TREATMENT OUTCOME AND ITS PREDICTORS AMONG DIABETIC PATIENTS ATTENDING AT SELECTED HOSPITALS OF SOUTHERN ETHIOPIA.

Background Diabetes is one of the most serious health crises of the twenty-first century, with the World Health Organization (WHO) estimating that hyperglycemia is the third leading cause of early death globally, following high blood pressure and cigarette use. It is an important cause of blindness, kidney failure, lower limb amputation and other long-term consequences that impact significantly on quality of life. People get sick, die, and health care costs go up as a result. Objectives Diabetes mellitus treatment outcome and determinants in patients undergoing diabetes treatments in selected hospitals in southern Ethiopia, 2021. Methods A source population included all diabetic patients who attended chosen hospitals in southern Ethiopia. A cross-sectional study with an institutional focus was conducted in a few hospitals in southern Ethiopia. A pre-tested questionnaire was used to collect information about the patient. Following data cleaning and error checking, the data was loaded into Epi-data to eliminate errors before being exported to SPSS for analysis. The descriptive data were presented using tables and graphics. The result variable was evaluated using a logistic regression model to uncover predictors once the underlying assumptions of the regression analysis were verified. All independent variables with p0.25 were considered for multivariate analysis. The level of significance was then set at p0.05, and the final model was AOR with 95% CL. Result 277 (65.6%) of the whole sample had positive treatment outcomes. The existence of complication AOR 95%CI; 0.425 (0.217.832), and elevated fasting blood glucose AOR 95%CI; 0.080 (0.034, 0.188) were revealed to be independent predictors. Given the low size of treatment outcome, providing health information regarding sticking to prescribed medicine and monitoring fasting blood glucose level will result in a positive clinical outcome.


Introduction
Diabetes mellitus is not a single disease entity, but rather a spectrum of metabolic illnesses 57 characterized by hyperglycemia caused by abnormalities in insulin secretion, insulin action, or is to reduce mortality and complications by stabilizing blood glucose levels. However, despite 75 adequate medication, blood glucose levels may rise, leading in problems such as changes in fat 76 metabolism, nerve damage, and eye disease (4, 6). Diabetes is a major cause of blindness, 77 kidney failure, heart attacks, stroke and lower limb amputation (7). 78 Ethiopia is among the top four countries with the highest adult diabetic populations in sub- 79 Saharan Africa. The total country prevalence of diabetes mellitus was 5.2%, the number of 80 people with diabetes was 2,567,900, and the number of people with undiagnosed diabetes was 81  . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 23, 2023. Zα/2 is Z value which is 1.96 at 95% confidence interval, 131 P is the proportion of diabetes patients, which is 0.5, and d is the marginal error, which is 0.05.

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In order to accommodate the broadest range of patients visiting diabetic clinics, the sample size 133 will be 384 at 95% confidence interval and p value of 0.5. Adding 10% non-respondent rate, 134 the final sample size will be 422.  . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
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The copyright holder for this preprint this version posted July 23, 2023. To assure data quality, a well-constructed data collection tool was created, pretested in a 182 hospital that was not chosen to evaluate the instrument's understandability and applicability, 183 and data collectors and supervisors will receive three days of training. On each data 184 collection day, the supervisor and lead investigator examined and confirmed the collected 185 data for completeness. After double-checking the information, it was entered into Epi-data 196 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 23, 2023. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 23, 2023. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 23, 2023.  is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 23, 2023. were found to be poor.

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Sociodemographic factors associated with treatment outcome . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
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The copyright holder for this preprint this version posted July 23, 2023.  Blood glucose level were found to be associated significantly ( See table 6 below).
243 Table 6:-behavioural factors associated with treatment outcome among the respondents at 244 selected hospitals of southern Ethiopia, 2021 (n=422).

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(which was not certified by peer review)
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(which was not certified by peer review)
The copyright holder for this preprint this version posted July 23, 2023.  (11). This could be attributed to . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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The copyright holder for this preprint this version posted July 23, 2023. ; https://doi.org/10.1101/2023.07.19.23292871 doi: medRxiv preprint differences in measuring scales, improved patient treatment outcomes, and research conducted 261 in various health settings in southern Ethiopia. 262 This study also revealed that those who did not adhere to the suggested dietary practices had a 263 7.6% higher AOR; 0.924; 95% (0.869, 0.983) risk of receiving a poor treatment outcome than 264 those who did. As a result, this study revealed that dietary recommendations were closely 265 linked to glycemic control in diabetes patients. The findings of this study are consistent with 266 those of studies conducted in Gulf Cooperation Council countries (12) and Turkey (13), which 267 found that low dietary compliance is significantly related to poor glycemic control, and it was 268 also discovered to be associated independently (9). 269 It is clear that lifestyle changes, such as following the recommended diet, are critical methods 270 for regulating patients' blood sugar levels. As a result, poor adherence to a recommended diet 271 may make blood sugar control more difficult.

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This study also found that individuals who experienced problems had a 57.5% higher AOR; 273 0.425; and 95% (0.217, 0.832) worse treatment outcomes than those who did not.

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Other investigations conducted in Ethiopia's south west tertiary hospitals (15) and Gondar 275 hospital (14) discovered that complications were significantly associated with poor glycemic 276 outcomes.

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Other studies (15) at numerous public hospitals in western Ethiopia found a strong link 278 between the prevalence of complications and poor glycemic control.

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When compared to those with FBS between 60 and 140mg/dl, those with FBS >= 140mg/dl 280 had 8% higher AOR; 0.080; and 95% (0.034,0.188) worse treatment outcomes. It is 281 commonly understood that as an individual's FBS rises, so is the likelihood of a poor 282 treatment outcome.

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The magnitude of treatment outcome was determined to be poor in this study. The study also 285 discovered that dietary practices, the existence of complications, and having FBS greater than 286 140mg/dl all predicted independently.

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Since the magnitude of treatment outcome were found to be low, the health care providers 289 together with the responsible bodies should strengthen to provide toward improvement of 290 factors affecting the patients by inhibiting them not to be in a state of good treatment.

LIMITATION S
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The copyright holder for this preprint this version posted July 23, 2023. College of Medicine and Health Science approved it. After promising secrecy, each study 306 subject provided written informed consent in order for the study to begin. An individual 307 who was uninterested in participating in the study was permitted to withdraw. We also 308 guarantee that there were no dangers that put the participants in danger. 311 We all agree on publication. I am the corresponding author and the first author of this 312 finding.

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Consent to publish 314 The consent form is held by the authors. Written informed consent was obtained from the 315 participant.

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Availability of data and materials 317 The study finding was putted in public repositories. So that the readers can access the data 318 with the following cite called https://www.hindawi.com/research.data/#statement.

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There is no opposing interest.

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There is no need for funding. To conduct this research, the researcher received no specific 323 funding and worked as a co-author on their own initiative to do research at the university 324 hospital. It was primarily based on their prior hospital experience with us at the university.
. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 23, 2023. There is no conflict of interest because there is no funding for this research. We also request 326 a free publication cost because both writers live in Ethiopia, an impoverished sub-Saharan 327 African country.

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Author's contribution 329 The author contributes to the conceptualization and design, data collecting, data analysis 330 and interpretation. They also help to draft articles, revise them, and approve manuscripts 331 before they are published, and they are held accountable for the job they do on the text.

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Acknowledgement 333 We would like to thank the Hawassa University College of Medicine and Health Science's 334 Ethical Review Board for conducting an ethical clearance. We would also want to thank the 335 hospitals for agreeing to direct the study in the chronic outpatient clinic. Furthermore, we 336 would like to thank the study participants for their excellent contributions to the study.

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Furthermore, the pre-print of this work is available 338