Muhammad Q Masood1, Kavita Singh2, Dimple Kondal3, Mohammed K Ali4, Minaz Mawani5, Raji Devarajan6, Usha Menon7, Premlata Varthakavi8, Vijay Viswanathan9, Mala Dharmalingam10, Ganapathi Bantwal11, Rakesh Sahay12, Rajesh Khadgawat13, Ankush Desai14, Dorairaj Prabhakaran15, K M Venkat Narayan16, Nikhil Tandon17. 1. Aga Khan University, Department of Medicine, Section of Endocrinology and Diabetes, Stadium Road, Karachi 74800, Pakistan. Electronic address: qamar.masood@aku.edu. 2. Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, India. Electronic address: kavita@ccdcindia.org. 3. Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, India. Electronic address: Dimple.kondal@phfi.org. 4. Emory University, Rollins School of Public Health, 1518 Clifton Road, Rm CNR 701, Atlanta, GA 30322, USA. Electronic address: mkali@emory.edu. 5. Aga Khan University, Department of Medicine, Section of Endocrinology and Diabetes, Stadium Road, Karachi 74800, Pakistan. Electronic address: meenazmawani@yahoo.com. 6. Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, USA. Electronic address: raji@ccdcindia.org. 7. Amrita Institute of Medical Sciences, Department of Endocrinology & Diabetes, AIMS Ponekkara P.O., Kochi 682 041, Kerala, India. Electronic address: ushamenon@aims.amrita.edu. 8. TNM College & BYL Nair Charity Hospital, Department of Endocrinology, Dr. A. L. Nair Road, Mumbai Central, Mumbai 400 008, Maharashtra, India. Electronic address: premavar@hotmail.com. 9. MV Hospital for Diabetes & Diabetes Research Centre, No 4, West Madha Church Street, Royapuram, Chennai 600 013, Tamil Nadu, India. Electronic address: vijayviswanathan92@gmail.com. 10. Bangalore Endocrinology & Diabetes Research Centre, #35, 5th Cross, Malleswaram Circle, Bangalore 560 003, Karantaka, India. Electronic address: drmaladharmalingam@gmail.com. 11. St. John's Medical College & Hospital, Department of Endocrinology, Sarjapur Road, Koramangala, Bangalore 560 034, Karantaka, India. Electronic address: mallyaganapathi70@gmail.com. 12. Osmania General Hospital, Department of Endocrinology, 2nd Floor, Golden Jubilee Block, Afzalgunj, Hyderabad 500 012, Telangana, India. Electronic address: sahayrk@gmail.com. 13. All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Ansari Nagar, New Delhi 110 029, India. Electronic address: rajeshkhadgawat@hotmail.com. 14. Goa Medical College, Endocrine Unit, Department of Medicine, Bambolim, Goa 403202, India. Electronic address: ankush_desai@rediffmail.com. 15. Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon 122 002, Haryana, India. Electronic address: dprabhakaran@ccdcindia.org. 16. Emory University, Rollins School of Public Health, 1518 Clifton Road, Rm CNR 7049, Atlanta, GA 30322, USA. Electronic address: KNARAYA@emory.edu. 17. All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India. Electronic address: nikhil_tandon@hotmail.com.
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.
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.
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