Glycemic Control of Type 2 Diabetic Patients Managed in Tertiary Care Internal Medicine Clinics Using HbA1c (original) (raw)
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Journal of Pharmacy Research
Objective: The objectives of this research is to examine the extent of glycemic control achieved and to find relate if any selected demographic and clinical factors have a role in influencing glycemic control in Saudi patients of Southwestern Saudi Arabia. Methods: This is a cross sectional retrospective study of patients which included all adult type 2 DM patients who were referred to Aseer Diabetic Center. The eligible patients who got registered were assessed for glycemic control using primary outcome parameter of HbA1c and related factors influence on HbA1c were determined. Results: Among the medical records available, 251 patients fulfilled the criteria and were included in the study. Out of these 251 patients, 222 patient medical records had documentation of HbA1c values. Maximum number of patients, n=197(78.5%) were with duration of DM above 10 years. Almost three quarter of patients, n =177(70.5%) were having HbA1c>8%. The mean (±SD) BMI for men, 28.42(±5.08) kg/m 2 was significantly lesser (p<0.0001) than women, 33.51(±6.80) kg/m 2. The HbA1c target range of less than 7% was achieved by n=18(7.1%) patients only. Except for duration of diabetes mellitus all other factors (age, sex, family history, type of treatment and BMI)does not seems to influence HbA1c values. Conclusion: The trend of glycemic level reflected by HbA1c showed that the inadequate control of diabetes may be disastrous as this may propagate the microvascular and macrovascular complications. Efforts should be taken to make aware the importance of disease, and role of medication adherence.
Saudi Pharmaceutical Journal, 2014
Objectives: To evaluate glycemic control of diabetic patients at the King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. Methods: A cross sectional study was conducted among diabetic patients attending KKUH, Riyadh. Patients were identified through the hospital pharmacy records, over a one year period (January-December, 2009). A total of 20,000 patients were identified, and 1520 patients were selected by a simple random method. Medical charts were reviewed, the data were collected in a specially designed data sheet: and entered in a computer, and finally analyzed using a SPSS program. Results: About 90% of patients were older than 40 years old and 90% were overweight or obese. Fasting blood sugar was above 7.2 mmol/L in 60% of the patients and random blood sugar was more than 10 mmol/L in about 70% of patients. The overall glycemic control as evaluated by HBA1C was acceptable in about 40% of the patients. Cholesterol level was normal in more than 70% of patients while triglyceride was normal in 56% of patients. In about half of the patients systolic blood pressure was not controlled, while in 27% the diastolic blood pressure was above the target level. Conclusion: The control of diabetes and its associated cardiovascular risk factors in this hospitalbased survey, in Riyadh is far from optimal. Further studies are needed to find out the possible causes for this defective care of diabetic patients.
EC Diabetes and Metabolic Research, 2020
Background: About 19.5% of the UAE's population is now living with diabetes. More than 90% of diabetic subjects have type 2 diabetes. Strict glycemic control is imperative to prevent the acute and chronic complications of diabetes. Aim of Study: To assess the pattern of the glycemic control among patients with type II diabetes mellitus. Methods: A cross sectional survey was conducted among 256 patients with type 2 diabetes in Ajman, using an interviewer questionnaire to achieve the objectives of this research. The research was approved by the "Ethics and Research Committees" of GMU and MOH, UAE. Data was analyzed using SPSS version 22. Logistic regression analysis was done to identify the predictors of poor glycemic control. Results: The frequency of poor glycemic control was very high with 62.1% of the participants having HbA1c value of ≥ 7%. The age increased glycemic control improved. Employed participants had almost three times more odds of poor glycemic control than the unemployed participants. There was no significant difference in Age, nationality, marital status, level of education, or living status of the participants. Overweight and obesity had a poor glycemic. Where those with low physical activity had poor glycemic. Those who did not receive diet counseling had almost 3 times more chance of poor glycemic. Conclusion: The frequency of poor glycemic control was very high with 62.1% of the participants having HbA1c value of ≥ 7.
Journal of Diabetes & Metabolism, 2015
Aims: To assess the clinical profile, glycemic control associated risk factors, co morbidities and complications of patients with diabetes who were referred from primary health care facilities. Methods: A highly specialized National Diabetes and Endocrine center (NDEC) has been established in Muscat, Oman in 2013. Clinical details, glycemic control and co morbidities of all referred patients between February 2013 to January 2014 were recorded from their medical records. A total of 611 patients with type 1 and type 2 diabetes of any age and either sex were included in this study. The center receives cases requiring a better care for complicated patients with diabetes from primary, secondary and tertiary care facilities on referral base. Results: A total of 611 patients were registered and among them 476 were with type 2 and 135 with type 1 diabetes. The mean age was 45.3 years. Nearly, 31% and 50% were overweight and obese among type 2 patients. The study highlights that above 40% patients had an HbA1c of >10% (85.8 mmol/mol) at baseline. A greater reduction in HbA1c (1.4%) was observed in type 2 patients whereas it was 0.5 % in type 1. Majority of type 2 had dyslipidaemia (84%) and hypertension (62.8%). Nephropathy was found in 40.1 and 24.4% with type 2 and type 1 diabetes whereas retinopathy was reported in 14.3 and 8.9% respectively. Female gender and longer duration of diabetes emerged as significant risk factors associated with poor glycemic control. Conclusions: Patients with diabetes referred to a tertiary care setup in Oman had high percentage of overweight and obesity. Majority of them had poor glycemic control with associated presence of co-morbidities. Effective strategies, including education of staff and patients, are highly recommended to improve the current setup at primary care level to facilitate early detection of complications.
2020
The prevalence of diabetes and its associated complications have continued to increase globally. Tight glycemic control has been one of the effective ways towards the management of diabetes and its complications. This study was conducted to investigate independent predictors of glycemic levels among patients with diabetes attending a diabetic clinic of a tertiary health care facility. More than half (54.2%) of the 216 participants had good glycemic control. Participants with Body Mass Index (BMI) more than 25 had 79% lower odds of having controlled glycemic levels (95% CI; 0.095, 0.479), compared to those with BMI≤25.Patients on combination therapy have a significantly higher odds of having good glycemic control compared to those on monotherapy [AOR 3.43 (1.615, 7.302)]. Other identified significant predictors of glycemic control include multiple complications, retinopathy, ethnicity, and self-reported physical activity (p<0.05). Our findings demonstrated that ethnicity, BMI, phy...
African Journal of Food Agriculture Nutrition and Development
Type 2 Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia due to relative insulin secretion deficiency and insulin resistance. It is a global public health concern with increasing prevalence each year. Social demographic, lifestyle and metabolic characteristic, play a crucial role in development and progression of Type 2 diabetes mellitus. Poor glycemic control worsens the condition, leading to complications that are very costly to treat. This calls for a need to explore the relationship between patient characteristics and glycemic control (HbA1c). One hundred and fifty three (153) participants with Type 2 diabetes mellitus aged 20-79 years and attending the Thika Level Five Hospital were enrolled in the study. Sociodemographic, clinical and lifestyle data were obtained using questionnaires. The nutrition status was determined by anthropometry. Lipid profile that included total cholesterol, (TC); high density lipoprotein-cholesterol, (HDL-c); low density lipoprotein cholesterol, (LDL-c) and triglyceride, (TG,) were determined by enzymatic method while glycated hemoglobin (HbA1c) and fasting blood sugar (FBS) were determined using high-performance liquid chromatography (HPLC) and glucose oxidase methods, respectively. Blood pressure of the patients was also determined. Overall sample size was 153 (40.5% men and 59.5% women). The overall mean age of patients was 56.07 years, and the mean age of patients with poor glycemic control (HbA1c>7%) was 56.79 years. The prevalence of the poor glycemic control (HbA1c>7%) was 77.8%. Participants with HbA1c > 7% showed statistically significant higher means for FBG, TC, and LDL-c than their counterparts with good glycemic control [11.71±3.11mmol/l vs. 8.54±3.19; 5.11±1.21mmol/l vs. 4.48±1.16 and 2.66±1.07 mmol/l vs. 2.22±1.04, respectively, (P<0.005; 0.000, 0.008 and 0.034, respectively]. The study showed a significant strong positive correlation between HbA1c and FBG (r=0.679, p<0.01); family history of diabetes, (FHD) (r=0.165, p<0.05); systolic blood pressure, (SBP) moderated with FHD (r=0.168, p<0.05); and diastolic blood pressure (DBP) moderated with FHD(r=0.181, p<0.05). In conclusion, poor glycemic control is associated with high/ blood pressure, high blood glucose and dyslipidemia, which are risk factors for macrovascular, microvascular and cardiovascular complications.
Factors associated with good glycemic control among patients with type 2 diabetes mellitus
Journal of diabetes investigation, 2014
The aim of the present study was to determine the status of glycemic control and identify factors associated with good glycemic control among diabetic patients treated at primary health clinics. A systematic random sample of 557 patients was selected from seven clinics in the Hulu Langat District. Data were collected from patients' medication records, glycemic control tests and structured questionnaires. Logistic regression analysis was carried out to predict factors associated with good glycemic control. Variables associated with good glycemic control included age (odds ratio 1.033; 95% confidence interval 1.008-1.059) and duration of diabetes mellitus (odds ratio 0.948; 95% confidence interval 0.909-0.989). Compared with the patients who were receiving a combination of insulin and oral antidiabetics, those receiving monotherapy (odds ratio 4.797; 95% confidence interval 1.992-11.552) and a combination of oral antidiabetics (odds ratio 2.334; 95% confidence interval 1.018-5.353...
Type 2 diabetes mellitus (T2DM) is prevalent in the Middle East and North Africa as a consequence of increasing aging populations, rapid urbanization, lack of physical exercise, and obesity. Our study objective is to explore glycemic outcomes in people with T2DM patients who initiated basal insulin treatment or who received a further adjustment of existing insulin treatment. Multinational, multicenter, non-interventional study was conducted in the Gulf region. The primary objective was to assess HbA1c reduction from baseline, to three and six months following treatment with insulin-based regimens. Secondary outcomes included the percentage of patients achieving the HbA1c target of <7.0% at 6 months, change in fasting, and postprandial blood glucose, insulin dose, body weight, the incidence of hypoglycemia, and patient characteristics associated with the success of glycemic control. Overall, 1196 patients from 102 centers were recruited and 1083 received a basal insulin-based therapy for six-months. Mean (SD) baseline characteristics were: age 56.2 ? 12 years, weight 82.7 ? 14.9 kg, BMI 29.8 ? 5.2 kg/m?, diabetes duration 11 ? 6.9 years, and 55% were male. Initiation or adjustment of basal insulin reduced mean HbA1c from 9.8% ? 1.6% to 7.6% ? 1% and mean FBG from 208.1 ? 70 mg/dl to 128.6 ? 32.3 mg/dl. At 6 months, 25.9% of patients achieved target HbA1c <7.0%. Predictors of glycemic control (HbA1c <7%) included age (OR = 1.01; p = 0.043), baseline HbA1c (OR = 0.68; p < 0.001), BMI (OR = 0.96; p = 0.012), and exercise (OR = 1.5; p = 0.036). Incidence of hypoglycemia was 5.3%, and no significant change in body weight was observed (p = 0.074). In conclusion, Basal insulin treatment with or without addition of prandial insulin is an efficacious and well tolerated regimen for T2DM patients from the Gulf regions inadequately controlled with oral antidiabetic drugs.
Glycemic control among patients with type 2 diabetes at a primary health care center in Oman
Primary Care Diabetes, 2014
Type 2 diabetes mellitus is a growing, worldwide public health concern. The countries of Arabic Gulf appear to have a higher prevalence of diabetes than the global average. The recent and rapid socioeconomic development of these countries has been associated with this rising prevalence. Although the rate of type 2 diabetes management based on glycosylated hemoglobin level in the countries of Arabic Gulf is labeled as poor, the outcomes are almost similar to those reported from elsewhere. Unfortunately, overweight and obesity are driving the global diabetes epidemic. A minority of patients with type 2 diabetes had a normal body weight which might make the control of diabetes difficult. Anyhow, Greater efforts are urgently needed to properly manage diabetes early in order to prevent short and long-term complications. Practical strategies aimed at more effective management of type 2 diabetes patients are strongly needed.
Glycemic Control and Accompanying Risk Factors: 4-Year Primary Care Study
Journal of Diabetes and Metabolism, 2015
Objective: This study is to assess the glycemic control and the other risk factors like LDL, blood pressure readings and body mass index for type 2 diabetes mellitus (T2DM) in 8 primary care centers over 4 years of time. Methods: An observational, retrospective cohort, multicenter study which was conducted in 8 National Guard primary health care centers. Four of the centers were located in Riyadh; while the others are from different regions in Saudi Arabia. A stratified random sampling method was used according to number of diabetic patients at each center The main study outcomes were to measure the mean HbA1c, LDL levels, blood pressure and BMI readings and the percentage of diabetic patients who reached the ADA goal of HbA1c, LDL, and blood pressure and how it changed during 4 years of time. Also the percentage of adults with diabetes who have HbA1c<0.07 and the changes of controlled patients within the study period. Results: Total number of type-2 diabetic patients of this study was 778, with mean age of 55.03 ± 11.4, 62.7% of them were females. The mean of the HbA1c was 8.7 on 2006 and reduced to 8.6 within four years, 16.6% of diabetic patients had their last HbA1c reading reached the HbA1c goal (≤7%). The LDL and diastolic blood pressure decreased also within the follow up years insignificantly (-0.299 and-1.37). While the systolic blood pressure and BMI increased over 4 years of time (+0.58 and +0.27). HbA1c level shows a significant relation with the education levels in 2007 and 2008. HbA1c also prove a significant relation with LDL for three years in sequence. Age and BMI had a significant relation with the systolic blood pressure. Conclusion: Poor glycemic control has serious impact not only on patients but on the society. The primary health care setting and structure were not well-prepared to properly manage diabetes and its related comorbidities.