Department of Community and Family Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India.
Department of General Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, India.
Curr Diabetes Rev. 2024;20(2):e270423216246. doi: 10.2174/1573399819666230427094530.
Diabetes mellitus (DM) is a chronic disease, which requires optimal glycemic control to prevent its ensuing vascular complications. Pathway to optimal glycemic control in T2DM has a complex socio-behavioral construct, especially in vulnerable populations, like slum dwellers, who have reduced health-care access and lower prioritization of health needs.
The study aimed to map trajectories of glycemic control amongst individuals with T2DM living in urban slums and identify key determinants associated with unfavourable glycaemic trajectory.
This study was a community-based longitudinal study conducted in an urban slum of Bhopal in Central India. Adult patients diagnosed with T2DM and on treatment for more than one year were included. All 326 eligible participants underwent a baseline interview, which captured sociodemographic, personal behavior, medication adherence, morbidity profile, treatment modality, anthropometric and biochemical measurements (HbA1c). Another 6-month follow-up interview was conducted to record anthropometric measurements, HbA1c and treatment modality. Four mixed effect logistic regression models (through theory-driven variable selections) were created with glycemic status as dependent variable and usage of insulin was considered as random effect.
A total of 231 (70.9%) individuals had unfavorable glycemic control trajectory (UGCT), and only 95 (29.1%) had a favorable trajectory. Individuals with UGCT were more likely to be women, with lower educational status, non-vegetarian food preference, consumed tobacco, had poor drug adherence, and were on insulin. The most parsimonious model identified female gender (2.44,1.33-4.37), tobacco use (3.80,1.92 to 7.54), and non-vegetarian food preference (2.29,1.27 to 4.13) to be associated with UGCT. Individuals with good medication adherence (0.35,0.13 to 0.95) and higher education status (0.37,0.16 to 0.86) were found to be protective in nature.
Unfavorable glycemic control trajectory seems to be an inescapable consequence in vulnerable settings. The identified predictors through this longitudinal study may offer a cue for recognizing a rational response at societal level and adopting strategy formulation thereof.
糖尿病（DM）是一种慢性病，需要最佳的血糖控制以预防随之而来的血管并发症。2 型糖尿病达到最佳血糖控制的途径存在复杂的社会行为结构，尤其是在弱势群体中，如贫民窟居民，他们获得医疗保健的机会减少，对健康需求的重视程度较低。
本研究旨在描绘城市贫民窟中 2 型糖尿病患者的血糖控制轨迹，并确定与不良血糖轨迹相关的关键决定因素。
这是一项在印度中部博帕尔市一个城市贫民窟进行的基于社区的纵向研究。纳入患有 2 型糖尿病且治疗时间超过一年的成年患者。所有 326 名符合条件的参与者都接受了基线访谈，其中包括社会人口统计学、个人行为、药物依从性、发病情况、治疗方式、人体测量学和生化测量（HbA1c）。另外还进行了 6 个月的随访访谈，以记录人体测量学、HbA1c 和治疗方式。使用 4 个混合效应逻辑回归模型（通过理论驱动的变量选择），以血糖状态为因变量，胰岛素使用为随机效应。
共有 231 名（70.9%）患者的血糖控制轨迹不佳（UGCT），仅有 95 名（29.1%）患者的血糖控制轨迹良好。UGCT 患者更有可能是女性，教育程度较低，偏好非素食，吸烟，药物依从性差，且使用胰岛素。最简化模型确定女性（2.44，1.33-4.37）、吸烟（3.80，1.92-7.54）和偏好非素食（2.29，1.27-4.13）与 UGCT 相关。药物依从性好（0.35，0.13-0.95）和教育程度高（0.37，0.16-0.86）的患者具有保护作用。
在脆弱环境中，不良的血糖控制轨迹似乎是不可避免的后果。通过这项纵向研究确定的预测因素可能为在社会层面识别合理反应并制定相应策略提供线索。
