Diabetes management requires a comprehensive approach continuing medical care and patient education so as to prevent short-term and long-term complications (Labrose-Lhermine et al., 2007; Benoit et al., 2005). Glycemic control is the essential treatment objective for diabetes care. Glycemic control is a medical phrase that presumes to support blood glucose levels within the normal range in people with diabetes. Glycemic control can be assessed based on controlling two measurements; fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c). HbA1c is an intermediary measure of the normal blood glucose levels over the past two to three months (Labrose-Lhermine et al., 2007). Consequently, HbA1c is known to be the best indicator for long-term glycemic control in people with diabetes (Labrose-Lhermine et al., 2007). Type 2 diabetes is the point upon which the human body loses the capacity to create or utilization insulin effectively. It is often called “adult-onset” diabetes representing nearly 90% of all cases of diabetes (Labrose-Lhermine et al., 2007). Quandt et al. (2005) relates Type 2 diabetes to personal lifestyle habits that include poor diet and physical inactivity. However, the underlying cause is still unknown, although genetic and environmental factors are significant risk factors (Alberti et al., 2007).
Glycemic control by reducing blood glucose down to the normal range remained the essential therapeutic for diabetes administration and anticipation of target organ damage and different diabetes-related complexity. Although it is known that glycemic control improves microvascular outcomes, less is known about factors that influence control (Khattab et al., 2010). In clinical practice, standard glycemia is hard to acquire on a long-term basis because of the multifaceted nature of glycemic control in type 2 diabetes. Both patients and health care providers may contribute to poor glycemic control (Chiu et al., 2010). Studies (Chiu et al., 2010; Daly et al., 2009) suggest that there are various factors associated with glycemic control.
According to Daly and colleagues (2010), demographics, clinical conditions, and treatment have an influence on glycemic control. Labrose-Hermine and colleagues (2007) argue that minority group and adults who have had diabetes for a long time, who have co-morbidities, or who use insulin or multiple oral agents have high HbA1c levels. Benoit and colleagues (2005) carried out a longitudinal study to determine demographic, health status, treatment, access/quality of care. The investigation also sought to find behavioral factors associated with poor glycemic control in patients with Type 2 diabetes in low-income minority San Diego population. The sample included 573 patients with a racial/ethnical mix of 53% Hispanic, 7% Black, 18% Asian, 20% white and 2% others, so the outcomes demonstrated that patients who were uninsured had diabetes for more time duration, utilized insulin or various oral agents and had higher HbA1c values over the long period (Benoit et al., 2005). The younger subjects were indicators of poor glycemic control. Moreover, patients who were uninsured had a 5.3% increase in HbA1c level. Among these individuals, patients with diabetes for more than ten years had a 16% higher HbA1c level compared to the persons who had diabetes under one year. Additionally, patients who had diabetes 6 to 10 years and 1 to 5 years had a significant higher HbA1c qualities in relation to those with diabetes under one year. Quandt et al. (2005) carried an investigation of the predictive factors of glycemic control in older adults (above 54 years). According to their findings, participants who reported having more chronic diseases had higher HbA1c levels than those who reported having few chronic diseases or a shorter duration of diabetes (2005, p. 660).
Review of these literatures indicates that people with lower education levels, higher BMIs, longer duration of diabetes, have prolonged use of intensive treatment include medication and insulin. This because they have the highest proportion of poor glycemic control. Therefore, incorporating intensive lifestyle interventions may lead to favorable changes in biochemical parameters including FPG, %HbA1c, and lipid profile, which may help prevent the occurrence of type 2 diabetes-related complications.
References
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Benoit S.R., Fleming R., Tsimikas A.P., Ji M. (2005). Predictors of glycemic control among patients with Type 2 Diabetes: A longitudinal study. BioMed Cen Pub Health, 5(2), 36-48
Chiu C, Wray L.A. (2010) Factors predicting glycemic control in middle-aged and older adults with Type 2 diabetes. Prev Chronic, 7(1), A08
Daly J.M., Hartz A.J., Xu Y., Levy B.T., James P.A., merchant M.L., Garret R.E. (2009). An Assessment of Attitudes, Behaviours, and Outcomes of Patients with Type 2 Diabetes. J Am Board Fam Med, 22(2), 280-290
Egede L.E and Michel Y. (2006). Medical mistrust, Diabetes self-management, and glycemic control in an indigent population with type 2 diabetes. Diabetes Care, 29(1), 131-132
Khattab M., Khader Y.S., Al-Khawaldeh A., Ajlouni K., (2010). Factors associated with poor glycemic control among patients with type 2 diabetes. J Diab Comp, 24(1), 84-89
Labrose-Lhermine, F., Cazals, L., Ruidavets, J.B., and Hanaiare, H (2007). Long-term treatment combining continuous subcutaneous insulin infusion with oral hypoglycemic agents is effective in type 2 diabetes. Diabetes Metabolism, 33(5), 256-260
Quandt S.A., Bell R.A, Snivery B.M, Smith S.L., Stafford J., Wetmore L.K., (2005). Ethnic disparities in glycemic control among rural older adults with type 2 diabetes, Ethn Dis, 15(4), 656-663.