Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)

Abstract

Background : Achieving and maintaining glycemic targets are a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. Methodology : This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. Results : 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22]; p < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94]; p = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77]; p = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39]; p < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18]; p < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81]; p < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. Conclusion : The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv ing their management.