Determinants of glycemic control among insulin treated diabetic patients in Southwest Ethiopia: hospital based cross sectional study.

Good glycemic control reduces the risk of diabetic complications. Despite this, achieving good glycemic control remains a challenge in diabetic patients. The objective of this study is to identify determinants of glycemic control among insulin treated diabetic patients at Jimma University Hospital, Southwest Ethiopia.Hospital-based cross-sectional study was conducted on systematically sampled 284 insulin-treated diabetic patients with a regular follow up. Data was collected by interviewing patients during hospital visits and reviewing respective databases of September 2010 to December 2011. Data collection took place from February 20 to May 20, 2012. Poor glycemic control was defined as fasting blood sugar (FBS) ≥126 mg/dL. Binary logistic regression analysis was conducted to identify predictors of poor glycemic control.Patients had a mean age of 41.37 (±15.08) years, 58.5% were males, the mean duration of insulin treatment was 4.9 (±5.1) years, 18.3% achieved good glycemic control (FBS≤126 mg/dL), 95% self-reported repeated use of disposable insulin syringe-needle and 48% correctly rotating insulin injection sites. Most (83.1%) of study participants had one or more complications. On multivariable logistic regression analyses, body weight of >70 Kg (AOR = 0.21; P<0.001), total daily dose of insulin ≤35 IU/day (AOR = 0.26; P<0.001), total daily dose variation without checking glycemic level (AOR = 3.39; P = 0.020), knowledge deficit about signs and symptoms of hyperglycemia (AOR = 3.60; P = 0.004), and non-adherence to dietary management (AOR = 0.35; P = 0.005) were independent predictors of poor glycemic control.The proportion of patients with poor glycemic control was high, which resulted in the development of one or more complications regardless of duration on insulin treatment. Hence, appropriate management of patients focusing on the relevant associated factors and independent predictors of poor glycemic control would be of great benefit in glycemic control

Anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia: nested case-control study.

This study was carried out to determine the incidence and predictors of anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia.A nested case-control study was conducted by reviewing charts of all TB/HIV co-infected patients who commenced anti-TB treatment from January 2008 to December 2011 at Jimma University Hospital. Patients who had developed hepatotoxicity after at least 5 days of standard doses of anti-TB drug therapy were labeled as "cases" and those without hepatotoxicity were "controls". Each case with anti-TB drug induced hepatotoxicity was compared with 3 controls selected randomly from the cohort. From a cohort of 296 TB/HIV co-infected patients 8 were excluded from the study as the causality between anti-TB drugs and hepatotoxicity was not confirmed, 33 had developed hepatotoxicity. On bivariate logistic regression analysis, body mass index (BMI) <18.5 Kg/m(2) [P = 0.01; OR (95%CI): 3.6 (1.4-9.5)], disseminated pulmonary TB [P = 0.00; OR (95%CI): 5.6 (2.2-14.6)], CD4 count ≤50 [P = 0.016; OR (95%CI): 3.6(1.27-10.23)] and WHO stage 4 [P = 0.004, OR (95%CI): 3.8 (1.68-8.77)] were significantly associated with anti-TB drug induced hepatotoxicity. Predictor variables with p-value <0.05 by bivariate analysis were analyzed using multivariable logistic regression analysis and identified disseminated pulmonary TB [P = 0.001; AOR (95%CI) = 5.6 (2.1-15.0)] and BMI <18.5 [P = 0.014; AOR (95%CI)= 3.6 (1.3-10.1)] as independent predictors of anti-TB drug induced hepatotoxicity.The incidence of anti-TB drug induced hepatotoxicity was 11.5%. The results suggest that in the presence of disseminated pulmonary TB and/or BMI <18.5 Kg/m(2), TB/HIV co-infected patients should be closely followed for the occurrence of hepatotoxicity during the intensive phase of TB treatment to prevent morbidity and mortality

Demographic characteristics and glycemic control of patients receiving insulin at Jimma University Hospital, Southwest Ethiopia.

<p><b>Note:</b> Good glycemic control is defined as a fasting blood glucose level of <126 mg/dl, based on American Diabetes Association criteria <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0061759#pone.0061759-Behan1" target="_blank">[12]</a>.</p

Multivariate logistic regression analyses predicting poor glycemic control at Jimma University Hospital, Southwest Ethiopia.

<p><b>B:</b> Beta, slope of logistic regression line; <b>AOR:</b> Adjusted odds ratio.</p

Bivariate logistic regression analysis of factors affecting glycemic control at Jimma University Hospital, Southwest Ethiopia.

<p>Bivariate logistic regression analysis of factors affecting glycemic control at Jimma University Hospital, Southwest Ethiopia.</p

Bivariate logistic regression analysis of factors affecting glycemic control at Jimma University Hospital, Southwest Ethiopia.

<p><b>COR</b>: Crude odds ratio.</p

Duration of patients stay on anti-TB drugs before the occurrence of hepatotoxicity by BMI.

<p>Duration of patients stay on anti-TB drugs before the occurrence of hepatotoxicity by BMI.</p

Degree of severity of anti-TB drug induced hepatotoxicity, according to the WHO classification of drug toxicity.

<p>Degree of severity of anti-TB drug induced hepatotoxicity, according to the WHO classification of drug toxicity.</p

Bivariate analyses of factors associated with anti-TB drug-induced hepatotoxicity.

<p>COR: Crude Odds Ratio, BMI: Body mass index; NVP: nevirapine; EFV: efavirenz.</p

Multivariate regression analysis of factors associated with (or predictive factors of) anti-TB drug induced hepatotoxicity.

<p>AOR: Adjusted Odds Ratio; CI: Confidence interval; Diss.: Disseminated.</p