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      Factors associated with glycemic control among adult patients with type 2 diabetes mellitus: a cross-sectional survey in Ethiopia

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          Abstract

          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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          Most cited references21

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          Concurrent and predictive validity of a self-reported measure of medication adherence.

          Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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            Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus.

            In persons with diabetes, chronic hyperglycemia (assessed by glycosylated hemoglobin level) is related to the development of microvascular disease; however, the relation of glycosylated hemoglobin to macrovascular disease is less clear. To conduct a meta-analysis of observational studies of the association between glycosylated hemoglobin and cardiovascular disease in diabetic persons. Search of the MEDLINE database by using Medical Subject Heading search terms and key words related to glycosylated hemoglobin, diabetes, and cardiovascular disease. Prospective cohort studies with data on glycosylated hemoglobin levels and incident cardiovascular disease. Relative risk estimates were derived or abstracted from each cohort study that met the inclusion criteria. Adjusted relative risk estimates for glycosylated hemoglobin (total glycosylated hemoglobin, hemoglobin A1, or hemoglobin A1c levels) and cardiovascular disease events (coronary heart disease and stroke) were pooled by using random-effects models. Three studies involved persons with type 1 diabetes (n = 1688), and 10 studies involved persons with type 2 diabetes (n = 7435). The pooled relative risk for cardiovascular disease was 1.18; this represented a 1-percentage point increase in glycosylated hemoglobin level (95% CI, 1.10 to 1.26) in persons with type 2 diabetes. Results in persons with type 1 diabetes were similar but had a wider CI (pooled relative risk, 1.15 [CI, 0.92 to 1.43]). This review largely reflects the limitations of the literature. Important concerns were residual confounding, the possibility of publication bias, the small number of studies, and the heterogeneity of study results. Pending confirmation from large, ongoing clinical trials, this analysis shows that observational studies are consistent with limited clinical trial data and suggests that chronic hyperglycemia is associated with an increased risk for cardiovascular disease in persons with diabetes.
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              Effect of glycemic exposure on the risk of microvascular complications in the diabetes control and complications trial--revisited.

              The Diabetes Control and Complications Trial (Diabetes 44:968-983, 1995) presented statistical models suggesting that subjects with similar A1C levels had a higher risk of retinopathy progression in the conventional treatment group than in the intensive treatment group. That analysis has been cited to support the hypothesis that specific patterns of glucose variation, in particular postprandial hyperglycemia, contribute uniquely to an increased risk of microvascular complications above and beyond that explained by the A1C level. We performed statistical evaluations of these models and additional analyses to assess whether the original analyses were flawed. Statistically, we show that the original results are an artifact of the assumptions of the statistical model used. Additional analyses show that virtually all (96%) of the beneficial effect of intensive versus conventional therapy on progression of retinopathy is explained by the reductions in the mean A1C levels, similarly for other outcomes. Furthermore, subjects within the intensive and conventional treatment groups with similar A1C levels over time have similar risks of retinopathy progression, especially after adjusting for factors in which they differ. A1C explains virtually all of the difference in risk of complications between the intensive and conventional groups, and a given A1C level has similar effects within the two treatment groups. While other components of hyperglycemia, such as glucose variation, may contribute to the risk of complications, such factors can only explain a small part of the differences in risk between intensive and conventional therapy over time.
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                Author and article information

                Contributors
                semegntarekegn@gmail.com
                tesfuc@gmail.com
                hailushepi@gmail.com
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                1756-0500
                9 February 2016
                9 February 2016
                2016
                : 9
                : 78
                Affiliations
                [ ]Dilchora Hospital, Dire Dawa, East Ethiopia
                [ ]Department of Clinical Pharmacy, College of Health Sciences, Jimma University, Jimma, Ethiopia
                [ ]Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia
                [ ]Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
                Article
                1896
                10.1186/s13104-016-1896-7
                4748519
                26861243
                801508d0-f9aa-4971-b510-aa9dedbda521
                © Kassahun et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 November 2015
                : 31 January 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005068, Jimma University;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Medicine
                glycemic control,fast blood glucose,cross-sectional,type 2 diabetic mellitus,ethiopia
                Medicine
                glycemic control, fast blood glucose, cross-sectional, type 2 diabetic mellitus, ethiopia

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