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Publications

Journal Article Comparative Study Ppublish

PubMed: 42934853 DOI: 10.1111/jnu.70140

Correlates of Glycemic Control in Type 2 Diabetes Adults With and Without Comorbid Heart Failure.

J Nurs Scholarsh 58(6)

Authors: Fekadu Aga, Sandra B Dunbar, Tedla Kebede, Senbeta Guteta, Melinda Kay Higgins, Rebecca Gary

Affiliations

  • School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Charles Howard Candler Professor of Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
  • Consultant Physician in Internal Medicine, Diabetes & Endocrinology, Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.

Abstract

INTRODUCTION

Attaining good glycemic control (GC) in patients with Type 2 diabetes (T2D) is critical, yet the presence of comorbidities like heart failure (HF) presents overwhelming self-care complexities. The aim of this study was to investigate and compare the demographic, psychosocial, and clinical factors associated with glycemic control among T2D adults with and without comorbid HF.

DESIGN

A comparative cross-sectional study.

METHODS

A total of 210 adult T2D patients (105 with comorbid HF, 105 without comorbid HF) in Tikur Anbessa Specialized Referral Hospital (TASRH), the largest tertiary healthcare setting in Addis Ababa, Ethiopia, were enrolled. Data gathered included demographic traits, clinical parameters including the outcome variable HbA1c (categorized as "good glycemic control" for HbA1c < 7% and "poor glycemic control" for HbA1c ≥ 7%), and standardized psychosocial scales (SDSCA, PDSMS, DKT2, PHQ-9, and ESSI). Bivariate analysis (Chi-square and biserial correlation) and Enter method logistic regression analysis were performed.

RESULT

Across both groups, good GC (HbA1c < 7%) was alarmingly low, only 10.43% in the non-HF and 9.52% in the HF comorbid group (p = 0.818). In the non-HF group, the multivariate model revealed that only a higher social support (ESSI) score significantly predicted a higher likelihood of good GC (AOR = 1.518, 95% CI: 1.002, 2.302, p = 0.049). Conversely, for those with comorbid HF, a higher diabetes self-efficacy (PDSMS) score (AOR = 1.569, 95% CI: 1.045, 2.355, p = 0.030) and taking a higher number of daily medications (AOR = 2.502, 95% CI: 1.050, 5.962, p = 0.038) significantly predicted good GC.

CONCLUSION

This study highlights a critical gap in glycemic control regardless of HF status. However, the actionable drivers of glycemic success diverge fundamentally: social support systems are vital for GC success in uncomplicated T2D, whereas promoting self-efficacy and total count of daily medications dictates success in the face of complex HF comorbidity.

MeSH

Diabetes Mellitus, Comorbidity, Heart Failure, Heart, Nursing, Demography, Glycemic Control, Diabetes Mellitus, Type 2