Factors associated with glycemic control among type 2 diabetes mellitus patients attending Mathari National Teaching and Referral Hospital, Nairobi County

Abstract

With the prevalence of diabetes escalating globally, diabetes prevalence in Kenya is estimated to be 4.56% with an approximate 12% and 2.7% in both urban and rural settings respectively. Many patients are still reffered to national referral hospitals and even outside country for specialized end organs damage care due to poor glycemic controls. The study determined factors associated with glycemic control, among T2DM patients attending Mathari National Teaching and Referral Hospital diabetes clinic Nairobi, Kenya. A descriptive cross sectional study design was applied and a systematic random sampling technique to recruit 149 study subjects. Scientific and Ethical approval was sought from KNH/UON- ERC before data collection. Quantitative data was collected using a structured questionnaire and a guide was used for qualitative data (one key informant interviews and two focus group discussions). Blood samples were drawn to determine HbA1c, lipid profile, blood sugar and urine for microalbumin Creatinine Ratio levels. Data was analyzed using Statistical Package for Social Scientists version 20 (SPSS). Descriptive analysis was used to summarise the data and associations between variables were tested using Chi Square statistics. Differences between parameters estimates were deemed statistically significant at p < 0.05. Qualitative data was analyzed thematically after translation and transcription. The mean age of the study participants was 54.9 (SD ± 10.14) and a total of 122 (81.9%) out of 149 T2DM patients had poor glycemic control with a mean HbA1c of 9.1%. Over three quarter 135 (90.6%) had uncontrolled FBS, 37.6% with elevated T-Chol, 60.4% having dyslipedemia and 35.4% having moderate to severely increased UACR. Gender (OR = 3.029, 95% CI: 1.287 – 7.129, p = 0.010), FBS (OR = 8.14, 95% CI; 2.541 - 26.0810, p = 0.001) and using drugs for other co-morbidities OR = 2.519, 95% CI; 1.009 - 6.288, p = 0.035) were significantly associated with glycemic control. This study revealed a high burden of poor glycemic control among T2DM patients attending Mathari Teaching and Referral Hospital and thus emphasis on improving awareness and management through structured diabetes education programs to fill the practice gap in glycemic control. Keeping tight control of FBS and routine screening for co-morbidities like hypertension, kidney disorders and dyslipidemia to prevent premature development of complications.