Glycaemic control and associated factors in type 2 Diabetic patients attending a public health facility clinic in Tanga regional hospital, Tanzania 2012.

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 viii 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