Non-Dietary Factors Associated with Glycemic Status among Adults Diagnosed with Type 2 Diabetes Mellitus in Malawi

ABSTRACT

We assessed glycemic status and associations with socio-demographic, biomedical, anthropometric, and physical activity (PA) levels among adults with type 2 diabetes mellitus (T2DM) (n = 428; urban n = 288; semi-urban n = 140) using a cross-sectional study. Multivariate linear regression was used to determine factors associated with glycosylated hemoglobin (A1C) . A1C was clinically elevated ≥8% for 60.3% of the participants. Overall, age and PA levels showed a negative association with A1C, and positively with underweight status, duration of diabetes, and participants’ view of fluctuating/unstable blood glucose and blood glucose not improved compared to first diagnosed. A significant negative association with A1C was shown with PA levels and additional blood glucose monitoring (BGM) beyond that received at the public clinic in the urban area. Whilst, in the semi-urban area, there was a significant positive association with A1C with regards to duration of diabetes and insulin regimen. Determinants of A1C in this target group are multifactorial, therefore, interventions aiming to improve diabetes clinical outcomes are needed to reduce the likelihood of serious ramifications. Additionally, a team approach from healthcare professionals is needed in conjunction with active patient engagement as well as the development of more comprehensive diabetes care guidelines and policies.

KEYWORDS:

• Glycemic status
• glycosylated hemoglobin
• Malawi
• type 2 diabetes mellitus
• non-dietary

Acknowledgments

We would like to acknowledge management and staff of Kamuzu Central Hospital and Kasungu District Hospital for authorizing us to conduct the study and T2DM patients for their participation. We would like also to acknowledge human nutrition postgraduate students at Lilongwe University of Agriculture and Natural Resources in Malawi and undergraduate dietetics students at Michigan State University for helping in data collection and entry, respectively.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the United States Agency for International Development, as part of the Feed the Future initiative, under the CGIAR Fund [BFS-G-11-00002], and the predecessor fund the Food Security and Crisis Mitigation II grant, award number EEM-G-00-04-00013.