Factors linked to poor glycemic control in an outpatient diabetic clinic: a cross-sectional study in Saint-Nicolas Hospital, Haiti

Abstract

Adequate glycemic control prevents acute complications and reduces the risk of long-term complications, the use of services, and societal costs. In clinical practice, achieving good glycemic control for a diabetic patient over the long term is a challenge, considering the complexity of the factors. No study to date has been carried out on diabetic patients and the factors that may be linked to poor glycemic control in Haiti. The main objective of this study was to identify factors related to poor glycemic control in diabetic patients. This analytical cross-sectional study was designed to evaluate the long-term management of diabetic patients. Patients seen in an outpatient clinic in Saint-Nicolas Hospital (Saint-Marc, Haiti) from March to May 2022 were recruited. During this period, 268 diabetic patients were seen during their routine medical visits, of which 226 met our criteria and agreed to participate. They were interviewed by the examiners, with questions that allowed us to assess the association of poor glycemic control according to the American Diabetes Association objectives, with demographic and clinical factors identified from our literature review. The analysis included descriptive, bivariate and multivariate logistic regression using Epi Info 7.2.2.6. P value <0.05 was considered statistically significant. The majority, 84.96%, was of female sex with a mean age of 60 ±9.87. More than half of the patients (59.29%) had their diagnosis for at least 5 years, and 67.26% had poor glycemic control. According to the Morisky score, 50.88% had good adherence. The main comorbidities were hypertension and obesity/overweight, 95% and 59%, respectively. Multivariate analysis after logistic regression showed that pathological proteinuria (odds ratio (OR)= 2.20, 95% confidence interval (CI) 1.0356 - 4.6920, p=0.04) and patients receiving both oral hypoglycemic drugs and insulin (OR=2.58, 95% CI: 1.0613 - 6.3109, p=0.03) increased the probability of having poor glycemic control. Patients on oral hypoglycemic drugs and insulin who also had pathological proteinuria were linked to poor glycemic control. Strengthening patient education before optimizing pharmacological treatment would improve glycemic control, preventing renal complications. A larger study considering other potential barriers would be necessary to add further knowledge to what this study has presented.