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      Magnitude and predictors of poor glycemic control among patients with diabetes attending public hospitals of Western Ethiopia

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          Abstract

          Background

          Diabetes is one of the most prevalent non-communicable diseases globally, which rapidly is increasing in developing countries. Ethiopia is also facing growing morbidity and mortality related to diabetes complications. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess the magnitude and predictors of poor glycemic control among diabetic patients in western Ethiopia.

          Methods

          The cross-sectional study design was employed on a sample of 423 diabetic patients. A systematic random sampling method was employed. An interviewer-administered structured questionnaire was used. The data entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p-<0.25 in bivariate were entered into multivariate analysis. The multivariable logistic regressions were used to determine predictors’ poor glycemic control by considering the Adjusted Odds Ratio at CI 95% and the significance level was set at p <0.05.

          Results

          The magnitude of poor glycemic control was 64.1%. Being females (AOR = 1.684,95%CI = 1.066,2.662), duration of diabetes >8years (AOR = 2.552,95%CI = 1.397, 4.665), presence of diabetes complication (AOR = 2.806,95%CI = 1.594,4.941), negligence of blood glucose test at home (AOR = 1.720, 95%CI = 1.078, 2.743), poor self-care behavior (AOR = 1.787, 95%CI = 1.083,2.959) and poor self-efficacy (AOR = 1.934, 95%CI = 1.078,3.469) were significant predictors of poor glycemic control.

          Conclusion

          The proportion of poor glycemic control was high which was nearly comparable to that reported from many countries. This could be due to factors that were significantly associated with poor glycemic control like lack of home blood glucose test, increased duration of diabetes, presence of diabetes complications, poor self-efficacy, and poor self-care behaviors. Each were significant independent predictors of poor glycemic control. Thus, we recommend patients with diabetes and health care providers enhancing self-monitoring practices, and preventing potential complications should be a priority concern to improve blood glucose levels. Further studies are also recommended to explore important factors which were not identified by the current study.

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          Most cited references41

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          6. Glycemic Targets: Standards of Medical Care in Diabetes—2020

          (2019)
          The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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            The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control

            Background Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA1c constitutes a significant limitation of an instrument’s use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed. Methods A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, ‘Glucose Management’ (GM), ‘Dietary Control’ (DC), ‘Physical Activity’ (PA), and ‘Health-Care Use’ (HU), as well as a ‘Sum Scale’ (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ’s item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA1c was compared to the SDSCA. Results The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA1c: -0.23 ± 0.09). Overall internal consistency (Cronbach’s alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA1c (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA1c were significantly stronger than those obtained with the SDSCA. Conclusions This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients.
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              Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia

              Background Even though the prevalence of type 2 diabetes mellitus is swelling rapidly in Ethiopia, data regarding glycemic control, a key strategy for marked reduction of diabetes mellitus complications, is scant. We have assessed the status of glycemic control and its contributing factors among adult patients with type 2 diabetes mellitus. Methods This was a facility based cross-sectional survey of 325 adults with type 2 diabetes mellitus attending in Jimma University Teaching Hospital, South west Ethiopia. Data from all the patients were collected between February and April 2014. Glycemic level was assessed by using fasting blood glucose level, and ‘poor glycemic control’ was defined when fasting blood glucose level was above 130 mg/dL (7 mm/L). Analysis included both descriptive and inferential statistics, and SPSS version 20.0 was used for all analysis. Results 309 respondents were included in the survey. More than two-third (70.9 %) of the patients had poor blood glycemic control. Patients who were illiterate (AOR = 3.46, 95 % CI 1.01–11.91) and farmer (AOR = 2.47, 95 % CI 1.13–5.39) had high odds of poor glycemic control. In addition, taking combination of insulin and oral medication (AOR = 4.59, 95 % CI 1.05–20.14) and poor medication adherence (AOR = 5.08 95 % CI 2.02–12.79) associated statistically with poor glycemic control. Conclusion Majority of patients had poor glycemic control. Patients with low level of education, being employed, on combinations of insulin and oral medication, and lower adherence to their medication were likely to have poor glycemic control. Education and awareness creation could be a cross cutting intervention for the significant factors.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 February 2021
                2021
                : 16
                : 2
                : e0247634
                Affiliations
                [1 ] Department of Nursing, School of Nursing, and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
                [2 ] Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
                West Virginia University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0003-4262-0585
                Article
                PONE-D-20-15499
                10.1371/journal.pone.0247634
                7906479
                33630936
                3799535c-2246-4027-a50c-20a544d85c62
                © 2021 Oluma et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 May 2020
                : 5 February 2021
                Page count
                Figures: 2, Tables: 4, Pages: 16
                Funding
                Funded by: Wollega University
                This research work was funded by Wollega University. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript
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