title: Predictors of poor glycaemic control during the initial five years post-diagnosis in rural adults with type 2 diabetes.
abstract: OBJECTIVE
  To identify factors predicting suboptimal glycaemic control in rural adults during the initial five years post-type 2 diabetes diagnosis.
  
  
  METHODS
  Retrospective medical record audit. Quantitative study.
  
  
  METHODS
  Rural community-based primary health service, South Gippsland, Victoria, Australia.
  
  
  METHODS
  Two hundred and seventy-two de-identified medical records randomly selected from the type 2 diabetes outpatient database.
  
  
  METHODS
  Demographic, biochemical, anthropometric, pharmacological, co-morbidity and lifestyle data during the first five years post-diabetes diagnosis were retrospectively collected. Univariate analysis was performed to identify variables associated with poor diabetes control (HbA1c ≥ 7%).
  
  
  RESULTS
  Independent predictors of poor glycaemic control in this rural cohort were elevated fasting glucose at diagnosis (odds ratio (OR) 1.97, 95% confidence interval (CI) 1.31-2.97, P < 0.001), weight gain during the initial 2.5 years of diabetes (OR 1.33, 95% CI 1.11-1.59, P < 0.01), excessive body weight at diagnosis (OR 1.07, 95% CI 1.03-1.12, P < 0.001) and younger age at diagnosis (OR 0.94, 95% CI 0.88-1.00, P < 0.05). These variables combined explained 48% of the variation in HbA1c. Gender, body mass index, waist circumference and lifestyle factors at diagnosis were not significant predictors of diabetes control.
  
  
  CONCLUSIONS
  Young-middle-aged adults (≤58 years) with elevated fasting glucose (≥9.0 mmol L(-1) ) and excessive body weight (≥93.1 kg) at type 2 diabetes diagnosis and those unable to lose weight early in the course of the disease are more likely to experience a rapid deterioration in glucose control. Rural clinicians should target these individuals for aggressive diabetes management from the time of diagnosis.
authors.affiliation: Department of Rural and Indigenous Health, Monash University, Melbourne, Australia. nicole.kellow@gshs.com.au
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Kellow
authors.forename: Gayle S
authors.initials: GS
authors.lastname: Savige
authors.forename: Hanan
authors.initials: H
authors.lastname: Khalil
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D015331:Cohort Studies; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D004032:Diet / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D011788:Quality of Life; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin