Patient-Related Determinants of Glycaemic Control in People with Type 2 Diabetes in the Gulf Cooperation Council Countries: A Systematic Review

Table 5

Results of the included studies.

Author; Year	Risk factors examined	Risk factors associated with glycaemic control	Statistical analysis of positive results					Main conclusion
Ajabnoor; 1987 [18]	Age, gender, duration of diabetes, FPG, and treatment modality	FPG and treatment modalities	FPG/HbA1c correlation ,					HbA1c is associated with FBG and treatment modality but not with age, gender, and duration of diabetes
			Treatment modality	Mean HbA1c		value
			Insulin	14.3 ± 1.3
			Oral	17.0 ± 0.0		<0.001
			Diet	16.3 ± 1.8		0.02
Binhemd; 1992 [19]	Knowledge, attitude and practice (KAP), diabetes type, and diabetes duration	KAP and diabetes duration	Positive correlation between HbA1c and diabetes duration (). Negative correlation between HbA1c and the practice () and the attitude ()					The positive correlation between HbA1c and the patients’ practice and attitude reflects the need for continuous patient education, follow-up, and support
Al-Nuaim; 1998 [20]	Age, BMI, region, residency, gender, and treatment modalities	TTT modalities	Adjusted odds ratio and 95% confidence interval (95% CI) of poor glycaemic control					There is a significant relation between glycaemic control and treatment modalities
			TTT modality (ref: diet regimen)
				Odds ratio		95% CI	value
			Oral agent	1.7		1.1–2.6	0.005
			Insulin	2.6		1.4–5.0
Malik; 1999 [24]	Age, gender, ethnicity, diabetes duration, family history, treatment modalities, and follow-up location	Duration of diabetes, follow-up location, and family history	Control			Odds ratio ( value)		Improvements are needed in primary care and in the community-based approach to diabetes control
						Fair	Poor
			Diabetes duration (years)			1.03 (0.329)	1.08 (0.007)
			Follow-up at health centres (ref: hospital)			1.86 (0.036)	2.47 (0.001)
			Family history (ref: none)			0.62 (0.095)	0.39 (0.001)
Abdelmoneim; 2002 [21]	Age, gender, family history, diabetes duration, BMI, cholesterol level, complications, number of health education session, and crowding index	Gender and health education	Odds ratio ( value) (ref: good control)					Female sex is a significant predictor of poor glycaemic control, and among females, the lower the number of education sessions, the poorer the diabetes control
			Gender (ref: male)	2.84 (<0.05)
			Health education among females	0.28 (<0.05)
			Health education among males	1.39 (<0.05)
Al-Kaabi; 2008 [10]	Age, gender, marital status, level of education, occupation, smoking, eating practice, BMI, abdominal circumference, blood pressure, and lipid profile	Carbonated drinks age	Regression analyses of HbA1c level (adjusted beta coef. ( value))					The dietary practice of people with diabetes in the UAE is inadequate and needs improvement
			Number of carbonated drinks	0.201 (0.029)
			Age	0.023 (0.047)
Al-Kaabi; 2009 [11]	Age, gender, nationality, marital status, level of education, employment, income, diabetes duration, smoking, diabetes complications, physical activity, BMI, abdominal circumference, and blood pressure	No significant association	Multiple regression analysis of HbA1c in relation to age, gender, education, duration of diabetes, and physical activity did not reveal any significant association					The physical activity practice of people with diabetes in the UAE is largely inadequate to meet the recommendations
Al-Lawati; 2012 [22]	Age, gender, duration of diabetes, treatment modalities, BMI, eGFR, smoking, and healthcare index	Age, gender, eGFR, diabetes duration, and TTT modalities	Adjusted odds ratio and value of good glycaemic control					Younger Omani adults exhibit worse glycaemic levels compared to older adults
			Age (ref: 20–39 yrs)		40–59 yrs	1.7	0.01
					60+ yrs	2.5	0.0001
			Sex (ref: men)		Women	1.5	0.001
			Diabetes duration (ref: <5 yrs)		≥5 yrs	0.8	0.041
			Treatment type (ref: diet)		Oral	0.2	0.001
					Insulin ± oral	0.1	0.001
			eGFR (ref: <60 ml/min/1.73 m^2		≥60 ml/min	1.9	0.001
Al-Hayek; 2012 [8]	Age, gender, marital status, employment, BMI, self-care management behaviour, self-monitoring of blood glucose, medication adherence, anxiety, and depression	Medication adherence, anxiety, and depression			HbA1c < 7%	HbA1c ≥ 7%	value	Poor diabetes self-care management behaviour, low adherence to medicine, and higher level of anxiety and depression are associated with poor glycaemic control
			Medication adherence		7.4 ± 1.4	5.4 ± 1.2	0.0007
			Anxiety		7.9 ± 1.3	10.3 ± 1.7	0.0005
			Depression		6.9 ± 0.9	9.8 ± 1.3	0.0002
			Total hospital anxiety and depression scale (HADS)		14.8 ± 1.8	20.1 ± 2.1	0.0001
Shamsi; 2013 [25]	Dietary practice	Dietary practice	Dietary practice		HbA1c (mean ± SD)		value	There is a significant relation between the dietary practice and the HbA1c level
			Very poor		10.95 ± 1.56		0.006
			Poor		7.46 ± 1.74
			Average		7.46 ± 1.97
			Good		7.31 ± 2.07
			Very good		5.97 ± 1.36
Al Balushi; 2014 [14]	Age, gender, diabetes duration, BMI, blood pressure, creatinine, and lipid profile	Total cholesterol, diastolic blood pressure, and LDL			HbA1c < 7%	HbA1c ≥ 7%	value	There is a significant association between HbA1c and diastolic blood pressure, total cholesterol, and LDL
			Diastolic blood pressure, mmHg (mean ± SD)		80 ± 8	84 ± 9	0.006
			Total cholesterol, mmol/l (mean ± SD)		4.7 ± 0.8	5.2 ± 1.3	0.002
			LDL, mmol/l (mean ± SD)		3.0 ± 1.2	3.8 ± 1.0	0.034
Alrahbi; 2014 [23]	Diabetes self-management	No association between diabetes self-management and glycaemic control was found	No association was found					There is no association between diabetes self-management and glycaemic control
D’Souza; 2015 [15]	Age, gender, education, diabetes duration, diabetes education, medication, BMI, and patient empowerment	Age, education, diabetes duration prior to diabetes education, TTT modalities empowerment, effect of diabetes on activities of daily living			HbA1c < 7%	HbA1c ≥ 7%	value	Interventions to increase the empowerment of people with T2DM should be made for better glycaemic control
			Age (no. (%))	30–39 yrs	24 (51.1)	23 (48.9)	0.000
				40–49 yrs	52 (50.5)	51 (49.5)
				50–59 yrs	36 (39.1)	56 (60.9)
				≥60 yrs	26 (44.8)	32 (55.2)
			Education (no. (%))	Until 8th grade	56 (47.9)	61 (52.1)	0.000
				High school	51 (54.3)	43 (45.7)
				Diploma/tech	31 (10.3)	58 (67.4)
			Duration of diabetes (no. (%))	0–9 yrs	57 (50.9)	55 (49.1)	0.000
				10–19 yrs	68 (47.2)	76 (52.8)
				≥20 yrs	13 (29.5)	31 (70.5)
			Diabetes education program (no. (%))	No	54 (47.0)	61 (53.0)	0.000
				Yes	84 (45.4)	101 (54.6)
			Medications (no. (%))	Oral	109 (50.5)	107 (49.5)	0.000
				Insulin and oral	29 (34.5)	55 (65.5)
			Regression analysis
			Empowerment and glycaemic control		Beta coef.	value
					0.657	0.001

HbA1c: haemoglobin A1c; FPS: fasting plasma sugar; eGFR: estimated glomerular filtration rate; TTT: treatment; ref: reference.