Abstract
Background: Poor glycemic control remains a persistent challenge in diabetes care, contributing to preventable microvascular and macrovascular complications, particularly in low- and middle-income settings where behavioral and health-system barriers converge. This study investigated the factors influencing glycemic control among diabetic patients attending Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria.
Methods: A descriptive cross-sectional design was employed among 422 adult diabetic patients selected by systematic random sampling from the RSUTH diabetic clinic. Data were collected using a structured interviewer-administered questionnaire covering socio-demographic characteristics, glycemic control status, medication adherence, dietary practices, physical activity, clinic follow-up attendance, and self-monitoring behavior, supplemented with clinical records where available. Descriptive statistics and chi-square tests were used for analysis, with significance set at p < 0.05.
Results: Only 31.8% of respondents with HbA1c data were well controlled (<7%), while 68.2% showed moderate-to-poor control. Medication adherence was suboptimal (62.3% daily compliance), driven by cost (45.7%), stock-outs (44.3%), and self-discontinuation (31.0%). Dietary practice fell short of counseling received, with 68.0% frequently consuming high-carbohydrate foods and only 39.8% following a structured meal plan. Only 50.7% engaged in regular physical activity despite high awareness of its benefits (84.4%). Educational level, monthly income, health insurance coverage, and diagnosis duration were significantly associated with glycemic control (p < 0.001 to p = 0.006), while sex was not (p = 0.397). Regular clinic attendance and regular self-monitoring were each significantly associated with better glycemic control (χ² = 16.83 and 19.47 respectively, p < 0.001).
Conclusion: Glycemic control among diabetic patients at RSUTH is shaped by a convergence of economic, educational, behavioral, and health-system barriers rather than any single determinant. Multi-level interventions combining adherence support, culturally adapted dietary counseling, structured exercise programmes, expanded insurance coverage, and improved access to self-monitoring supplies are recommended to improve outcomes.