Predictors of glycemic control in type-2 diabetes mellitus: Evidence from a multicenter study in Ghana

Abstract

Background

The burden of uncontrolled type-2 diabetes (T2DM) sub-Saharan Africa is high, with an increased risk of developing microvascular and macrovascular complications. We sought to identify predictors of poor diabetes control among Ghanaians with T2DM.

Methods

A cross-sectional study involving 1226 participants with T2DM enrolled at five health facilities in Ghana (2 tertiary, 2 district and 1 rural hospital). Data on demographics, medical history, lifestyle factors, anti-diabetic medications, and treatment adherence were collected. Additional questionnaires on sources of diabetes treatment medications and challenges with accessing these medications were also administered. Glycated hemoglobin was measured and a cut-off value of ≥7.0% used to define poor control. Predictors of diabetes control were assessed using a multivariate logistic regression model.

Key results

The mean ± SD age of study participants was 57 ± 12.1 years, with a female preponderance (77.5%). The mean HbA1C among all study participants was 8.9 ± 4.9% of which 70% had HBA1C >7%. Duration of diabetes diagnosis (aOR = 1.04; 95% CI 1.02–1.06), the absence of the Ghana National Health Insurance Scheme (aOR = 1.41; 95% CI 1.09–1.82) and the number of diabetes medicines (aOR = 1.73; 95% CI 1.45–2.07) were adversely associated with poor glycemic control while male gender (aOR = 0.66; 95% CI 0.49–0.88), increasing age (aOR of 0.97; 95% CI of 0.96–0.98) and dual diagnosis of diabetes and hypertension (aOR = 0.69; 95% CI 0.50–0.95) had positive associations with good glycemic control.

Conclusion

7 out of 10 patients with T2DM in Ghana are poorly controlled. Multidisciplinary interventions that improve patient education, quality of care, access to antidiabetics including insulin, are all needed to avert deaths related to diabetes complications associated with uncontrolled T2DM in Ghana.