血糖控制不佳：刚果民主共和国金沙萨2型糖尿病患者的患病率、影响因素及护理意义：一项横断面研究
Poor glycaemic control: prevalence, factors and implications for the care of patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a cross-sectional study.
作者信息
Fina Lubaki Jean-Pierre, Omole Olufemi Babatunde, Francis Joel Msafiri
机构信息
Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Family Medicine and Primary Care, Protestant University of Congo, Kinshasa, Democratic Republic of Congo.
出版信息
Front Clin Diabetes Healthc. 2023 Nov 20;4:1241882. doi: 10.3389/fcdhc.2023.1241882. eCollection 2023.
INTRODUCTION
Diabetes is a significant problem in sub-Saharan Africa and achieving glycaemic control poses a health challenge among patients living with type 2 diabetes. There are limited data on glycaemic control in Kinshasa, Democratic Republic of the Congo. This study assessed the prevalence and factors associated with glycaemic control to inform potential interventions to improve glycaemic control in Kinshasa.
METHODS
This was a cross-sectional study conducted between November 2021-September 2022 among patients recruited from 20 randomly selected health facilities in Kinshasa. Participants were asked to complete a structured questionnaire and to provide two millilitres of blood for Hb1AC assay. Poor glycaemic control was defined as HbA1c ≥7%. Univariate and multivariable logistic regressions were performed to identify factors associated with poor glycaemic control.
RESULTS
A total of 620 participants were recruited for this study. Study participants had a median age of 60 (IQR=53.5-69) years with the majority being female (66.1%), unemployed (67.8%), having income below the poverty line (76.4%), and without health insurance (92.1%). About two-thirds of the participants (420; 67.6%) had poor glycaemic control. Participants on monotherapy with insulin (AOR=1.64, 95%CI [1.10-2.45]) and those on a treatment duration ≥7 years (AOR=1.45, 95%CI [1.01-2.08]) were associated with increased odds of poor glycaemic control while being overweight (AOR= 0.47, 95%CI [0.26-0.85]) and those with uncontrolled blood pressure (AOR=0.65, 95% CI [0.48-0.90]) were protective for poor glycaemic control.
CONCLUSION
Poor glycaemic control is prevalent among patients with type 2 diabetes in Kinshasa, DRC. Being on insulin alone and a duration of diabetes treatment equal or more than 7 years predisposed to poor glycaemic control. By contrary, having uncontrolled blood pressure and being overweight had protective effect against poor glycaemic control. These links between uncontrolled blood pressure and overweight on the one hand, and glycaemic control on the other are unusual. These reflect, among other things, the specific characteristics of diabetes in sub Saharan Africa.
引言
糖尿病是撒哈拉以南非洲的一个重大问题，实现血糖控制对2型糖尿病患者构成了一项健康挑战。在刚果民主共和国金沙萨，关于血糖控制的数据有限。本研究评估了血糖控制的患病率及其相关因素，以为改善金沙萨血糖控制的潜在干预措施提供依据。
方法
这是一项横断面研究，于2021年11月至2022年9月在金沙萨随机选取的20家医疗机构招募的患者中进行。参与者被要求填写一份结构化问卷，并提供两毫升血液用于糖化血红蛋白（Hb1AC）检测。血糖控制不佳定义为糖化血红蛋白（HbA1c）≥7%。进行单因素和多因素逻辑回归以确定与血糖控制不佳相关的因素。
结果
本研究共招募了620名参与者。研究参与者的年龄中位数为60岁（四分位间距=53.5 - 69岁），大多数为女性（66.1%），失业（67.8%），收入低于贫困线（76.4%），且没有医疗保险（92.1%）。约三分之二的参与者（420人；67.6%）血糖控制不佳。接受胰岛素单药治疗的参与者（调整后比值比[AOR]=1.64，95%置信区间[CI][1.10 - 2.45]）以及治疗时长≥7年的参与者（AOR=1.45，95%CI[1.01 - 2.08]）血糖控制不佳的几率增加，而超重者（AOR=0.47，95%CI[0.26 - 0.85]）和血压未得到控制者（AOR=0.65，95%CI[0.48 - 0.90]）对血糖控制不佳具有保护作用。
结论
在刚果民主共和国金沙萨，2型糖尿病患者中血糖控制不佳的情况普遍存在。仅使用胰岛素以及糖尿病治疗时长等于或超过7年易导致血糖控制不佳。相反，血压未得到控制和超重对血糖控制不佳具有保护作用。一方面血压未得到控制和超重与另一方面血糖控制之间的这些联系并不常见。这在一定程度上反映了撒哈拉以南非洲糖尿病的特殊特征。
Zotero 插件