Barriers to Glycaemic Control Among Diabetes Patients at the Korle-Bu Teaching Hospital

Abstract

Background: Diabetes is a condition whereby the body fails to regulate levels of glucose in the body, resulting in too much glucose being present in the body. Despite the strong consensus that good glycaemic control minimizes the risk of developing complications such as nephropathy, and cardiovascular diseases in Type 2 Diabetes Mellitus (T2DM), only few patients can obtain optimal glycaemic control. Objective: This study was to explore factors associated with poor glycaemic control among diabetes patients at the Korle-Bu Teaching Hospital. Design: A case control study of 230 diabetes patients consisting of 115 cases with HbA1c value ≥7, and 115 controls with HbA1c value <7. Method: Data was collected by trained interviewers through questionnaire interviews of a total of 230 diabetes patients older than 20 years of age, and who had an HbA1c test within the previous three months. Univariate and multivariate logistic regression analysis were carried out to identify socio demographic factors, and to find out if there was association between lifestyle factors, knowledge about diabetes and hypertension that were likely to influence glycaemic control. Results: Poor glycaemic control was found to be significantly associated with persons aged >40 years (OR: 3.99) and persons who were retired from active work but still working. Women were at a higher risk of having poor glycaemic control than men (OR: 3.57). People who had poor knowledge of their fasting plasma glucose (FPG) were found to have a higher risk of poor glycaemic control (OR: 5.71). There was a significant association of poor glycaemic control and increasing number of pills to swallow daily (OR: 2.86), and persons who did not adhered to medication regimen and missed out on some medications. Furthermore, poor glycaemic control was found to be significantly associated with persons who defaulted in follow up review visits to the physician’s office (OR: 2.56), and persons who visited the physician’s office for treatment every three month (OR: 4.65 95% 0.07, 0.68) with p-value 0.008. Hypertension was found not to be statistically associated with poor glycaemic control. Conclusion: There is evidence suggesting that some socio demographic factors such as age and sex, knowledge about fasting plasma glucose, and lifestyle factors such as non adherence to medication regimen and follow up visit to the hospital/physicians’ office were significantly associated with poor glycaemic control. Therefore a good control is essential for the future well being of all diabetes patients. Addressing these issues may help to decrease the disparities that currently exist in diabetes management.