Diabetes is a complex, chronic illness that requires continuous medical care to reach target glycaemic level in order to prevent acute and chronic complications. Poorly managed diabetes leads to serious complications that include: loss of vision, kidney disease, nerve damage, peripheral circulatory disorders, stroke, heart disease and other complications, and premature death. Improving glycaemic control is a high priority in decreasing burden of diabetes and delaying complications [1, 2].
Diabetes is an important public health problem, one of the four priority non-communicable diseases (NCDs) targeted for action by world leaders in the 2011 Political Declaration on the Prevention and Control of NCDs, including cardiovascular diseases, cancers and chronic respiratory diseases. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The prevalence is growing most rapidly in low- and middle-income countries [3, 4]. According to IDF Diabetes Atlas 2017, in Ethiopia, prevalence of diabetes in adults was 5.2%, total cases of adults with diabetes were 2,567,900, number of diabetes related deaths in adults was 30,972, cost per person with diabetes was 551 USD and number of cases of diabetes in adults that are undiagnosed was 1,960,300. Ethiopia is also projected to have 14.1 million people with Impaired Glucose Tolerance (IGT) in the year 2045 which will make the country among the top ten countries worldwide [5, 6].
A systematic review of literatures conducted in low- and higher-income countries from 2011–2015 shows that glycaemic control is suboptimal in majority (40%-60%) of people with diabetes. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type2 diabetes, leaving these patients at increased and avoidable risk of serious complications. Similarly, a systematic review of literatures among type 2 diabetes patients in Arabian Gulf council countries shows poor glycaemic control .
A study conducted in Uganda shows that 73.5% of the participants has suboptimal glycaemic control and metformin monotherapy and insulin therapy were found to be major predictors . Similarly, a study conducted at Mathari national teaching hospital in Kenya shows that level of poor glycaemic control among Type 2 DM patients was 81.6% and being female, having high FBS and using drugs for other co-morbid illness were factors significantly associated with poor glycaemic control .
Studies regarding diabetes control level have been conducted among different regions of Ethiopia. A study conducted in Suhul Hospital, Northwest Tigray, shows that level of poor glycaemic control was 63.5%. Moderate physical exercise, taking meal prescribed by their physician appropriately and medication adherence were factors associated with good glycaemic control . This study is consistent with studies reported from Yekatit 12 hospital (Addis Ababa) and Limmu Genet hospital, showing level of poor glycaemic control of 69.7% and 63.8% respectively [12, 13]. In addition, a study conducted at Shana Gibe hospital among Type 2 DM patients shows that level of poor glycaemic control was 59.2% and significant factors were female sex, educational level, duration of diabetes treatment and adherence to follow up .
Similarly, a study conducted in Gondar shows that level of poor glycaemic control was 64.7% and significant predictors were being Type 1 DM patient, being on insulin treatment and poor medication adherence. Also, a study conducted in Jimma shows that level of poor glycaemic control was 70.9% and being illiterate, farmer, taking combination of insulin and oral medication and poor medication adherence to be factors associated with poor glycaemic control [15, 16]. A study conducted at Tikur Anbessa Specialized hospital among Type 2 DM patients attending diabetes clinic also shows high level of poor glycaemic control (80.0%) and significant factors were longer duration of diabetes and being on insulin treatment .
Majority of these studies considered observation duration of 2–4 months and a few studies for about a year. But all of these studies measured glycaemic control for all patients together irrespective of the duration of diagnosis and initiation of treatment.
Diabetes is a chronic disease and as patients develop the disease at different times, they could also achieve optimal glycaemic control at different times. The time when they achieve target glucose level is an important component of follow up that predicts short and long term complications and death than just measuring magnitude of glycaemic control at one point in time . Therefore, measurement of glycaemic control should be made in consideration of the time since diagnosis and initiation of treatment. Such kind of measurement will help clinicians to know if patients are achieving target in a reasonable amount of time or not.
In this study, we tried to address this issue by reviewing medical charts of newly diagnosed T2DM patients who received care within five years prior to the study with the aim of assessing achievement of optimal glycaemic control at different point in time and identifying associated factors among T2DM patients attending diabetes clinic of public teaching hospitals in Addis Ababa, Ethiopia.