LEVELS AND BARRIERS OF GLYCEMIC CONTROL AND SELF-MANAGEMENT AMONG DIABETIC PATIENTS IN PRIMARY HEALTH CARE IN JEDDAH: A CROSS-SECTIONAL STUDY.

Objectives: To assess the level of and factors affecting glycemic control, quality of diabetes self-management, and the impact of self-management on glycemic control among patients with type 2 diabetes (T2D) at the primary healthcare(PHC) level. Methods: This was a cross-sectional study involving adult patients with T2D visiting PHC centers in Jeddah, Saudi Arabia. Stratified two-stage clustered sampling was used to select participants from 10 PHC centers. Optimal glycemic control was defined as a glycated hemoglobin (HbA1c) level<7% on the last (≤3 months from the start of the study) HbA1c reading. Diabetes self-management was assessed using the Diabetes Self-Management Scale (DSMS), comprising 7 subscales and calculated as a score (range=60-240). Results: Diabetes control was expressed as mean (standard deviation [SD]) HbA1c of 8.23% (1.76), and was optimal in 25.6% (95% confidence interval [CI]=21.2%, 30.5%) of the 359 patients. Reliability testing of the DSMS showed a Cronbach?s alpha of 0.960. Mean (SD) DSMS score for the total study population was 150.30 (30.61; range=60-238). There was a weak but significant negative correlation between HbA1c (%) and raw DSMS score (r=0.265; B=0.016; p=0.001). Patients who had optimal glycemic control had higher DSMS (mean [SD]=167.13 [29.82]) compared to those with suboptimal glycemic control (mean [SD]=145.72 [29.34]; p=0.001). In univariate binary logistic regression, predictors of optimal glycemic control included age≥60 years (odds ratio [OR]=0.28; p=0.030); high educational level (OR=3.80; p=0.038); diabetes duration 6-10 years (OR=0.51; p=0.037); treatment regimen comprising insulin alone (OR=0.18; p=0.011) or combined with oral antidiabetic drugs (OR=0.19; p=0.009); and excellent quality of self-management (DSMS≥170/240; OR=8.18; p=0.003). Conclusion: Optimal glycemic control was achieved in approximately 25% of patients. The level of glycemia is significantly associated with the quality of self-management. Old age, low educational level, and treatment regimen containing insulin are the most significant factors associated with poor glycemic control.