Kamuhabwa Appolinary R, Charles Emmanuel
Unit of Pharmacology and Therapeutics, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Drug Healthc Patient Saf. 2014 Oct 24;6:155-65. doi: 10.2147/DHPS.S68786. eCollection 2014.
Tanzania has recently experienced a significant rise in the burden of diabetes, and it is estimated that more than 400,000 people are living with diabetes. A major concern in the management of diabetes is the occurrence of diabetic complications that occur as a result of poor glycemic control. Identification of the factors associated with poor glycemic control is important in order to institute appropriate interventions for the purpose of improving glycemic control and prevention of chronic complications.
The aim of this study was to determine the level of glycemic control and explore the factors associated with poor glycemic control among patients with type 2 diabetes mellitus (T2DM).
A cross-sectional study was carried out at the diabetic clinics for T2DM patients at the national and municipal hospitals in Dar es Salaam. A total of 469 patients were enrolled over a period of 8 weeks from March 2013 to May 2013. Patients' information such as sociodemographic characteristics, self-care management behaviors, and medication adherence were obtained through interviews. Blood pressure, weight, and height were measured during the day of the interview. All available last readings for fasting blood glucose (FBG) measurements, lipid profile, and other clinical characteristics were obtained from patients' records.
The mean age of patients was 54.93 years. The majority (63.5%) of patients were females and only eight patients had records of lipid profile measurements. Out of 469 patients, 69.7% had FBG of ≥7.2 mmol/L, indicating poor glycemic control. Females aged between 40 years and 59 years had significantly higher poor glycemic control (76.1%) as compared with their male counterparts. Thirty-eight percent of patients had poor medication adherence, which was associated with poor glycemic control. The proportion of poor glycemic control increased with age. A significantly high proportion of poor glycemic control was observed in patients who had had the disease for more than 20 years since diagnosis. Factors associated with poor glycemic control included lack of health insurance, using more than one oral hypoglycemic agent, normal body mass index, obesity, and nonadherence to diabetic medications.
Patients in this study had generally poor glycemic control. From these findings it is recommended that diabetic patients should be routinely screened for lipid profile to determine levels of cholesterol, triglycerides, and low-density lipoproteins, which are risk factors for cardiovascular events. An education program should be developed to educate patients on the importance of medication adherence and weight management for better glycemic control.
坦桑尼亚近期糖尿病负担显著上升，据估计超过40万民众患有糖尿病。糖尿病管理中的一个主要担忧是血糖控制不佳导致的糖尿病并发症的发生。识别与血糖控制不佳相关的因素对于实施适当干预以改善血糖控制和预防慢性并发症很重要。
本研究的目的是确定2型糖尿病（T2DM）患者的血糖控制水平，并探索与血糖控制不佳相关的因素。
在达累斯萨拉姆的国家和市立医院的糖尿病诊所对T2DM患者进行了一项横断面研究。在2013年3月至2013年5月的8周时间里，共纳入了469名患者。通过访谈获取患者的社会人口学特征、自我护理管理行为和药物依从性等信息。在访谈当天测量血压、体重和身高。所有可用的空腹血糖（FBG）测量的末次读数、血脂谱和其他临床特征均从患者记录中获取。
患者的平均年龄为54.93岁。大多数（63.5%）患者为女性，只有8名患者有血脂谱测量记录。在469名患者中，69.7%的患者FBG≥7.2 mmol/L，表明血糖控制不佳。40至59岁的女性血糖控制不佳的比例（76.1%）显著高于男性。38%的患者药物依从性差，这与血糖控制不佳有关。血糖控制不佳的比例随年龄增加。自诊断以来患病超过20年的患者中观察到血糖控制不佳的比例显著较高。与血糖控制不佳相关的因素包括缺乏医疗保险、使用不止一种口服降糖药、正常体重指数、肥胖和不坚持服用糖尿病药物。
本研究中的患者总体血糖控制较差。根据这些发现，建议对糖尿病患者进行血脂谱常规筛查，以确定胆固醇、甘油三酯和低密度脂蛋白水平，这些是心血管事件的危险因素。应制定一项教育计划，教育患者认识到药物依从性和体重管理对更好地控制血糖的重要性。
