Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Home Print this page Email this page
Users Online:: 1233

 Table of Contents  
Year : 2016  |  Volume : 19  |  Issue : 4  |  Page : 190-195

Determinants of glycemic control among persons with type 2 diabetes mellitus in Niger Delta

1 Department of Family Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
2 Department of Medical Laboratory Science, College of Health Sciences, Igbinedion University, Okada, Nigeria
3 Department of Medical Laboratory Science, Chevron Hospital, Warri, Nigeria
4 Department of Internal Medicine, Central Hospital (HMB), Warri, Nigeria

Date of Web Publication21-Dec-2016

Correspondence Address:
Chukwuani Ufuoma
Department of Medical Laboratory, Chevron Hospital, PMB 1244, Warri, Delta State
Login to access the Email id

DOI: 10.4103/1118-8561.196361

Rights and Permissions

Background: The rising burden of type 2 diabetes mellitus (T2DM) with its attendant's complication can be successively steamed in the face of appropriate self-care management. The latter is positively imparted by the level of knowledge of the disease itself, its impact on quality of life and available basic technique of its control. Aims: The study is, therefore, aimed to assess the level of glycemic control and its determinants among type 2 subjects attending a secondary hospital in Niger Delta. Subjects and Methods: Two hundred consenting adult type 2 diabetes patients of age more than 40 years and attended diabetes outpatient clinics at the Central Hospital Warri between March and August 2014 were used for this cross-sectional study. Two different questionnaires were administered to all the participants to collect the necessary information on diabetes knowledge as well as factors that might affect their glycemic control. Blood samples were collected for fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) for all the respondents. Weight and height were also measured to the nearest 0.5 kilogram and centimeter using standardized equipment. Body mass index was then calculated as the ratio of weight in kilogram and height in meters square (kg/m 2 ). Statistical Analysis Used: Statistical Package for Social Science Version 16 was used to compute the data generated. Results: The mean age and diabetic duration of all participants were 54.8 ± 11.9 years and 8.5 ± 3.2 years, respectively. The overall mean knowledge score of the subjects was 6.90 ± 1.8 (69.0 ± 18.2%) The mean FBG level and HbA1c of respondents were 7.89 ± 3.6 mmol/L (range 4-20 mmol/L) and 8.2%, respectively, with 55% of the population having poor glycemic control and 45% good glycemic control. The diabetic knowledge scoring of those with poor glycemic control was significantly lower than those with good glycemic control. In addition, diabetics' with poor glycemic control HbA1c >7.0 had longer diabetic duration (1-19 years; 8.06 ± 4.30) when compared with those with good glycemic control, HbA1c < 7.0 (1-15 years; 6.44 ± 4.02). Conclusions: The proportion of poor glycemic control among patients with T2DM in Central Hospital Warri is relatively high with diabetic duration and inadequate diabetic knowledge identified as significant determinants.

Keywords: Diabetes knowledge, glycemic control, glycosylated hemoglobin, Warri

How to cite this article:
Ufuoma C, Godwin YD, Kester A D, Ngozi J C. Determinants of glycemic control among persons with type 2 diabetes mellitus in Niger Delta. Sahel Med J 2016;19:190-5

How to cite this URL:
Ufuoma C, Godwin YD, Kester A D, Ngozi J C. Determinants of glycemic control among persons with type 2 diabetes mellitus in Niger Delta. Sahel Med J [serial online] 2016 [cited 2020 Feb 29];19:190-5. Available from: http://www.smjonline.org/text.asp?2016/19/4/190/196361

  Introduction Top

The prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasing all over the world. [1] Global estimates of diabetes prevalence were predicted as 6.4%, affecting 285 million adults as at 2010 and will increase to 7.7% and 439 million adults by 2030. [2] This is due to population growth, aging, urbanization, as well as increase in the prevalence of obesity and physical inactivity. [3] In Nigeria, the prevalence of T2DM in adult populations varies from 0.65 in rural Mangu village (Plateau) to 11% in urban Lagos. [4] Nigeria as a developing country already overburdened with a growing population in the face of low resources and increasing life expectancy is likely to produce sub-optimal treatment of its increasing chronic non communicable disease. [5] Poor glycemic control is likely to be an outcome of such sub-optimal treatment. Glycemic control has been defined as type 2 diabetes achieving a target of fasting plasma glucose level of between 80 and 110 mg/dl, or glycosylated hemoglobin (HbA1C) of <7.0%. HbA1c is a test that measures the average amount of diabetic control over a period of about 3 months (the average red blood cell lifetime) and used as a significant indicator and marker of glycemic control. Diabetics who manage to keep their HbA1c below 7.0% are considered to have good glycemic control while those above 7.0% are considered to have a poor glycemic control. [6] Achieving the above targets is considered the basis in the management and prevention of diabetic complications. This has been demonstrated by the UK prospective diabetes study (UKPDS) which showed that proper control of blood glucose could reduce the complications of diabetes. [7] This target is, however, difficult to maintain thus resulting in suboptimal diabetic control. The latter is the resultant effect of the variable outcome of quality of life which has been negatively imparted in Nigeria. [8],[9] Therefore, to achieve proper glucose control, patients need to adhere to medications, undertake lifestyle modifications, and frequent blood glucose monitoring. If people living with diabetes are to follow such physicians' recommendations, it is imperative for the physicians and other caregivers to understand their knowledge of diabetes. Such information gleaned may help in designing an effective intervention program for those living with diabetes. Several studies have demonstrated that knowledge of diabetes is a key factor that imparts on appropriate self-care management thus resulting in poor glycemic control. [10],[11],[12],[13] Furthermore, there has been demonstrated variation of how these factors (diabetes knowledge and coexisting factors) affects glycemic control in different care settings. [12],[13],[14] It is noteworthy also that some of the studies that has been carried out on glycemic control did not use HbA1c as index of control; [11] hence, this study was conducted in a secondary health center using HbA1c as an index of assessing glycemic control.

  Subjects and methods Top

Study design and patients

The study is a cross-sectional design and conducted among T2DM patients aged 40 years, (although, there are documented evidence of a few persons below 40 years with type-like features) and above, who attended diabetes outpatient clinics at the Central Hospital Warri between March and August 2014. A random sample size of 200 consenting patients calculated using formula for calculating sample size for cross-sectional study by Daniel et al. in 1999 [15] were recruited for the study. Patients were excluded from the study if they refused consent were below 40 years and those with severe speech or obvious mental impairment. The study was approved by the Ethical Committee of Central Hospital Warri.

Study instruments

Upon recruitment, a two-part questionnaire with Part A accessing social demographic factors and Part B assessing patient self-care behavior as well as an instrument from the University of Michigan (2006) of 14 items were administered to all the participants. (Michigan questionnaire and the abridged one in Appendix 1). The first questionnaire sought information about sociodemographic and relevant characteristics including age, gender, onset and duration of T2DM as well as information related to patient's self-care behaviors. Diabetes knowledge test (DKT) questionnaire [16] consisted 10 items directly from the University of Michigan DKT (2006) of 14 items but with modification, substituting the food items on the original DKT with the locally available food consumed in the study population was the second questionnaire used. The instruments were in-depth interview guide and questionnaire, which was either self-administered or interview administered, depending on the literacy level of the respondent. For the illiterate respondents, the questionnaire was transcribed in pidgin English, which is a local language understood and spoken by all the indigene of the city. The respondents were scored based on total correct responses out of 10 items and were classified as either having low or high diabetes knowledge. Each correct answer was awarded 1 point with a maximum score obtainable in the DKT as 10 points. Higher scores (>7 points) indicate higher knowledge based on the DKT.

Laboratory and anthropometric measurements

After an overnight fast, 3 ml each of venous blood sample was collected from all the participants into fluoride and ethylenediaminetetraacetic acid (EDTA) bottles then send to the laboratory where fasting plasma glucose was analyzed by glucose oxidase method [17] on a BM/Hitachi 902 auto analyzer. (Roche Diagnostics GmbH, D-68298 Mannheim, Germany) auto analyzer. (Roche Diagnostics GmbH, D-68298 Mannheim, Germany) and HbA1c was measured immunochemically on DCA 2000 HbA1c auto analyzer using kits supplied by Boehringer Mannheim (Mannheim, Germany) [18] auto analyzer. (Boehringer diagnostics, Mannheim) and HbA1c was measured by suitable tubes (EDTA tubes) immunochemically on DCA 2000 HbA1c auto analyzer using kits supplied by Boehringer Mannheim (Mannheim, Germany) [18] commercially prepared standards and control samples were used to ensure accuracy of test results. Glycemic status was categorized as good glycemic control if HbA1c <7% and poor glycemic control if HbA1c ≥7%. [19] Weight and height were measured with light clothes and taking the shoes off, respectively. Weight was taken to the nearest 0.5 kg and height was taken to the nearest centimeter. Weight was measured without shoes or heavy clothing with a SECCA® scale. It was recorded to the nearest 0.5 kg. Height was determined to the nearest 0.5 cm with a rigid measure against a vertical wall. Body mass index (BMI) was then calculated as the ratio of weight in kilograms to the square of height in meters. [20] Statistical Package for Social Science Version 16 (Released 2007. SPSS for Windows, Chicago) was used to compute the data generated.

  Results Top

The total number of 200 patients that participated in the study had mean age and duration of diabetes, 54.8 ± 11.9 years and 8.5 ± 3.2 years, respectively. Majority were male 52% and 53% had more than secondary education. Other demographics are shown in [Table 1].
Table 1: Patients demographic

Click here to view

The overall mean knowledge score of the subjects was 6.90 ± 1.8 (69.0 ± 18.2%) with the percentage distribution of responses on DKT shown in [Table 2]. The mean fasting blood glucose level and HbA1c of respondents were 7.89 ± 3.6 mmol/L (range 4-20 mmol/L) and 8.2%, respectively, with 55% of the population having poor glycemic control and 45% good glycemic control. There was no statistically significant difference in the age gender and BMI of those with poor glycemic control when compared to those with good control; however, there was statistical significance difference in diabetic duration and higher scores in diabetic knowledge between the two groups [Table 3].
Table 2: Percentage distribution of responses on diabetes knowledge test

Click here to view
Table 3: Determinants associated with glycemic control

Click here to view

  Discussion Top

More than half (55%) of the participants in our study group had poor glycemic control. This finding is similar to reports from other countries with prevalence of poor glycemic control ranging from 50% to 60% (Ethiopia, US, Saudi), [21],[22],[23] but lower than those reported in Bahrain, [24] UK, [25] and Jordan [13] with values between 65% and 79%.

The differences in variation may be explained by the differences in study designs, characteristics of the study populations, and the types of treatment facilities. Furthermore, differences in race and ethnicity of the studied populations, [26] dosage for oral medication, compliance with regimens, self-monitoring of blood glucose, and socioeconomic status may differ by race/ethnic group leading to greater improvements in control in some groups but not in others. Socioeconomic status may influence diabetes management and control since it is often associated with access to health care, healthcare utilization, use of medication, and access to good nutrition.

In Nigeria, however lower rates 34-45% has been reported in Enugu [27] and Ibadan. [28] Although a comparative higher value of 65.7% has been reported in a different study in a secondary care setting in Ibadan, South-West Nigeria by Adisa et al. 2011. [29] This difference seen in these variation could probably be explained by the nature of cases seen in the tertiary setting where most often poorly controlled and complicated cases are managed as it is a reference center. Even though in most teaching hospital, proper counseling and teaching of diabetic patients in the clinic either in the form of the regular group counseling with the presence of family physicians or with nurses, pharmacist, and dietitian. The impact of these measures did not seem to reflect in the study population by Adisa et al. This approach had been shown to enhance the patient-doctor relationship and to have a positive effect on the compliance of the patient.

The current study showed that patients with duration of diabetes of more than 10 years were more likely to have poor glycemic control compared to those with duration of 10 years or less. This finding is consistent with that reported in previous studies where longer duration of diagnosed diabetes was associated with increased HbA1c values. [30],[31],[32]

This might be explained by the fact that the amount of carbohydrate attached to the HbA1c increases with increasing duration of the disease. [33] The UKPDS [7] and the Belfast Diet Study [34] showed that beta cell function begins to decline 5-10 years after diagnosis of diabetes which lead to decreases in insulin, consequently poor glucose utilization thus poor control.

Almost all the respondents (80%) know what a diabetic free food is. Furthermore, the DKT question that was most frequently answered correctly (83%) by our respondents was the one that asked about which food was highest in carbohydrate. This we think may be as a result of the type of education or prevailing cultural thinking about diabetes which suggests that diabetes patients are to avoid any sugar containing food. Expectedly, our respondents also performed poorly with regard to the question about HbA1c test. Majority of them (75%) did not know that HbA1c test measures average blood glucose level 6-10 weeks prior to the test. This is no surprise because as at the time of this study no such test was routinely available in the hospital. Several studies have recorded similar findings of patients having poor knowledge of HbA1c test. [11],[35],[36],[37]

Consequently, there was statistically significant difference in the mean knowledge scores of respondent with poor glycemic control when compared to those with good control P = 0.001 showing that diabetic knowledge have significant relationships with glycemic control. This is consistent with other studies [38],[39],[40],[41] that reported that diabetes knowledge and other factors such as attitude and adherence to health regimens were associated with glycemic control. This corroborates the fact that knowledge is necessary to produce the behavioral changes required for effective self-management and eventual metabolic control. [41] Arseneau et al. have found that illness-specific knowledge is one component of effective self-management. [42]

This, however, differs from other authors who found that there was no correlation between knowledge [43] with glycemic control. The implication of the finding is that diabetes knowledge is an important factor on how patients will follow their management plan but should not be seen as an end in it.

Lack of relationships among age and gender and poor glycemic control in our study is consistent with Shani et al., [44],[45] who found neither age nor gender was related to the achievement of good glycemic control. However, Wahba and Chang [46] found that older patients had better improvements in HbA1c. The BMI of those with poor control were not statistically different from those with good glycemic control. This may be as a result of the fact that most of the participants in the study were obese with a mean BMI of 31.00.

Limitation of the study

Some of the respondents had nonresponse (missing value) in most of the questions, this was a limitation as the remaining cases after listwise deletion might not be the true representative of the responses if there was no missing value.

In addition, the responses to all the questions were all self-reported. There could be the problem of recall from the respondents, which might make the reliability of the responses difficult to validate.

  Conclusions Top

Inadequate knowledge of diabetes, as well as the duration of the disease, was significantly associated with poor glycemic control. The proportion of the poor glycemic control among patients with T2DM in Central Hospital Warri is relatively high. A misconception in the knowledge of blood glucose motoring with HbA1c test was seen as a major drawback in the DKT even though their overall knowledge was slightly adequate. Health care facilities focused on easily comprehensible educational programs that emphasize lifestyle modification and blood glucose monitoring are therefore recommended.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

King H, Aubert RE, Herman WH. Global burden of diabetes,1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care 1998;21:1414-31.  Back to cited text no. 1
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.  Back to cited text no. 2
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 3
Akinkugbe OO, editor. Final Report of National Survey on Non Communicable Diseases in Nigeria. Ser. 1. Lagos: Federal Ministry of Health and Social Services; 1997.  Back to cited text no. 4
Okoro EO, Adejumo AO, Oyejola BA. Diabetic care in Nigeria: Report of a self-audit. J Diabetes Complications 2002;16:159-64.  Back to cited text no. 5
American Diabetes Association. Standards of medical care in diabetes--2006. Diabetes Care 2006;29 Suppl 1:S4-42.  Back to cited text no. 6
U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: A progressive disease. U.K. Prospective Diabetes Study Group. Diabetes 1995;44:1249-58.  Back to cited text no. 7
John ME, Effiong MU, Essien OE. Compliance and glycaemic control in adult diabetic patients in rural Nigeria. Diabetes Int 2005;13:17-20.  Back to cited text no. 8
Adebisi SA, Oghagbon EK, Akande TM, Olarinoye JK. Glycated haemoglobin and glycaemic control of diabetics in Ilorin. Niger J Clin Pract 2009;12:87-91.  Back to cited text no. 9
Al-Akour NA, Khader YS, Alaoui AM. Glycemic control and its determinants among patients with type 2 diabetes mellitus attending teaching hospital. J Diabetes Metab 2011;2:129.  Back to cited text no. 10
Odili VU, Isiboge PD, Eregie A. Patients' knowledge of diabetes mellitus in a Nigerian city. Trop J Pharm Res 2011;10:637-42.  Back to cited text no. 11
Al Omari M, Khader Y, Dauod AS, Al-Akour N, Khassawneh AH, Al-Ashker E, et al. Glycaemic control among patients with type 2 diabetes mellitus treated in primary care setting in Jordan. Prim Care Diabetes 2009;3:173-9.  Back to cited text no. 12
Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications 2010;24:84-9.  Back to cited text no. 13
Chin MH, Zhang JX, Merrell K. Specialty differences in the care of older patients with diabetes. Med Care 2000;38:131-40.  Back to cited text no. 14
Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th ed. New York: John Wiley & Sons; 1999.  Back to cited text no. 15
Fitzgerald JT, Funnell MM, Hess GE, Barr PA, Anderson RM, Hiss RG, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 1998;21:706-10.  Back to cited text no. 16
Raabo E, Terkildsen TC. On the enzymatic determination of blood glucose. Scand J Clin Lab Invest 1960;12:402-7.  Back to cited text no. 17
Hiar CE. Clinical Summary Report. Clinical Performance of DCA 2000+Hemoglobin A1c System Six-Minute Assay. Bayer Diagnostic Division; 1-7, 1998.  Back to cited text no. 18
Buell C, Kermah D, Davidson MB. Utility of A1C for diabetes screening in the 1999 2004 NHANES population. Diabetes Care 2007;30:2233-5.  Back to cited text no. 19
Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes 1985;9:147-53.  Back to cited text no. 20
Gudina EK, Amade ST, Tesfamichael FA, Ram R. Assessment of quality of care given to diabetic patients at Jimma university specialized hospital diabetes follow-up clinic, Jimma, Ethiopia. BMC Endocr Disord 2011;11:19.  Back to cited text no. 21
Resnick HE, Foster GL, Bardsley J, Ratner RE. Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999-2002: The National Health and Nutrition Examination Survey. Diabetes Care 2006;29:531-7.  Back to cited text no. 22
Al-Nuaim AR, Mirdad S, Al-Rubeaan K, Al-Mazrou Y, Al-Attas O, Al-Daghari N. Pattern and factors associated with glycemic control of Saudi diabetic patients. Ann Saudi Med 1998;18:109-12.  Back to cited text no. 23
Modebe O, Masoomi MA. Microalbuminuria and associated factors in Bahraini patients with type 2 diabetes mellitus. Ann Saudi Med 2000;20:157-60.  Back to cited text no. 24
Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S. 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;28:388-95.  Back to cited text no. 25
Coker AO, Fasanmade AO. Quality of care for patients with type 2 diabetes in Lagos University Teaching Hospital. Nig Q J Hosp Med 2006;16:6-9.  Back to cited text no. 26
Okafor CI, Ofoegbu EN. Control to goal of cardiometabolic risk factors among Nigerians living with type 2 diabetes mellitus. Niger J Clin Pract 2012;15:15-8.  Back to cited text no. 27
  Medknow Journal  
Yusuff KB, Obe O, Joseph BY. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharm World Sci 2008;30:876-83.  Back to cited text no. 28
Adisa R, Fakeye TO, Fasanmade A. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in Southwestern Nigeria. Pharm Pract (Granada) 2011;9:72-81.  Back to cited text no. 29
Verma M, Paneri S, Badi P, Raman PG. Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity. Indian J Clin Biochem 2006;21:142-6.  Back to cited text no. 30
Benoit SR, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with type 2 diabetes: A longitudinal study. BMC Public Health 2005;5:36.  Back to cited text no. 31
Corpus RA, George PB, House JA, Dixon SR, Ajluni SC, Devlin WH, et al. Optimal glycemic control is associated with a lower rate of target vessel revascularization in treated type II diabetic patients undergoing elective percutaneous coronary intervention. J Am Coll Cardiol 2004;43:8-14.  Back to cited text no. 32
Sampson MJ, Hughes DA, Carrier MJ, Davies IR. Status of HbA1c during acute hyperglycemia in type 2 diabetes. Diabetes care 2002;25:537-41.  Back to cited text no. 33
Levy J, Atkinson AB, Bell PM, McCance DR, Hadden DR. Beta-cell deterioration determines the onset and rate of progression of secondary dietary failure in type 2 diabetes mellitus: The 10-year follow-up of the Belfast Diet Study. Diabet Med 1998;15:290-6.  Back to cited text no. 34
Adejoh SO. Sociological investigation of diabetes management among the Igala in Kogi State Nigeria. Nigeria: Unpublished doctoral dissertation; 2011.  Back to cited text no. 35
Wang S, Tikellis G, Wong N, Wong TY, Wang JJ. Lack of knowledge of glycosylated hemoglobin in patients with diabetic retinopathy. Diabetes Res Clin Pract 2008;81:e15-7.  Back to cited text no. 36
Arslantas D, Unsal A, Metintas S, Koc F. Knowledge of diabetic patients about diabetes at the primary stage in Eskisehir, Turkey. Pak J Med Sci 2008;24:263-8.  Back to cited text no. 37
Bains SS, Egede LE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes Technol Ther 2011;13:335-41.  Back to cited text no. 38
Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, et al. Patient adherence improves glycemic control. Diabetes Educ 2005;31:240-50.  Back to cited text no. 39
Gopichandran V, Mahadevan S, Ravikumar L, Parasuraman G, Sathya A, Srinivasan B, et al. Assessment of knowledge, attitudes and practices about tight glycemic control in the critically ill among endocrinologists and intensivists practicing in Chennai. Indian J Crit Care Med 2007;11:122-6.  Back to cited text no. 40
  Medknow Journal  
West JD, Goldberg KL. Diabetes self-care knowledge among outpatients at a Veterans Affairs medical center. Am J Health Syst Pharm 2002;59:849-52.  Back to cited text no. 41
Arseneau DL, Mason AC, Wood OB, Green SE. A comparison of learning activity packages and classroom instruction for diet management of patients with non-insulin-dependent diabetes mellitus. Diabetes Educ 1994;20:509-14.  Back to cited text no. 42
Sánchez CD, Newby LK, McGuire DK, Hasselblad V, Feinglos MN, Ohman EM. Diabetes-related knowledge, atherosclerotic risk factor control, and outcomes in acute coronary syndromes. Am J Cardiol 2005;95:1290-4.  Back to cited text no. 43
Shani M, Taylor TR, Vinker S, Lustman A, Erez R, Elhayany A, et al. Characteristics of diabetics with poor glycemic control who achieve good control. J Am Board Fam Med 2008;21:490-6.  Back to cited text no. 44
Moreira ED Jr., 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;87:407-14.  Back to cited text no. 45
Wahba H, Chang YF. Factors associated with glycemic control in patients with type 2 diabetes mellitus in rural areas of the United States. Insulin 2007;2:134-41.  Back to cited text no. 46


  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Factors Associated with Poor Hemoglobin A1c Control in Patients with Type 2 Diabetes
Salam Alqudah,Anan S. Jarab,Eman A. Alefishat,Fadia Mayyas,Maher Khdour,Sharrel Pinto
Current Diabetes Reviews. 2019; 15(2): 164
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
  Subjects and methods
   Article Tables

 Article Access Statistics
    PDF Downloaded358    
    Comments [Add]    
    Cited by others 1    

Recommend this journal