Glycaemic control in diabetic patients in Zambia

Introduction: the glycaemic control status of diabetic patients affects the management of their disorder. We examined the glycaemic control and clinical factors that may influence the achievement of the glycaemic control targets among diabetic out-patients. Methods: this was a hospital based cross-sectional study carried out at the University Teaching Hospital diabetic clinic in Lusaka, Zambia. A simple random sample of 198 consenting participants was selected from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture socio-demographic data as well as needed clinical data from clients’ medical records and laboratory results. Multivariate binary logistic regression analysis was carried out to examine factors that may be associated with the glycaemic control status of these diabetic patients. Results: overall (n=198), mean (SD) age was 53.19±13.32 years. Majority (61.3%) of the patients had poor glycaemic control status (HbA1c≥49 mmol/mol). Insulin treatment (OR 0.13, 95% CI: 0.01 - 1.41), systolic blood pressure (OR 1.04, CI: 1.00 - 1.08) and fasting plasma glucose (previous; OR 0.81, CI: 0.72 - 0.90 and current; OR 0.85, CI: 0.78 - 0.93) were statistically significantly associated with glycaemic control. The poor glycaemic control observed in this study is similar to that reported in other published studies. Conclusion: we found evidence of poor glycaemic control in the study population suggesting need to explore the reasons for this. Association of Insulin, systolic blood pressure and fasting plasma glucose with glycaemic control further suggests the efficiency of traditional basic monitoring parameters which should be exploited in sharpening primary preventive strategies especially those that support lifestyle modification. Such efforts should also be integrated in all information, education and communication strategies that target but not limited to hospital based patients too

Relationship between glycated haemoglobin and fasting plasma glucose among diabetic out-patients at the University Teaching Hospital, Lusaka, Zambia

Background: Glycated haemoglobin (HbA1c) measurement provides an accurate result of glycaemic levels from blood drawn at any time of day without reference to prandial state. We established the relationship between HbA1c and fasting plasma glucose (FPG) in diabetic out-patients among diabetic outpatients in Lusaka, Zambia.Methods: This cross-sectional study was carried out at the University Teaching Hospital diabetic clinic, Lusaka, Zambia. A total sample of 198 consenting participants was selected randomly from diabetic out-patients between September and December 2013. A structured interview schedule was used to capture data on socio-demographics and laboratory examination results. The Pearson’s correlation coefficient, Student’s t-test and Paired Samples t-test were used for data analysis.Results: A total of 198 patients (mean age+SD= 53.19±13.32 years) were involved in the study. Majority (60.10%) of the patients were females while 39.90 per cent were males. The mean±SD of FPG of the patients slightly increased from the previous 10.75±7.78 mmo/L to the current 11.09±6.23 mmo/L (p = 0.592). The mean±SD of HbA1c of the patients was 54.77±17.12 mmol/mol. There was a statistically significant weak and moderate positive correlation between HbA1c and the previous and current FPG (r = 0.282, P = 0.001 and (r = 0.385, p = 0.001), respectively. However, there was a statistically significant but weak negative correlation between HbA1c and age (r = -0.163, p = 0.023).Conclusion: We found evidence of an association between HbA1c and FPG proposing that as the FPG levels increase, the HbA1c levels also increase in a predictable way. There is need to sensitise more especially the major stakeholders in the management of diabetes mellitus to consider FPG as an alternative in glycaemic control monitoring in the absence of HbA1c

Glycaemic Control and Associated Self-Management Behaviours in Diabetic Outpatients: A Hospital Based Observation Study in Lusaka, Zambia

Background. The control of diabetes mellitus depends on several factors that also include individual lifestyles. We assessed glycaemic control status and self-management behaviours that may influence glycaemic control among diabetic outpatients. Methods. This cross-sectional study among 198 consenting randomly selected patients was conducted at the University Teaching Hospital diabetic clinic between September and December 2013 in Lusaka, Zambia. A structured interview schedule was used to collect data on demographic characteristics, self-management behaviours, and laboratory measurements. Binary logistic regression analysis using IBM SPSS for Windows version 20.0 was carried out to predict behaviours that were associated with glycaemic control status. Results. The proportion of patients that had good glycaemic control status (HbA1c≤ 48 mmol/mol) was 38.7% compared to 61.3% that had poor glycaemic control status (HbA1c≥ 49 mmol/mol). Adherence to antidiabetic treatment and fasting plasma glucose predicted glycaemic control status of the patients. However, self-blood glucose monitoring, self-blood glucose monitoring means and exercise did not predict glycaemic control status of the patients.  Conclusion. We find evidence of poor glycaemic control status among most diabetic patients suggesting that health promotion messages need to take into account both individual and community factors to promote behaviours likely to reduce nonadherence