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 2021-01, Vol.171, p.108555-108555, Article 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: Article
• Language: English
• 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
• 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  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  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 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.