Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)
Background: Achieving and maintaining glycemic targets are？a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. Methodology: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. Results: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22]; p？< 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];
References
[1]
UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33). Lancet, 352, 837-853. https://doi.org/10.1016/S0140-6736(98)07019-6
[2]
The Advance Collaborative Group (2008) Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine, 358, 2560-2572. https://doi.org/10.1056/NEJMoa0802987
[3]
Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P.D., et al. (2009) Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. New England Journal of Medicine, 360, 129-139.
https://doi.org/10.1056/NEJMoa0808431
[4]
The Action to Control Cardiovascular Risk in Diabetes Study Group (2008) Effects of Intensive Glucose Lowering in Type 2 Diabetes. New England Journal of Medicine, 358, 2545-2459. https://doi.org/10.1056/NEJMoa0802743
[5]
Buse, J.B., Wexler, D.J., Tsapas, A., Rossing, P., Mingrone, G., Mathieu, C., et al. (2020) 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care, 43, 487-493.
https://doi.org/10.2337/dci19-0066
Darmon, P., Bauduceau, B., Bordier, L., Charbonnel, B., Cosson, E., Detournay, B., et al. (2019) Prise de position de la Société Francophone du Diabète (SFD) sur la prise en charge médicamenteuse de l’hyperglycémie du patient diabétique de type 2—2019. Médecine des Maladies Métaboliques, 13, 711-732.
https://doi.org/10.1016/S1957-2557(19)30215-9
[8]
Aschner, P., Gagliardino, J.J., Ilkova, H., Lavalle, F., Ramachandran, A., Mbanya, J.C., et al. (2020) Persistent Poor Glycaemic Control in Individuals with Type 2 Diabetes in Developing Countries: 12 Years of Real-World Evidence of the International Diabetes Management Practices Study (IDMPS). Diabetologia, 63, 711-721.
https://doi.org/10.1007/s00125-019-05078-3
[9]
Gazzaz, Z.J., Iftikhar, R., Jameel, T., Baig, M. and Murad, M.A. (2020) Association of Dyslipidemia and Comorbidities with Risk Factors among Diabetic Patients: A Retrospective Analysis. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 935-941. https://doi.org/10.2147/DMSO.S235546
[10]
Achila, O.O., Ghebretinsae, M., Kidane, A., Simon, M., Makonen, S. and Rezene, Y. (2020) Factors Associated with Poor Glycemic and Lipid Levels in Ambulatory Diabetes Mellitus Type 2 Patients in Asmara, Eritrea: A Cross-Sectional Study. Journal of Diabetes Research, 2020, Article ID: 5901569.
https://doi.org/10.1155/2020/5901569
[11]
Anioke, I.C., Ezedigboh, A.N., Dozie-Nwakile, O.C., Chukwu, I.J. and Kalu, PN. (2019) Predictors of Poor Glycemic Control in Adult with Type 2 Diabetes in South-Eastern Nigeria. African Health Sciences, 19, 2819-2828.
https://doi.org/10.4314/ahs.v19i4.3
[12]
Camara, A., Baldé, N.M., Sobngwi-Tambekou, J., Kengne, A.P., Diallo, M.M., Tchatchoua, A.P.K., et al. (2015) Poor Glycemic Control in Type 2 Diabetes in the South of the Sahara: The Issue of Limited Access to an HbA1c Test. Diabetes Research and Clinical Practice, 108, 187-192.
https://doi.org/10.1016/j.diabres.2014.08.025
[13]
Belhadj, M., Arbouche, Z., Brouri, M., Malek, R., Semrouni, M., Zekri, S., et al. (2019) BAROMèTRE Algérie: Enquête nationale sur la prise en charge des personnes diabétiques. Médecine des Maladies Métaboliques, 13, 188-194.
https://doi.org/10.1016/S1957-2557(19)30055-0
[14]
Ben El Mostafa, S., Boutayeb, W., Zitouni, N. and Maamri, A. (2019) Facteurs associés au mauvais contrôle glycémique chez des diabétiques de type 2 au Nord-Est du Maroc: à propos de 80 cas. Annales des Sciences de la Santé, 22, 1-14.
[15]
Hai, A.A., Iftikhar, S., Latif, S., Herekar, F. and Patel, M.J. (2019) Diabetes Self-Care Activities and Their Relation with Glycemic Control in Patients Presenting to The Indus Hospital, Karachi. Cureus, 11, e6297. https://doi.org/10.7759/cureus.6297
[16]
De Pablos-Velasco, P., Parhofer, K.G., Bradley, C., Eschwège, E., Gönder-Frederick, L., Maheux, P., et al. (2014) Current Level of Glycaemic Control and Its Associated Factors in Patients with Type 2 Diabetes across Europe: Data from the PANORAMA Study. Clinical Endocrinology, 80, 47-56. https://doi.org/10.1111/cen.12119
[17]
Umpierrez, G.E., Isaacs, S.D., Bazargan, N., You, X., Thaler, L.M. and Kitabchi, A.E. (2002) Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes. Journal of Clinical Endocrinology & Metabolism, 87, 978-982. https://doi.org/10.1210/jcem.87.3.8341
[18]
Demoz, G.T., Gebremariam, A., Yifter, H., Alebachew, M., Niriayo, Y.L., Gebreslassie, G., et al. (2019) Predictors of Poor Glycemic Control among Patients with Type 2 Diabetes on Follow-Up Care at a Tertiary Healthcare Setting in Ethiopia. BMC Research Notes, 12, Article No. 207. https://doi.org/10.1186/s13104-019-4248-6
[19]
Afroz, A., Ali, L., Karim, M.N., Alramadan, M.J., Alam, K., Magliano, D.J., et al. (2019) Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh—An Urgent Need for Optimization of Management Plan. Scientific Reports, 9, Article No. 10248. https://doi.org/10.1038/s41598-019-46766-9
[20]
Duarte, F.G., da Silva Moreira, S., da Conceição C Almeida, M., de Souza Teles, C.A., Reingold, A.L. and Moreira Jr., E.D. (2019) Sex Differences and Correlates of Poor Glycaemic Control in Type 2 Diabetes: A Cross-Sectional Study in Brazil and Venezuela. BMJ Open, 9, e023401. https://doi.org/10.1136/bmjopen-2018-023401
[21]
Khunti, K., Chen, H., Cid-Ruzafa, J., Fenici, P., Gomes, M.B., Hammar, N., et al. (2020) Glycaemic Control in Patients with Type 2 Diabetes Initiating Second-Line Therapy: Results from the Global DISCOVER Study Programme. Diabetes, Obesity and Metabolism, 22, 66-78. https://doi.org/10.1111/dom.13866
[22]
Smalls, B.L., Ritchwood, T.D., Bishu, K.G. and Egede, L.E. (2020) Racial/Ethnic Differences in Glycemic Control in Older Adults with Type 2 Diabetes: United States 2003-2014. International Journal of Environmental Research and Public Health, 17, Article No. 950. https://doi.org/10.3390/ijerph17030950
[23]
Tapsoba, M.T. (2001) Evaluation de l’équilibre glycémique à partir d’une étude rétrospective sur 04 ans chez les diabétiques suivis au CHNYO. Thèse de doctorat en médecine, No. 11, Université de Ouagadougou, Ouagadougou.
[24]
Xie, F.Y., Chan, J.C.N. and Ma, R.C.W. (2018) Precision Medicine in Diabetes Prevention, Classification and Management. Journal of Diabetes Investigation, 9, 998-1015. https://doi.org/10.1111/jdi.12830
[25]
Kalra, S., Das, A.K., Bajaj, S., Priya, G., Ghosh, S., Mehrotra, R.N., et al. (2020) Utility of Precision Medicine in the Management of Diabetes: Expert Opinion from an International Panel. Diabetes Therapy, 11, 411-422.
https://doi.org/10.1007/s13300-019-00753-5
[26]
Morisky, D.E., Ang, A., Krousel-Wood, M. and Ward, H.J. (2008) Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. Journal of Clinical Hypertension, 10, 348-354.
https://doi.org/10.1111/j.1751-7176.2008.07572.x
[27]
Haute Autorité de Santé (2014) Principales dyslipidémies. Stratégies de prise en charge. Haute Autorité de Santé, Paris. https://www.has-sante.fr
[28]
Kibirige, D., Atuhe, D., Sebunya, R. and Mwebaze, R. (2014) Suboptimal Glycaemic and Blood Pressure Control and Screening for Diabetic Complications in Adult Ambulatory Diabetic Patients in Uganda: A Retrospective Study from a Developing Country. Journal of Diabetes & Metabolic Disorders, 13, Article No. 40.
https://doi.org/10.1186/2251-6581-13-40
[29]
Omar, S.M., Musa, I.R., Osman, O.E. and Adam, I. (2018) Assessment of Glycemic Control in Type 2 Diabetes in the Eastern Sudan. BMC Research Notes, 11, Article No. 373. https://doi.org/10.1186/s13104-018-3480-9
[30]
Souliotis, K., Koutsovasilis, A., Vatheia, G., Golna, C., Nikolaidi, S., Hatziagelaki, E., et al. (2020) Profile and Factors Associated with Glycaemic Control of Patients with Type 2 Diabetes in Greece: Results from the Diabetes Registry. BMC Endocrine Disorders, 20, Article No. 16. https://doi.org/10.1186/s12902-020-0496-7
[31]
Cai, X.L., Hu, D.Y., Pan, C.Y., Li, G.W., Lu, J.M., Ji, Q.H., et al. (2020) Evaluation of Effectiveness of Treatment Paradigm for Newly Diagnosed Type 2 Diabetes Patients in Chin: A Nationwide Prospective Cohort Study. Journal of Diabetes Investigation, 11, 151-161. https://doi.org/10.1111/jdi.13092
[32]
Tekalegn, Y., Addissie, A., Kebede, T. and Ayele, W. (2018) Magnitude of Glycemic Control and Its Associated Factors among Patients with Type 2 Diabetes at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. PloS ONE, 13, e0193442.
https://doi.org/10.1371/journal.pone.0193442
[33]
Rahman, M., Nakamura, K., Hasan, S.M.M., Seino, K. and Mostofa, G. (2020) Mediators of the Association between Low Socioeconomic Status and Poor Glycemic Control among Type 2 Diabetics in Bangladesh. Scientific Reports, 10, Article No. 6690. https://doi.org/10.1038/s41598-020-63253-8
[34]
Da Vico, L., Monami, M., Biffi, B., Lamanna, C., Martelli, C., Marchionni, N., et al. (2013) Targeting Educational Therapy for Type 2 Diabetes: Identification of Predictors of Therapeutic Success. Acta Diabetologica, 50, 309-317.
https://doi.org/10.1007/s00592-012-0377-2
[35]
Guira, O., Ouedraogo, A., Zoungrana, L., Bognounou, R., Traore, S., Tonde, A. and Drabo, Y.J. (2019) Evaluation du suivi trimestriel des patients diabétiques en médecine interne au Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou. Revue Africaine de Médecine Interne, 6, 21-26.
[36]
Otieno, C., Kariuki, M. and Ng’ang’a, L. (2003) Quality of Glycaemic Control in Ambulatory Diabetics at the Out-Patient Clinic of Kenyatta National Hospital, Nairobi. East African Medical Journal, 80, 406-410.
https://doi.org/10.4314/eamj.v80i8.8731
[37]
Institut National de la Statistique et de la Démographie (2016) Annuaire Statistique 2016. Institut National de la Statistique et de la Démographie, Burkina Faso.
https://www.sante.gov.bf
[38]
Captieux, M., Pearce, G., Parke, H.L, Epiphaniou, E., Wild, S., Taylor, S.J.C., et al. (2018) Supported Self-Management for People with Type 2 Diabetes: A Meta-Review of Quantitative Systematic Reviews. BMJ Open, 8, e024262.
https://doi.org/10.1136/bmjopen-2018-024262
[39]
Wu, M., Wen, J.B., Qin, Y., Zhao, H.L., Pan, X.Q., Su, J., Du, W.C., Pan, E.C., Zhang, Q., Zhang, N., Sheng, H.Y., Liu, C.L. and Shen, C. (2017) Familial History of Diabetes is Associated with Poor Glycaemic Control in Type 2 Diabetics: A Cross-Sectional Study. Scientific Reports, 7, Article No. 1432.
https://doi.org/10.1038/s41598-017-01527-4
[40]
Cheng, L.J., Wang, W., Lim, S.T. and Wu, VX. (2019) Factors Associated with Glycaemic Control in Patients with Diabetes Mellitus: A Systematic Literature Review. Journal of Clinical Nursing, 28, 1433-1450. https://doi.org/10.1111/jocn.14795
[41]
Shamshirgaran, S.M., Mamaghanian, A., Aliasgarzadeh, A., Aiminisani, N., Iranparvar-Alamdari, M. and Ataie, J. (2017) Age Differences in Diabetes-Related Complications and Glycemic Control. BMC Endocrine Disorders, 17, Article No. 25
https://doi.org/10.1186/s12902-017-0175-5
[42]
Mirahmadizadeh, A., Khorshidsavar, H., Seif, M. and Sharifi, M.H. (2020) Adherence to Medication, Diet and Physical Activity and the Associated Factors Amongst Patients with Type 2 Diabetes. Diabetes Therapy, 11, 479-494.
https://doi.org/10.1007/s13300-019-00750-8
[43]
Fekadu, G., Bula, K., Bayisa, G., Turi, E., Tolossa, T. and Kebebe, H. (2019) Challenges and Factors Associated with Poor Glycemic Control among Type 2 Diabetes Mellitus Patients at Nekemte Referral Hospital, Western Ethiopia. Journal of Multidisciplinary Healthcare, 12, 963-974. https://doi.org/10.2147/JMDH.S232691
[44]
Kazemian, P., Shebl, F.M., Mc Cann, N., Walensky, R.P. and Wexler, D.J. (2019) Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016. JAMA Internal Medicine, 179, 1376-1385.
https://doi.org/10.1001/jamainternmed.2019.2396
[45]
Peng, K., Chen, G., Liu, C., Mu, Y., Ye, Z., Shi, L., et al. (2018) Association between Smoking and Glycemic Control in Diabetic Patients: Results from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal (REACTION) Study. Journal of Diabetes, 10, 408-418. https://doi.org/10.1111/1753-0407.12625
[46]
Willi, C., Bodenmann, P., Ghali, W.A., Faris, P.D. and Cornuz, J. (2007) Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis. JAMA, 298, 2654-2664. https://doi.org/10.1001/jama.298.22.2654
[47]
Ohkuma, T., Iwase, M., Fujii, H., Kaizu, S., Ide, H., Jodai, T., et al. (2015) Dose- and Time-Dependent Association of Smoking and Its Cessation with Glycemic Control and Insulin Resistance in Male Patients with Type 2 Diabetes Mellitus: The Fukuoka Diabetes Registry. PLoS ONE, 10, e0122023.
https://doi.org/10.1371/journal.pone.0122023
[48]
Wiss, D.A. (2019) The Relationship Between Alcohol and Glycohemoglobin: A Biopsychosocial Perspective. BioResearch Open Access, 8, 146-154.
https://doi.org/10.1089/biores.2019.0009
[49]
Tiéno, H., Bouda M., Ouédraogo, D-D., Traoré, R., Ouédraogo, C. and Drabo, Y.J. (2010) Observance du traitement antidiabétique dans un pays en développement: Le cas du Burkina Faso (Afrique subsaharienne). Médecine des Maladies Métaboliques, 4, 207-210. https://doi.org/10.1016/S1957-2557(10)70046-8
[50]
Irving, G., Neves, A.L., Dambha-Miller, H., Oishi, A., Tagashira, H., Verho, A., et al. (2017) International Variations in Primary Care Physician Consultation Time: A Systematic Review of 67 Countries. BMJ Open, 7, e017902.
https://doi.org/10.1136/bmjopen-2017-017902
[51]
Pokhrel, S., Shrestha, S., Timilsina, A., Sapkota, M., Bhatt, M.P. and Pardhe, B.D. (2019) Self-Care Adherence and Barriers to Good Glycaemic Control in Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study. Journal of Multidisciplinary Healthcare, 12, 817-826.
https://doi.org/10.2147/JMDH.S216842
[52]
Alzaheb, R. and Altemani, A. (2018) 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, 11, 15-21.
https://doi.org/10.2147/DMSO.S156214
[53]
Mekni, S., Nacef, I.B., Jenouiz, Z., Rojbi, I., Mchirgui, N., Lakhoua, Y., et al. (2017) Impact of Hospitalization on Glycemic Control in Patients with Poorly Controlled Diabetes. Annales d’Endocrinologie, 78, 421-422.
https://doi.org/10.1016/j.ando.2017.07.668
