Glycemic Variability and Associated Individual and Clinical Factors among Type 2 Diabetic Patients Attending Out-Patient Clinic at Diabetes Center of Excellence in Kenya (Formally Diabetic Comprehensive Care Clinic)

Background: Diabetes mellitus a common health challenge having expanded its incidence and prevalence globally. The association between chronic complications, sociodemographic and patients' HbA1c glycemic levels are not well understood in developing countries such as Kenya. Methods: A cross-sectional hospital-based study was carried out among 275 type 2 diabetic respondents attending out-patient Diabetes Centre for Excellence in Nakuru County in south-western Kenya. A standard questionnaire was employed to obtain information on sociodemographic characteristics, HbA1c glycemic levels, relevant chronic complications and adherence to insulin medication. Results: The mean age of the 275 respondents was 49.4 years with 152 (55%) being female. While anon-adherence rate of insulin medication of 9% was realized, only 32.4% (n=89) monitored their HbA1c glycemic levels. At least one chronic complication was documented among 59% of the respondents (n=162) The prevalence of key complications was: hypertension 56% (n=155), retinopathy and eyesight complications (30%, n=83), foot ulcers (6%n=17) and others 7% (n=9). Among the hypertensive and those with eyesight complications, 57% and 66% were females respectively. 41% and 23% of respondents aged greater than51 years were hypertensive and reported eyesight complications respectively. Of the 89 who monitored their HbA1c levels, 58% were females but overall, only 7.9% (n=7) had good glycemic control (HbA1c less than= 6%) constituting of 3 females. Of the 82 respondents who had poor glycemic control (HbA1c greater than 6.1%), 58% were female (n=34). 30.3% (n=27) of those aged greater than51 years had HbA1c greater than6.1% compared to 62% (n=55) aged ?51 years. 50.6% (n=45) with poor glycemic control (HbA1c greater than6.1%) had hypertension. Conclusion: Adherence to anti-diabetic medications is crucial to reach metabolic control while non-adherence is associated with increased levels of HbA1c. In the current study, the non-adherence rate was at 9%. More female than male had poor glycemic control. Chronic complications were seen with advancing age and in those with poor glycemic control. Hypertension and eyesight illnesses were the key complications. Management of diabetes mellitus is resource-intensive in terms of time and direct medication costs, and indirect costs associated with accessing medical care from distant clinics that will burden the economy due to higher medical costs and a reduction in productivity.