TITLE:
Factors Associated with Glycated Hemoglobin Levels > 6.5% among Diabetic Patients Attending Kenyatta National Hospital, Kenya
AUTHORS:
Maina Charity Muringo, Joseph Mutai, John Gachohi
KEYWORDS:
Diabetes Mellitus, Glycemic Control, Glycated Hemoglobin, Kenya
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.11 No.1,
February
9,
2021
ABSTRACT: Introduction: Good quality care in Type 2 diabetes mellitus (T2DM), whose prevalence is
approximately 10% in Kenya, may prevent or delay diabetes complications. This study
determined blood glycemic targets, defined by HbA1c levels (>6.5% [53 mmol/mol]) and associated factors
among patients receiving diabetes management at Kenyatta National Hospital in Kenya. Methods: In this cross-sectional study
conducted between May to September 2017, we obtained blood samples from 381 consenting
T2DM patients attending KNH. The study collected data using a detailed questionnaire
while taking glycemic measurements. Factors associated with poor glycemic control (HbA1c levels >6.5%) were determined using
Ordinal logistic regression modeling, STATA software version 13. Results: 103 (27.1%) T2DM patients with
poor glycemic control were identified. In multivariate analysis, independent risk
factors associated with poor glycemic control and their 95% confidence intervals
included: concurrent hypertension (aOR 1.6, [1.1, 2.4]), receiving ≥3 oral anti-diabetes
medication (aOR 2.4, [1.3, 4.6]) and good
adherence to medication based on self-reporting (aOR 6.2, [1.9, 41.3). Independent
protective factors included self-monitoring of blood glucose levels (aOR 0.35, [0.2,
0.4]), patients aged 51 to 60 years (aOR 0.5, [0.3, 0.9]), weight between 50 and
70 kgs (aOR 0.5,
[0.3, 0.9]) and receiving 1 to 2 diabetes medication (aOR 0.4, [0.3, 0.7]). Conclusion: Significantly high proportion of T2DM patients receiving treatment at KNH had
poor glycemic control. Addressing comorbidities and promoting good glycemic control
among long-standing T2DM patients receiving ≥3 oral anti-diabetes medication is key to delaying or preventing chronic
diabetes complications. Self-monitoring of blood glucose levels needs to be encouraged
as suggested by its protective effect. While differences in risk between diverse
weights and ages need further studies, innovative ways of authenticating self-reports,
e.g., triangulation, are required to ensure credibility.
This work supports the Government of Kenya’s Vision 2030 in creating a healthy and productive population contributing
to the country’s economic growth.