Inadequate Control of Diabetes and Metabolic Indices among Diabetic Patients: A Population Based Study from the Kerman Coronary Artery Disease Risk Study (KERCADRS)

Document Type : Original Article


1 Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

2 Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran


The goal of diabetes control should be feasible in order to minimize the risk of its adverse events and to reduce its burden and cost on patients. The current study aimed to assess the status of glycemic control in male and female patients with Type 2 Diabetes Mellitus (T2DM) in Kerman, Iran.
In the present study, 500 T2DM (300 women and 200 men) from the Kerman Coronary Artery Disease Risk Study (KERCADRS), a population-based study from 2009 to 2011, were selected. Patients were >18 years old, had Fasting Blood Sugar (FBS) higher than 126 mg/dl, and had been through treatment for their diagnosed disease. All participants underwent Glycosylated Hemoglobin (HbA1c) analysis. HbA1c less than 7% was considered as good glucose control. Other metabolic indices based on American Diabetes Association (ADA) target recommendations were considered.
The mean level of HbA1c in total subjects was 8.56 ± 4.72% that only 31.66% of men and 26.00% of women had controlled level of HbA1c. Total cholesterol less than 200 mg/dl was reported in 64.50% of men and 44.00% of women, High Density Lipoprotein (HDL) more than 40 mg/dl was revealed in 20.50% of men and 34.67% of women, and Low Density Lipoprotein (LDL) less than 100 mg/dl was reported in 41.50% of men and 25.33% of women. In multivariate logistic regression model, longer duration of disease and higher Waist Circumference (WC) were positively associated with uncontrolled diabetes status.
The findings of the present study revealed that diabetes control in T2DM was inadequate. Changing the policy of treatment in individual patient and establishing better diabetes clinic to decrease the frequency of uncontrolled T2DM are crucial. Paying attention to other affecting metabolic components such as WC in the process of T2DM management is important.


Main Subjects

Hossain P, Kawar B, EI Nahas M. Obesity and diabetes in the developing world-A growing challenge. N Engl J Med 2007; 356: 213-5. doi: 10.1056/nejmp068177
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-53. doi: 10.1016/s0140-6736(98)07019-6
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-53. doi: 10.2337/diacare.27.5.1047
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-86. doi: 10.1056/NEJM199309303291401
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353: 2643-53. doi: 10.1161/circulationaha.111.077487
Qaseem A, Vijan S, Snow V, Cross JT, Weiss KB, Owens DK, et al. Glycemic control and type 2 diabetes mellitus: the optimal hemoglobin A1c targets. A guidance statement from the American College of Physicians. Ann Intern Med 2007; 147: 417-22. doi: 10.7326/0003-4819-147-6-200709180-00012
American Diabetes Association. Standards of medical care in diabetes–2013. Diabetes Care 2013; 36: S11-66. doi: 10.2337/dc13-s011 
American Association of Clinical Endocrinologists. The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: the AACE System of Intensive Diabetes Self-Management—2002 Update. Endocr Pract 2002; 8: 40-82. doi: 10.2337/dc13-s011
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycemia with microvascular and macro vascular complications of type 2 diabetes mellitus (UKPDS 35): prospective observational study. BMJ 2000; 321: 405-12.
Klein R, Klein BE, Moss SE. Relation of glycemic control to diabetic microvascular complications in diabetes mellitus. Ann Intern Med 1996; 124: 90-6. doi: 10.7326/0003-4819-124-1_part_2-199601011-00003
Gilmer TP, O'Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care 1997; 20: 1847-53. doi: 10.2337/diacare.20.12.1847
Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care 1995; 18(2): 258-68. doi: 10.2337/diacare.18.2.258
Azizi F, Gouya MM, Vazirian P, Dolatshahi P, Habibian S. The diabetes prevention and control programme of the Islamic Republic of Iran. East Mediterr Health J 2003; 9: 1114-21.
Delavari A, Alikhani S, Nili S, Birjandi RH, Birjandi F. Quality of care of diabetes mellitus type II patients in Iran. Arch Iran Med 2009; 12: 492-5.
Delavari AR. [National Program for Control and Prevention of Diabetes]. Tehran: Center for Disease Control; 2004. [In Persian]
Agency for Healthcare Research and Quality (AHRQ). Quality Indicators - Guide to Patient Safety Indicators. No. 03-R203, Revision 2. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
Kelishadi R, Ardalan G, Gheiratmand R, Adeli K, Delavari A, Majdzadeh R, The Caspian Study Group.Paediatric metabolic syndrome and associatedanthropometric indices: the CASPIAN Study. Acta Paediatr 2006; 95: 1625-34. doi: 10.1080/08035250600750072
Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-CommunicableDiseases of Iran. Diabetes Care 2008; 31: 96-8. doi: 10.2337/dc07-0959
Najafipour H, Mirzazadeh A, Haghdoost A, Shadkam M, Afshari M, Moazenzadeh M, et al. Coronary Artery Disease Risk Factors in an Urban and Peri-urban Setting, Kerman, Southeastern Iran (KERCADR Study): Methodology and Preliminary Report. Iranian J Public Health 2012; 41: 86-92
Najafipour H, Sanjari M, Shokoohi M, Haghdoost AA, Afshari M, Shadkam M, et al. Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes and its predictors in general population aged 15 to 75 years: A community-based study (KERCADRS) in southeastern Iran. J Diabetes 2014; 15. doi: 10.1111/1753-0407.12195
Delavari A, Alikhani S,  Nili S, Birjandi RH, Birjandi F. Quality of care of diabetes mellitus type II patients in Iran. Arch Iranian Med 2009; 12: 492-5.
Chuang LM, Tsai ST, Huang BY, Tai TY. The status of diabetes control in Asia-a cross sectional survey of 24317 patients with diabetes mellitus in 1998. Diabetic Med 2002; 19: 978-85. doi: 10.1046/j.1464-5491.2002.00833.x
Fox KM, Gerber RA, Bolinder B, Chen J, Kumar S. Prevalence of inadequate Glycemic control among patients with diabetes in the United Kingdom general practice research data base: a series of retrospective analysis of data from 1998–2002. Clinl Ther 2006; 28: 388-95. doi: 10.1016/j.clinthera.2006.03.005
Harris SB, Worrall G, Macaulay A, Norton P, Webster-Bogaert S, Donner A, et al. Diabetes Management in Canada: Baseline Results of the Group Practice Diabetes Management Study. Can J Diabetes 2006; 30: 131-7. doi: 10.1016/s1499-2671(06)02005-3
Mark T, Andrew J, Merlin C. The management of diabetes in Indigenous Australians from primary care. BMC Public Health 2007; 7: 303. doi: 10.1016/s1499-2671(06)02005-3
Alvarez Guisasola F, Mavros P, Nocea G, Alemao E, Alexander CM, Yin D. Glycaemic control among patients with type 2 diabetes mellitus in seven European countries: findings from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) study. Diabetes Obes Metab 2008; 10: 8-15. doi: 10.1111/j.1463-1326.2008.00881.x
Chan JC, Gagliardino JJ, Baik SH, Chantelot JM, Ferrera SR, Hancu N, et al. Multifaceted determinants for achieving glycemic control: The international diabetes management practice study (IDMPS). Diabetes Care 2009; 32: 227-33. doi: 10.2337/dc08-0435
Ji LN, Lu JM, Guo XH, Yang WY, Weng JP, Jia WP, et al. Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables. BMC Public Health 2013; 13: 602. doi: 10.2337/dc08-0435  
Afridi MA, Khan MN. Role of health education in the management of diabetes mellitus. J Coll Physician Surg Pak 2003; 13: 558-61.
Sarkadi A, Rosenqvist U. Fiels test of a group education program for type 2 diabetes: measures and predictors of successon individual and group levels. Patient Educ Counseling 2001; 4: 129-39.
Gilden JL, Hendryx M, Casia C, Singh SP. The effectiveness of diabetes education programs for older patients and their spouses. J Am Geriatr Soc 1989; 37: 1023-30.
Gilden JL, Hendryx MS, Clar S, Casia C, Singh SP. Diabetes support groups improve health care of older diabetic patients. J Am Geriatr Soc 1992; 40: 147-50.
Mazzuca SA, Moorman NH, Wheeler ML, Norton JA, Fineberg NS, Vinicor F, Cohen SJ, et al. The diabetes educationstudy: a controlled trial of the effectsof diabetes patient education. Diabetes Care 1986;9: 1-10.
Hundley JM. Diabetes-overweight: US problems. J Am Diet Assoc 1956; 32: 417-22.
Blaha MJ, Gebretsadik T, Shintani A, Elasy TA. Waist circumference, not the metabolic syndrome, predicts glucose deterioration in type 2 diabetes. Obesity (Silver Spring) 2008; 16: 869-74. doi: 10.1038/oby.2008.12
Farin HM, Abbasi F, Reaven GM. Body mass index and waist circumference correlate to the same degree with insulin-mediated glucose uptake. Metabolism 2005; 54: 1323-8. doi: 10.1016/j.metabol.2005.04.021
Janiszewski PM, Janssen I, Ross R. Does waist circumference predict diabetes and cardiovascular disease beyond commonly evaluated cardiometabolic risk factors? Diabetes Care 2007; 30: 3105-9. doi: 10.2337/dc07-0945
Kyrou I, Kumar S. Weight management in overweight and obese patients with type 2 diabetes mellitus. Br J Diabet Vasc Dis 2010; 10: 274-83. doi: 10.1177/1474651410388976
Otiniano ME, Al Snih S, Goodwin JS, Ray L, Alghatrif M, Markides KS. Factors associated with poor glycemic control in older Mexican American diabetics aged 75 years and older. J Diabetes Complications 2012; 26: 181-6. doi: 10.1016/j.jdiacomp.2012.03.010
Longo-Mbenz B,  Muak MM, Mbenza G. Risk factors of poor control of HBA1c and diabetic retinopathy: Paradox with insulin therapy and high values of HDL in African diabetic patients. International Journal of Diabetes Metabolism 2008; 16: 69-78.
Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications 2010; 24: 84-9. doi: 10.1016/j.jdiacomp.2008.12.008
Verma M, Paneri S, Badi P, Raman PG. Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity. Indian J Clin Biochem 2006; 21: 142-6. doi: 10.1016/j.jdiacomp.2008.12.008
Kilpatrick ES, Dominiczak MH, Small M. The effects of ageing on glycation and the interpretation of glycaemic control in Type 2 diabetes. QJM 1996; 89: 307-12. doi: 10.1093/qjmed/89.4.307
Yu NC, Su HY, Tsai ST, Lin BJ, Shiu RS, Hsieh YC, et al. ABC control of diabetes: survey data from National Diabetes Health Promotion Centers in Taiwan. Diabetes Res Clin Pract 2009; 84: 194-200. doi: 10.1016/j.diabres.2009.02.020
Arai K, Hirao K, Matsuba I, Takai M, Matoba K, Takeda H, et al. The status of glycemic control by general practitioners and specialists for diabetes in Japan: a cross sectional survey of 15,652 patients with diabetes mellitus, Diabetes Res Clin Pract 2009; 83: 397-401. doi: 10.1016/j.diabres.2008.11.036
Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S. Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: a series of retrospective analyses of data from 1998 through 2002. Clin Ther 2006; 28: 388-95. doi: 10.1016/j.clinthera.2006.03.005
Goudswaard AN, Stolk RP, Zuithoff P, Rutten GE. Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care. Eur J Epidemiol 2004; 19: 541-5. doi: 10.1016/j.clinthera.2006.03.005
Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in U.S. adults? Diabetes Care 2008; 31: 81-6. doi: 10.2337/dc07-1572
Shah BR, Hux JE, Laupacis A, Mdcm BZ, Austin PC, van Walraven C. Diabetic patients with prior specialist care have better glycaemic control than those with prior primary care. J Eval Clin Pract 2005; 11: 568-75. doi: 10.1111/j.1365-2753.2005.00582.x
Hawthorne K, Tomlinson S. Pakistani Moslems with Type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycaemic control. Diabet Med 1999; 16: 591-7. doi: 10.1046/j.1464-5491.1999.00102.x
Salcedo-Rocha AL, Garcia de Alba-Garcia JE, Frayre-Torres MJ, Lopez-Coutino B. Gender and metabolic control of type 2 diabetes among primary care patients. Rev Med Inst Mex Seguro Soc 2008; 46: 73-81.