Predictive factors of glycemic control in patients with type 2 diabetes mellitus in primary health care
Abdelaziz, A.B.; Soltane, I.; Gaha, K.; Thabet, H.; Tlili, H.; Ghannem, H.
Revue d'Epidemiologie et de Sante Publique 54(5): 443-452
2006
ISSN/ISBN: 0398-7620 PMID: 17149165 Document Number: 595933
The factors associated with poor glycaemic control in type 2 diabetic patients followed in primary care units in Sousse, Tunisia were determined. A cross-sectional study was conducted on a representative sample of type 2 diabetic patients followed at least two years in primary health care units in Sousse, Tunisia. Data were gathered from three sources: a self-administered questionnaire, analysis of patient files and HbA1c level. HbA1c level was measured with turbidimetric immunoinhibition assay. Patients were considered well-controlled if glycated haemoglobin (HbA1c) was less than 7%, according to the American Diabetics Association (ADA) recommendations. The study enrolled 404 type 2 diabetic patients. The mean age was 60.5+or-10.89 years; sex-ratio was 0.5, and mean disease duration was 8.7+or-6.1 years. ADA recommendations were met by 16.7% of patients. Multivariate analysis using variables in relation with the patient, his/her family, the disease, the treatment and the health care unit, showed that only poor geographic access to the care centre (adjusted OR: 1.89, p=0.009) and Body Mass Index (BMI) less than 30 kg/m2 (adjusted OR: 2.21, p=0.034) were significantly and independently associated with poor glycaemic control. CONCLUSION: Glycaemic control in type 2 diabetic patients is poor. It depends strongly on geographic access to health care. Type 2 diabetic patients should be referred, as much as possible, to the nearest health care unit.