TY - JOUR
T1 - Factors affecting achievement of glycemic targets among type 2 diabetes patients in South Asia
T2 - Analysis of the CARRS trial
AU - On behalf of the CARRS Trial Group
AU - Masood, Muhammad Q.
AU - Singh, Kavita
AU - Kondal, Dimple
AU - Ali, Mohammed K.
AU - Mawani, Minaz
AU - Devarajan, Raji
AU - Menon, Usha
AU - Varthakavi, Premlata
AU - Viswanathan, Vijay
AU - Dharmalingam, Mala
AU - Bantwal, Ganapathi
AU - Sahay, Rakesh
AU - Khadgawat, Rajesh
AU - Desai, Ankush
AU - Prabhakaran, Dorairaj
AU - Narayan, K. M.Venkat
AU - Tandon, Nikhil
N1 - Funding Information:
The CARRS trial was funded in part by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services, under contract number HHSN268200900026C, and by UnitedHealth Group, Minneapolis, Minnesota. Several members of the research team at the Public Health Foundation of India and Emory University were supported by the Fogarty International Clinical Research Scholars and Fellows program through grant number 5R24TW007988 from the National Institutes of Health, Fogarty International Center through Vanderbilt University, Emory Global Health Institute, and D43 NCDs in India Training Program through award number 1D43HD05249 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Fogarty International Center. Dr. Singh is supported by the Fogarty International Center, National Institutes of Health, under award number K43TW 011164. Dr. M K Ali is supported by the National Institute of Mental Health supplemental grant under award number: R01MH100390-04S1.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Glycemic targets
KW - Quality improvement
KW - South Asia
KW - Type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85097709277&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2020.108555
DO - 10.1016/j.diabres.2020.108555
M3 - Article
C2 - 33242515
AN - SCOPUS:85097709277
SN - 0168-8227
VL - 171
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 108555
ER -
