Examining glycaemic control status and associated factors in diabetes mellitus out-patients at the University Teaching Hospital, Lusaka, Zambia

Abstract

Background: Diabetes mellitus is one of the main growing public health concerns worldwide. There are two major types of diabetes mellitus. Type 1 diabetes mellitus which appears early in life and Type 2 diabetes mellitus which appears in adult life. It is important to regularly monitor the glycaemic control status in diabetic patients so as to manage their condition better. This improves the patient’s quality of life, delaying and preventing complications and deaths due to diabetes mellitus. Monitoring of glycaemic levels can best be achieved by HbA1c test as it comprehensively evaluates glycaemic control status in the past 8 to 12 weeks. In this study, the researcher examined the glycaemic control status and associated factors in diabetic out-patients at the University Teaching Hospital in the Lusaka province of Zambia. Methods: An institutional-based cross-sectional study was conducted at the University Teaching Hospital diabetic clinic. A simple random sampling method was used to sample diabetic out-patients from within Lusaka. The data, specimens and anthropometric measurements were collected from patients who consented for enrolment from September to November 2013. Immunoturbidimetry and Trinder colorimetric techniques were used to measure the levels of HbA1c and fasting plasma glucose respectively. A structured interview schedule was used to capture data. Binary logistic regression analysis of the data was carried out using IBM® SPSS® Statistics for Windows version 20.0 to predict factors influencing glycaemic control status of diabetic out-patients. Results: A total of 198 patients were sampled and out of these, 75 (38.7%) had good glycaemic control status (HbA1c ≤ 48 mmol/mol) and 119 (61.3%) had poor glycaemic control status (HbA1c ≥ 49 mmol/mol) in those whose data was complete. In addition, the mean of the previous and current fasting plasma glucose was 10.71 ± 7.75 mmol/L and 10.98 ± 6.22 mmol/L respectively. The glycaemic control status was associated with adherence to anti-diabetic treatment, type of anti-diabetic treatment, systolic blood pressure and fasting plasma glucose. Conclusion: This study established that non-adherence, insulin treatment and raised blood pressure and fasting plasma glucose influenced HbA1c levels. At the University Teaching Hospital, there is need to consider full scale use of HbA1c for glycaemic control monitoring in diabetic out-patients alongside other tests as this will consequently improve the management of the diabetic patients. Further studies should evaluate the role of diabetic patients in the management of their disorder and consider a large scale study and compare glycaemic control status between types 1 and 2 diabetic patients and associated factors.