Glycaemic control and associated factors in adult patients with diabetes mellitus, South Sudan, 2021

Abstract

Introduction: Many patients with diabetes mellitus are not attaining optimal glycaemic control, although the rate is unknown in South Sudan. Maintaining  adequate glycaemic control is the most effective means of preventing complications associated with diabetes. This record review assesses  the proportion of patients with diabetes on follow-up not adequately controlled using glycated haemoglobin (HbA1c) and describes associated factors.  Method: This is retrospective cross-sectional review of electronic patient records from a private for-profit health facility in Juba, South Sudan. The study  assesses follow-up HbA1c levels of type I (T1DM) and type II (T2DM) patients with diabetes 18 years and older. An HbA1c value of less than 7% was  regarded as reflecting adequate control. Logistic regression was used to assess factors associated with inadequate control. From an unadjusted analysis,  variables were retained for the adjusted analysis that were significant at the 95% confidence level. Crude and adjusted odds ratios (AOR) were reported.  Results: Of the 291 patients assessed, 62.2% were male, mean age was 54 (SD =12.6) years, and the median body mass index (BMI) was 27.2 (IQR=24.5-  30). Those with hypertension were 28.5% and 35% had medical insurance. Overall, 60 patients (20.6%) achieved target HbA1c levels of <7%. One hundred  patients had HbA1c levels between 7-10% and 131 had values of >10%. Independent predictors of non-achievement of target HbA1c were female gender,  adjusted prevalence ratio, PR (95% CI) =1.18 (1.01-1.32); normal BMI, adjusted PR (95% CI) =1.41 (1.07-1.83) and having no medical insurance cover,  adjusted PR (95%CI) =1.13 (1.10-1.29). Conclusion: About 80% of patients did not attain target HbA1c levels. Diagnosis of diabetes, care and treatment of patients with diabetes is not well  organised in South Sudan leading to poor outcomes even in private clinics. Women and those without medical insurance cover are at greater  disadvantage. We recommend better diagnosis and classification of patients with diabetes as well as reorganisation of care and treatment. We also  recommend initiatives that will increase coverage of services to women and putting more people on medical insurance cover.