Abstract:
Global quality care of Type 2 diabetes mellitus (T2DM), whose prevalence is
approximately 10% in Kenya, may prevent or delay diabetes complications. Diabetes
is a public health concern that influences the quality of life in diabetic patients.
Complications due to DM increase risk for those who are not properly treated, resulting
in reduced life expectancy. The main objective of this study was to determine the blood
glycemic levels, defined by HbA1c levels as the main effect of diabetic and associated
factors among patients receiving diabetes management at Kenyatta National Hospital
(KNH) in Kenya. This was a cross-sectional study conducted at the Diabetic clinic,
KNH. The study population was T2DM patients attending Diabetic Clinic at KNH
where a sample size of 385 was determined. The study collected data using a structured
questionnaire and recorded glycemic measurements. Five ml whole blood sample was
collected and analyzed using DIRUI CS 4000 clinical chemistry analyzer. This study
was approved by KNH/UON ERC and consenting issues were adhered to. Results
shows that 103 (27.1%) T2DM patients with poor glycemic control were identified. In
multivariate analysis, independent risk factors associated with poor glycemic control
and their 95% confidence intervals included: concurrent hypertension (OR 1.6, [1.1,
2.4]), receiving ≥3 oral anti-diabetes medication (OR 2.4, [1.3, 4.6]) and good
adherence to medication based on self-reporting (OR 6.2, [1.9, 41.3). Independent
protective factors included self-monitoring of blood glucose levels (OR 0.35, [0.2,
0.4]), patients aged 51 to 60 years (OR 0.5, [0.3, 0.9]), weight between 50 and 70kgs
(OR 0.5, [0.3, 0.9]) and receiving 1 to 2 diabetes medication (OR 0.4, [0.3, 0.7]).
Significantly high proportion of T2DM patients receiving treatment at KNH had poor
glycemic control. Addressing comorbidities and promoting good glycemic control
among long-standing T2DM patients receiving ≥3 oral anti-diabetes medication is key
to delaying or preventing chronic diabetes complications. Self-monitoring of blood
glucose levels needs to be encouraged as suggested by its protective effect. While
differences in risk between diverse weights and ages need further studies, innovative
ways of authenticating self-reports, e.g., triangulation, are required to ensure
credibility. This work supports the Government of Kenya's Vision 2030 in creating a
healthy and productive population contributing to the country's economic growth.
Given the significant association between poor glycemic control and concurrent
hypertension, integrated management of diabetes and comorbid conditions should be
prioritized in clinical care protocols. Patients receiving three or more oral anti-diabetic
medications were more likely to have poor glycemic control. Regular medication
reviews and individualized treatment plans should be emphasized to optimize
therapeutic outcomes and reduce medication burden.
