Factors Associated with Poor Hemoglobin A1c Control in Patients with Type 2 Diabetes

Author(s): Salam Alqudah, Anan S. Jarab*, Eman A. Alefishat, Fadia Mayyas, Maher Khdour, Sharrel Pinto.

Journal Name: Current Diabetes Reviews

Volume 15 , Issue 2 , 2019

Become EABM
Become Reviewer


Background: The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan.

Objective: To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan.

Methods: Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and healthrelated quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c.

Results: Medication adherence was inversely associated with HbA1c values (β = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (β = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (β = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (β = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values.

Conclusion: Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes.

Keywords: Type 2 diabetes, HbA1c, glycemic control, adherence, clinical pharmacy, Jordan.

Edition, IDF Diabetes Atlas Seventh. (2015). "Electronic resource." Available from: https: //www. idf. org/idf-diabetes-atlas seventhedition.
Ajlouni K, Jaddou H, Batieha A. Diabetes and impaired glucose tolerance in Jordan: Prevalence and associated risk factors. J Intern Med 1998; 244(4): 317-23.
World Health Organization. Noncommunicable diseases: Country profiles. 2011. ISBN: 9789241502283..
Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications 2010; 24: 84-9.
Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. BMJ 2000; 321(7258): 405-12.
American Diabetes Association. Diabetes Care 2016; 39 (Suppl 1): S39-S46. Available from: https: //doi.org/10.2337/dc16-S008.
Fox CS, Coady S, Sorlie PD, et al. Increasing cardiovascular disease burden due to diabetes mellitus: The Framingham Heart Study. Circulation 2007; 115: 1544-50.
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229-34.
Ross SA. Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes. Am J Med 2013; 126(9)(Suppl. 1): S38-48.
Aronson R, Orzech N, Ye C, Brown RE, Goldenberg R, Brown V. Specialist-Led diabetes registries and prevalence of poor glycemic control in type 2 diabetes: the diabetes registry outcomes project for HBA1C reduction (DROP HBA1C). Diabetes Care 2016; 39(10): 1711-7.
Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. JMCP 2012; 18(7): 516-26.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24(1): 67-74.
Speight J, Bradley C. The ADKnowl: Identifying knowledge deficits in diabetes care. Diabet Med 2001; 18(8): 626-33.
Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes selfcare activities measure: results from 7 studies and a revised scale. Diabetes Care 2000; 23(7): 943-50.
EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990; 16(3): 199-208.
Sakamaki H, Ikeda S, Ikegami N, et al. Measurement of HRQL using EQ-5D in patients with type 2 diabetes mellitus in Japan. Value Health 2006; 9(1): 47-53.
Field A. Discovering statistics using SPSS 3rd ed 2009; London: Sage ISBN: 978-1-84787907-3
Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004; 291: 335-42.
Vivian EM. The pharmacist’s role in maintaining adherence to insulin therapy in type 2 diabetes mellitus. Consult Pharm 2007; 22(4): 320-32.
Joel M, John D, Mohan M. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care 2002; 25(6): 1015-21.
Krass I, Susan J, Carlene ST, Armour CL. Impact on medication use and adherence of Australian Pharmacists’ diabetes care services. J Am Pharm Assoc 2005; 45: 33-40.
Lerman I. Adherence to treatment: the key for avoiding long-term complications of diabetes. Arch Med Res 2005; 26(3): 300-6.
Kim KJ, Choi JH, Kim KJ, et al. Diabetes. determinants of long-term durable glycemic control in new-onset type 2 diabetes mellitus. Metab J 2017; 1(4): 284-95.
Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006–2009. Prev Chronic Dis 2012; 9: 1-10.
Haffner S, Hazuda H, Stern M. Effect of socio-economic status on hyperglycemia and retinopathy levels in Mexican Americans with NIDDM. Diabetes Care 1989; 12(2): 128-34.
Kamuhabwa AR, Charles E. Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam. Drug Healthc Patient Saf 2014; 24(6): 155-65.
Jarab AS, Almrayat R, Alqudah S, et al. Predictors of non-adherence to pharmacotherapy in patients with type 2 diabetes. Int J Clin Pharm 2014; 36(4): 725-33.
Marcum ZA, Gellad WF. Medication adherence to multi-drug regimens. Clin Geriatr Med 2012; May 28(2): 287-300.
Ufuoma C, Godwin YD, Kester AD, Ngozi JC. Determinants of glycemic control among persons with type 2 diabetes mellitus in Niger Delta. Sahel Med J 2016; 19(4): 190-5.
Pamungkas RA, Hadijah St. Andi Mayasari A, Nusdin. Factors associated with poor glycemic control among type 2 diabetes mellitus in Indonesia. BNJ 2017; 3(3): 272-80.
Glasgow RE, Toobert DJ, Gillette CD. Psychological barriers to diabetes self management and quality of life. Diabetes Spectr 2001; 14(1): 33-41.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care (2005e); 28: S4-S36..
American Diabetes Association. Standards of medical care in diabetes Diabetes Care (2006a); 29: S4-S42..
Lee VW, Leung PY. Glycemic control and medication compliance in diabetic patients in a pharmacist-managed clinic in Hong Kong. Am J Health Syst Pharm 2003; 60(24): 2593-6.
Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care 2002; 25(6): 1015-21.
Krapek K, King K, Warren S, et al. Medication adherence and associated Hemoglobin HbA1c in type 2 diabetes. Ann Pharmacother 2004; 38(9): 1357-62.
Pladevall M, Williams L, Potts L, Divine G, Xi H, Lefata JE. Clinical outcomes and adherence to medications measured by claims data in patients with diabetes. Diabetes Care 2004; 27: 2800-5.
Rhee M, Slocum W, Ziemer D, et al. Patient adherence improves glycaemic control. Diabetes Educ 2005; 31: 240-50.
Lin LK, Sun Y, Heng BH, Chew DEK, Chong PN. Medication adherence and glycemic control among newly diagnosed diabetes patients BMJ Open Diabetes Res Care 2017; 31; 5(1).
Mosen DM, Glauber H, Stoneburner AB, Feldstein AC. Assessing the association between medication adherence and glycemic control. Am J Pharm Benefits 2017; 9(3): 82-8.
Glasgow RE, McCaul KD, Schafer LC. Self-care behaviours and glycaemic control in Type I diabetes. J Chronic Dis 1987; 40(5): 399-412.
Wooldridege K, Wallston K, Graber A. The relationship between health beliefs, adherence, and metabolic control of diabetes. Diabetes Educ 1992; 18(6): 495-500.
Howteerakul N, Rittichu S, Rawdaree P. Adherence to regimens and glycaemic control of patients with type 2 diabetes. Asia Pac J Public Health 2007; 19: 43-9.
George CF, Peveler RC, Heiliger S, Thompson C. Compliance with tricyclic antidepressants: the value of four different methods of assessment. Br J Clin Pharmacol 2000; 50(2): 166-71.
Patel RP, Taylor SD. Factors affecting medication adherence in hypertensive patients. Ann Pharmacother 2002; 36(1): 40-5.
Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and\ evaluation of the adherence to refills and medications scale (ARMS) among low literacy patients with chronic disease. Value Health 2009; 12(1): 118-23.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [164 - 170]
Pages: 7
DOI: 10.2174/1573399814666180510144858
Price: $65

Article Metrics

PDF: 27