Prevalence of and factors associated with uncontrolled diabetes mellitus among people with type 2 diabetes attending specialized care center in Karachi, Pakistan
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
The escalating prevalence of type 2 diabetes mellitus (DM, especially in the developing world will put additional burdens on the already squeezed health care system in the near future, as projected. DM, if not controlled, is associated with irreversible chronic complications with direct, indirect, tangible and intangible costs. To reduce the financial and social suffering and devise public health measures it is necessary to estimate the proportion of people with type 2 DM unable to keep their blood glucose under control. Determining the associated factors will help progress towards minimizing the proportion by directing the available resources to a high risk group. On this background, a center-based cross sectional study was conducted in District Central Karachi, with the objectives of estimating prevalence of uncontrolled DM and determining factors associated with it, among people with type 2 diabetes. From September '02 to January '03, 452 people with type 2 DM were recruited into the study. They were interviewed, tested for glycated hemoglobin and measured for their height and weight. Prevalence of uncontrolled DM defined as glycated hemoglobin (HbA1c) level ≥ 8%, was found to be 38.9o/o (95%CI: 34.4% - 43.4%. The group had a mean age of almost 50 yrs (SD: 10), two third were women, above 90% were mohajirs by ethnicity, and two thirds had ever been to school with mean of 6.4 years of schooling. Three fourths of the participants were married. A multivariate model built through logistic regression analysis found that age <50 yrs (OR: 1.8; 95% CI: 7.2 - 2.8), female sex (OR: 1.6; 95% CI: 1.0 - 2.6), being diagnosed at non-specialized care center (OR: 1.9; 95% CT: 7.2 - 3.0), no information through print media (OR: 2.1; 95% CI: 7.2 - 3.6), higher treatment cost (OR: 7.9; 95% CI: 1.3 - 2.9), lack of regular brisk walking (OR: 7.5; 95% CI: 1.0 – 2.2), absence of tremulousness (OR: 7.8; 95% CI: 1.8 - 2.7) and higher consumption of tea (OR: 1.3; 95% CI: 1.1 - 1.5) were independently associated with uncontrolled DM. Duration of diabetes, BMI & anxiety-depression were not statistically significantly associated with uncontrolled DIU in our study. The prevalence of uncontrolled DM of 40% among health cautious people with type 2 DM attending specialized care center could be an underestimate of the true prevalence. Further, people with DM in the study population should be categorically asked for the factors associated with the uncontrolled DM, print media should be encouraged to publish more information regarding DM, more specialized care center should be established so that final diagnosis of suspected DM could be made there, subsidized health care should be available to as many PWD as possible, importance and benefits of regular physical activity should be emphasized to PWD, reduction in tea intake should be advised and further studies should be conducted to further validate the results of this study and to investigate role of other social and biochemical factors having yet inconclusive association with the uncontrolled DM.
Siddiqui, F. J. (2003). Prevalence of and factors associated with uncontrolled diabetes mellitus among people with type 2 diabetes attending specialized care center in Karachi, Pakistan (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.