Predictors of glycemic control, quality of life and diabetes self-management of patients with diabetes mellitus at a tertiary hospital in Ghana.

Abstract

Background: The burden of diabetes mellitus (DM) in Sub-Saharan Africa is high and continues to increase. Effective DM management focuses on key goals such as glycemic control, prevention of complications and improvement of quality of life (QOL). This study therefore assessed predictors of glycemic control, QOL and diabetes self-management (DSM) of patients with DM in a tertiary hospital in Ghana.

Methods: We conducted a cross-sectional study involving face-to-face interviews of patients with DM attending clinic using structured questionnaires and validated study instruments as well as review of medical records. A multivariable logistic regression analysis was used to identify independent factors associated with good glycemic control, poor QOL and poor DSM practices.

Results: The study involved 360 patients with mean age of 62.5 ± 11.6 years and mean FBG of 9.0 ± 4.8 mmol/L, of which 40.8% had FBG < 7 mmol/L. Patients who were not on insulin(aOR 1.82; 95% CI 1.12-2.96, p = 0.017) were more likely to have good glycemic control. Urban residence (aOR 0.24; 95% CI 0.06-0.87, p = 0.030) was protective of having poor QOL. However, poor DSM(aOR 18.30; 95% CI 7.98-44.5, p < 0.001) and recent hospitalization(within the past 3 months) (aOR 4.58; 95% CI 1.58-13.26, p = 0.005) had higher odds of poor QOL. Patients who were divorced(aOR 6.92; 95% CI 1.24-43.20, p = 0.031) had higher odds of poor DSM, while having attended the clinic for more than 3 years(aOR 0.32; 95% CI 0.13-0.84, p = 0.018) was protective of poor DSM.

Conclusion: 4 out of 10 patients attending diabetes clinic are well controlled. Not being on insulin is independently associated with good glycemic control. Urban residence, DSM and recent hospitalization are associated with QOL while being divorced and duration in clinic predict DSM. Prevention of acute hospitalizations and promotion of good self-management among patients with diabetes can improve their quality of life.