Determinants Of Poor Glycemic Control Research Articles

Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis.

Prior primary studies have examined the prevalence and factors associated with glycaemic control among patients with type 2 diabetes mellitus, but studies with evidence-based synthesis of the primary data remained unknown. Hence, we aimed to determine the prevalence of poor glycemic control and identify determinants of poor glycemic control in patients with type 2 diabetes in Ethiopia. We performed searches in the online databases of PubMed, Google Scholar, Scopus, Science Direct, and the Cochrane Library. Microsoft Excel was used to extract data, and STATA statistical software (v. 16) was used for analysis. Publication bias was explored by forest plots, Begg's rank test, and Egger's regression test. To check for heterogeneity, I2 was computed. Subgroup analysis was conducted based on region and publication year. In addition, the pooled odds ratio for associated factors was calculated. Out of 1,045 studies assessed, 23 studies were included fulfilling our inclusion criteria. In all, 6,643 individuals were enrolled in the study. It was estimated that 61.11% of type 2 diabetes patients had poor glycemic control (95% CI, 57.14-65.19). The subgroup analysis by study region and publication year revealed that the highest prevalence was observed in the Addis Ababa region (68.57%) and studies published before 2019 (61.76%), respectively. Poor glycemic control was associated with older age > 50 years (AOR = 2.12; 95% CI: 1.27-2.97), not attending formal education (AOR = 3.60; 95% CI: 2.75, 4.46), having diabetes for longer duration (10 years; AOR = 2.57; 95% CI: 1.65-3.49), having comorbidity (AOR = 2.43; 95% CI: 2.05-2.80), and low adherence to diabetes management (AOR = 3.67; 95% CI: 2.41-4.92). Our findings indicate a high prevalence of poor glycemic control among people with type 2 diabetes in Ethiopia. Being older, not attending formal education, having a longer duration of diabetes, having comorbidity, and having low adherence to diabetes management were all associated. Therefore, we recommend health organizations implement measures to monitor and control patients' blood glucose levels. Patient education and training of healthcare professionals could serve as a short-term strategy to achieve adequate glycemic control. PROSPERO, identifier CRD42022349792, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022349792.

Determinants of poor glycaemic control and proteinuria in patients with type 2 diabetes: a retrospective analysis of general practice records in Ireland

BackgroundAnalysis of general practice records can address the information gap on the epidemiology of type 2 diabetes (T2DM) in Ireland, informing practice and the development of interventions in primary care. The aim of this study was to identify patients with poor glycaemic control, risk factors for complications and evidence of end organ damage in a large multi-practice study and to profile their characteristics.MethodsPatients with T2DM were identified using disease coding in Health One practice management software in 41 general practices. Patients’ demographics and clinical data were extracted. Rates of poor glycaemic control (glycated haemoglobin > 58 mmol/mol) and albumin creatinine ratio > 3 mg/mmol were calculated. A multilevel logistic regression analysis using both patient and practice variables was conducted.ResultsData was collected from 3188 patients of whom 29% (95% CI 28 to 31%) had poor glycaemic control, which was associated with younger age, higher BMI and higher total cholesterol. Only 42% of patients (n = 1332) had albumin creatinine ratio measured with 42% (95% CI 40 to 45%) of these having values > 3 mg/mmol. Older age groups, men, those with hypertension, eGFR < 60 ml/min/1.73m2 and poor glycaemic control were most associated with higher values of albumin creatinine ratio.ConclusionsAnalysing this large multi-practice dataset gives important information on the prevalence and characteristics of diabetic patients who are most at risk of poor outcomes. It highlights that recording of some data could be improved.

Prevalence and determinants of poor glycaemic control in individuals aged between 18-60 years, at a regional hospital in KwaZulu-Natal Province, South Africa- a cross sectional study.

Achieving optimal blood glucose control is imperative for preventing diabetes related complications and negative socio-economic consequences associated with them. The aim of the study was to determine the prevalence and determinants of poor glycaemic control amongst type II diabetic outpatients presenting at a regional semi-rural hospital in eThekwini district, Kwa-Zulu Natal. An observational, analytic cross-sectional study was conducted amongst 384 systematically sampled type 2 diabetes patients. Data were collected by an interviewer administered questionnaire, clinical record review and anthropometric measurements. Bivariate and multivariate analyses were performed. Ninety one percent of the study population (349/384) had poorly controlled diabetes. Amongst uncontrolled diabetics, 80% (n=281) were older than 35 years' age group; 58% (n= 203) were male; 85% (n=295) completed primary school education and 93% (n=324) were overweight. Patients that were 35 years and older, female, employed, had a high body mass index, were on oral hypoglycaemic and/or insulin in combination, and receiving treatment longer than 3 years, had an increased odd of uncontrolled diabetes. Being female and receiving oral hypoglycaemic and/or insulin were significantly associated with poor blood glucose control. Patient that were female overweight, having a lower level of education, and greater than three-year duration of medication and on oral hypoglycaemic agent and/or insulin were more likely to have poor blood glucose control. These factors should serve as early identifiers of potential poor control and an alert clinician to adopt a more active approach to optimize treatment.

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 &lt;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 &lt;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.

Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched case-control study.

Poor glycemic control is one of the most determinant factors for type 2 diabetes-related morbidity and mortality. The proportion of type 2 diabetes mellitus patients with poor glycemic control remains high. Yet evidence on factors contributing to poor glycemic control remains scarce. The aim of this study is to identify determinants of poor glycemic control among type 2 diabetes mellitus patients at a diabetes mellitus clinic in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Determinants of Poor Glycemic Control among Type 2 Diabetes mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched Case-Control Study. A hospital-based case-control study was conducted from June to September 2020. Using convenience sampling techniques, a total of 90 cases and 90 controls with type 2 diabetes were recruited. The data were entered into Epidata version 4.6.0.2 and analyzed by Stata version 14.A multivariable logistic regression analysis was performed to assess the association between independent variables and glycemic control. Both 95% CI and p-value<0.05 were used to determine the level and significance, respectively. The mean age ( ± standard deviations) for the cases and controls were 57.55± 10.42 and 61.03± 8.93% respectively. The determinants of poor glycemic control were age (Adjusted odd ratio (AOR)= 0.08; 95% CI= 0.02-0.33), inadequate physical exercise (AOR = 5.05; 95% CI = 1.99-11.98), presence of comorbidities (AOR = 5.50; 95% CI = 2.06-14.66), non-adherence to anti-diabetes medications (AOR= 2.76; 95% CI= 1.19-6.40), persistent proteinuria (AOR=4.95; 95% CI=1.83-13.36) and high-density lipoprotein less than 40 mg/dl (AOR=3.08; 95% CI= 1.30-7.31). Age less than 65 years, inadequate physical exercise, presence of comorbidities, non-adherence to anti-diabetes medications, persistent proteinuria, and high-density lipoprotein less than 40 mg/dl were the determinants of poor glycemic control. Therefore, targeted educational and behavioral modification programs on adequate exercise and medication adherence should be routinely practiced. Furthermore, early guideline-based screening and treatment of comorbidities and complications is required to effectively manage diabetes mellitus.

Poor glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia, 2020: facility-based cross sectional retrospective study design

Diabetes mellitus is a global public health problem. Glycemic control is a major public health problem. Diabetes results from elevated levels of glycaemia such as increased glucose and glycated hemoglobin, and controlling glycaemia is an integral component of the management of diabetes. Glycemic control in children is particularly difficult to achieve. Identifying determinants of poor glycemic control is important for early modification of diabetic related end organ damages. This study was aimed to assess the status of glycemic control and associated factors among pediatric diabetes mellitus patients in northwest Ethiopia. Facility-based cross sectional retrospective cohort study design was used and this study was conducted from September, 2015 to February, 2018. Simple random sampling was used to select 389 samples. Data were collected using an extraction checklist. Data were entered into Epi-data − 4.6, and analyzed using Stata-16. Finally, multivariable binary logistic regression was done. Poor glycemic control was more common among pediatric patients 39.3% (95% CI 34.6, 44.3). Treatment discontinuation (AOR 2.42, 95% CI 1.25, 4.69), age (AOR 1.15, 95% CI 1.03, 1.28) and treatment dose (AOR 0.96, 95 CI 0.92, 0.99) were significantly associated with poor glycemic control. Prevalence of poor glycemic control was high. Patient’s age, history of treatment discontinuation and dose of treatment were the significant contributing factors to poor glycemic control. These need to be addressed to attain the objective of adequate glycemic control.

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...

Lipid Profile and Glycemic Control in Type 2 Diabetic Patients

Objective: To estimate the prevalence of dyslipidemia in type 2 diabetes mellitus, to investigate the association between dyslipidemia and glycemic control, and to highlight potential determinants of poor glycemic control. Methods: A cross-sectional study was conducted in which 450 patients with type 2 diabetes, attending the National Diabetes Center, Baghdad during 2019, were included. Each participant was interviewed using a data collection form to collect the needed demographic, medical, and social data. All participants were investigated for lipid profile assay comprising of TC, TG, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Data on the patients’ HbA1C levels were recorded. Results: The prevalence of dyslipidemia among patients with type 2 diabetes was 69.8%; poor glycemic control was associated with dyslipidemia. Smoking and lack of regular self-monitoring of blood sugar were associated with poor glycemic control. Increased weight and higher waist circumference were associated with higher HbA1c levels. Higher mean of HbA1c was found in female gender. The glycemic control affects not only the blood sugar levels of the patients but also their lipid profile. Good glycemic control has an important role in controlling dyslipidemia and preventing and reducing diabetic complications. Conclusions: Poor glycemic control is significantly associated with dyslipidemia in type 2 diabetic patients.

Prevalence and determinants of poor glycaemic control among adults with type 2 diabetes mellitus in a selected urban population of Mysuru district

Background: India is referred to as the “diabetic capital of the world” and is home to the second-largest number of adults with diabetes worldwide. Urbanization is a key reason for the Indian diabetes epidemic. Poor glycaemic control in type 2 diabetes patients is a serious public health issue and a key risk factor for both progression and complication of diabetes. This study, therefore, intends to assess glycaemic control status and factors influencing poor glycaemic control among T2DM patients.Methods: This was a community-based cross-sectional study done over a period of four months, among T2DM patients in urban Mysuru, using a pre-tested semi-structured questionnaire by interview method. A total of 372 T2DM patients who had the latest reports of fasting blood sugar value were included in the study. SPSS version 23 was used to analyse the collected data and to identify the determinants and risk factors leading to poor glycaemic control.Results: Among 372 study participants, 63.7% of patients had poor glycaemic control. The mean FBS value of the study population was 146.886±43.2700 and the mean age of the study participants was 55.50±12.238 years. Further, it was found that longer diseases durations, irregular check-ups, type of medication, non-adherence to both medication and diabetic diet were risk factors for poor glycaemic status.Conclusions: The prevalence of poor glycaemic control among diabetics in Mysuru was found to be high; therefore, proper health education, counselling of diabetics and organizing health awareness programmes are needed to control it and hence reduce the disease burden.

Prevalence and determinants of poor glycaemic control amongst patients with diabetes followed at Vanga Evangelical Hospital, Democratic Republic of the Congo.

BackgroundThe prevalence of diabetes mellitus is increasing dramatically in developing countries, where diabetic patients usually present with poor glycaemic control, leading to complications and worsening the prognosis.AimThe aim of this study was to determine the extent of poor glycaemic control and its determinants in diabetic patients.SettingThe study was conducted in a rural area of the province of Kwilu, Democratic Republic of the Congo.MethodsThis research comprised a cross-sectional study involving 300 Type 1 and 2 diabetic patients attending Vanga Evangelical Hospital in the Democratic Republic of the Congo from January 2018 to March 2018. Patients’ sociodemographic, clinical and biological characteristics, accessibility to the health structure and treatment were described. The determinants of poor glycaemic control were identified using multivariate logistic regression at the p < 0.05 level of statistical significance.ResultsThe mean age of participants was 46.9 ± 16.3 years, 68.4% were men, and 62.3% had Type 2 diabetes mellitus. Poor glycaemic control was present in 78% of patients. The independent determinants of poor glycaemic control were tobacco use (adjusted odds ratio [aOR]: 2.01 [1.77–5.20], p = 0.015), the presence of comorbidities (aOR: 2.86 [1.95–6.65], p = 0.007), the presence of a factor contributing to hyperglycaemia (aOR: 2.74 [1.83–3.67], p = 0.014), missing scheduled appointments (aOR: 2.59 [1.94–7.13], p = 0.006) and non-adherence to treatment (aOR: 4.09 [1.35–6.39], p = 0.008).ConclusionThis study shows that more than three-quarters of diabetics undergoing treatment are not controlled, with mainly patient-related factors as the main explanatory factors for this poor glycaemic control. Therefore, the establishment of a therapeutic education programme and wider integration of diabetes care services, mainly at the primary level of the healthcare pyramid, should contribute to improved diabetes treatment.

Glycemic control and its associated factors among patients with diabetes mellitus: a cross-sectional study in Bangladesh

PurposeDiabetes mellitus is becoming a growing concern worldwide. Hence, the purpose of this study is to assess the magnitude of poor glycemic control and to identify the determinants of poor glycemic control among diabetic patients attending a tertiary care hospital in Bangladesh.Design/methodology/approachThis cross-sectional study was conducted among 732 diabetes patients seeking care at the outpatient department of Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. Information, including glycemic status, was collected from patients’ medical records using a structured questionnaire.FindingsAbout 87.6% of the patients were found to have poor glycemic control (glycosylated hemoglobin = 7%). Variables that were significant in bivariate analysis were put into a multivariate model where the factors associated with poor glycemic control were patients aged 41–60 years (odds ratio (OR)=2.26; 95% confidence interval (CI): 1.19–4.32, p = 0.013), suffering from diabetes for > 7 years (OR = 1.84; 95% CI: 1.12–2.99, p = 0.015), using insulin (OR = 2.34; 95% CI: 1.23–4.47; p = 0.010) or diet alone (OR = 0.20; 95% CI: 0.05–0.80, p = 0.023) as a type of diabetes treatment and proper use of medicine (OR = 0.37; 95% CI: 0.17–0.82, p = 0.015).Originality/valueThe high prevalence of poor glycemic control among diabetic patients is evident; therefore, strategic management and proper attention focusing on the predictors of poor glycemic control are necessary to reduce the long-term complications of diabetes.

English

BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing quickly all over the world. In spite of effective treatment guidelines for type 2 diabetes, in majority of the people, the disease is poorly controlled with existing therapies. Glycaemic control is considered as the most important step for prevention of organ damage and other complications of diabetes. A study on the prevalence and determinants of poor glycaemic control can assist in understanding the expanse of this problems and the ways to address it. We wanted to study the prevalence and determinants of poor glycaemic control among adult patients with type II diabetes mellitus attending a primary health care setting. METHODS The cross-sectional study was conducted in the outpatient department of NCD clinic in a Primary health centre of Kerala for a period of six months. Two hundred and fifty individuals diagnosed with Type II DM for a year were recruited as study participants. The study participants were interviewed using a semi-structured questionnaire. Adherence to medication was assessed using The Morisky Medication Adherence Scale. Anthropometric measurements and blood pressures were recorded. HbA1c and RBS was measured using semi quantitative technique. Any patient with an HbA1c of more than 7 was defined as having poor glycaemic control. RESULTS 64.4 % of the participants had poor glycaemic control. Poor adherence to medication, fewer visits to doctor, lack of diet modification, frequent junk food consumption, higher body mass index and lack of exercise were found to be significantly associated with poor glycaemic control. CONCLUSIONS A focused approach targeting these modifiable risk factors, especially in primary care setting, has the potential to bring about better glycaemic control which can prevent and minimize the occurrence of diabetes complications. KEYWORDS Poor Glycaemic Control, Uncontrolled Diabetes, Diabetes Mellitus, HbA1c, Diabetes Complications

Factors associated with glycemic control among South African adult residents of Mkhondo municipality living with diabetes mellitus.

This study examines the rate and the influencing factors of glycemic control among adult residents living with DM in Mkhondo Municipality of South Africa.In this cross-sectional study, 157 individuals attending care for DM were recruited. Glycemic control status was categorized as poor if glycated hemoglobin (HbA1c) > 7% and very poor if HbA1c ≥ 9%. Multivariate regression analysis was used to identify the significant determinants of poor and very poor glycemic control.The majority of the study participants were females (84.71%) and above 45 years old (88.55%). The overall prevalence of poor glycemic control was 77.71% (n = 122), while very poor glycemic control occurred in 50.6% (n = 80) of the study cohort. In the multivariate logistic regression model analysis, African traditional [AOR = 0.15; 95% confidence interval (95% CI) 0.04–0.57], fast food consumption (AOR = 5.89; 95% CI 2.09–16.81), elevated total cholesterol (TC) [odds ratio (OR) = 2.33; 95% CI 1.50–5.17], elevated low-density lipoprotein cholesterol (LDL-C) (AOR = 5.28; 95% CI 1.89–14.69), and triglyceride (TG) (AOR = 4.39; 95% CI 1.48–13.00) were the independent and significant determinants of poor glycemic control. Age (AOR = 0.46; 95% CI 0.23–0.92) was the only independent and significant determinant of very poor glycemic control.We found a high rate of poor glycemic control (77.71%) possibly attributed to religious affiliation, fast food consumption, and dyslipidemia. On the contrary, about half of the study sample had very poor glycemic control (HbA1c ≥9%), which was predominant among younger cohort with diabetes mellitus. Interventions aimed at improving glycemic control in this population must also target religious practice, dietary patterns and dyslipidemia as well as tailored-approach for young people.

Glycated Hemoglobin and Blood Pressure Levels in Adults With Type 2 Diabetes: How Many Patients Are on Target?

ObjectivesAchieving glycated hemoglobin (A1C) and blood pressure targets is an important strategy for preventing chronic vascular complications in diabetes. Our aim in this study was to determine the proportion of type 2 diabetes patients who meet the recommended A1C and arterial blood pressure targets and to identify the determinants of failure to do so. MethodsA cross-sectional study was conducted in an outpatient endocrine clinic at a university hospital. The A1C goal was 7% in general and 8% for patients with advanced chronic complications. Regarding blood pressure, the overall expected target was 140/90 mmHg. ResultsA total of 602 type 2 diabetes patients were analyzed: 62% were female, 14% self-reported as black, mean age was 63±11 years, mean diabetes duration was 17±9 years and median A1C was 8.0% (interquartile range, 7.0% to 9.5%). Macrovascular disease was present in 33% of the patients, diabetic retinopathy in 47%, peripheral neuropathy in 43% and diabetic kidney disease in 56%. Regarding metabolic control, 403 (67%) patients were not at the adjusted target A1C level, and being female, black, young and an insulin user were the main determinants of poor glycemic control. Regarding blood pressure, 348 (58%) patients were not at the recommended targets, and a more advanced age was the main associated factor. ConclusionsBecause more than half of type 2 diabetes outpatients do not meet the recommended A1C and blood pressure target values, there is a major call to overcome the therapeutic inertia and target treatment of patients on an individual basis.

Prevalence and determinants of poor glycaemic control: a cross-sectional study among Moroccan type 2 diabetes patients.

BackgroundDiabetes remains poorly controlled in a high proportion of diabetes patients. This study examines the prevalence of poor glycaemic control and associated factors in type 2 diabetes patients in the Beni-Mellal Khenifra region in Morocco.MethodsA cross-sectional survey was conducted in 2017 among 1456 diabetes patients attending primary health centres. Demographic and clinical data were collected through face-to-face interviews using structured and pre-tested questionnaires. Anthropometric measurements, including body weight, height and waist circumference were taken using standardized techniques and calibrated equipment. Glycaemic control was assessed in terms of the glycated haemoglobin (HbA1c) level and poor glycaemic control was defined as HbA1c ≥7% and a level <7% reflects good glycaemic control.ResultsOf the total participants, 66.3% had poor glycaemic control. Bivariate analysis showed that sex (p=0.010), education level (p=0.013), body mass index (p=0.048), duration of diabetes (p<0.0001) and type of therapeutic regimen (p<0.0001) were significantly associated with HbA1c level. However, multiple logistic regression analyses revealed that only a longer duration of diabetes (OR 1.525 [95% confidence interval {CI} 1.183–1.967], p=0.001) and receiving insulin therapy alone (OR 1.589 [95% CI 1.157–2.183], p=0.004) or a combination of oral antidiabetics with insulin (OR 2.554 [95% CI 1.786–3.653], p<0.001) were significantly associated with inadequate glycaemic control.ConclusionsDespite the particularities of the region, the findings about glycaemic control and its cross-sectionally associated factors are in line with findings from other regions of Morocco. In this subgroup, the longer duration of diabetes and insulin treatment could constitute a cause leading to poor glycaemic control. However, inverse causality cannot be excluded.

Determinants of Poor Glycemic Control in Patients with Kidney Transplants: A Single-Center Retrospective Cohort Study in Canada

Background:Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT).Objectives:To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients.Design:This is a single-center retrospective observational cohort study.Setting:The Ottawa Hospital, Ontario, Canada.Participant:A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant.Measurements:Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions.Methods:We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression.Results:A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist (P < .01) and diabetes nurse (P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT.Limitations:Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists.Conclusion:Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.

Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study

Objective and backgroundIn 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017.MethodsFacility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control.ResultThe study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10–5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33–8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46–8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33–7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70–13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23–10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90–29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52–13.16].ConclusionLack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.

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.

Glycaemic control among adults with self-reported diabetes in health and demographic surveillance site (HDSS) of rural North India

Achievement of adequate glycaemic control is important to alleviate complications, improve quality of life and reduce mortality among persons with diabetes. This study estimated the level of glycaemic control and determinants of poor glycaemic control among persons with diabetes in a rural population of North India. We randomly selected 245 persons aged ≥ 18 years with self-reported diabetes from the information of 100,000 individuals available in Health Information Management System of Health Demographic Surveillance Site (HDSS) Ballabgarh. Glycaemic control was assessed by measurement of glycated haemoglobin (HbA1c). Blood pressure, weight, height, waist and hip circumference were measured with standard procedures. Information regarding disease and treatment history was recorded. Mean age of participants was 56.2 (± 11.3) years. Mean HbA1c was 8.04% (± 2.54), with no significant difference across age and sex. Good glycaemic control (HbA1c 10 years since diagnosis of diabetes (OR = 2.71, 95% C.I. 1.08–6.81), and high serum triglyceride (OR = 2.17, 95% C.I. 1.19–3.98) levels were significantly associated with poor glycaemic control, while persons aged > 60 years were less likely of poor glycaemic control. Achievement of adequate glycaemic control in this population is poor and warrants prompt interventions.

Socio-demographic Determinants of Poor Glycaemic Control among Type 2 Diabetes Mellitus (T2DM) Patients Attending Clinics at the Three Selected Health Facilities in Suva, Fiji in 2011-2016

Introduction and Aim: Diabetes is one of the largest health emergencies in the 21st century. In Fiji, type 2 diabetes mellitus (T2DM) is the number one cause of premature deaths and disability. The aim of this study was to determine the socio-demographic determinants of poor glycemic control among T2DM patients attending clinics at the three selected health facilities in Suva, Fiji. Methods: This facility based 5-year retrospective folder audit among 338 randomly selected T2DM patient records registered between August 1, 2011 to August 1, 2016 from three selected health facilities in Suva, Fiji through proportionate sampling method and met the following inclusion criteria: T2DM adults >18 years; on treatment for >1 year; had >4 clinic visits and; had recent HbA1c result in 2017. Glycemic level was assessed using the most recent HbA1c level and poor glycemic control was defined as HbA1c of >7%. Data analysis included both descriptive and inferential statistics using SPSS v. 22 to assess the independent variable’s association with glycemic control. P value <0.05 was considered significant. Results: The 338 T2DM patients had a mean age of 56.5 years (SD=+9.9), 62.1% were <60 years old, 62.1% were females and 63.9% were of Fijian of Indian Descent (FID). The prevalence of poor glycemic control was 77.2%. Mean HbA1c was 8.6% (SD=+2.04). In logistic regression analysis, T2DM patients <60 years had twice the chances of having poor glycemic control than their younger counterparts: odds ratio (OR) =2.29; 95% confidence interval (CI): 1.32, 3.9; p=0.003. Those attending Suva diabetes Centre were found to be three times more likely to have poor glycemic control than those attending other diabetes clinics: OR =3.32; 95% CI: 1.22, 9.04; p=0.019. Conclusion: This study found a significantly high proportion of poorly controlled T2DM patients. Younger patients and those attending Suva Diabetes Centre were significant socio-demographic determinants of poor glycemic control. Health care workers dealing with T2DM patients should consider socio-demographic factors associated with glycemic control for a more patient-centered diabetes care.