Azagew Abere Woretaw, Mekonnen Chilot Kassa, Lambie Mark, Shepherd Thomas, Babatunde Opeyemi O
College of Medicine and Health Sciences, School of Nursing, Department of Medical Nursing, University of Gondar, Gondar, Ethiopia.
Institute of Global Health, School of Medicine, Keele University, Newcastle-Under-Lyme, UK.
BMC Public Health. 2025 Feb 21;25(1):714. doi: 10.1186/s12889-025-21828-y.
Variability in blood glucose remains a challenge in diabetic management. Therefore, this review aimed to estimate the overall poor glycemic control and identify its predictors among people living with diabetes in low- and middle-income countries (LMICs).
The authors searched articles in PubMed, Embase, OVID, CINAHL Plus, Cochrane Library, PsychInfo, Google, and Google Scholar. The search results were exported to the Rayyan software to check their eligibility. The Newcastle-Ottawa scale was used to assess the study quality. Stata version 17 was used for analysis. A random effect model was computed. Heterogeneity was assessed by the Cochrane Q test and I-squared (I). The funnel plot asymmetry test and/or Egger's regression test (p < 0.05) were used to detect the publication bias. Then it was treated by the trim and fill analysis. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the reference number CRD42023430175.
In total, forty-nine articles were used. Of which forty-five articles with 15,981 participants were used for pooled prevalence estimation. The pooled prevalence of poor glycemic control among people living with diabetes in LMICs was found to be 69.06% (95% CI: 65.66-72.46), I = 96.1%, p < 0.001). Alcohol intake (AOR = 2.07: 95% CI: 1.27-3.36), poor adherence to dietary recommendations (AOR = 3.16, 95% CI: 1.13-8.85), poor adherence to anti-diabetic medication (AOR = 2.85, 95% CI: 1.04 -7.85), diabetic complications (AOR = 1.37, 95% CI: 1.00-1.88), and co-morbid conditions (AOR = 1.98, 95% CI: 1.28-30.07) were found to be predictors of poor glycemic control.
The pooled prevalence of poor glycemic control was significantly high in LMICs. Drinking alcohol, poor adherence to dietary recommendations, poor adherence to anti-diabetic medication, diabetes complications, and co-morbid conditions were found to be the determinants of poor glycemic control among people living with diabetes. Tight glycemic control strategies have been implemented to achieve optimal blood glucose. Further research on the regional and contextual factors influencing glycemic control would be recommended.
血糖变异性仍然是糖尿病管理中的一项挑战。因此，本综述旨在评估低收入和中等收入国家（LMICs）糖尿病患者总体血糖控制不佳的情况，并确定其预测因素。
作者检索了PubMed、Embase、OVID、CINAHL Plus、Cochrane图书馆、PsychInfo、谷歌和谷歌学术上的文章。检索结果导出到Rayyan软件中以检查其合格性。采用纽卡斯尔-渥太华量表评估研究质量。使用Stata 17版本进行分析。计算随机效应模型。通过Cochrane Q检验和I²（I）评估异质性。采用漏斗图不对称检验和/或Egger回归检验（p<0.05）检测发表偏倚。然后通过修剪和填充分析进行处理。该方案已在国际系统评价前瞻性注册库（PROSPERO）中注册，注册号为CRD42023430175。
总共使用了49篇文章。其中45篇文章共15981名参与者用于合并患病率估计。发现LMICs糖尿病患者血糖控制不佳的合并患病率为69.06%（95%CI：65.66-72.46），I=96.1%，p<0.001）。饮酒（AOR=2.07：95%CI：1.27-3.36）、对饮食建议依从性差（AOR=3.16，95%CI：1.13-8.85）、对抗糖尿病药物依从性差（AOR=2.85，95%CI：1.04-7.85）、糖尿病并发症（AOR=1.37，95%CI：1.00-1.88）和合并症（AOR=1.98，95%CI：1.28-30.07）被发现是血糖控制不佳的预测因素。
LMICs中血糖控制不佳的合并患病率显著较高。饮酒、对饮食建议依从性差、对抗糖尿病药物依从性差、糖尿病并发症和合并症被发现是糖尿病患者血糖控制不佳的决定因素。已实施严格的血糖控制策略以实现最佳血糖水平。建议进一步研究影响血糖控制的区域和背景因素。
