Factors Associated with Glycated Hemoglobin Levels > 6.5% among Diabetic Patients Attending Kenyatta National Hospital, Kenya

Abstract

Introduction: Good quality care in Type 2 diabetes mellitus (T2DM), whose prevalence is approximately 10% in Kenya, may prevent or delay diabetes complications. This study determined blood glycemic targets, defined by HbA1c levels (>6.5% [53 mmol/mol]) and associated factors among patients receiving diabetes management at Kenyatta National Hospital in Kenya. Methods: In this cross-sectional study conducted between May to September 2017, we obtained blood samples from 381 consenting T2DM patients attending KNH. The study collected data using a detailed questionnaire while taking glycemic measurements. Factors associated with poor glycemic control (HbA1c levels >6.5%) were determined using Ordinal logistic regression modeling, STATA software version 13. Results: 103 (27.1%) T2DM patients with poor glycemic control were identified. In multivariate analysis, independent risk factors associated with poor glycemic control and their 95% confidence intervals included: concurrent hypertension (aOR 1.6, [1.1, 2.4]), receiving ≥3 oral anti-diabetes medication (aOR 2.4, [1.3, 4.6]) and good adherence to medication based on self-reporting (aOR 6.2, [1.9, 41.3). Independent protective factors included self-monitoring of blood glucose levels (aOR 0.35, [0.2, 0.4]), patients aged 51 to 60 years (aOR 0.5, [0.3, 0.9]), weight between 50 and 70 kgs (aOR 0.5, [0.3, 0.9]) and receiving 1 to 2 diabetes medication (aOR 0.4, [0.3, 0.7]). Conclusion: Significantly high proportion of T2DM patients receiving treatment at KNH had poor glycemic control. Addressing comorbidities and promoting good glycemic control among long-standing T2DM patients receiving ≥3 oral anti-diabetes medication is key to delaying or preventing chronic diabetes complications. Self-monitoring of blood glucose levels needs to be encouraged as suggested by its protective effect. While differences in risk between diverse weights and ages need further studies, innovative ways of authenticating self-reports, e.g., triangulation, are required to ensure credibility. This work supports the Government of Kenya’s Vision 2030 in creating a healthy and productive population contributing to the country’s economic growth.