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

• Published in: Diabetes research and clinical practice Vol. 171; p. 108555
• Main Authors: Masood, Muhammad Q., Singh, Kavita, Kondal, Dimple, Ali, Mohammed K., Mawani, Minaz, Devarajan, Raji, Menon, Usha, Varthakavi, Premlata, Viswanathan, Vijay, Dharmalingam, Mala, Bantwal, Ganapathi, Sahay, Rakesh, Khadgawat, Rajesh, Desai, Ankush, Prabhakaran, Dorairaj, Narayan, K.M. Venkat, Tandon, Nikhil
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-01-2021
• Subjects: Asia; Blood Glucose - metabolism; Diabetes Mellitus, Type 2 - epidemiology; Female; Glycemic targets; Humans; Male; Middle Aged; Quality improvement; Quality Improvement - standards; Risk Factors; South Asia; Type 2 diabetes mellitus; Asia; Quality improvement; Type 2 diabetes mellitus; Glycemic targets; South Asia
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2020.108555

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