DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20160320

Obesity and poor glycemic control in patients with type 2 diabetes

Razieh Anari, Reza Amani, Masoud Veissi

Abstract


Background: Diabetic patients are extremely recommended to control their blood glucose levels below the standard targets. This study was aimed to evaluate the association between obesity status and poor glycemic control in these patients.

Methods: Type 2 diabetic outpatients (n=157) from a diabetes clinic in Ahvaz were recruited for the study. Patients who had insulin therapy were excluded from participants. Weight, height and BMI were recorded for each participant. Obesity status was defined by BMI. Glycosylated hemoglobin (HbA1c) was measured in fasting blood samples to estimate glycaemia status.

Results: Mean age of participants was 54.47±9.39 years and mean BMI was 29.26±5.04 kg/m2. Poor glycemic control (HbA1c≥7%) was observed in 63.7% of participants. The rate of poor glycemic control in obese group was 60.3% and there was no correlation between obesity and poor HbA1c control using logistic regression we found no association between obesity and poor glycemic control (OR=0.796; p=0.504). Obese patients had lower education level than non-obese patients (p=0.035). Females had higher poor glycemic control than males; however, it was not significant (62% vs. 50% in obese and 68.5% vs. 62.2% in non-obese groups).

Conclusions: More than half of participants had poor glycemic control. Obese patients had similar rate of hyperglycemia to non-obese ones. Lower educational level was contributed to obesity. Underlying risk factors for poor glycemic control status in diabetic patients are still unclear.


Keywords


BMI, Diabetes, Poor glycemic control, HbA1c, Obesity

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References


International Diabetes Federation. IDF diabetes atlas (6th ed) 2013. Available at http://www.idf.org/diabetesatlas. Accessed Jan 30, 2014).

Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, et al. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care. 2008;31(1):96-8.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36 (Suppl 1):S67-74.

Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003;290:891-7.

American Diabetes Association. Standards of medical care in diabetes – 2013. Diabetes Care. 2013;36(Suppl. 1):S11-66.

American Diabetes Association: Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(Suppl. 1):S11-61.

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.

UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854-65.

Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey: NHANES 2001-2002. Available at http://www.cdc.gov/nchs/nhanes.htm. Accessed 11 January 2011.

Cheung BM, Ong KL, Cherny SS, Sham PC, Tso AW, Lam KS. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med. 2009;122:443-53.

Dorocka-Bobkowska B, Zozulinska-Ziolkiewicz D, Wierusz-Wysocka B, Hedzelek W, Szumala-Kakol A, Budtz-Jorgensen E. Candida-associated denture stomatitis in type 2 diabetes mellitus. Diabetes Res Clin Pract. 2010;90(1):81-6.

Ghazanfari Z, Niknami Sh, Ghofranipour F, Larijani B, Agha-Alinejad H, Montazeri A. Determinants of glycemic control in female diabetic patients: a study from Iran. Lipids Health Dis. 2010;9:83.

Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, et al. Position statement executive summary: guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011;34:1414-23.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-12.

Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff BM, Brunzell JD, et al. Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes. 2004;53(8):2087-94.

Zimmet P, Alberti KGMM, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782-7.

Carey VJ, Walters EE, Colditz GA, Solomon CG, Willet WC, Rosner BA, et al. Body fat distribution and risk of non-insulin dependent diabetes in women: the Nurses' Health Study. Am J Epidemiol. 1997;145:614-9.

Hajian-Tilaki KO, Heidari B. Prevalence of obesity, central obesity and the associated factors in urban population aged 20-70 years in the north of Iran: a population-based study and regression approach. Obes Rev. 2007;8:3-10.

Seidell JC. Obesity, insulin resistance and diabetes-a worldwide epidemic. Br J Nutr. 2000;83(suppl 1):S5.

Marjani A. Prevalence of obesity among type 2 diabetes mellitus in Gorgan (South East of Caspian Sea), Iran. J Chin Clin Med. 2011;6(2):85-92.

Nathan DM, Zinman B, Cleary PA, Backlund JY, Genuth S, Miller R, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group. Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications and Pittsburgh Epidemiology of Diabetes Complications Experience (1983-2005). Arch Intern Med. 2009;169:1307-16.

Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103-17.

UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53.

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129-39.

Moritz T, Duckworth W, Abraira C. Veterans Affairs Diabetes Triald corrections. N Engl J Med. 2009;361:1024-5.

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577-89.

Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, et al. Body weight and mortality among women. N Engl J Med. 1995;333(11):677-85.

Davidson MB. How our current medical care system fails people with diabetes: lack of timely, appropriate clinical decisions. Diabetes Care. 2009;32:370-2.