Factors affecting achievement of glycemic targets among type 2 diabetes patients in South Asia: Analysis of the CARRS trial

• Authors: Kabayam Venkat Narayan, Emory University; Dorairaj Prabhakaran, Emory University; Muhammad Q Masood, Aga Khan University; Kavita Singh, Emory University; Dimple Kondal, Emory University; Mohammed Ali, Emory University; Minaz Mawani, Aga Khan University; Raji Devarajan, Public Health Foundation of India; Usha Menon, Amrita Institute of Medical Sciences; Premlata Varthakavi, TNM College & BYL Nair Charity Hospital; Vijay Viswanathan, MV Hosp Diabet & Diabet Res Ctr; Mala Dharmalingam, Bangalore Endocrinology & Diabetes Research Centre; Ganapathi Bantwal, St. John's Medical College & Hospital; Rakesh Sahay, Osmania General Hospital; Rajesh Khadgawat, All India Institute of Medical Sciences; Ankush Desai, Goa Medical College; Venkat KM Narayan, Emory University; Nikhil Tandon, All India Institute of Medical Sciences
• Journal Title: DIABETES RESEARCH AND CLINICAL PRACTICE
• Volume: Volume 171
• Publisher: ELSEVIER IRELAND LTD | 2021-01-01, Pages 108555-108555
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.diabres.2020.108555
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; Type 2 diabetes mellitus; Glycemic targets; Quality improvement; South Asia

Abstract

Objective: To assess the predictors of achieving and maintaining guideline-recommended glycemic control in people with poorly controlled type 2 diabetes. Methods: 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 < 7%) and those that remained persistently poorly controlled (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 < 7% and HbA1c > 9% at the end of the trial, adjusting for trial group assignment and site. Results: 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 < 7%). Presence of microvascular complications (RR: 0.70; 95%CI: 0.53–0.92) reduced the probability of achieving guideline-recommended glycemic control (HbA1c 7%). Further, longer duration of diabetes (>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%). Conclusion: 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.