Characteristics and risk factors of glycemic control among middle-aged and elderly diabetes patients under management: a cross-sectional survey based on national essential public health services in Mianyang City

Abstract

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.