Department of Medicine, College of Medicine, Kirkuk University


Background: Diabetes mellitus is a major cause of morbidity and mortality. In the Arab region, the overall prevalence of DM in the Kingdom of Saudi Arabia is (23.7%) among people with age between 30 and 70 years. The prevalence of diabetes in the United Arab Emirates, Bahrain, and Kuwait were (20.1%), (14.9%) and (12.8%), respectively. Several large clinical trials have demonstrated that tight blood glucose control correlates with a reduction in the microvascular complications of diabetes. The American Diabetes Association (ADA) has designated HbA1c level of ≤ (7%) as a goal of optimal blood glucose control, and the American Association of Clinical Endocrinologist has further recommended HbA1c level of ≤ (6.5%). Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications, high proportion of patients remain poorly controlled. Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes. 
Aim of the study: To estimate the proportion of the patients with poor glycemic control and determine factors associated with poor glycemic control among patients with type 2 diabetes in Kirkuk city. 
Materials and Methods:A cross-sectional study conducted on 500 patients with type 2 DM, were randomly selected who were attended outpatient clinic in Azadi teaching hospital or private clinic over a period of 12month in 2014. A pre-structured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviors, medication adherence, and attitude towards diabetes. Weight, and height were measured. Available last readings of hemoglobin A1c(HbA1c), were abstracted from patients' records. Poor glycemic control was defined as HbA1c ˃ (7%). Results:Of the total 500 patients, (74.2%) had HbA1c ˃ (7%). In the multivariate analysis, increased duration of diabetes,increased Body Mass Index(BMI),low education level,hypertension,type of treatment, non-adherence to diabetes self- care management behavior,poor medication adherence, were significantly associated with increased odds of poor glycemic control.(pvalue<0.005). 
Conclusions and recommendations: Results indicate that duration of diabetes, age, obesity and morbidity are risk factors for poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Regular checking of RBS, adherence to treatment, 30 minute exercise and followinghealthy diet are important attitude of patients towards DM for good glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence totreatment regimen, regular exercise and dietary regimen would be of great benefit in glycemic control.