Assessment of glycemic control using glycated hemoglobin among diabetic patients in Jimma University specialized hospital, Ethiopia

Abstract

Background: Globally, diabetes mellitus (DM) has risen dramatically over the past two decades and is expected to keep rising for the next 20 years. If uncontrolled it may lead to complications to the patients that could be prevented or delayed. The disease could be diagnosed and monitored by blood glucose and/or glycated hemoglobin (HbA1) testing. HbA1 can tell long term hyperglycemia of the last 2–3 months period and can predict the risk of diabetic complications; however, the use of glycated hemoglobin test in the country, specifically, in the study area is almost none. Therefore, this study had the aim of assessing glycemic control and describing the risk of complications among diabetic patients using glycated hemoglobin. Methods: Cross-sectional study was conducted in Jimma University specialized hospital among 148 diabetic patients from May to July 2012. After the study was ethically approved, HbA1, random blood sugar (RBS), socio-demographic data and clinical information were collected from every diabetic patients who were willing to participate in the study among patients coming to the hospital for their routine follow up visits. Results: Even though all the study participants were on diabetes treatment, majority of them were found to be poor glycemic control. It was found out that the mean HbA1 and RBS level of the participants were 7.6 % and 280 mg/dL (15.5 mmol/L), respectively. Using HbA1,5 9.5 % of the patients had poor glycemic control and these patients were considered to be at higher risk of developing complications. Among all the study subjects with poor glycemic control, 70.8 % were within 15–30 years of age; 62.3 % were females; 60.8 % were urban dwellers; 67.4 % were illiterate; 69.6 % were with BMI less than 18.5 kg/m2, and 61.4 % were taking injectable drugs. Among 136 patients whose clinical history was reviewed, 52.9 % had one or more documented history of major microvascular complications: visual disturbance accounting for 21.3 %, nephropathy 19.1 % and peripheral neuropathy 13.2 %. Eighty-four had poor glycemic control of which 54.7 % had already documented history of one or more complications but the remaining 45.2 % had no documented history. Conclusion: Even if all of the diabetic patients were on treatment, the mean HbA1 level as well as RBS level of the study subjects was above the normal range indicating poor glycemic control. More than half of diabetic patients in the hospital had poor glycemic control and were at higher risk of developing diabetic complications or they already developed the complications. Accordingly we recommended tracing the cause of this poor glycemic control for mitigating the problem.