Factors that influence glycaemic control in diabetes mellitus: A case study of Kenyatta National Hospital
Ochieng, Edwina A.
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Data from Kenyatta National Hospital indicated that 50% of all diabetic patients attending the outpatient diabetic clinic recorded random blood glucose levels of over 10 mmol/1. These patients were thus predisposed to suffer from complications of the disorder. Lowering blood glucose levels towards normal decreases the risk of developing some chronic complications of diabetes. The purpose of this descriptive cross-sectional survey was therefore to investigate factors that influence glycaemic control levels of diabetic patients who attended the outpatient diabetic clinic at Kenyatta National Hospital. The variables considered in this study were therapies used; duration patients have suffered from diabetes, diet and weight status. Data were collected using three interview schedules. A hundred patients who had attended then clinic at least thrice prior to the study period, two Nutritionists and one Doctor from the diabetic clinic were surveyed. Data were analyzed using the statistical package of social sciences. The statistics employed were Chi-square, Pearson's correlation, Independent t-test, linear regression and logistic regression. Descriptive statistics namely frequencies. mean and percentages were used to describe characteristics of patients. The anthropometric data were analyzed using the cut-off points for Body Mass Index of 20 - 24.9 and the biochemical data through the recommended cut off points for random blood sugar level of 4 - 10 mmol/1. Results of the study showed no significant differences in blood sugar levels of male and female patients (P = 0.85). There were also no significant differences in body mass index of male and female patients (P = 0.39). however there were significant differences in the blood sugar levels but not the body mass indices of insulin dependent diabetes and non-insulin diabetics (P = 0.013) and (P = 0.57) respectively. Glycaemic control and Body Mass Index were most affected by the use of Insulin and type used but not number of times per day used (P = 0.05) and (P = 0.00) respectively. Patients on diet alone reported the best glycaemic control levels followed by those on diet and oral hypoglycemic agents. Patients on diet alone were 0.1 times less likely to report poor blood sugar levels compared to those on diet, insulin and oral hypoglycaemic agents. There were significant differences in blood sugar levels of patients with various Body Mass Index and those who engaged in varied levels of physical activities (P = 0.004). The poorer the weight control was, the poorer the glycaemic control was. There were however no significant differences in Body Mass Index of patients who engaged in various levels of physical activities. Results also showed no significant difference in blood sugar levels of patients who had suffered from the disorder for different durations (P = 0.67) (r = 0.18). However from the cross-tabs, it was concluded that the longer patients had suffered from diabetes, the poorer the blood sugar levels were. Generally, the calorie intake of patients was significantly related to glycaemic control levels and Body Mass Index (P = 0.03) and (P = 0.01) respectively. The intake of calories had a strong positive relationship with glycaemic control levels of patients (r =0.787). Patients generally adhered to their dietary recommendations. From this study it was concluded that the type of diabetes, therapy patients used in managing their conditions, patient's Body Mass Index and the calorie intake influenced their glycaemic control levels. It was therefore recommended that in counseling the patients, these factors should be taken into consideration and counseling tailored to meet each patient's characteristics in this regard.