Factors affecting achievement of glycemic targets among type 2 diabetes patients in South Asia: Analysis of the CARRS trial.

Abstract

OBJECTIVE:

To assess the predictors of achieving and maintaining guideline-recommended glycemic control in people with poorly controlled type 2 diabetes.

METHODS:

We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial (n = 1146), to identify groups that achieved guideline-recommended glycemic control (HbA1c < 7%) and those that remained persistently poorly controlled (HbA1c > 9%) over a median of 28 months of follow-up. We used generalized estimation equations (GEE) analysis for each outcome i.e. achieving guideline-recommended control and persistently poorly controlled and constructed four regression models (demographics, disease-related, self-care, and other risk factors) separately to identify predictors of HbA1c < 7% and HbA1c > 9% at the end of the trial, adjusting for trial group assignment and site.

RESULTS:

In the final multivariate model, adherence to prescribed medications (RR: 1.46, 95%CI: 1.09, 1.95), adherence to diet plans (RR: 1.79, 95% CI: 1.43, 2.23) and middle-aged: 50-64 years (RR: 1.32; 95% CI: 1.02-1.71) were associated with achieving guideline-recommended control (HbA1c < 7%). Presence of microvascular complications (RR: 0.70; 95%CI: 0.53-0.92) reduced the probability of achieving guideline-recommended glycemic control (HbA1c 7%). Further, longer duration of diabetes (>15 years), RR: 1.41; 95% CI: 1.15, 1.72, hyperlipidemia, RR: 1.19; 95% CI: 1.06, 1.34 and younger age group (35-49 years vs. >64 years: RR: 0.61; 95% CI: 0.47-0.79) were associated with persistently poor glycemic control (HbA1c > 9%).

CONCLUSION:

To achieve and maintain guideline-recommended glycemic control, care delivery models must put additional emphasis and effort on patients with longer disease duration, younger people and those having microvascular complications and hyperlipidemia.

• Authors: Muhammad Q Masood, Kavita Singh, Dimple Kondal, Mohammed K Ali, Minaz Mawani, Raji Devarajan, Usha Menon, Premlata Varthakavi, Vijay Viswanathan, Mala Dharmalingam, Ganapathi Bantwal, Rakesh Sahay, Rajesh Khadgawat, Ankush Desai, Dorairaj Prabhakaran, K M Venkat Narayan, Nikhil Tandon, CARRS Trial Group
• Journal: Diabetes research and clinical practice (Diabetes Res Clin Pract) Vol. 171 Pg. 108555 (Jan 2021) ISSN: 1872-8227 [Electronic] Ireland
• PMID: 33242515 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Blood Glucose

Topics

• Asia
• Blood Glucose (metabolism)
• Diabetes Mellitus, Type 2 (epidemiology)
• Female
• Humans
• Male
• Middle Aged
• Quality Improvement (standards)
• Risk Factors