Factors Associated with Long Term Glycemic Control among Diabetic Patients in a National Referral Hospital in Kenya

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.