Factors influencing the optimal glycemic levels in type 2 diabetes mellitus patients attending the diabetic clinic of a tertiary care hospital in New Delhi.
Strengthening medication adherence counselling, lifestyle modification, and structured follow-up within tertiary care diabetes clinics may substantially improve glycaemic outcomes and reduce the long-term burden of diabetes-related complications.
Abstract
Background
Optimal glycaemic control is essential for preventing complications of type 2 diabetes mellitus (T2DM), yet a large proportion of patients fail to achieve recommended glycaemic targets even in tertiary care settings. Identifying independent behavioural and treatment-related determinants of glycaemic control is crucial for improving diabetes management.
Methods
A hospital-based analytical cross-sectional study was conducted among 416 adult patients with T2DM attending the diabetic outpatient department of a tertiary care hospital. Data were collected using a structured, pre-tested questionnaire covering sociodemographic profile, lifestyle practices, treatment adherence, and healthcare access. Glycaemic control was assessed using HbA1c values and categorized as optimal (< 7%) and poor (≥ 7%). Descriptive statistics, chi-square test, Spearman correlation, and multivariable logistic regression were applied using IBM SPSS Statistics for Mac (Version 31.0).
Results
Optimal glycaemic control was observed in 239 (57.5%) participants, while 177 (42.5%) had poor control. Higher physical activity, adherence to a diabetic diet, and consistent medication adherence were significantly associated with optimal glycaemic control in bivariate analysis (p < 0.05). Spearman correlation showed a strong positive correlation between medication adherence and glycaemic control, followed by physical activity and regular follow-up. In multivariable regression analysis, medication adherence, physical activity, and regular follow-up emerged as significant independent predictors of optimal glycaemic control, whereas sociodemographic factors showed weaker adjusted effects.
Conclusion
Glycaemic control among patients with T2DM is predominantly influenced by modifiable behavioural and treatment-related factors. Strengthening medication adherence counselling, lifestyle modification, and structured follow-up within tertiary care diabetes clinics may substantially improve glycaemic outcomes and reduce the long-term burden of diabetes-related complications.
CLINICAL TRIAL NUMBER
Not applicable.
Background: Diabetes mellitus is a major public health problem associated with significant morbidity and mortality. Adequate knowledge and lifestyle modification play an important role in achieving optimal glycemic control and preventing diabetes-related complications. This study aimed to determine the association between knowledge and lifestyle modification with control of HbA1c among patients with Type 2 Diabetes Mellitus. Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, Combined Military Hospital (CMH), Sylhet over a period of 06 months. A total of 150 patients with Type 2 Diabetes Mellitus were selected by purposive and convenient sampling methods. Data were collected using a structured questionnaire regarding sociodemographic profile, clinical characteristics, diabetes-related knowledge and lifestyle modification practices. Glycemic control was assessed by HbA1c level. Statistical analysis was performed using SPSS version 25.0. Results: The majority of patients were male (66.7%) and aged ≤40 years (41.3%). Most patients had uncontrolled HbA1c levels (84.0%). Knowledge regarding HbA1c was low, as only 20.0% knew that HbA1c reflects long-term blood glucose control. Regular physical exercise was reported by 52.7% of patients, while only 13.3% monitored blood glucose regularly. Significant associations were found between controlled HbA1c and knowledge about HbA1c (p=0.004), diabetic diet adherence (p=0.048), regular physical exercise (p=0.021) and self-monitoring of blood glucose (p=0.043). Conclusion: Poor diabetes-related knowledge and inadequate lifestyle modification were significantly associated with uncontrolled HbA1c levels among patients with Type 2 Diabetes Mellitus.
A. Rahman, Brigadier General Nasir Uddin Ahmed, Brigadier General Shamima Yasmin et al.· Scholars Journal of Applied...· 0 citations
BACKGROUND
Poor glycaemic control is common among adults with type 2 diabetes mellitus (T2DM) in low- and middle-income settings in South-Eastern Europe, yet patient-level data on its correlates from Albania are scarce. We examined the demographic, clinical and treatment-related factors associated with poor glycaemic control (HbA1c ≥ 7%) in Albanian adults with T2DM.
METHODS
Cross-sectional study of 176 consecutive adults with T2DM attending a hospital-based outpatient diabetes service in northern Albania. Poor glycaemic control was defined a priori as HbA1c ≥ 7% (53 mmol/mol). Sociodemographic characteristics, diabetes duration, insulin therapy and physician-confirmed comorbidities were recorded. Associations were assessed using univariate and multivariable logistic regression, estimating odds ratios (OR) with 95% confidence intervals (CI); comorbidity was modelled both as individual conditions (primary model) and as a comorbidity-burden index (sensitivity model). Model calibration and discrimination were evaluated using the Hosmer-Lemeshow test and the area under the ROC curve.
RESULTS
Mean age was 65 years, 51% were men and mean diabetes duration was 11 years. The prevalence of poor glycaemic control was 58.5% (95% CI 50.9-65.9%), and 54% were receiving insulin. In univariate analyses, poor control was more frequent with insulin therapy (OR 5.64, 95% CI 2.93-10.87), longer diabetes duration (OR 1.42 per 5 years, 1.09-1.85) and ischaemic heart disease (OR 2.10, 1.09-4.08). After mutual adjustment, insulin therapy was the only factor independently associated with poor control (adjusted OR 6.32, 95% CI 2.71-14.71); age, diabetes duration, hypertension, ischaemic heart disease and multimorbidity were not. Results were unchanged in the sensitivity model. The primary model was well calibrated (Hosmer-Lemeshow p = 0.96), with moderate discrimination (area under the ROC curve 0.74).
CONCLUSIONS
In this Albanian outpatient population, poor glycaemic control was common and insulin therapy was the only factor independently associated with it. This reflects confounding by indication rather than harm from insulin: insulin is initiated when oral therapy no longer maintains targets, so insulin-treated patients form a clinically identifiable subgroup with more advanced disease who warrant priority for structured treatment intensification and individualised follow-up. Prospective multicentre studies are needed to confirm these associations and their temporal direction.
TRIAL REGISTRATION
Not applicable (observational, non-interventional study).
Type 2 diabetes mellitus (T2DM) is a metabolic disease that requires continuous medical care. Attaining glycemic control in patients with T2DM usually requires more complicated medication regimens. Increased medication regimen complexity (MRC) may affect glycemic control. This study aimed to assess the complexity of medication regimens and its association with glycemic control among patients with T2DM at the Debre Birhan Comprehensive and Specialized Hospital (DBCSH). A hospital-based cross-sectional study was conducted at DBCSH from April 30 to July 30, 2025. Medication Regimen Complexity Index (MRCI), a 65-item validated tool, was used to assess MRC. MRCI scores were calculated using Microsoft Access Version 1.0. Glycemic control was assessed using fasting blood glucose (FBG), as HbA1c measurement was not available in the study setting. The data were analyzed using SPSS version 27. A p-value of less than 0.05 at a 95% confidence interval was considered a significant variable in multivariable analysis. A total of 370 patients with T2DM were included in the final analysis. More than half of the patients were female (56.5%). About 30% of the participants were classified as having a high diabetes-specific MRCI, whereas 27.3% of the participants were classified as having high patient-specific MRCI. Compared with low MRCI, moderate diabetes-specific MRCI (AOR = 2.2; 95% CI = 1.1–4.1), moderate patient-specific MRCI (AOR = 3.4; 95% CI = 1.5–5.3), and high patient-specific MRCI (AOR = 6.6; 95% CI = 2.8–15.6) were significantly associated with poor glycemic control. The findings of this study showed that patients with T2DM have high medication regimen complexity. It also revealed that moderate diabetes-specific MRC and moderate and high patient-specific MRC were significantly associated with poor glycemic control. Further prospective cohort studies are needed to determine the temporal relationship between medication regimen complexity and glycemic control.
Emneteab Mesfin Ayele, M. Seid, Samuel Agegnew Wondm· Scientific Reports· 0 citations
This study aimed to explore the demographic characteristics and risk factors of glycemic control among type 2 diabetes mellitus (T2DM) patients aged 40 years and above enrolled in the National Essential Public Health Services (NEPHS) in China, providing scientific evidence for further improving grassroots glycemic control management.
A stratified multi-stage sampling method was used to select 1500 patients. Their diabetes management files were retrieved, and questionnaire surveys, physical examinations, and laboratory tests were conducted simultaneously. Skewed quantitative variables were described as median (25th percentile, 75th percentile), and nonparametric rank-sum tests were used for group comparisons. Categorical variables were expressed as frequencies and percentages (%) with group comparisons using χ² tests. Logistic regression with Huber–White (sandwich) standard errors was performed to identify risk factors for glycemic control. Furthermore, interaction models (knowledge level × insulin injection, blood glucose monitoring adherence× insulin injection) were established to evaluate the stratified effects.
49.5% of patients achieved good glycemic control (HbA1c < 7.0%). Multivariate analysis revealed that age ≥ 60 years (OR = 1.41, 95% CI: 1.12–1.77,
P
= 0.003), rural (OR = 1.33, 95% CI: 1.06–1.66,
P
= 0.012), regular physical exercise (OR = 1.51, 95% CI: 1.21–1.88,
P
< 0.001), periodic HbA1c monitoring (1 time/year: OR = 1.44, 95% CI: 1.11–1.89,
P
= 0.007; ≥4 times/year: OR = 1.93, 95% CI: 1.31–2.85,
P
= 0.001), and comorbid hypertension (OR = 1.31, 95% CI: 1.06–1.62,
P
= 0.015) were independently cross-sectionally associated with good glycemic control. Conversely, diabetes duration ≥ 10 years (OR = 0.67, 95% CI: 0.50–0.89,
P
= 0.006), current smoking (OR = 0.66, 95% CI: 0.48–0.91,
P
= 0.010), moderate knowledge level (OR = 0.61, 95% CI: 0.46–0.81,
P
= 0.001), treatment status (oral antidiabetic agents only: OR = 0.49, 95% CI: 0.24–0.98,
P
= 0.045; insulin only: OR = 0.36, 95% CI: 0.15–0.86,
P
= 0.022), and high blood glucose monitoring adherence (OR = 0.59, 95% CI: 0.41–0.86,
P
= 0.006) were cross-sectionally associated with poor glycemic control. Interaction analysis demonstrated a significant positive interaction between high knowledge level and insulin therapy (OR = 4.60, 95% CI: 1.78–11.89,
P
= 0.002). No significant interaction was observed between blood glucose monitoring adherence and insulin therapy (
P
> 0.05).
Glycemic control among aged ≥ 40 years with T2DM under the NEPHS remains suboptimal. Strengthened proactive clinical monitoring and integrated multimorbidity care are warranted to improve primary care diabetes outcomes. The observed knowledge–treatment interaction, while suggesting potential for precision stratified management, requires confirmation through prospective or interventional studies before implementation.
Wenjuan Xiao, Fei Tong, Peiyang Mao et al.· BMC Endocrine Disorders· 0 citations
Aims: Current diabetes mellitus (DM) prevention and treatment strategies rely on risk factors adapted from developed countries, which may not be effective in most poor sub-Saharan Africa settings. This study investigated the association between diabetic treatment outcomes and complications with sociodemographic and diabetic risk factors among type 2 DM (T2DM) patients in Rwanda. Methods: This cross-sectional study analyzed the records of T2DM patients who accessed care at Kigali University Teaching Hospital (CHUK) between January and December 2020, using a non-random sampling technique. Treatment outcomes (improved or not improved based on glycemic control target) and complication outcomes (presence or absence of DM-related microvascular and macrovascular events) were the primary outcome variables. Data were analyzed using t -tests, chi-square tests, and multivariable analyses as appropriate. Results: After adjusting for confounders, only age remained significantly associated with treatment and complication outcomes. The adjusted prevalence ratio (PR) of treatment outcomes for patients aged <50 years was 1.43 (95% CI 1.07–1.92; p = 0.016) and for those aged 50–64 years was 1.12 (95% CI 0.83–1.52; p = 0.462), both relative to the ≥65 years reference category. The adjusted PR for complication outcomes was 0.59 (95% CI 0.40–0.86; p = 0.005) for patients aged <50 years and 0.72 (95% CI 0.57–0.91; p = 0.007) for those aged 50–64 years, compared with the ≥65 years reference category. The adjusted PRs for smoking, alcohol consumption, pharmacological therapy, non-pharmacological therapy, and diet were attenuated and no longer statistically significant (all p > 0.05). Conclusion: The outcomes of diabetic treatment in Rwanda are associated with the age of the patients, rather than the type of therapy or the assessed sociodemographic and risk factors. The causal interpretation and generalizability of this study are limited by its cross-sectional design, non-random sampling, and the single-center setting.
A. Alagbonsi, Aime P. N. Kagina, Denyse Ingabire et al.· Diabetes, Metabolic Syndrome...· 0 citations
Background and Objectives
Achieving optimal glycemic control in type 1 diabetes mellitus (T1DM) remains challenging despite the use of automated insulin delivery (AID) systems. This study evaluated glycemic outcomes and factors associated with poor control among T1DM patients using AID.
Patients and Methods
A descriptive cross-sectional study was conducted among 23 patients with T1DM. Data included demographics, age at diagnosis, duration of AID use, hospitalization, and HbA1c levels. Glycemic control was classified as good (<7%) or poor (≥7%) according to ADA guidelines.
Results
Participants were predominantly adults (82.6%), with a mean age of 23.9 ± 7.6 years, and mostly female (73.9%). The mean age at diagnosis was 10.3 ± 6.0 years. Poor glycemic control was observed in 78.3% of patients, with a mean HbA1c of 8.0 ± 1.7%. Better control was significantly associated with older age at diagnosis and AID use for 6-12 months (p < 0.05). HbA1c showed no significant correlations with age, age at diagnosis, or AID duration. Logistic regression identified younger age at diagnosis as the only independent predictor of poor glycemic control.
Conclusion
Suboptimal glycemic control remains common among T1DM patients using AID systems. Early age at diagnosis is a key risk factor for poor outcomes.