Hypertension is a common comorbidity among patients with type 2 diabetes (T2D) and is associated with poorer treatment outcomes.

 To describe the epidemiology of hypertension among patients with T2D in Kinshasa, Democratic Republic of the Congo.

 A multisite study among 20 randomly selected health facilities in Kinshasa.

 This was an analytical cross-sectional study among 620 participants with T2D. The overall prevalence of hypertension and uncontrolled hypertension was determined. Multivariable mixed effects logistic regression determined factors associated with hypertension and hypertension control among participants with T2D.

 One-third (34.7%) of study participants were classified as having hypertension. The factors associated with hypertension were unemployment (adjusted odds ratio [aOR] = 1.93, 95% confidence interval [CI]: 1.18-3.17), overweight (aOR = 2.71; 95% CI: 1.78-4.13), diabetes duration ≥ 5 years (aOR = 1.84, 95% CI: 1.24-2.73), protestant religion (aOR = 0.48, 95% CI: 0.29-0.82) and severe diabetes distress (aOR = 0.47; 95% CI: 0.28-0.79). The prevalence of uncontrolled hypertension among participants with diabetes-hypertension comorbidity was 50.2%. Being overweight was associated with uncontrolled hypertension (aOR = 2.02; 95% CI: 1.08-3.79).

 Hypertension was common among patients with T2D in Kinshasa, Democratic Republic of Congo (DRC), and in most patients it was uncontrolled. There is a need to strengthen the hypertension prevention and control strategies among patients with T2D, including lifestyle modifications to maintain optimal body weight.Contribution: This study provides insight into the diabetes-hypertension comorbidity in an African urban setting.

Effective glycemic control is essential for managing diabetes-related complications. While studies in Ethiopia have shown poor glycemic control based on fasting blood glucose levels, further research using the glycated hemoglobin (HbA1c) test is necessary. This study aimed to evaluate glycemic control and identify associated factors among patients with type 2 diabetes. A hospital-based cross-sectional study was conducted from February 1 to March 30, 2023, involving 465 type 2 diabetes patients. Socio-demographic and clinical data were collected using a semi-structured questionnaire through consecutive sampling. Laboratory tests, including glycated hemoglobin, fasting blood sugar, renal function, and lipid profiles, were performed. Data analysis was carried out using Epi-data version 4.6.0.4 and SPSS version 26, employing descriptive statistics and binary logistic regression. Multivariable analysis was performed on variables with P < 0.25. The results were presented using numbers, frequencies, and tables. Approximately 73.5% (95% CI = 69.5, 77.4) of the patients demonstrated poor glycemic control. Factors associated with poor glycemic control were lack of formal education (AOR = 4.94, 95% CI = 2.99, 8.15), obesity (AOR = 5.32, 95% CI = 2.02, 14.04), overweight (AOR = 3.77, 95% CI = 1.65, 8.63), high total cholesterol (AOR = 7.79, 95% CI = 4.44, 13.66), and a diabetes duration of more than 10 years (AOR = 3.32, 95% CI = 1.87, 5.89). The research highlights a significant proportion of diabetic patients with inadequate glycemic control, which is associated with factors such as education level, BMI, total cholesterol, and the duration of diabetes. Addressing these factors through personalized management strategies is essential for improving glycemic control and reducing complications.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by combinations of insulin resistance and insulin deficiency. Non-alcoholic fatty liver disease (NAFLD) is emerging as a public health problem worldwide and affects up to 70% of patients with T2DM. Although patients with T2DM have an increased risk of developing advanced liver disease compared to healthy individuals, varying prevalence rates of NAFLD among patients with T2DM, ranging from 34% to 94%, have been reported.

To determine prevalence and identify associated factors of NAFLD among Limbe patients with T2DM and evaluate correlation with glycemic control.

A cross-sectional study was carried out from February to June 2024 among patients with T2DM. Gamma-glutamyl transferase (GGT) activity and serum triglycerides (TGs) were measured by spectrophotometry. NAFLD was diagnosed using the fatty liver index score. Data were analyzed using SPSS version 26.0 for Windows. Student's t-test was used to compare the means of two groups. The χ 2 test was applied to determine the association of NAFLD and T2DM. Logistic regression analysis was performed to identify predictors of NAFLD. P < 0.05 was considered statistically significant.

Of the 150 patients with T2DM recruited for this study, 63 (58%) were females and the majority (84.7%) had good glycemic control (glycated hemoglobin < 7%). Prevalence of NAFLD among patients with T2DM was 19%. Patients with NAFLD had significantly elevated levels of TGs, GGT, and increased body mass index and waist circumference compared to those without NAFLD. There was a significant association between NAFLD and glycemic control. Predictive factors of NAFLD among patients with T2DM were vegetable intake of less than three times per week [adjusted odds ratio (aOR): 0.131, 95%CI: 0.020-0.839; P = 0.032], central obesity (aOR: 0.167, 95%CI: 0.037-0.748; P = 0.019), and metformin treatment for T2DM (aOR: 0.167, 95%CI: 0.037-0.718; P < 0.001).

The prevalence of NAFLD in patients with T2DM in Limbe Regional Hospital was 19%. Age, central obesity, metformin use, and infrequent consumption of vegetables were important predictors of NAFLD.

Variability 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).

The 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.

In 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.

The 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.

In recent years, the investigation of autophagy mechanisms has gained prominence as a key focus for understanding the pathogenesis and therapeutic potential of diabetic cardiomyopathy. This study aims to present an overview of the current state, major research areas, and emerging trends in autophagy related to diabetic cardiomyopathy through bibliometric analysis, offering a scientific foundation for future research.

The Web of Science Core Collection served as the data source for this study, from which full-text publications were extracted. Using CiteSpace 6.3.R1, VOSviewer v1.6.18, and R-Bibliometrix, the analysis evaluated research output across dimensions such as subjects, countries, institutions, journals, authors, and co-cited references, generating a comprehensive visual map.

A total of 367 publications met the inclusion criteria. Between 2014 and 2024, the volume of articles demonstrated a consistent upward trajectory. Research on autophagy in diabetic cardiomyopathy predominantly spans the disciplines of biology and medicine. China and the Fourth Military Medical University emerged as leading contributors among 41 countries and 505 institutions. Sun Dongdong was identified as the most prolific author, while Jia GH was the most frequently cited. Key journals in this field include Biochimica et Biophysica Acta - Molecular Basis of Disease and Frontiers in Cardiovascular Medicine, while Circulation Research recorded the highest number of co-citations. The most cited reference was an experimental study by Xie ZL. Current research focuses on autophagy, diabetic cardiomyopathy, oxidative stress, and their underlying mechanisms.

Research on the role of autophagy in diabetic cardiomyopathy has reached a stable phase of development. Future investigations should prioritize mechanistic studies and emphasize the clinical application of novel pharmacological interventions, thereby advancing therapeutic strategies and contributing to improved human health outcomes.

Achieving optimal glycemic control is vital for managing diabetes mellitus and preventing its complications, yet it is particularly challenging for individuals with diabetes and concurrent chronic kidney disease. Chronic kidney disease disrupts glucose metabolism and excretion, leading to pronounced and variable blood glucose fluctuations, thereby complicating diabetes management. So far, the intricate impact of chronic kidney disease on the glycemic control status of diabetic patients remains obscure, especially in Sub-Saharan Africa where both diseases pose an escalating burden.

This study aimed to assess prescription patterns, glycemic control status, and the contributing factors to poor glycemic control among diabetic patients with comorbid chronic kidney disease at Tikur Anbessa Specialized Hospital, Ethiopia.

A facility-based cross-sectional study was conducted from March 15 to May 15, 2024, from the electronic medical records of diabetic patients with comorbid chronic kidney disease who had received regular treatment and follow-up at the adult diabetes mellitus clinic of Tikur Anbessa Specialized Hospital. The sample size was calculated by using a single population proportion formula and accordingly, a total of 384 patients were recruited randomly and enrolled in this study. Descriptive statistics was employed for analyzing quantitative variables. Logistic regression analysis was performed to identify predictors of poor glycemic control status. Statistical significance was established at p-value < 0.05.

This study found that 98.2% of patients had type 2 diabetes, with a mean diabetes duration of 16.36 years. Only 4.4% achieved good glycemic control (glycated hemoglobin [HbA1c] < 7%), while 95.6% had poor glycemic control (HbA1c ≥ 7%). Insulin, metformin, and sodium glucose cotransporter-2 (SGLT-2) inhibitors were the most frequently prescribed anti-diabetic drug classes which accounted for 80.2%, 59.1%, and 41.4%, respectively. Presence of hypertension (AOR: 3.70, 95% CI: 1.08-12.71, P = 0.038) and regimen change in the past 01year (AOR: 0.34, 95% CI: 0.11-1.01, P = 0.050) were predictors of poor glycemic control status.

This study reveals significant challenges in glycemic control among diabetic patients with comorbid chronic kidney disease (CKD). With only 4.4% of participants achieving optimal HbA1c levels, the findings underscore a critical public health concern regarding the management of diabetes in this vulnerable population.

Not applicable.

Diabetes, a known syndrome marked by hyperglycemia and glucose intolerance, is increasing at an alarming rate worldwide. Over half a billion people worldwide have DM, and most live in low- and middle-income countries. Poor glycemic control is a public health concern in type 2 diabetes mellitus. Glycemic control and identifying factors associated with poor glycemic control can help healthcare providers design programs that improve glycemic control and the quality of services provided to patients.

This study was designed to assess the level of glycemic control and associated factors in patients with type 2 diabetes in Jimma Medical Center, Southwest Ethiopia.

This institution-based prospective observational study was conducted among 420 patients with type 2 diabetes at Jimma Medical Center's diabetic clinics. A pretested structured interviewer-administered questionnaire was used to collect data, and a checklist was used to assess patient documents. The data were analyzed using SPSS version 26. The variables linked to poor glycemic control were investigated using binary logistic regression. Variables with p values less than 0.05 were considered statistically significant.

Six-month follow-ups were conducted among 420 patients with type 2 diabetes, among whom 220 (52.38%) were women. The median age of the participants was 54(IQR = 40-60 years old). The proportion of respondents with uncontrolled fasting blood glucose was 58.1%. Sex (AOR = 2.576, 95% CI [2.80-11.479], P = 0.001), age(≥ 60) (AOR = 2.024, 95% CI [1.794-4.646], P = 0.002), diabetes duration > 10 years (AOR = 3.036, 95% CI [2.616-8.306], P = 0.003), type 2 diabetes mellitus on insulin + oral antidiabetic (OADs) (AOR = 2.08, 95% CI [298-3.918], P = 0.004), obesity (AOR = 2.18, 95% CI [(1.218-4.218)], P = 0.003), diabetic complications (AOR = 3.193, 95% CI [2.324-6.05], p = 0.002) and poor self-care practices (AOR = 3.034, 95% CI [5.821-7.02], P = 0.005) were found to be significantly associated with poor glycemic control.

At the Jimma Medical Center, the prevalence of poor glycemic control was high. Based on these findings, teaching and counseling provided by healthcare providers should focus on improving diabetes self-care activities, weight reduction, and diabetic complications to achieve good glycemic control.

Not applicable.

The burden of diabetes is rising in developing countries, and this is significantly linked to the increasing prevalence of poor glycemic control. The cost of glycated haemoglobin (HbA1c) testing is a barrier to timely glycemic assessments, but newer tests such as glycated albumin may be cheaper and tempting alternatives. Additional research must ascertain if glycated albumin (GA) can act as a viable supplement or alternative to conventional HbA1c measurements for glycemic control in diabetic individuals. GA as a biomarker is an emerging area of interest, particularly for those who display unreliable HbA1c levels or cannot afford the test. This study aims to investigate the prevalence of poor glycemic control in outpatient diabetic patients and the utility of glycated albumin in this population's monitoring of glycemic control. Method. A cross-sectional study of 203 diabetic patients will be conducted at the Dodoma Regional Referral Hospital and Benjamin Mkapa Hospital from August 1st, 2023, to August 31st, 2024. Patients diagnosed with diabetes mellitus for over six months will be screened for eligibility. Informed consent, history, clinical examination, and voluntary blood sample collection will be obtained from all eligible patients. Glycated Albumin levels will be obtained from the same blood samples collected. The glycemic status of all patients will be defined as per HbA1c, and a level of greater than 7% will considered as a poor control. The analysis will be computed with SPSS version 28.0, and a predictor variable, P<0.05, will be regarded as statistically significant, with the utility of GA determined by plotting the area under the ROC curve and the confusion matrix.

Glycaemic control remains suboptimal in the Democratic Republic of the Congo. Defining interventions to improve glycaemic control requires a clear knowledge of factors driving poor glycaemic control. Qualitative studies exploring the perspectives of key stakeholders on this issue are lacking in the Democratic Republic of the Congo. This study aimed to explore the perspectives of persons with type 2 diabetes and healthcare providers on ways to improve glycaemic control in Kinshasa, Democratic Republic of the Congo.

This qualitative study used face-to-face, semistructured interviews on 26 purposively sampled participants: 10 persons with type 2 diabetes and 16 healthcare providers. The study used deductive, constructionist and thematic analyses. Themes were organised and integrated using the WHO Innovative Care for Chronic Conditions Framework.

The healthcare providers recommended better preparation of the healthcare system for better care of diabetes. This is achieved through training of healthcare providers, equipping healthcare structures and organising a reliable drug delivery system. Healthcare providers must also act to ensure that patients get adequate support from their surroundings and the community by providing adequate information about diabetes. The policy environment must create conditions for alleviating the cost of care and prevention of diabetes. In addition, patients with diabetes identified three needs: need mainly for financial support to overcome the cost of diabetes, knowledge for better self-management of the illness and support from healthcare providers to succeed in self-management.

Improving glycaemic control in persons with type 2 diabetes requires multidimensional strategies, with particular focus on empowering patients and their families for efficient self-management, strengthening the healthcare system for diabetes care and greater involvement of the government in terms of funding and adopting positive policies. To be efficient, these interventions need to be integrated into the chronic diseases management framework.

Globally, the prevalence of diabetes is increasing, especially in low- and middle-income countries (LMICs), including those in the sub-Saharan African region. However, the independent socioeconomic correlates of glycemic control as measured by hemoglobin A1C have yet to be identified. Therefore, the aim of this analysis was to understand the independent correlates of glycemic control in South Africa.

Data from the 2016 South Africa Demographic and Health Survey on adults with diabetes were used for this analysis. The dependent variable, glycemic control, was defined using hemoglobin A1c (HbA1c). Independent variables included: age, gender, ethnicity, marital status, region, urban/rural residence, ability to read, education, insurance, wealth, occupation, and employment in the last year. Analysis of variance was used to test for differences in mean HbA1c for each category of all independent variables, and a fully adjusted linear regression model was used to identify independent correlates of glycemic control (HbA1c).

Among the 772 people included in this analysis, there were significant differences in mean HbA1c by age (p < 0.001), ethnicity (p < 0.001), place of residence (p = 0.024), wealth index (p = 0.001), and employment in the last year (p = 0.008). Independent correlates of HbA1c included age, ethnicity, and wealth index.

This study used data from a large diverse population with a high prevalence of diabetes in sub-Saharan Africa and provides new evidence on the correlates of glycemic control and potential targets for interventions designed to lower HbA1c and improve diabetes-related health outcomes of adults in South Africa.

In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.

Poor glycaemic control is a multifactorial and complex problem with dire clinical and economic implications. In the Democratic Republic of the Congo, recent studies have shown alarming poor control rates. There is no policy framework to guide corrective actions.

To build a consensus on interventions to improve glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo.

This was a two-round electronic Delphi study involving 31 local and 5 international experts. The experts rated proposed interventions from previous studies on glycaemic control in sub-Saharan Africa and Kinshasa on a 4-Likert scale questionnaire. Additionally, the experts were asked to suggest other recommendations useful for the purpose. The mode, mean and standard deviation of each statement were calculated for each round.

Participants reached consensus in five domains that included 39 statements on how to improve glycaemic control in Kinshasa: strengthening the health system, enhancing the awareness of diabetes, alleviating the financial burden of diabetes, enhancing the adoption of lifestyle modifications, and reducing the proportion of undiagnosed diabetes.

Improved glycaemic control needs to be considered within the broader framework of managing noncommunicable diseases in a more integrated, coordinated and better financed healthcare system. Further studies are needed to operationalise the interventions identified for successful implementation.

To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin.

Systematic review and meta-analysis.

A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package).

A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control.

This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.

Glycaemic control is of one the main goals for managing type 2 diabetes. In sub-Saharan Africa and the Democratic Republic of the Congo, studies have reported alarming poor control rates. Patients with poor glycaemic control are exposed to complications leading to high cost of care and deteriorated quality of life. In recent studies by our group, we have demonstrated that poor glycaemic control is high and driven by proximal (individual) and distal (structural) factors in Kinshasa, Democratic Republic of the Congo. Financial constraints impacted many aspects of care at multiple levels from the Government to persons living with diabetes. Financial constraints prevented good preparation, organization and access to diabetes care. Difficulties in implementing lifestyle changes, lack of health literacy and limited healthcare support were also contributing to poor glycaemic control. Through a Delphi study, a group of experts reached a consensus on five potential strategies for improving glycaemic control in the Democratic Republic of Congo as follows: changing the healthcare system for better diabetes care extended to other noncommunicable diseases, ensuring consistent financing of the healthcare, augmenting the awareness of diabetes among the general population and the persons living with diabetes, easing the adoption of lifestyle modifications and reducing the burden of undiagnosed diabetes. This paper reflects on the urgent need for an improved management framework for diabetes care in the Democratic Republic of the Congo. Specifically, the Government needs to increase the investment in the prevention and treatment of noncommunicable diseases including diabetes.

Diabetes mellitus is one of the risk factors for malignant otitis externa. There are very few studies on the disease in Africa and there is a need to pool the prior studies to highlight the characteristics of the disease. The study type is a systematic review and the PRISMA guidelines were followed. Using the appropriate terms, relevant medical databases were systematically searched. Thirty-two studies met the eligibility criteria with a total sample size of 848, who were mainly elderly. Diabetes mellitus was present in 94% of the participants. Average duration of diabetes diagnosis in the participants was 12.4 years. The pooled HbA1c was 9.8%. The most common symptoms were otalgia (96.1%), otorrhoea (75.8%) and hearing loss (56.1%). Pseudomonas was the most common isolate (72%). Fluoroquinolones and the 3rd-generation cephalosporins were the preferred antibiotics. The pooled cure rate from antimicrobial usage was 76.2%. In addition to medications, 24.6% of the affected individuals required debridement. About 1.6% of the participants died from malignant otitis externa. Malignant otitis externa is associated with poorly controlled diabetes. Pseudomonas is the most common cause and a significant proportion gets cured with prolonged antibiotherapy.

Diabetes is a significant problem in sub-Saharan Africa and achieving glycaemic control poses a health challenge among patients living with type 2 diabetes. There are limited data on glycaemic control in Kinshasa, Democratic Republic of the Congo. This study assessed the prevalence and factors associated with glycaemic control to inform potential interventions to improve glycaemic control in Kinshasa.

This was a cross-sectional study conducted between November 2021-September 2022 among patients recruited from 20 randomly selected health facilities in Kinshasa. Participants were asked to complete a structured questionnaire and to provide two millilitres of blood for Hb1AC assay. Poor glycaemic control was defined as HbA1c ≥7%. Univariate and multivariable logistic regressions were performed to identify factors associated with poor glycaemic control.

A total of 620 participants were recruited for this study. Study participants had a median age of 60 (IQR=53.5-69) years with the majority being female (66.1%), unemployed (67.8%), having income below the poverty line (76.4%), and without health insurance (92.1%). About two-thirds of the participants (420; 67.6%) had poor glycaemic control. Participants on monotherapy with insulin (AOR=1.64, 95%CI [1.10-2.45]) and those on a treatment duration ≥7 years (AOR=1.45, 95%CI [1.01-2.08]) were associated with increased odds of poor glycaemic control while being overweight (AOR= 0.47, 95%CI [0.26-0.85]) and those with uncontrolled blood pressure (AOR=0.65, 95% CI [0.48-0.90]) were protective for poor glycaemic control.

Poor glycaemic control is prevalent among patients with type 2 diabetes in Kinshasa, DRC. Being on insulin alone and a duration of diabetes treatment equal or more than 7 years predisposed to poor glycaemic control. By contrary, having uncontrolled blood pressure and being overweight had protective effect against poor glycaemic control. These links between uncontrolled blood pressure and overweight on the one hand, and glycaemic control on the other are unusual. These reflect, among other things, the specific characteristics of diabetes in sub Saharan Africa.

Comorbidity rates in the geriatric population have increased because of rising life expectancy; thus, patients have had to use more medications. Type 2 diabetes mellitus, one of the most common diseases, may influence the number of drugs used in geriatric patients. The present study was designed to investigate the association between the level of type 2 DM and polypharmacy. Fifty patients with type 2 diabetes over the age of 65 were included according to the inclusion criteria; 23 were well-controlled and 27 had poorly controlled diabetes. The groups were similar in terms of age, sex, WBC, Hb, Plt, AST, ALT, serum creatinine, fasting glucose, and eGFR levels. Patients with HbA1c values above 7.5 were classified as poorly controlled diabetes patients, and those below were considered well-controlled diabetes patients and were evaluated for inappropriate medication use. The number of medications used daily by the cases (p < 0.001), the number of concomitant diseases (p = 0.001), and the number of increased risks according to the Beers Criteria (p = 0.02) were observed to be high in poorly controlled type 2 diabetes mellitus subjects. HbA1c levels were related to the number of medications (r = 0.4, p = 0.004), comorbidities (r = 0.28, p = 0.04), and the number of increased risks according to the Beers Criteria (r = 0.31, p = 0.014). In conclusion, the number of medications used in patients with poorly controlled type 2 diabetes mellitus was found to be more elevated than in individuals with well-controlled type 2 diabetes mellitus. The HbA1c values varied among patients regarding polypharmacy, comorbidities, and increased risks according to the Beers Criteria.

Glycaemic control is a significant problem in the Democratic Republic of the Congo (DRC), the perspectives associated with glycaemic control are not fully known as previous studies rarely explored patients' perspectives and lived experiences. This qualitative study described the perspectives regarding glycaemic control among persons with type 2 diabetes in Kinshasa, DRC. A total of 23 participants were purposively selected in seven health centres in Kinshasa. In-depth interviews were used for data collection. The study used a phenomenology approach, and deductive, constructionist and thematic analysis. Data analysis was performed using the MAXQDA 2022. Five themes were identified as perspectives for glycaemic control in Kinshasa: financial constraints, limited social and relational support, difficulties with lifestyle changes, beliefs and practices about diabetes and ability to adapt for caring for the illness. Themes were integrated using social cognitive theory. Participants expressed that they were unable to achieve better glycaemic control due to financial constraints, limited social and relational support and difficulty in changing their lifestyle. Their beliefs and practices about diabetes also constituted a barrier. Our results showed that lack of adequate funding is a major determinant of glycaemic control and therefore it is crucial to integrate a consistent and reliable funding system for care of people living with diabetes. Persons with diabetes must be empowered to successfully adapt to the requirements of diabetes care. In this process, support for people living with type 2 diabetes is also essential and should involve their families as well as healthcare providers.

Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.

diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. While there's increasing evidence that social support from caregivers improves health outcomes in chronic illness management, the potential associations of the different types of social support and glycemic control among Type II diabetes clients have largely been ignored in Kenya. This cross-sectional study sought to establish the association between tangible, emotional, and informational social support and glycemic levels among clients diagnosed with Type II diabetes in Machakos County, Kenya.

semi-structured interviews were conducted with 726 randomly selected Type II diabetes clients enrolled in diabetes care and treatment programs in government-owned public health facilities in Masinga and Matungulu sub-counties, Machakos, Kenya. Descriptive statistics and multinomial logistic regression were conducted to elucidate any associations.

seventy-three percent (73%) of the respondents were female, and 27% were male, with the majority (77.9%) being above 50 years and having lived with diabetes for over 3 years (61.5%). Opportunities for social support existed, with 62% of the respondents living with more than 2 persons above 18 in their households. From the Random Blood Glucose test analysis, 38.9% of the clients had high glycemic levels, partly because the majority (66.9%) of the respondents did not practice good diabetes self-management practices at the time of the study. While all three types of social support were reported as provided, only 30.6% reported receiving adequate social support. An association was found between social support and glycemic levels with respondents receiving adequate informational- P<0.05, OR 1.92, emotional -P<0.05, OR 3.7, and tangible support -P<0.05, OR 4.1 more likely to have better glycemic control than those with inadequate support.

clients receiving adequate informational, emotional, and tangible social support were 2, 4, and 4 times, respectively, likely to have better glycemic control than those with inadequate support. Of the three types of social support, tangible support was most needed. Ultimately, a greater understanding of these interactions through longitudinal studies is required to identify solutions and optimize glycaemic control for diabetes clients in Kenya and beyond.

Glycemic control is of paramount importance in care and management for patients with type 2 diabetes mellitus (T2DM). Poor glycemic control is a major health problem that greatly contributes to the development of diabetes related complications. This study aims to assess the prevalence of poor glycemic control and associated factors among outpatients with T2DM attending diabetes clinic at Amana Regional Referral Hospital in Dar-es-salaam, Tanzania from December 2021 to September 2022. A face to face interviewer semi-structured questionnaire was administered during data collection. Binary logistic regression under multivariable analysis was used to determine the independent predictors of poor glycemic control. A total of 248 patients with T2DM were included in the analysis with mean age of 59.8 ± 12.1 years. The mean fasting blood glucose was 166.9 ± 60.8 mg/dL. The prevalence of poor glycemic control was 66.1% (fasting blood glucose > 130 mg/dL or < 70 mg/dL). Failure to adhere to regular follow-up (AOR = 7.53, 95% CI = 2.34-19.73, p < 0.001) and alcoholism (AOR = 4.71, 95% CI = 1.08-20.59, p = 0.040) were the independent predictors of poor glycemic control. The prevalence of poor glycemic control observed in this study was significantly high. Emphasis should be placed on ensuring that patients have regular follow-up for their diabetes clinics and they should also continue modifying some of lifestyle behaviors including refraining from alcoholism, this can help them to have good glycemic control.

The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34-0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69-4.77 and White: AOR = 3.84, 95% CI: 1.46-10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13-10.29], social support [average: AOR = 2.51, 95% CI: 1.05-6.00 and good: AOR = 4.49, 95% CI: 1.61-7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10-0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33-0.10 and good: AOR = 1.86, 95% CI: 0.71-4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47-5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.

Poor glycemic control is one of the most determinant factors for type 2 diabetes-related morbidity and mortality. The proportion of type 2 diabetes mellitus patients with poor glycemic control remains high. Yet evidence on factors contributing to poor glycemic control remains scarce. The aim of this study is to identify determinants of poor glycemic control among type 2 diabetes mellitus patients at a diabetes mellitus clinic in University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia Determinants of Poor Glycemic Control among Type 2 Diabetes mellitus Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: Unmatched Case-Control Study.

A hospital-based case-control study was conducted from June to September 2020. Using convenience sampling techniques, a total of 90 cases and 90 controls with type 2 diabetes were recruited. The data were entered into Epidata version 4.6.0.2 and analyzed by Stata version 14. A multivariable logistic regression analysis was performed to assess the association between independent variables and glycemic control. Both 95% CI and p-value<0.05 were used to determine the level and significance, respectively.

The mean age ( ± standard deviations) for the cases and controls were 57.55± 10.42 and 61.03± 8.93% respectively. The determinants of poor glycemic control were age (Adjusted odd ratio (AOR)= 0.08; 95% CI= 0.02-0.33), inadequate physical exercise (AOR = 5.05; 95% CI = 1.99-11.98), presence of comorbidities (AOR = 5.50; 95% CI = 2.06-14.66), non-adherence to anti-diabetes medications (AOR= 2.76; 95% CI= 1.19-6.40), persistent proteinuria (AOR=4.95; 95% CI=1.83-13.36) and high-density lipoprotein less than 40 mg/dl (AOR=3.08; 95% CI= 1.30-7.31).

Age less than 65 years, inadequate physical exercise, presence of comorbidities, non-adherence to anti-diabetes medications, persistent proteinuria, and high-density lipoprotein less than 40 mg/dl were the determinants of poor glycemic control. Therefore, targeted educational and behavioral modification programs on adequate exercise and medication adherence should be routinely practiced. Furthermore, early guideline-based screening and treatment of comorbidities and complications is required to effectively manage diabetes mellitus.