Determinants Of Glycemic Control Research Articles

Public health insurance: An approach to mitigate the burden of diabetes in low resource settings

Background: Diabetes mellitus is a significant public health concern globally as well as in Owerri, Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin levels greater than 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking on specific risk factors associated with poor glycemic control among diabetes mellitus patients in Owerri. There is a gap in the literature regarding the association between health insurance and glycemic control in diabetic patients in Owerri. With health insurance assuming a significant position in healthcare service delivery in Nigeria, addressing this gap is valuable. Methods: We performed a cross-sectional study of health insurance as a determinant of glycemic control among 160 type 2 diabetic patients attending the family medicine clinic at the Federal University Teaching Hospital, formerly the Federal Medical Center, Owerri. Participants were measured as not insured, insured-private, and insured-public/National Health Insurance Scheme. The dependent variable was glycemic control measured using glycosylated hemoglobin. We used ecosocial theory as the theoretical framework of this research. SPSS was used for data analysis; multiple logistic regression was applied to assess the association between insurance status and glycemic control in the participants. Results:In the patients without health insurance coverage, the prevalence of poor glycemic control was 93.8% whereas in those with health insurance coverage, the prevalence was 60.0%. Logistic regression analysis showed that lack of access to health insurance was a determinant of glycemic control, with uninsured subjects at 28 times and 6 times increased risk of poor glycemic control compared with insured-private and insured-public subjects, respectively. Conclusion: We have shown in our study that insured enrollees have an increased likelihood of good glycemic control relative to uninsured subjects. This finding has the potential to promote positive social change through optimization of the National Health Insurance Scheme. Enabling regulations and designing policies to explicitly cover diabetes preventive and control services in the scheme could lead to improved glycemic control, and, thus, reduce the burden of the disease.

Catabolism of fats and branched-chain amino acids in children with Type 1 diabetes: Association with glycaemic control and total daily insulin dose.

Hyperglycaemia in Type 1 diabetes (T1D) results from an absolute insulin deficiency. However, insulin resistance (IR) may exacerbate glycaemic instability in T1D and contribute to long-term cardiovascular complications. We previously showed that IR in teenagers with obesity is associated with sex-dependent derangements in the catabolism of branched-chain amino acids (BCAA) and fatty acids. Here we hypothesized that byproducts of BCAA and fatty acid metabolism may serve as biomarkers or determinants of glycaemic control and IR in prepubertal or early pubertal children with T1D. Metabolites, hormones and cytokines from fasting blood samples were analysed in 28 children (15 females, 13 males; age 6-11 years) with T1D. Principal components analysis (PCA) and multiple linear regression models were used to correlate metabolites of interest with glycaemic control, total daily insulin dose (TDD, units/kg/d), adiponectin and the triglyceride (TG) to high-density lipoprotein (HDL) ratio. Males and females were comparable in age, BMI-z, insulin sensitivity, glycaemic control, inflammatory markers, BCAAs and C2/C3/C5-acylcarnitines. The majority of components retained in PCA were related to fatty acid oxidation (FAO) and BCAA catabolism. HbA1c correlated positively with Factor 2 (acylcarnitines, incomplete FAO) and Factor 9 (fasting glucose). TDD correlated negatively with C3 and C5 and Factor 10 (BCAA catabolism) and positively with the ratio of C2 to C3 + C5 and Factor 9 (fasting glucose). These findings suggest that glucose intolerance in prepubertal or early pubertal children with T1D is accompanied by incomplete FAO while TDD is associated with preferential catabolism of fats relative to amino acids.

Glycemic Control and Its associated Determinants among Type II Diabetic Patients at Tertiary Care Hospital in North India

Introduction: Good glycemic control has been defined as achieving a target of fasting plasma glucose level of between 80 and 110 mg/dl, or glycosylated haemoglobin (HbA1C) of <7.0%. Poor glycemic control is highly correlated with chronic conditions related to the damaging effects of hyperglycaemia, resulting in serious complications. To restrict and delay the complications of diabetes mellitus, good glycemic control is essential. Objective: To identify the determinants associated with poor glycemic control among Type 2 diabetes mellitus patients. Method: A cross sectional study was conducted among 403 confirmed type 2 diabetic patients who attendedone of the tertiary care hospitals of North India over a period of six months (July- December 2021). The collected data was analysed using IBM SPSS version 28. Chi-square test was applied to compare various determinants of glycemic control. A p-value of <0.05 was considered to be statistically significant. Results: Out of 403 participants, 57.6% had poor glycemic control of diabetic condition. Higher age of participants, illiteracy, being overweight, having positive history of smoking and alcohol, longer duration of diabetes, participants taking both oral and insulin treatment for diabetes, taking medicine irregularly were the significant determinants of poor glycemic control. Conclusion: Higher percentage(57.6%) of poor glycemic control was observed in the study.To improve the glycemic control, efforts should be made towards improving modifiable factors like overweight, smoking, alcohol, regularity of medication etc. Good lifestyle interventions help in control of poor glycemic control.

Association Between Social Determinants of Health and Glycemic Control Among African American People with Type 2 diabetes: The Jackson Heart Study.

Social determinants of health have a significant impact on health outcomes. However, the complexity and interaction of multiple factors influencing glycemic control remain understudied. This study examined associations of socioeconomic position (income, education, and occupation), environmental (physical activity facilities, neighborhood social cohesion, neighborhood problem, and violence), behavioral (physical activity, nutrition, and smoking), and psychological factors (depressive symptoms, stress, and discrimination) with glycemic control (hemoglobin A1c [A1c]) using the World Health Organization Social Determinants of Health framework in African American adults with type 2 diabetes. A secondary data analysis was conducted using a longitudinal cohort of 1,240 African American adults with type 2 diabetes who participated in the community-based Jackson Heart Study. Socioeconomic position, environmental, behavioral, and psychological factors were measured using validated instruments in the Jackson Heart Study. Longitudinal structural equation modeling was used with glycemic control (A1c) collected over time (Exams 1-3) as the study outcome. Our study presents the complex interplay of socioeconomic determinants of health and glycemic control over time. Higher socioeconomic position (higher income, higher level of education, and professional occupation) was directly associated with improvement in glycemic control over time. An association of socioeconomic position on glycemic control mediated through health behavior factors was also observed. In this analysis, socioeconomic position components were determinants of glycemic control in African American adults with type 2 diabetes. Future studies aimed at reducing health disparities and achieving equality of outcomes in this population will benefit from embedding socioeconomic position components into their design.

Proportion And Determinants of Glycemic Control in Type 1 Diabetes Mellitus among Children and Adolescents Attending Assiut Health Insurance Clinic

Proportion And Determinants of Glycemic Control in Type 1 Diabetes Mellitus among Children and Adolescents Attending Assiut Health Insurance Clinic

Rate of glycaemic control and associated factors in patients with type 2 diabetes mellitus treated with insulin-based therapy at selected hospitals in Northwest Ethiopia: a multicentre cross-sectional study

ObjectivesThis study was aimed to determine the level of glycaemic control and associated factors in patients with type 2 diabetes mellitus (T2DM) treated with insulin-based therapy.DesignsInstitutional-based multicentre cross-sectional study design...

Muscle strength, an independent determinant of glycemic control in older adults with long-standing type 2 diabetes: a prospective cohort study

BackgroundAlthough the proportion of older patients with type 2 diabetes mellitus (T2DM) has increased, few studies have reported the factors affecting glucose levels in older patients with long-standing T2DM. This study assessed the determinants of glycemic control in older adults with T2DM of a duration of ≥10 years, including muscle mass, muscle quality, and β-cell function.MethodsThis was a prospective study of older patients aged ≥60 years with a T2DM duration of ≥10 years. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index, handgrip strength (HGS), and body composition through bioelectrical impedance analysis were assessed. The primary outcome was a composite of: (i) increment of glycated hemoglobin (HbA1c) from the baseline ≥0.6% and (ii) HbA1c ≥ 9% at any time point during the follow-up period. To find the predicting determinants of the outcome, we performed the Cox proportional hazard analysis.ResultsAmong 100 patients (mean age, 64.0 ± 8.6 years; median duration of diabetes, 20 [interquartile range (IQR), 17–23] years; median HbA1c at baseline, 7.1 [IQR, 6.7–7.4] %), the primary outcome was observed in 40 (40.0%) patients during 4.0 (IQR 2.3–5.0) years of follow-up. A Cox proportional hazards model adjusted for age, sex, baseline HbA1c, obesity, duration of DM and anti-diabetic medication at baseline showed that low HGS and insulin resistance at the baseline were independent determinants of the primary outcome (hazard ratio [HR] = 2.23 [95% confidence interval (CI), 1.06–4.72] and 2.39 [95% CI, 1.18–4.83], respectively). Sex stratification confirmed that HGS and muscle mass were independent determinants of the primary outcome only in women (HR per quartile, 0.58 [95% CI, 0.37–0.93] and 0.46 [95% CI, 0.25–0.85], respectively). `.ConclusionsLow HGS and insulin resistance were independent risk factors for aggravated glycemic control among older patients with long standing T2DM.

Determinants of glycaemic control among type 2 diabetes mellitus patients in Northern State of Kedah, Malaysia: a cross-sectional analysis of 5 years national diabetes registry 2014-2018.

Introductiontype 2 diabetes mellitus has become a global public health crisis. The increment in the cases has contributed significantly to the parallel increase in the prevalence of overweight and obesity. This paper aimed to analyse the relationship between lipid profile, waist circumference and body mass index (BMI) with the glycaemic control of the diabetes patients in Kedah.Methodsa cross-sectional study was conducted, using the Kedah audit samples data extracted from the National Diabetes Registry (NDR) from the year 2014 to 2018. A total of 25,062 registered type 2 diabetes mellitus patients were selected using the inclusion and exclusion criteria from the registry. Only patients with complete data on their HbA1C, lipid profile, waist circumference and BMI were analysed using SPSS version 21.Resultsthe means for the age, BMI and waist circumference of the samples were 61.5 (±10.85) years, 27.3 (±5.05) kg/m2 and 89.46 (±13.58) cm, respectively. Poor glycaemic control (HbA1c>6.5%) was observed in 72.7% of the patients, with females having poorer glycaemic control. The BMI and waist circumference were found to be significantly associated with glycaemic control (P<0.001). The total cholesterol, triglycerides and low-density lipoproteins values showed positive correlation with glycaemic control (r = 0.178, 0.157, 0.145, p<0.001), while high-density lipoproteins values are negatively correlated (r = -0.019, p<0.001).Conclusionimplementing lifestyle changes such as physical activity and dietary modifications are important in the management of BMI, waist circumference and body lipids, which in turn results in improved glycaemic control.

Association between health literacy and glycemic control in elderly patients with type 2 diabetes and modifying effect of social support.

ABSTRACTObjective:To investigate the association between inadequate functional health literacy, considering the Short Assessment of Health Literacy for Portuguese-speaking Adults, and glycemic control in elderly patients with type 2 diabetes, and to examine this association in low social support settings, according to Medical Outcomes Study .Methods:Cross-sectional study conducted at the diabetes referral center of a university hospital. Participants were recruited among type 2 diabetes patients aged 60 years or older, between May 2013 and November 2014. The primary outcome was the most recent glycated hemoglobin value measured within the last 6 months.Results:A total of 398 elderly patients with type 2 diabetes were evaluated. Of these, 232 were not eligible to participate. The final sample comprised 166 participants. Hierarchical multiple linear regression was performed. The following variables were entered in three blocks: sociodemographic characteristics, clinical variables and health literacy scores. Regression analysis of the interaction between health literacy and social support as a determinant of glycemic control was also performed. Mean age of subjects was 68.0 years (standard deviation of 5.9). Mean glycated hemoglobin value was 8.5% (standard deviation of 1.4). Short assessment of health literacy for Portuguese speaking adults score was independently associated with glycated hemoglobin (B=-0.059; p=0.043). The interaction between social support and health literacy score (p=0.003) was a determinant of glycemic control.Conclusion:Health literacy is associated with glycemic control. Social support may modify the relation between health literacy and glycemic control.

Determinants of glycaemic control among patients with type 2 diabetes: testing a process model based on self-determination theory

AimsTo investigate a hypothesised process model based on self-determination theory (SDT) in a population of people with type 2 diabetes. The model suggests that autonomy support from healthcare professionals is an important determinant of autonomous motivation and perceived competence in diabetes, which correlate positively in turn with wellbeing and negatively with HbA1c. MethodsThis cross-sectional study used baseline questionnaire data and HbA1c levels from a randomised controlled trial investigating the effects of a person-centred consultation program. The questionnaire used validated scales and items assessing autonomy support, wellbeing, motivation, self-care activities, diabetes distress and perceived competence. Pearson correlations were calculated, and mediation analysis was conducted by multivariate linear regression analysis. Results116 participants completed the questionnaire. Autonomy support was significantly correlated with perceived competence and controlled motivation. Perceived competence correlated negatively with diabetes distress and positively with self-care activities. Diabetes distress correlated negatively with wellbeing. Controlled motivation correlated positively with autonomous motivation, which correlated positively with both wellbeing and self-care activities. Self-care activities correlated negatively with HbA1c. ConclusionAs suggested by the hypothesised SDT process model, autonomy support, autonomous motivation and perceived competence are associated with better wellbeing and improved HbA1c.

Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence

BackgroundAlthough important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC.MethodsA multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping.ResultsThe population (N = 513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, − 0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, − 0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049).ConclusionsSocioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.

Imputing HbA1c from capillary blood glucose levels in patients with type 2 diabetes in Sri Lanka: a cross-sectional study

ObjectiveTo develop a population-specific methodology for estimating glycaemic control that optimises resource allocation for patients with diabetes in rural Sri Lanka.DesignCross-sectional study.SettingTrincomalee, Sri Lanka.ParticipantsPatients with non-insulin-treated type 2 diabetes (n=220)...

62-LB: Psychosocial and Socioeconomic Well-Being as Determinants of Quality of Life and Glycemic Control in Haitian Youth with Diabetes

In low- and middle-income countries (LMIC), youth with diabetes suffer from poor glycemic control even if free insulin and diabetes care are provided. In Haiti, health-related quality of life (HRQL) among youth with diabetes is low. We validated depression, self-esteem and self-management scales (Table 1) in Haitian youth with diabetes and evaluated them as well as perceived health, subjective and objective social status as determinants of glycemic control and HRQL. In 85 participants (59% female, mean age 17.5±5 years, mean diabetes duration 3.7±3.5 years, mean HbA1c 11.3±2.6%, mean HRQL 61±16 out of 100, mean satisfaction score 64±20 out of 100) mild, moderate and moderately-severe depression rates were 38%, 21% and 7% respectively, self-esteem score was 61±12 on a scale of 0 to 100 and perceived self-management score was 45±17 on a scale of 0 to 100. No measure predicted glycemic control (p&amp;gt;0.05 for all). When adjusted for age, sex and diabetes duration, higher self-esteem (p=0.003), higher subjective SES (p=0.04) and lower depression score (p&amp;lt;0.05) remained significant determinants of HRQL. Higher objective SES (p=0.01) and lower depression score (p=0.04) remained determinants of satisfaction. Depression and objective SES emerge as intervention targets while subjective psychosocial health emerges as a resilience worth nurturing to improve HRQL and life satisfaction. Disclosure R. Vincent: None. Z. Kamal: None. B. Coriolan: None. K. Altenor: None. J.E. von Oettingen: None.

230-OR: Personalized Nutrition for Prediabetes by Prediction of Glycemic Responses

Prediabetes is a leading risk factor for the development of type 2 diabetes mellitus (T2DM) and its metabolic complications. Current practice for prevention of diabetes includes weight loss-targeting dietary and lifestyle modifications but has had limited success. Alternative approaches, such as dietary interventions that directly target blood glucose levels for prevention of T2DM, are not well established and have been much less studied. In particular, postprandial (post-meal) glucose responses (PPGR) are a major determinant of glycemic control, but dietary methods for controlling PPGRs are rare and show limited efficacy. We previously recruited a population-based cohort of 900 people in which we continuously tracked blood glucose and obtained clinical and gut microbiota measurements. Our data of ∼50,000 PPGRs revealed that different people have vastly different responses to the same meal. We devised a machine learning algorithm based on clinical and microbiome features that accurately predicted personalized PPGRs to any food combination. Here, we sought to evaluate the long-term clinical efficacy of a dietary intervention based on our algorithm in prediabetes, and test the hypothesis that a dietary treatment that targets meal PPGR can lead to long-term improvements in glycemic control and other metabolic outcomes, as compared to a standard Mediterranean-style diet. To this end, we conducted a 6-month randomized controlled diet intervention trial (RCT) followed by a 6-month post-intervention follow-up program, and randomly assigned 225 adults with prediabetes to receive a Mediterranean-style (Med) diet or a Personalized Postprandial-targeting (PPT) diet. At 6 months, mean daily time of glucose levels above 140 mg/dl changed by -29% and -65% in the Med diet and PPT diet, respectively (p=3.4x10-10). Mean HbA1c% levels changed by -0.08% and -0.16% in the Med diet and PPT diet, respectively (p=6.9x10-3). The favorable effects of the ’PPT diet’ on glycemic control persisted also at one year follow up. Disclosure O. Ben-Yacov: None. A. Godneva: None. E. Segal: Consultant; Self; DayTwo.

WITHDRAWN: Determinants of glycaemic control among patients with type 2 diabetes: Testing a process model based on self-determination theory

WITHDRAWN: Determinants of glycaemic control among patients with type 2 diabetes: Testing a process model based on self-determination theory

School performance among diabetic Children and adolescents

Type 1 Diabetes millets it has a direct impact on cognitive functions. For prevent this problem, needs a good glycemic control, which can do by self-measurement blood glucose or need assistant from parents or teachers.&#x0D; The child’s school performance will be best if the blood sugar remains in the acceptable range. Left untreated both high and low blood sugar levels can affect the child’s ability to concentrate on schoolwork and participate in school activities.&#x0D; The cross section study was conducted on 100 diabetic patients aged between 8-18 years from Aldiwaniyah diabetic center, in Aldiwanyia city, from period of 1st March to 1st June, to estimated the effect of glycemic control on school performance, after selected patients, made an interviewed with them &amp;/ parents, asked about demographical information (age, sex, level of education, residence, occupation &amp; education of parents) disease variables (onset, duration, complication hypoglycemia or hyperglycemia, hospitalization, episodes of admission, insulin treatment times doses, blood sugar level, self measure &amp;injection, regular visit to clinic), bad glycemic controls consider by level of HbA1c above 7% or had hyperglycemia for more than 3 times or hypoglycemia more than 2 times in last six months. School characters (failure, absences, skipping, exercise, activity) Poor school performance consider if she/he had absence from school more than 3 days, had school failure, skipping.&#x0D; The bad school performance was observed in 73%, those with bad glycemic control represented (61%), in (83.7%) of bad glycemic control had poor school performance, in (79.6) patients with longer disease duration had poor school performance, on other hand (83.6%) of Patients with more frequent admission to hospital due to Diabetics complication had poor school performance.&#x0D; In conclusion bad glycemic control, frequency of admission and disease duration were negatively effect on school performance, level of education patients his mother and self measurement of blood sugar were a determinants of glycemic control.&#x0D; Recommendation was concentrated on ways of glycemic control by frequent self measurement, education of patients and relatives on nature of Diabetes and enhance compliance and motivation of patients. Frequent supervising by health care provider to schools of patients for reassurance and support of children and teachers.

Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018)

BackgroundDiabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population. MethodsNational database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control. ResultsIn this study 73.0% and 56.5% of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3% and 23.3% respectively. Poor glycemic control was associated with male gender (OR=1.06, p=0.001), obesity (OR=1.03, p=0.05), duration of diabetes (OR=1.018, p<0.001), smoking (OR=1.08, p=0.041), hypertension (OR=1.53, p<0.001), hyperlipidemia (OR=1.15, p<0.001), insulin therapy (OR=1.26, p<0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR=2.36, p<0.001). ConclusionWe demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets.

2391-PUB: Determinants of Poor Glycemic Control among Adolescents with Type 1 Diabetes

Objective: The majority of adolescents with type 1 diabetes have poor glycemic control, calling for an action to be taken. The aim of this study was to identify the determinants of poor glycemic control among adolescents with type 1 diabetes. Methods: Data were collected for all adolescents with type 1 diabetes (age &amp;lt; 20 years), who attended diabetes clinics at one hospital, and had at least one result of HbA1c performed during the study year. The average level of HbA1c was calculated from all the HbA1c results collected over one year. Glycemic control was defined as poor if the HbA1c was &amp;gt;8%. Variables studied were gender, age, age at diagnosis, diabetes duration, annual clinic attendance, frequency of blood glucose monitoring, healthy eating, medication adherence, and frequency of HbA1c performance over one year. Results: The study included 78 adolescents with type 1 diabetes (47.4% males). Mean age was 15.4+2.0 years, mean age at diagnosis was 9.0+3.6 years, and mean duration of diabetes was 6.6+3.8 years. The mean of the average level of HbA1c was 10.2+1.9%, and 84.6% had HbA1c &amp;gt;8%. Mean frequency of HbA1c performance was twice per year, and mean annual clinic attendance was three visits. Poor glycemic control was significantly associated with female gender (p&amp;lt;0.05). Healthy eating, medication adherence, and frequent HbA1c performance (&amp;gt; 3 per year) were significantly associated (p&amp;lt;0.001) with better glycemic control (HbA1c&amp;lt;8%). With regression analysis, healthy eating, medication adherence and HbA1c performance remained as the major determinants of the glycemic control. Conclusions: The overall glycemic control in adolescents with type 1 diabetes was poor, putting them at high risk of developing diabetes complications at an early stage of life. Healthy behavior was a major determinant of glycemic control. Behavioral healthy intervention strategies should be integrated in the management plan of diabetes care to improve glycemic control and reduce diabetes complications in this vulnerable group. Disclosure A.M.A. Aladsani: None.

2382-PUB: Socioeconomic Disparities in the Management of Glycemic Control among Adults with Type 2 Diabetes in the United States

Optimal management of glycemic control is important to delay and prevent the onset of long-term complications in patients with type 2 diabetes (T2D). While health disparities in diabetes burden and complications are well-documented, limited data exist on socioeconomic status (SES) as a determinant of glycemic control. We conducted a study linking the National Health and Wellness Survey (NHWS), a nationally-representative, self-administered annual internet survey of about 75,000 adults (≥18), and two electronic health record (EHR) systems: Veradigm, which contains data for 46+ million unique patients, and Healthverity, a nationally-representative database with 60+ million unique patients. The study population consisted of T2D adults who responded to the NHWS between 2015-2018 and had clinical measurements in the EHR database for at least 6 months from NHWS response (i.e., at least 6 months of follow-up). Glycemic control was treated as a binary variable (HbA1c &amp;lt;7% or ≥7%) and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated adjusting for age and gender. Of 2,380 total T2D patients [mean age = 61.5 (standard deviation = 12.0), 54% males, 85% White, 32% employed, 84% living in an urban area], 501 (21%) had at least one HbA1c test taken within 6 months of NHWS participation. Of these 501 patients, 197 (39%) had uncontrolled HbA1c (≥7%). Black/African American patients were significantly more likely to have uncontrolled HbA1c compared with White patients (OR = 2.0; 95% CI: 1.02, 3.92; p = 0.04). Further, Medicaid and uninsured patients were significantly more likely to have uncontrolled HbA1c compared to those with commercial health insurance (OR = 2.81; 95% CI: 1.46, 5.4; p &amp;lt; 0.005). There were no differences by geographic regions. The observed associations of glycemic control with race and health insurance may possibly be related to disparity in diabetes management. Future studies are needed further investigating the role of SES in diabetes management. Disclosure M. Pawaskar: Employee; Self; Merck &amp; Co., Inc. Stock/Shareholder; Self; Merck &amp; Co., Inc. J. Nguyen: Other Relationship; Self; Merck &amp; Co., Inc. S. Huynh: Other Relationship; Self; Merck &amp; Co., Inc. T. Haskell: Other Relationship; Self; Merck &amp; Co., Inc. L. Lee: Other Relationship; Self; Merck &amp; Co., Inc. S. Rajpathak: None.

Determinants of glycemic control among diabetes mellitus patients in a tertiary clinic in Gaborone, Botswana: findings and implications

ABSTRACTBackground and aims: Glycemic control among patients with diabetes mellitus is associated with a marked reduction of both macrovascular and microvascular complications; however, glycemic control remains an elusive goal worldwide. The aim of this study was to determine factors associated with glycemic control among patients attending a tertiary clinic in Botswana as limited information to date.Methods: Cross-sectional study in a tertiary clinic in Gaborone, Botswana. Patients were recruited between 21 July 2015 and 21 September 2015. The majority of the randomly recruited patients (368/380–96.8%) had documentation of glycemic control (HbA1c) within three months of study recruitment and were subsequently included in the analysis. Glycemic control was categorized as desirable, suboptimal and poor if HbA1c was <7%, 7–9% and >9%, respectively. Data were analyzed using SPSS for descriptive statistics including both bivariate and multinomial logistic regression. A value of p < 0.05 was considered statistically significant.Results: The analyzed study population consisted of 258/368 (70.1%) females with a mean age (SD) of 56.7 ± 13.6 years. Means (SDs) for diabetes duration and glycated hemoglobin were 7.2 ± 7.1 years and 7.97 ± 2.02%, respectively. Of the 368 patients, 136 (36.95%) and 132/368 (35.86%) had desirable and suboptimal glycemic control, respectively. Older age, attending the clinic for more or equal to 3 years and not being on insulin were associated with both desirable and suboptimal glycemic control whereas duration of diabetes between 5 and 10 years was associated with poor glycemic control.Conclusions: The majority of patients had poor glycemic control. Older age and not being on insulin were associated with better glycemic control. The fact that patients on insulin had poor glycemic control calls for more research to determine the timing of insulin initiations and dosing schedule factors as these will help to improve overall glycemic control in Botswana and elsewhere.