Abstract:
INTRODUCTION
Glycaemic control denotes regulating and maintaining blood sugar levels in diabetic patient
within normal ranges. World Health Organization (WHO) recommends the use of Glycated
Haemoglobin (HbA1c) test as an objective measure of Glycaemic control with a target of
maintaining HbA1c at an optimal value of 7.5% or less. Long-term glycaemic control reduces
later incidence of diabetic related complications, however attaining the target has been a
challenge to both patients and health care providers with 40% and 60% of patient unable to
reach the optimal targets in developed and developing countries respectively. Tanzania is
limited in studies exploring glycaemic control at local context, but the few studies conducted
show high proportion of patients (over 65%) with uncontrolled glycaemia. The study aimed at
determining the magnitude of glycaemic control and its associated factors among type 2
diabetic patients attending public health facility in Regional hospital of Tanga, Tanzania.
METHODS
This was a hospital based cross-sectional design with systematic random sampling conducted
from December 2012 to March 2013. Diet was assessed using Food Frequency Questionnaire
(FFQ), physical activity through the International Physical Activity Questionnaire (IPAQ),
anthropometric measurement performed, and blood sample collected for laboratory testing of
HbA1c levels. HbA1c level (>7.5% = 1, else = 0) was set as an outcome variable with other
factors being explanatory variables. Bivariate and multivariate analysis was performed and
Chi Square test was used in comparing proportions with a significant different set at P value of
0.05 or less. Ethical clearance was obtained from MUHAS Institutional Review Board (IRB).
RESULTS
A total of 224 study participants were enrolled into the study. Female were 137 (61.2%). The
mean age (SD) was 55.4 (12.9) years. The prevalence of unacceptable glycaemic control was
83% (186/224). Factors found to be significantly associated with unacceptable glycaemic
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control in univariate analysis were, frequent fruit intake OR (95% CI): 0.3 (0.1, 0.8); Moderate
physical activity, 3.0 (1.3, 6.9); Low physical active, 2.9, (1.2, 7.2); food insecurity, 7.1 (1.3,
53.9); high physical activity, 0.3 (0.1, 0.9); diabetic duration for more than 2 years, 2.5 (1.5,
5.1); Insulin treatment 6.0 (1.7, 15); being on Oral Hypoglycemic Agents (OHA) single drugs,
0.5 (0.2, 0.9; diet only therapy, 0.2 (0.1, 0.4); and satisfying self-diabetic care, 0.4 (0.2, 0.9).
In multivariate analysis, significant factors were satisfying self-diabetic care practice AOR
(95% CI): 0.3 (0.1, 0.8); on dietary therapy only, 0.2 (0.1, 0.6); on Insulin therapy, 6.7 (2.0,
22.4); Frequent fruit intake, 0.3 (0.1, 0.7); moderate physical activity, 3.41 (1.3, 9.0); and low
physical active, 3.4 (1.3, 11.6).
CONCLUSSION
High prevalence of unacceptable glycaemic control at a tertiary diabetic care clinic level
setting is alarming. Routine analysis, interpretation and use of information from patient’s
clinic visits record at facility needs to be empowered to facilitate close monitoring and
evaluation of quality of care provided. Good practices towards achieving glycaemic control
are to be encouraged to achieve a large number of patients practicing them for better
glycaemic control
