Patient-dependent characteristics related to poor glycemic control in type 2 diabetes in Yerevan: a case control study

Abstract

Introduction: Although it is well recognized now that level of glycemic control in patients with diabetes depends on many factors related to patient himself/ herself, health care providers, and care environment, a controversy exists in literature in terms of main characteristics associated to poor glycemic control in patients with the disease. There is no study done in Armenia to identify major factors related to non-satisfactory glucose control in type 2 diabetes patients, and there is a high need of such type of information. Objectives: This study was aimed to assess several patient and the disease-related variables for their effect on glycemic control in people with type 2 diabetes living in Yerevan, as well as to reveal current situation with type 2 diabetes in the Republic to help policy-makers to design appropriate strategies to overcome existing problems related to disease management. Design and methods: The study was an expansion of the cross-sectional epidemiologic study “Survey of type 2 diabetes mellitus patients in Yerevan” done in September 1998, i.e. a case-control secondary analysis of the data collected (1) during household interviews from 72 patients randomly selected from all the patients registered at the Yerevan's polyclinic as having type 2 diabetes, as well as (2) from medical records of those patients. Descriptive analysis was used to determine characteristics of cases and controls. Independent variables [such as age; gender; body mass index (BMI), socio-economic, smoking, self-rated health status, knowledge about diabetes, as well as duration of the disease and type of prescribed treatment] were studied for their association with poor glycemic control. Results: Statistically significant association was found between poor glucose control and (1)being older than 60 years (odds ratio (OR)= 3.3); (2) having BMI higher than 28 (OR = 2.8); (3) positive past smoking status (OR = 3.18); and (4) being treated by hypoglycemic pills vs. treatment by insulin (OR = 0.142). In addition several problems related to current diabetes management in Yerevan (quality of medical records, patient awareness about their rights) were revealed. Recommendations: Polyclinic-based endocrinologists should closely monitor patients at increased risk of poor glycemic control (age over 60, BMI over 28) and improve the quality of record keeping. Officials responsible for diabetes care in Yerevan (1) implementing diabetes related programs should take into account the most vulnerable groups in terms of poor glycemic control, (2) use more efficient ways of informing patients about their rights and services under the BBP, (3) to improve situation with diabetes education introduce new category of specialists, namely nurse-educator at the polyclinic level, (4) develop and inculcate unified medical record form to be used by polyclinic-based endocrinologists.