Glycaemic, blood pressure and low-density lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study

Mwita, Julius Chacha and Francis, Joel Msafiri and Omech, Bernard and Botsile, Elizabeth and Oyewo, Aderonke and Mokgwathi, Matshidiso and Molefe-Baikai, Onkabetse Julia and Godman, Brian and Tshikuka, Jose Gaby (2019) Glycaemic, blood pressure and low-density lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study. BMJ Open. ISSN 2044-6055 (In Press)

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Abstract

Objective: Control of glycaemic, hypertension and low-density lipoprotein-cholesterol (LDL-C) among type 2 diabetes mellitus (T2DM) patients is vital for the prevention of cardiovascular diseases (CVD). The current study was an audit of glycaemic, hypertension, and LDL-C control among ambulant patients with type 2 diabetes mellitus in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. Design: A cross-sectional study. Setting: A specialised public diabetes clinic in Gaborone, Botswana. Participants: Type 2 diabetes mellitus patients who had attended the clinic for ≥ three months between August 2017 and February 2018. Primary outcome measure: The proportion of patients with optimal glycaemic (HbA1c <7 %), hypertension (blood pressure <140/90mmHg) and LDL-C (<1.8mmol/L) control. Results: The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension, and 20.4% for LDL-C. Optimal glycaemic control was positively associated with age ≥ 50 years (AOR 5.79; 95% CI 1.08 - 31.14) but was inversely associated with an increase in diabetes duration (AOR 0.91; 95%CI 0.85 - 0.98). Being on an angiotensin-converting-enzyme inhibitor (ACE inhibitor) was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 - 0.85). Being female (AOR 0.24; 95% CI (0.09 - 0.59) was inversely associated with optimal LDL-C control. Conclusion: Patients with Type 2 diabetes mellitus in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.