Ahmed Yasir, Mohamed Abuelass Fatema Kamaleldien, Hamd Abdelwahab Salah Babiker, Mukhtar Musab, Ahmed Yousri, Elfahal Mohamed, Mohmed Elhussein Nahid Siddig
Acute Medicine, University Hospital of North Midlands, Stoke-on-Trent, GBR.
Internal Medicine, East Lancashire Teaching Hospital, Haslingden Road, Blackburn, GBR.
Cureus. 2025 Apr 17;17(4):e82464. doi: 10.7759/cureus.82464. eCollection 2025 Apr.
Poor glycemic control remains a pervasive challenge in type 2 diabetes mellitus (T2DM) management, contributing to elevated risks of complications and healthcare burdens globally. This systematic review aimed to synthesize evidence on the determinants of poor glycemic control (hemoglobin A1C (HbA1c) >7%) among adults with T2DM. We followed PRISMA guidelines to search for relevant studies across five different databases, where we found 239 studies. First, the studies were screened for duplicates and then assessed for eligibility by screening through titles, abstracts, and ultimately full text. Upon carefully assessing for eligibility using inclusion and exclusion criteria, only 12 studies were found relevant and were included in this systematic review. The review found that most studies had a moderate risk of bias based on the Newcastle-Ottawa Scale, with only three rated as low risk. Key factors linked to poor glycemic control included low socioeconomic status, medication non-adherence, longer diabetes duration, obesity, insulin-based regimens, and limited access to healthcare. Insulin use, in particular, was paradoxically associated with worse control due to its complexity and adherence challenges, especially in low-resource settings. Regional differences highlighted unique barriers like cultural practices in Ethiopia and gaps in diabetes education in Eritrea. These findings reflect the complex and context-specific nature of glycemic control, especially in low- and middle-income countries. The review calls for simplified treatments, affordable medications, and better management of comorbidities, while encouraging future research using longitudinal and mixed-methods approaches to guide more effective, patient-centered interventions.
血糖控制不佳仍是2型糖尿病（T2DM）管理中普遍存在的挑战，在全球范围内导致并发症风险升高和医疗负担加重。本系统评价旨在综合关于T2DM成年患者血糖控制不佳（糖化血红蛋白（HbA1c）>7%）的决定因素的证据。我们遵循PRISMA指南，在五个不同数据库中检索相关研究，共找到239项研究。首先，对研究进行重复筛选，然后通过标题、摘要，最终通过全文筛选评估其 eligibility。在使用纳入和排除标准仔细评估eligibility后，仅发现12项研究相关，并纳入本系统评价。该评价发现，根据纽卡斯尔-渥太华量表，大多数研究存在中度偏倚风险，只有三项被评为低风险。与血糖控制不佳相关的关键因素包括社会经济地位低、药物治疗依从性差、糖尿病病程长、肥胖、胰岛素治疗方案、以及获得医疗服务的机会有限。特别是胰岛素的使用，由于其复杂性和依从性挑战，尤其是在资源匮乏地区，反而与更差的控制效果相关。区域差异突出了独特的障碍，如埃塞俄比亚的文化习俗和厄立特里亚糖尿病教育的差距。这些发现反映了血糖控制的复杂性和特定背景性，尤其是在低收入和中等收入国家。该评价呼吁简化治疗、提供可负担的药物以及更好地管理合并症，同时鼓励未来采用纵向和混合方法进行研究，以指导更有效、以患者为中心的干预措施。 （注：原文中“eligibility”未明确中文释义，可根据上下文理解为“合格性”“符合条件性”等，这里保留英文未译，因为不确定准确的中文表述最合适。）
