0.27; 95% CI: 0.11 to 0.64), high physical activity (AOR 1.57, 95% CI 1.06–2.35, p = 0.025) and having a cardiovascular disease (AOR: 0.15; 95% CI: 0.05 to 0.46) appeared to positively influence glycaemic control. Self-monitoring of blood glucose and diet interventions did not appear to influence glycaemic control.ConclusionsThe study results showing that a high proportion of patients attending the Diabetes Clinic with uncontrolled diabetes has serious implications for the management of T2DM diabetes as it suggests that current hospital-based treatment measures are less effective. Comprehensive management of T2DM targeting all the key factors identified in this study and incorporating a multispectral collaborative effort based on holistic approach, combined with non-pharmacological components are strongly warranted.
Highlights
Type II Diabetes Mellitus (T2DM), one of the four major types of diabetes mellitus (DM) [1], is a leading cause of ill-health that requires continuous medical care, ongoing self-management, and support to prevent or reduce complications from hyperglycemia, hypoglycemia, hypertension, cardiovascular diseases, or kidney failure [2]
Poor glycaemic control was significantly associated with high body mass index of the patient (AOR 13.22; 95% CI: 1.95 to 89.80), having only elementary education (AOR 5.22, 95% CI 2.12–12.86, p
Seldom coffee intake (AOR: 0.27; 95% CI: 0.11 to 0.64), high physical activity (AOR 1.57, 95% CI 1.06–2.35, p = 0.025) and having a cardiovascular disease (AOR: 0.15; 95% CI: 0.05 to 0.46) appeared to positively influence glycaemic control
Summary
Type II Diabetes Mellitus (T2DM), one of the four major types of diabetes mellitus (DM) [1], is a leading cause of ill-health that requires continuous medical care, ongoing self-management, and support to prevent or reduce complications from hyperglycemia, hypoglycemia, hypertension, cardiovascular diseases, or kidney failure [2]. HbA1c is an effective biomarker of long-term glycaemic control, an efficient predictor of diabetes complications and independent risk factor for stroke and coronary heart disease, ideal for identifying and monitoring DM patients who are at high risk of cardiovascular complications [5]. Little controversy surrounds the ideal target for blood glucose control for those with diabetes on a range of 6.0–7.5% HbA1c, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend HbA1c cut-off point of 7.0% (53.0mmol/mol) as optimal [6, 7]. In Ghana, most HbA1c assay results from reputable laboratories such as Synlab Ghana Limited, MDS Lancet Laboratories Limited and Greater Accra Regional Hospital laboratory, which work hand-in-hand with health facilities and clinicians come with a glycaemic control guideline (reference range) that interprets or classifies diabetes status as HbA1c 10.0 as poor diabetes control [8]
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