Dataset Information

Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study.

ABSTRACT: DISCOVER is a 3-year observational study program of 15,983 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. We investigated the association between socioeconomic status and both the availability of a baseline glycated hemoglobin (HbA1c) measurement and poor glycemic control (HbA1c level ≥ 9.0%) in participants enrolled in DISCOVER. Factors associated with a lack of baseline HbA1c measurement or an HbA1c level ≥ 9.0% were assessed using three-level hierarchical logistic models. Overall, 19.1% of participants did not have a baseline HbA1c measurement recorded. Lower-middle country income (vs. high) and primary/no formal education (vs. university education) were independently associated with a reduced likelihood of having a baseline HbA1c measurement (odds ratio [95% confidence interval]: 0.11 [0.03-0.49] and 0.81 [0.66-0.98], respectively. Of the participants with an available HbA1c measurement, 26.9% had an HbA1c level ≥ 9.0%; 68.7% of these individuals were from lower- or upper-middle-income countries. Factors associated with an increased likelihood of poor glycemic control included low country income, treatment at a site with public and/or governmental funding (vs. private funding) and having public or no health insurance (vs. private). A substantial proportion of DISCOVER participants did not have an HbA1c measurement; more than one-quarter of these participants had poorly controlled type 2 diabetes. Both individual- and country-level socioeconomic factors are associated with the quality of care regarding glycemic control. Awareness of these factors could help improve the management of patients with type 2 diabetes.

SUBMITTER: Gomes MB

PROVIDER: S-EPMC9072655 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study.

Gomes Marília B MB Tang Fengming F Chen Hungta H Cid-Ruzafa Javier J Fenici Peter P Khunti Kamlesh K Rathmann Wolfgang W Shestakova Marina V MV Surmont Filip F Watada Hirotaka H Medina Jesús J Shimomura Iichiro I Saraiva Gabriela Luporini GL Cooper Andrew A Nicolucci Antonio A

Frontiers in endocrinology 20220422

DISCOVER is a 3-year observational study program of 15,983 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. We investigated the association between socioeconomic status and both the availability of a baseline glycated hemoglobin (HbA1c) measurement and poor glycemic control (HbA1c level ≥ 9.0%) in participants enrolled in DISCOVER. Factors associated with a lack of baseline HbA1c measurement or an HbA1c level ≥ 9.0% were assessed using three-level hier ...[more]

PMID: 35527995

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Project description:PurposeTo examine the association of individual and combined indicators of diabetes control with diabetic retinopathy and diabetic macular edema.Materials and methodsIn this clinical, cross-sectional study, 613 adults with type 2 diabetes (372 any diabetic retinopathy; 183 any diabetic macular edema) were examined. Diabetic retinopathy was assessed from fundus photographs; diabetic macular edema from Ocular Coherence Tomography scans; and HbA1c and serum lipid values from fasting blood samples. Poor glucose control was defined as HbA1c≥7%; poor blood pressure control as SBP≥130/DBP≥80; and poor lipid control as total cholesterol:HDL ratio≥4.0. The association of poor glucose control, poor blood pressure control and poor lipid control alone and in combination (poor glucose & blood pressure control; poor glucose & lipid control; poor blood pressure & lipid control; and poor glucose, blood pressure & lipid control) with diabetic retinopathy/diabetic macular edema was examined using multiple logistic regression models.ResultsPatients' mean±standard deviation age was 64.9±11.6 years (57% male). In adjusted models, compared to those with good control of all indicators (n = 99, 18.3%), the odds ratio (95% Confidence Interval) of having any diabetic retinopathy was 2.44 (1.34-4.46), 3.75 (1.75-8.07), 4.64 (2.13-10.12) and 2.28 (1.01-5.16) for poor glucose control only; poor glucose & blood pressure control; poor glucose & lipid control; and poor glucose, blood pressure & lipid control, respectively. Correspondingly for diabetic macular edema, they were 3.19 (1.55-6.59); 3.60 (1.58-8.22); 2.76 (1.18-6.44); and 3.01 (1.18-7.67), respectively. Odds were not significantly increased for other indicators.DiscussionCompared to individual indicators of poor diabetes control, risk of diabetic retinopathy and diabetic macular edema increased three to fourfold with a combination of these indicators. Targeting combined diabetes control indicators is important to reduce risk of diabetic retinopathy/diabetic macular edema.

Project description:IntroductionVariability in blood glucose remains a challenge in diabetic management. Therefore, this review aimed to estimate the overall poor glycemic control and identify its predictors among people living with diabetes in low- and middle-income countries (LMICs).MethodsThe authors searched articles in PubMed, Embase, OVID, CINAHL Plus, Cochrane Library, PsychInfo, Google, and Google Scholar. The search results were exported to the Rayyan software to check their eligibility. The Newcastle-Ottawa scale was used to assess the study quality. Stata version 17 was used for analysis. A random effect model was computed. Heterogeneity was assessed by the Cochrane Q test and I-squared (I2). The funnel plot asymmetry test and/or Egger's regression test (p < 0.05) were used to detect the publication bias. Then it was treated by the trim and fill analysis. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the reference number CRD42023430175.ResultsIn total, forty-nine articles were used. Of which forty-five articles with 15,981 participants were used for pooled prevalence estimation. The pooled prevalence of poor glycemic control among people living with diabetes in LMICs was found to be 69.06% (95% CI: 65.66-72.46), I2 = 96.1%, p < 0.001). Alcohol intake (AOR = 2.07: 95% CI: 1.27-3.36), poor adherence to dietary recommendations (AOR = 3.16, 95% CI: 1.13-8.85), poor adherence to anti-diabetic medication (AOR = 2.85, 95% CI: 1.04 -7.85), diabetic complications (AOR = 1.37, 95% CI: 1.00-1.88), and co-morbid conditions (AOR = 1.98, 95% CI: 1.28-30.07) were found to be predictors of poor glycemic control.ConclusionsThe pooled prevalence of poor glycemic control was significantly high in LMICs. Drinking alcohol, poor adherence to dietary recommendations, poor adherence to anti-diabetic medication, diabetes complications, and co-morbid conditions were found to be the determinants of poor glycemic control among people living with diabetes. Tight glycemic control strategies have been implemented to achieve optimal blood glucose. Further research on the regional and contextual factors influencing glycemic control would be recommended.

Dataset Information

Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study.

Publications

Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study.

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