Determinants of Poor Glycaemia Control Among Type 2 Diabetic Patients Attending Outpatient Diabetic Clinic at Victoria Chitepo Provincial Hospital

Abstract

Diabetes is a chronic condition which is one of the leading causes of premature mortality. If uncontrolled well, diabetes often causes severe long term complications which compromise quality of life and can cause permanent disability. The incidence of diabetes and its associated complications in Mutare reported through surveillance data has been on the rise, however, since the COVID-19 pandemic there have been a decrease in patients reporting to the diabetic clinic at Victoria Chitepo Provincial Hospital. Amongst those who report for their routine check-ups, there have been an increase in the number of patients with uncontrolled sugar levels. A 1:1 unmatched case control study was carried out. The outcome of interest was glycaemic control. A case was an adult aged 18 years and above, who had type 2 diabetes for at least 6 months with the latest HbA1c greater than 7% attending diabetic clinic at VCPH, 2021. A control was an adult aged 18 years and above, who had type 2 diabetes for at least 6 months with the latest HbA1c less than 7% attending diabetic clinic at VCH, 2021. A total of 300 diabetic patients were enrolled in this study. Interview administered questionnaires, records review and hospital checklist were used to collect data. Epi info version 7.2. software was used to generate means, frequencies, proportions, odds ratios and their corresponding 95% confidence intervals. Stratified analysis was used to identify possible confounding or effect modification. Forward step-wise logistic regression analysis was done to determine the independent factors associated with poor glycaemic control. Multivariate analysis showed poor level of education [AOR = 3.5, 95% CI (1.2 – 3.9) p=0.010], use of out of pocket to buy medications [AOR = 3.9, 95% CI (2.0 – 12.9) p=0.041], type of treatment [AOR = 18.8, 95% CI (3.3 – 21.2) p=0.001], failure to adhere to medications [AOR = 3.2, 95% CI (1.7 –9.5) p=0.021] and failure to travel to the hospital [AOR = 16.1, 95% CI (5.7 – 22.6) p=0.013] to be statistically significant predictors of poor glycaemic control. The study recommended the need to employ the differentiated care approach in providing health care services amongst diabetic patients to meet the differing needs and address the varying barriers to effective glycaemic control, development of diabetic clinics at district levels so as to avoid transportation costs to the province.