Background
Glycemic control among patients with diabetes mellitus has been shown to be associated with marked reduction of both macrovascular and microvascular complications. With a reported increase in the prevalence of diabetes in Sub Saharan Africa including Botswana, there is a dearth of published data on glycemic control. To date, no studies have been done in a tertiary care setting in Botswana. The objective of this study was to determine the extent of glycemic control and factors associated with good glycemic control among patients attending a tertiary clinic in Botswana, and subsequently use the findings to suggest future initiatives if needed.
Methods
A cross-sectional study was conducted among 380 randomly selected diabetic patients attending a tertiary clinic in Gaborone, the capital of Botswana. Over ninety five percent of the recruited patients, 368/380 (96.8%) had results of glycemic control (HbA1c) which was within three months of study recruitment and they were included in the analysis. Patients were recruited from 21st July 2015 to 21st September 2015.  Glycemic control was categorized as good if HbA1c was < 7%. A structured questionnaire was used both for interview and collecting clinical information from patients’ clinical records. Collected information included; Age, gender, level of education, marital status, type of diabetes, duration of diabetes, duration of attending the clinic, body mass index, modality of diabetes treatment, number of oral hypoglycemic agents, presence of complications, level of blood pressure control and HIV status. The questionnaire was based on previous studies and piloted before implementation. Data was analyzed using SPSS version 22 for descriptive statistics and both univariate and multivariate logistic regression to obtain determinants of glycemic control among the study population.
Results 
 The analyzed study population consisted of 258/368 (70.1%) females with a mean age (SD) of 56.7± 13.6 years. Means (SDs) for diabetes duration and glycated haemoglobin were 7.2± 7.1 years and 7.97± 2.02% respectively. Of the 368 patients, only 136/368 (36.9%) had good glycemic control. HIV positive status and older ages of 51-65 years and ≥ 66 years were the only factors associated with good glycemic control in a multivariate analysis with results of p-value = 0.018 (AOR= 0.35, 95% CI= 0.16- 0.79), p-value = 0.001 (AOR = 0.33, 95% CI =0.12-0.90 and AOR = 0.17, 95% CI=0.06 - 0.47) respectively (Table 2) 

Conclusion
The majority of patients had poor glycemic control as found in most previous studies. HIV positive status was associated with good glycemic control, which can potentially be explained by the fact that the HIV positive subgroup was found to be significantly associated with better antidiabetic adherence in the analysis of the same patients1. Good glycemic control was also associated with older age. This could possibly be due to the fact that elderly people are more likely to have complications and hence tend to adhere better to other aspects of glycemic control such as dietary modification and physical exercise. However, this needs further investigation. The observation that HIV patients have better glycaemic control despite appreciably increasing the pill count provides guidance for future to better improve overall glycemic control in Botswana.





1Rwegerera GM, Moshomo T, Gaenamong M, Oyewo TA, Gollakota S, Mhimbira FA, Fadare J, Godman B , Meyer JC, Rivera YP. Antidiabetic medication adherence and associated factors among patients in Botswana; implications for the future. Alexandria Journal of Medicine (2017). htpp//dx.doi.org/10.1016/j.ajme.2017.01.005

Determinants of glycemic control among diabetes mellitus patients in a tertiary clinic in Gaborone, Botswana