Glycemic control and its correlates in patients with diabetes in Venezuela: Results from a nationwide survey

doi:10.1016/j.diabres.2009.12.014

Diabetes Research and Clinical Practice

Volume 87, Issue 3, March 2010, Pages 407-414

https://doi.org/10.1016/j.diabres.2009.12.014 Get rights and content

Abstract

Aims

To determine the prevalence of inadequate glycemic control and its correlates in a large multicenter survey of Venezuelan patients with diabetes.

Methods

A cross-sectional study in a sample of adult patients with diabetes, attending health centers in Venezuela. Information about diabetes, current medications, complications, and diet were obtained by trained interviewers, using a standardized questionnaire. HbA_1c was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA_1c ≥ 7% were considered to have inadequate glycemic control.

Results

Overall 4075 patients were surveyed, 349(8.6%) with type 1 diabetes (T1D) and 3726(91.4%) with type 2 diabetes(T2D). Subjects’ mean age was 58 years, and 65% were female. The prevalence of inadequate glycemic control was 76%. Poor glycemic control was more common in T1D patients (87%) than in those with T2D(75%), p < 10⁻⁴. Satisfaction with current diabetes treatment was associated with improved glycemic control among non-insulin-treated patients with T2D, but gender, multi-professional care, and participation in a diabetes education program were not.

Conclusions

Despite clinical evidence supporting tight control of diabetes, few diabetic patients in Venezuela met recommended glycemic control targets. This may contribute to increased rates of diabetic complications. Our findings support the public health message of implementation of early, aggressive management of diabetes.

Introduction

The prevalence of diabetes is increasing due, among other reasons, to diet changes, aging, urbanization, and increasing prevalence of obesity and physical inactivity. In 2000, the World Health Organization indicated there were ∼170 million people with diabetes, and estimated that the number of cases of the disease worldwide will have more than doubled to 366 million by 2030 [1]. In the Americas, the number of diabetes cases will change from 33 million to 66.8 million in the same period [1]. Diabetes is associated with serious long-term complications including microvascular and macrovascular disease, which impose an additional socio-economic burden and account for substantial healthcare costs [2], [3].

Improved glycemic control in people with diabetes reduces the risk of long-term complications. The Diabetes Control and Complications Trial [4] and the United Kingdom Prospective Diabetes Study [5] have provided evidence for the benefits of tight and sustained glycemic control among type 1 and 2 diabetic patients. These and other studies emphasized the central role of consistently managing HbA_1c levels in patients with diabetes, as a result some professional associations proposed clinical guidelines in the range of 6.5–7.0% to motivate health professionals and patients to constantly manage blood glucose levels [6], [7]. Despite the numerous advances achieved in diabetes control and evaluation, the management of such a complex disease remains challenging. Recent epidemiological data from various international regions show most patients with diabetes are not controlled to recommended HbA_1c targets [8], [9], [10], [11], [12], [13], [14], [15], [16].

There is scarce and limited data about the epidemiology of diabetes in Venezuela. Estimates of the prevalence of diabetes in the urban Venezuelan population range from 3.8 to 7.3%, and there is evidence that it is increasing [17]. Information on the metabolic control of patients with diabetes is essential for planning programs on diabetes management. Our goal in this study was to estimate the prevalence of inadequate glycemic control and its correlates in a large multicenter survey of adult patients with diabetes in Venezuela.

Section snippets

Setting and participants

This was a cross-sectional and nationwide survey conducted from January to June 2007 in ambulatory and medical services for type 1 and/or type 2 diabetes patients in all but two regions in Venezuela (excluded because of low population density). The study was center based, given that it was not feasible to contact patients directly, and designed to obtain detailed information in the largest possible sample of diabetic adults in Venezuela. For the selection of diabetes centers, we asked two

Results

Overall 4075 patients were included in this survey, 349 (8.6%) with type 1 and 3726 (91.4%) with type 2 diabetes. Table 1 depicts the characteristics of the study participants. The age varied from 18 to 93 years, approximately 45% of the patients with type 1 diabetes were less than 40 years old, while the majority of the patients with type 2 diabetes (96%) were aged 40 years or older. Most of the survey participants were females, married or living with partner, and had attained primary school

Discussion

To our knowledge, this is the largest multicenter, nationwide survey to estimate prevalence rates of inadequate glycemic control in Venezuela, and the first to evaluate these rates in patients with type 1 or type 2 diabetes. The overall prevalence of inadequate glycemic control in our study (76%) was high, and greater than previous estimates from other studies including type 1 and 2 diabetic patients in Germany (40%) [12], Denmark (51%) [13] and Kenya (61%) [14].

The highest rates of inadequate

Conflict of interest

Edson D. Moreira Jr. is a consultant for Pfizer Inc.; Raimundo C.S. Neves has no conflicts of interest; Zaira O. Nunes has no conflicts of interest; Maria C.C. de Almeida has no conflicts of interest; Ana B.V. Mendes is an employee of Pfizer Inc. (at the time the study was conducted); João A.S. Fittipaldi is an employee and stock owner of Pfizer Inc.; Franklin Ablan has no conflicts of interest.

Acknowledgements

The authors wish to thank all the team members for their valuable participation in the blood samples collection, patient interviews and performance of HbA_1c tests. We also thank the Venezuelan Endocrinology Society and La Federación Nacional de Asociaciones y Unidades de Diabetes (FENADIABETES), for their support during the development of the study. We are in debt with Dr. Carmen Martínez for her assistance in planning the logistics and the data quality monitoring. The study was supported by an

References (33)

M. Kobayashi et al.
The status of diabetes control and antidiabetic drug therapy in Japan—a cross-sectional survey of 17,000 patients with diabetes mellitus (JDDM 1)
Diabetes Res. Clin. Pract.
(2006)
K.M. Fox et al.
Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: a series of retrospective analyses of data from 1998 through 2002
Clin. Ther.
(2006)
A. Ben Abdelaziz et al.
Predictive factors of glycemic control in patients with type 2 diabetes mellitus in primary health care
Rev. Epidemiol. Sante Publique
(2006)
S.B. Harris et al.
Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study)
Diabetes Res. Clin. Pract.
(2005)
K. Arai et al.
The status of glycemic control by general practitioners and specialists for diabetes in Japan: a cross-sectional survey of 15,652 patients with diabetes mellitus
Diabetes Res. Clin. Pract.
(2009)
M.C. Leinung et al.
Comparison of diabetes care provided by an endocrinology clinic and a primary-care clinic
Endocr. Pract.
(2000)
H. Ishii et al.
Improvement of glycemic control and quality-of-life by insulin lispro therapy: assessing benefits by ITR-QOL questionnaires
Diabetes Res. Clin. Pract.
(2008)
S. Wild et al.
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030
Diabetes Care
(2004)
D. Yach et al.
Epidemiologic and economic consequences of the global epidemics of obesity and diabetes
Nat. Med.
(2006)
K.M. Narayan et al.
Diabetes—a common, growing, serious, costly, and potentially preventable public health problem
Diabetes Res. Clin. Pract.
(2000)

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

N. Engl. J. Med.

(1993)

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

Lancet

(1998)

Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications...

American College of Endocrinology consensus statement on guidelines for glycemic control

Endocr. Pract.

(2002)

S.H. Saydah et al.

Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes

JAMA

(2004)

N.C. Yu et al.

ABC control of diabetes: survey data from National Diabetes Health Promotion Centers in Taiwan

Diabetes Res. Clin. Pract.

(2009)

Cited by (47)

The prevalence of glycemic control in patients with type 2 diabetes treated with insulin: a systematic review and meta-analysis
2023, Public Health
To estimate the overall prevalence of glycemic control among patients with type 2 diabetes (T2D) treated with insulin.
Systematic review and meta-analysis.
A systematic search was performed in PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from 2000 to January 2022. Cross-sectional studies were included if they were conducted on more than 292 patients with T2D and reported the number of insulin-treated patients who were justified as achieving glycemic control. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the included studies. Pooled estimates of the prevalence of glycemic control were calculated and reported with a 95% confidence interval (95% CI) using a random-effects model. All analyses were conducted using RStudio Version 2022.02.0, Build 443 (meta package).
A total of 42 studies (234,345 patients) met the inclusion criteria and were classified as having a low risk of bias. The overall estimated prevalence of glycemic control to insulin therapy among patients with T2D was 26.02% (95% CI: 23.17, 29.08). A subgroup of 34 studies that set the target HbA1c <7% showed that 23.75% (95% CI: 21.47, 26.18) of patients with T2D treated with insulin were justified as achieving good glycemic control.
This study provided summative evidence that glycemic control among patients with T2D treated with insulin was suboptimal and should be appropriately addressed.
Glycemic control, treatment and complications in patients with type 1 diabetes amongst healthcare settings in Mexico
2021, Diabetes Research and Clinical Practice
Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1).
Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up.
We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p < 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control.
Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.
Flexible nanosensors for non-invasive creatinine detection based on triboelectric nanogenerator and enzymatic reaction
2021, Sensors and Actuators, A: Physical
Citation Excerpt :
All of the experiments were performed at atmospheric pressure (1.01 × 105 Pa) and room temperature unless otherwise stated. Creatinine content in human blood and urine not only reflects the functional conditions of important internal organs such as kidney and thyroid but also serves as an important index for monitoring of diabetic nephropathy to a certain extent [39,40]. Non-invasive and continuous analysis of creatinine is of great significance in human life.
A creatinine nanosensor has been developed by PANI (polyaniline) and PDMS (polydimethylsiloxane). The mechanism is attributed to the coupling of the triboelectric nanogenerator (TENG) and the creatinine enzymatic reaction. After enzymatic modification, the triboelectric output from PANI and PDMS carries the information of the ambient creatinine concentration, which is due to the change of PANI electroconductivity in the enzymatic reactions. The nanosensors demonstrate high sensitivity at room temperature. The response reaches 51.42 % when creatinine concentration is 10⁻³ mol/L. Meanwhile, its good selectivity to creatinine is demonstrated compared with NaCl, glucose, and urea. The nanosensor also supports large flexibility in bending angle measurements (10°–40°), thereby potentially allowing creatinine detection in wearable sensing applications. Experimental results show that the flexible nanosensor can offer continuous and non-invasive detection of creatinine, paving the way for electronic skin and self-powered healthcare systems.
Evaluation of glycemic control status and its associated factors among diabetes patients on follow-up at referral hospitals of Northwest Ethiopia: A cross-sectional study, 2020
2020, Heliyon
Citation Excerpt :
In addition, suboptimal glycemic control is significantly higher in type I diabetic patients as compared to patients with type II diabetes. This is in line with similar studies [44, 45, 46]. Adherence to oral hypoglycemic agents might be more than adherence to insulin self-injection because of different factors.
Diabetes mellitus is one of the rapidly growing global health concerns of the twenty-first century ravaging millions of individuals from all across the world. The aim of this study is to evaluate glycemic control status and its associated factors among diabetes patients on follow-up at referral hospitals of Northwest Ethiopia.
A cross-sectional study was conducted among diabetes patients between February and June 2020. Four hundred twenty-three randomly selected adult patients were enrolled. Using standardized questionnaire, sociodemographic, behavioral and clinical data were collected. Lipid profiles, fasting blood sugar, glycated hemoglobin, and anthropometric indicators were determined. Bivariate and multivariate binary logistic regression analysis was performed.
The magnitude of suboptimal glycemic control was 73.5% (95% CI: 69.29%, 77.71%) among diabetic patients. Marital status [AOR (95% CI) 0.45 (0.20, 0.99), p < 0.05], medication non-adherence [poor: AOR (95% CI) 3.55 (1.81, 6.98)], duration with diabetes mellitus [AOR (95% CI) 3.16 (1.89, 5.28), p < 0.05], type of diabetes (type II referent) [AOR (95% CI) 2.53 (1.47,4.37), p < 0.05], and no use of other drugs [AOR (95% CI) 1.76 (1.05,2.96), p < 0.05] were significantly associated with suboptimal glycemic control.
A considerable number of patients with diabetes had suboptimal glycemic control. The suboptimal glycemic control has been contributed by marital status, medication non-adherence, duration with diabetes mellitus, type of diabetes and use of other drugs. These highlights the need for tailored management focusing on the identified associated factors to maintain good glycemic control.
Predictors of poor glycemic control and level of glycemic control among diabetic patients in west Ethiopia
2020, Annals of Medicine and Surgery
Citation Excerpt :
The present study also showed that the proportion of poor glycemic control was higher among type 1 DM patients (62.5%) than type 2 DM patients (54.8%). This is consistent with studies done at the University of Gondar referral hospital [22,28], Saudi Arabia [51] and Venezuela [52]. The reason could be because of the inappropriate use of insulin by the patients for the treatment of type 1 DM.
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. This study aims to assess the level of glycemic control and factors contributing to uncontrolled glycemia among diabetic patients at the Nekemte Referral Hospital, West Ethiopia.
A cross sectional study was conducted on diabetic patients attending the diabetes clinic of Nekemte Referral Hospital. A total of 252 study participants were included in the study. Data were collected by interviewing patients during hospital visits and reviewing respective databases. The association between dependent and independent variables was assessed using bivariable and stepwise multivariable logistic regression. A variable with a p-value < 0.05 was considered as an independent predictor. A patient's written informed consent was obtained after explaining the purpose and procedures of the study.
Mean age of the participants was 41.7 ± 17.6 years. The majority of the participants (67.1%) had poor knowledge about diabetes. The glycemic rate control was 40.5%; while more than half of the participants (59.5%) had poor glycemic control. On multivariable logistic analysis poor glycemic control was more likely to occur among unemployed (p < 0.001), patients with no family/social support (p = 0.024), duration of diabetes >10 years (p = 0.005), poor knowledge about diabetes (p = 0.012), taking insulin (p = 0.004) and taking metformin plus glibenclamide (p < 0.001).
A finding of this study revealed that a glycemic control of study participants was poor. Thus greater effort is needed to improve glycemic control. Health care professionals should work on improving the adherence to anti-diabetic medications of diabetic patients and knowledge of diabetic patients on diabetes by providing education to the patients during follow up to improve glycemic control.
Prevalence of diabetes in three regions of Venezuela. The VEMSOLS study results
2018, Primary Care Diabetes
The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela.
During 2006–2010, 1334 subjects ≥20 years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software.
Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%–10.0%), higher in men than women (11.2% and 7.0% respectively; p = 0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%–9.9%). This figure increased with age, with the lowest prevalence in the 20–29 year old group (1.8% [95% CI, 0.6%–4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%–40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%–2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%–16.7%), and only 48.2% were aware of their diabetes condition.
In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.

View all citing articles on Scopus

¹: The following is a list of co-authors, the members of the Venezuelan Diabetes Investigators’ Group: Alecia Nass, MD; Amílcar Schwazemberg, MD; Ana Herrera, MD; Ana Pereira, MD; Aníbal Rocheta, MD; Coromoto García, MD; Cruz Rodríguez, MD; Daniel Marante, MD; Elizabeth Moreira, MD; Elsy Velasquez, MD; Evelin Martínez, MD; Francesca Paone, MD; Gavis Palmucci, MD; Humberto Valbuena, MD; Irene Stulin, MD; Isis Campos, MSc; Khaled Souky, MD; Luís Ernesto Jaimes, MD; Maigualida de Aliton, MD; Maria E. Bolívar, MD; Maria I. Marulanda, MD; Maria Suniaga, MD; Mariela Simancas, MD; Miguel A. Padrón, MD; Nilda Avendaño, MD; Orlando Rodríguez, MD; Pablo Yustiz, MD; Raúl Caminos, MD; Rita Zambrano, MD; Roberto García, MD; Saúl González, MD; Tomás Toledo, MD; Yaritza Urdaneta, MD; and Zobeida Pereira, MD.

View full text

Glycemic control and its correlates in patients with diabetes in Venezuela: Results from a nationwide survey

Abstract

Aims

Methods

Results

Conclusions

Introduction

Section snippets

Setting and participants

Results

Discussion

Conflict of interest

Acknowledgements

Diabetes Res. Clin. Pract.

Clin. Ther.

Rev. Epidemiol. Sante Publique

Diabetes Res. Clin. Pract.

Diabetes Res. Clin. Pract.

Endocr. Pract.

Diabetes Res. Clin. Pract.

Global prevalence of diabetes: estimates for the year 2000 and projections for 2030

Diabetes Care

Epidemiologic and economic consequences of the global epidemics of obesity and diabetes

Nat. Med.

Diabetes—a common, growing, serious, costly, and potentially preventable public health problem

Diabetes Res. Clin. Pract.

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

N. Engl. J. Med.

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

Lancet

American College of Endocrinology consensus statement on guidelines for glycemic control

Endocr. Pract.

Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes

JAMA

ABC control of diabetes: survey data from National Diabetes Health Promotion Centers in Taiwan

Diabetes Res. Clin. Pract.