Associated factors of poor glycemic control in Iranian diabetic patients

How to Cite:Doustmohamadian S, Kia NS, Fatahi S. Associated factors of poor glycemic control in Iranian diabetic patients. koomesh. 2021;23(3):e149956. doi:

Abstract

Introduction: According to the world health organization the prevalence of type 2 diabetes in our country and world will increase sharply by 2030. Because improving glycemic control delays the onset and progression of diabetes complications, recognizing related factors is key step in the effective treatment of these patients. Therefore, this study was performed to determine the predictors of poor glycemic control. Materials and Methods: This study was a cross sectional study performed on 388 diabetic patients referring to the diabetes clinic in year 2019 (Semnan, Iran). The mean glycosylated hemoglobin was used as glycemic control index, and Hb A1C >7% was considered as poor glycemic control. Exclusion criteria were pregnancy, use of corticosteroid or cytotoxic drugs, malignancy, hemoglobinopathy, anemia, uremia, secondary diabetes, history of GI bleeding, surgery and blood transfusion in the last 3 month. All patients with type 2 diabetes who did not meet the exclusion criteria were included in the study. Results: The mean Hb A1C was 8.044 ± 1.46 and 74 % of the patients had poor glycemic control. 44.5% of the patients had BMI> 30 kg/m² and 89.9 % of them had abdominal obesity. There was an association between poor glycemic control and gender, type of treatment and duration of diabetes. Women, individuals treated with injectable insulin, and patients with the duration of diabetes less than 5 year had better control. Conclusion: Our study showed that duration of diabetes and type of treatment are independently associated factors of glycemic control.

Keywords

Glycemic Control

Glycated Hemoglobin A

Type 2 Diabetes Mellitus

References

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[1] Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes research and clinical practice. 2011;94 :311-21.
54.
https://doi.org/10.1016/j.diabres.2011.10.029.
55.
PMid:22079683.
56.
[2] Siddiqui FJ, Avan BI, Mahmud S, Nanan DJ, Jabbar A, Assam PN. Uncontrolled diabetes mellitus: Prevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan. Diabetes Research and Clinical Practice. 2015;107:148-56.
57.
https://doi.org/10.1016/j.diabres.2014.09.025.
58.
PMid:25451895.
59.
[3] Ellms AE. Identifying factors leading to uncontrolled diabetes mellitus in an outpatient clinic setting: a literature review and retrospective case-study. 2006.
60.
[4] Kamuhabwa AR, Charles E. Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam. Drug, healthcare and patient safety. 2014;6:155.
61.
https://doi.org/10.2147/DHPS.S68786.
62.
PMid:25368533 PMCid:PMC4216043.
63.
[5] Tripathi BK, Srivastava AK. Diabetes mellitus: Complications and therapeutics. Medical Science Monitor. 2006;12:RA130-RA47.
64.
[6] Zandkarimi E, Safavi AA, Rezaei M, Rajabi G. Comparison logistic regression and discriminant analysis in identifying the determinants of type 2 diabetes among prediabetes of Kermanshah rural areas. Journal of Kermanshah University of Medical Sciences (J Kermanshah Univ Med Sci). 2013;17:300-8. (persian).
65.
[7] Ali MK, Bullard K, Imperatore G, Barker L, Gregg EW. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes-National Health and Nutrition Examination Survey, United States, 2007-2010. MMWR Morb Mortal Wkly Rep. 2012;61:32-7.
66.
[8] El-Kebbi IM, Cook CB, Ziemer DC, Miller CD, Gallina DL, Phillips LS. Association of younger age with poor glycemic control and obesity in urban African Americans with type 2 diabetes. Archives of internal medicine. 2003;163:69-75.
67.
https://doi.org/10.1001/archinte.163.1.69.
68.
PMid:12523919.
69.
[9] Rothenbacher D, Rter G, Saam S, Brenner H. Younger patients with type 2 diabetes need better glycaemic control: results of a community-based study describing factors associated with a high HbA1c value. Br J Gen Pract. 2003;53:389-91.
70.
[10] Juarez DT. Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009. Preventing chronic disease. 2012;9.
71.
https://doi.org/10.5888/pcd9.120065.
72.
PMid:23017247 PMCid:PMC3475506.
73.
[11] Sanal T, Nair N, Adhikari P. Factors associated with poor control of type 2 diabetes mellitus: a systematic review and meta-analysis. Journal of diabetology. 2011;3:1-10.
74.
[12] Howard BV, Cowan LD, Go O, Welty TK, Robbins DC, Lee ET, et al. Adverse effects of diabetes on multiple cardiovascular disease risk factors in women: the Strong Heart Study. Diabetes Care. 1998;21:1258-65.
75.
https://doi.org/10.2337/diacare.21.8.1258.
76.
PMid:9702430.
77.
[13] Juutilainen A, Kortelainen S, Lehto S, Rnnemaa T, Pyrl K, Laakso M. Gender difference in the impact of type 2 diabetes on coronary heart disease risk. Diabetes care. 2004;27:2898-904.
78.
https://doi.org/10.2337/diacare.27.12.2898.
79.
PMid:15562204.
80.
[14] Steinberg HO, Paradisi G, Cronin J, Crowde K, Hempfling A, Hook G, et al. Type II diabetes abrogates sex differences in endothelial function in premenopausal women. Circulation. 2000;101:2040-6.
81.
https://doi.org/10.1161/01.CIR.101.17.2040.
82.
PMid:10790344.
83.
[15] Chiu C-J, Wray LA. Peer Reviewed: Factors Predicting Glycemic Control in Middle-Aged and Older Adults With Type 2 Diabetes. Preventing chronic disease. 2010;7.
84.
[16] FarhadMolashahi L, Kadeh H, Saravani S, Dashipoor A. Level of Glycemic Control in Diabetic Patients Reffering to Zahedan Dental School (Iran) in 2005. Journal of Mashhad Dental School. 2011;3:195-204. (persian).
85.
[17] Heidari S, Shirazi F, Sanjari M, Salimi S, Balegani S, Tizfahm T. Factors influencing glycemic control in type 2 diabetic patients referred to the Institute of Endocrinology and Metabolism, University of Iran Medical Sciences. Iranian Journal of Diabetes and Lipid. 2010;9:365-75. (persian).
86.
[18] Danai N, Tamadon M, Moonesan M. Survey of the level of diabetes control and some related to it in patients referred to diabetes clinic (Semnan Fatemieh hospital). Koomesh. 2004;6:31-6. (persian).
87.
[19] Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. Journal of diabetes and its complications. 2010;24:84-9.
88.
https://doi.org/10.1016/j.jdiacomp.2008.12.008.
89.
PMid:19282203.
90.
[20] Esmailnasab N, Afkhamzadeh A, Ebrahimi A. Effective factors on diabetes control in Sanandaj diabetes center. Iranian Journal of Epidemiology. 2010;6:39-45. (persian).
91.
[21] Mansour AM, Al Shalahi MH, Al Johani A, Rami M. Forward and backward logistic regression analysis to give the estimation of tight diabetes control: review. Int J Diabetes Endocrinol. 2017;2: 1:1-4.
92.
[22] Riyadh A Alzaheb, A H Altemani. The prevalence and determinants of poor glycemic control among adults with type 2 diabetes mellitus in Saudi Arabia. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2018: 11:15-21.
93.
https://doi.org/10.2147/DMSO.S156214.
94.
PMid:29430192 PMCid:PMC5797462.
95.
[23] Mauvais-jarvis F. Physiology & Behavior Gender differences in glucose homeostasis and diabetes. 2018; 187:20-3.
96.
https://doi.org/10.1016/j.physbeh.2017.08.016.
97.
PMid:28843891 PMCid:PMC5826763.
98.
[24] G Duarte F, Sandra Da M, Maria Da M, Carlos A de S T, Carnie S A, Art L Rein gold et al. Sex differences and correlates of poor glycemic control in type 2 diabetes: a cross-sectional study in Brazil and Venezuela . BMJ Open 2019; 9:e023401.
99.
https://doi.org/10.1136/bmjopen-2018-023401.
100.
PMid:30842107 PMCid:PMC6429715.
101.
[25] Darvish Moghaddam S, Nikian Y. The association between some demographic features and control of diabetes mellitus. Journal of Kerman university of medical sciences. 1994; 2: 8379. (persian).
102.
[26] Finotti P, Piccoli A, Carraro P. Alteration of plasma proteinase-antiproteinase system in type 1 diabetic patients. Influence of sex and relationship with metabolic control. Diabetes research and clinical practice. 1992;18:35-42.
103.
https://doi.org/10.1016/0168-8227(92)90053-T.
104.
[27] Haji-Arabi, E., Nobahar, M., & Ghorbani, R. Relationship between depression and knowledge about diabetes with the amount of self-care in patients with type 2 diabetes. Koomesh 2018; 20:210-220.

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Soraya Doustmohamadian:[PubMed][Scholar]
Naeim sadat Kia:[PubMed][Scholar]
Sepideh Fatahi:[PubMed][Scholar]

Journal of Semnan University of Medical Sciences

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Associated factors of poor glycemic control in Iranian diabetic patients

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