Evaluation of Blood Glycaemia Control and Related Factors in Patients with Type 2 Diabetes Mellitus Using Generalized Estimator Equations (GEE) Model

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Department of Epidemiology and Biostatistics, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background: Qualified care and decreased blood sugar can prevent or suspend the side effects in patients with type 2 diabetes mellitus. The present study aimed to determine the state of glycemic control and related factors in patients with type 2 diabetes mellitus in the post-diagnosis care period using generalized estimator equations (GEE) model.Methods: In this historical cohort study, data from 500 patients with type 2 diabetes mellitus that were under care in health centers in Golestan Province, Iran, were collected for three years (2013-2014). For each individual, the biological markers [fasting blood sugar, non-fasting blood sugar, and glycated hemoglobin (HbA1c)] outside the standard cut-point were counted as the response variable (called the "count of abnormal markers"). This variable could have numbers from zero to three. A higher number indicated less glycemic control.Findings: The mean age of the patients was 45.2 years, and 58.8% were women. The "count of abnormal markers" variable had a very slow downward trend over three years. The results of the model showed that associated significant factors with increasing "count of abnormal markers" included short duration of care (b = 0.77), no family history of diabetes (b = 0.47), low age of diagnosis (b = -0.06), obese-overweight (b = 0.03), having a history of hyperlipidemia (b = 0.31), and having insulin therapy (b = 0.24).Conclusion: According to the results, glycemic control does not show the desired condition, and in addition to continuous care and more strictness of patients, their weight, blood lipids, and insulin treatment should be controlled as well.

Keywords

References

  1. American Diabetes Association. Standards of Medical Care in Diabetes-2018 Abridged for Primary Care Providers. Clin Diabetes 2018; 36(1): 14-37.
  2. Griffin SJ, Borch-Johnsen K, Davies MJ, Khunti K, Rutten GE, Sandbaek A, et al. Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): A cluster-randomised trial. Lancet 2011; 378(9786): 156-67.
  3. Flores-Hernandez S, Saturno-Hernandez PJ, Reyes-Morales H, Barrientos-Gutierrez T, Villalpando S, Hernandez-Avila M. Quality of diabetes care: The challenges of an increasing epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012). PLoS One 2015; 10(7): e0133958.
  4. Szabo SM, Osenenko KM, Qatami L, Korenblat Donato BM, Korol EE, Al Madani AA, et al. Quality of care for patients with type 2 diabetes mellitus in Dubai: A HEDIS-Like Assessment. Int J Endocrinol 2015; 2015: 413276.
  5. Ferrari A, Comelli M. A comparison of methods for the analysis of binomial clustered outcomes in behavioral research. J Neurosci Methods 2016; 274: 131-40.
  6. Fitzmaurice GM, Laird NM, Ware JH. Applied Longitudinal Analysis. Hoboken, NJ: Wiley; 2011.
  7. Wu H, Zhang Y, Long JD. Longitudinal beta-binomial modeling using GEE for overdispersed binomial data. Statist Med 2017; 36(6): 1029-40.
  8. Ministry of Health and Medical Education. Country Disease Prevention and Control Program. Tehran, Iran: Ministry of Health and Medical Education; 2005. [In Persian].
  9. Li J, Chattopadhyay K, Xu M, Chen Y, Hu F, Chu J, et al. Glycaemic control in type 2 diabetes patients and its predictors: a retrospective database study at a tertiary care diabetes centre in Ningbo, China. BMJ Open 2018; 8(3): e019697.
  10. Moreira ED, Neves RC, Nunes ZO, de Almeida MC, Mendes AB, Fittipaldi JA, et al. Glycemic control and its correlates in patients with diabetes in Venezuela: Results from a nationwide survey. Diabetes Res Clin Pract 2010; 87(3): 407-14.
  11. Kayar Y, Ilhan A, Kayar NB, Unver N, Coban G, Ekinci I, et al. Relationship between the poor glycemic control and risk factors, life style and complications. Biomed Res 2017; 28(4): 1581-6.
  12. Ashur ST, Shah SA, Bosseri S, Fah TS, Shamsuddin K. Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: A clinic-based study in Tripoli, Libya. Libyan J Med 2016; 11: 31086.
  13. Khunti K, Ceriello A, Cos X, De BC. Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis. Diabetes Res Clin Pract 2018; 137: 137-48.
  14. Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358(24): 2545-59.
  15. Camilo DF, Vasques ACJ, Hayashi K, Tura A, da Silva CC, Zambon MP, et al. Adiposity and family history of type 2 diabetes in an admixed population of adolescents: Associations with insulin sensitivity, beta-cell function, and hepatic insulin extraction in BRAMS study. Diabetes Res Clin Pract 2018; 137: 72-82.
  16. American Diabetes Association. 7. Obesity management for the treatment of type 2 diabetes. Diabetes Care 2017; 40(Suppl 1): S57-S63.
  17. Lind M, Tuomilehto J, Uusitupa M, Nerman O, Eriksson J, Ilanne-Parikka P, et al. The association between HbA1c, fasting glucose, 1-hour glucose and 2-hour glucose during an oral glucose tolerance test and cardiovascular disease in individuals with elevated risk for diabetes. PLoS One 2014; 9(10): e109506.
  18. Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol 2018; 6(1): 69-80
Journal of Isfahan Medical School
Volume 38, Issue 576 - Serial Number 576
March and April 2020
Pages 347-353

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History

  • Receive Date: 11 April 2020
  • Revise Date: 25 May 2024
  • Accept Date: 06 April 2022

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