Sociodemographic and Clinical Predictors of Refractory Type 2 Diabetes Patients: Findings from a Case-control Study

Overview

Journal Saudi Med J

Specialty General Medicine

Date 2021 Feb 10

PMID 33563737

Citations 2

Authors

Turki J Alharbi

Ayla M Tourkmani

Abdulaziz Bin Rsheed

Abood F Al Abood

Yasser K Alotaibi

Affiliations

Soon will be listed here.

Abstract

Objectives: To identify the sociodemographic and clinical predictors of uncontrolled diabetic patients, to identify high-risk and people with impaired glycemic control, to establish more effective strategies for reducing morbidity and mortality.

Methods: This case-control study of 8209 enrolled patients were included from the diabetes registry by Chronic Illness Center (CIC), Family and Community Medicin, Prince Sultan Military Medical City, Riyadh Saudi Arabia between February 2019 and February 2020. Cases are defined as patients with type II refractory diabetes having persistent HbA1c >9, not reach adequate glycemic control despite intensified therapy under specialist care (CIC) for at least 6 months. Controls were defined as patients with Hba1c ≤9. Multivariable regression analysis was used to identify predictors for patients with the persistent outcome of HbA1c >9%.

Results: Overall, a total of 1152 cases and 4555 controls were included. Patients with refractory diabetes were younger (mean: 58.5, standard deviation [SD]: 11.7) and females (63.4%). Duration of diabetes (13.3, SD: 7.4, <0.001) and the mean value of low-density lipoprotein (LDL) (2.7, SD: 0.91, <0.001) were significantly higher in the refractory group. The findings from the final model revealed that with every unit increase in age (odds ratio [OR]: 0.97, [95% confidence interval [CI]: 0.96-0.98]) and body mass index the odds of having refractory diabetes significantly reduced by 0.97 times (OR: 0.97, [95% CI: 0.95-0.99]). While with every unit increase in the duration of diabetes (OR: 1.03, [95% CI: 1.01-1.05]), systolic blood pressure (OR: 1.01, [95% CI: 1.00-1.02]) and LDL (OR: 1.42, [95% CI: 1.23-.62]) the odds of having refractory diabetes significantly increased by 1.03 and 1.42 times respectively compared to controls when adjusted for gender, albumin creatinine, diastolic blood pressure.

Conclusion: The findings from this study helped classify the predictors of refractory patients with diabetes. Understanding refractory patients' predictors may help to develop new therapeutic strategies to boost their glycemic status safely.

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References

Glasgow R, Hampson S, Strycker L, Ruggiero L . Personal-model beliefs and social-environmental barriers related to diabetes self-management. Diabetes Care. 1997; 20(4):556-61. DOI: 10.2337/diacare.20.4.556. View

Rothenbacher D, Ruter G, Saam S, Brenner H . Younger patients with type 2 diabetes need better glycaemic control: results of a community-based study describing factors associated with a high HbA1c value. Br J Gen Pract. 2003; 53(490):389-91. PMC: 1314599. View

Shorr R, Franse L, Resnick H, Di Bari M, Johnson K, Pahor M . Glycemic control of older adults with type 2 diabetes: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Geriatr Soc. 2000; 48(3):264-7. DOI: 10.1111/j.1532-5415.2000.tb02644.x. View

Shah B, Hux J, Laupacis A, Mdcm B, Austin P, van Walraven C . Diabetic patients with prior specialist care have better glycaemic control than those with prior primary care. J Eval Clin Pract. 2005; 11(6):568-75. DOI: 10.1111/j.1365-2753.2005.00582.x. View

Juarez D, Sentell T, Tokumaru S, Goo R, Davis J, Mau M . Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009. Prev Chronic Dis. 2012; 9:120065. PMC: 3475506. DOI: 10.5888/pcd9.120065. View

Riddle M, Ambrosius W, Brillon D, Buse J, Byington R, Cohen R . Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care. 2010; 33(5):983-90. PMC: 2858202. DOI: 10.2337/dc09-1278. View

Alqurashi K, Aljabri K, Bokhari S . Prevalence of diabetes mellitus in a Saudi community. Ann Saudi Med. 2011; 31(1):19-23. PMC: 3101719. DOI: 10.4103/0256-4947.75773. View

Song S, Hardisty C . Early onset type 2 diabetes mellitus: a harbinger for complications in later years--clinical observation from a secondary care cohort. QJM. 2009; 102(11):799-806. DOI: 10.1093/qjmed/hcp121. View

Benoit S, Fleming R, Philis-Tsimikas A, Ji M . Predictors of glycemic control among patients with Type 2 diabetes: a longitudinal study. BMC Public Health. 2005; 5:36. PMC: 1090595. DOI: 10.1186/1471-2458-5-36. View

10.

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

11.

El-Kebbi I, Cook C, Ziemer D, Miller C, Gallina D, Phillips L . Association of younger age with poor glycemic control and obesity in urban african americans with type 2 diabetes. Arch Intern Med. 2003; 163(1):69-75. DOI: 10.1001/archinte.163.1.69. View

12.

Valle T, Koivisto V, Reunanen A, Kangas T, Rissanen A . Glycemic control in patients with diabetes in Finland. Diabetes Care. 1999; 22(4):575-9. DOI: 10.2337/diacare.22.4.575. View

13.

Basit A, Hydrie M, Hakeem R, Ahmedani M, Waseem M . Glycemic control, hypertension and chronic complications in type 2 diabetic subjects attending a tertiary care centre. J Ayub Med Coll Abbottabad. 2005; 17(2):63-8. View

14.

Bruce D, Davis W, Davis T . Glycemic control in older subjects with type 2 diabetes mellitus in the Fremantle Diabetes Study. J Am Geriatr Soc. 2000; 48(11):1449-53. DOI: 10.1111/j.1532-5415.2000.tb02636.x. View

15.

Borgermans L, Goderis G, Van Den Broeke C, Verbeke G, Carbonez A, Ivanova A . Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project. BMC Health Serv Res. 2009; 9:179. PMC: 2762969. DOI: 10.1186/1472-6963-9-179. View

16.

Khan H . Clinical significance of HbA1c as a marker of circulating lipids in male and female type 2 diabetic patients. Acta Diabetol. 2007; 44(4):193-200. DOI: 10.1007/s00592-007-0003-x. View

17.

Aronson R, Orzech N, Ye C, Goldenberg R, Brown V . Specialist-led diabetes registries and predictors of poor glycemic control in type 2 diabetes: Insights into the functionally refractory patient from the LMC Diabetes Registry database. J Diabetes. 2015; 8(1):76-85. DOI: 10.1111/1753-0407.12257. View

18.

Mullugeta Y, Chawla R, Kebede T, Worku Y . Dyslipidemia associated with poor glycemic control in type 2 diabetes mellitus and the protective effect of metformin supplementation. Indian J Clin Biochem. 2013; 27(4):363-9. PMC: 3477460. DOI: 10.1007/s12291-012-0225-8. View

19.

Clement M, Harvey B, Rabi D, Roscoe R, Sherifali D . Organization of diabetes care. Can J Diabetes. 2013; 37 Suppl 1:S20-5. DOI: 10.1016/j.jcjd.2013.01.014. View

20.

Al-Rubeaan K, Youssef A, Subhani S, Ahmad N, Al-Sharqawi A, Ibrahim H . A Web-based interactive diabetes registry for health care management and planning in Saudi Arabia. J Med Internet Res. 2013; 15(9):e202. PMC: 3786001. DOI: 10.2196/jmir.2722. View