<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health pract...<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. </span><b><i><span>Methodology</span></i></b><span>: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. </span><b><i><span>Results</span></i></b><span>: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];</span><i><span>p</span></i><span> < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];</span><i><span>p</span></i><span> = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];</span><i><span>p</span></i><span> = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];</span><i><span>p</span></i><span> < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];</span><i><span>p</span></i><span> < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];</span><i><span>p</span></i><span> < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. </span><b><i><span>Conclusion</span></i></b><b><span>: </span></b><span>The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv</span><span>ing</span><span> their management.</span>展开更多
Introduction: Hypertension is a real public health issue and its control is very difficult. We aim to determine the frequency of uncontrolled hypertension in hypertensive patients followed up as an outpatient at the c...Introduction: Hypertension is a real public health issue and its control is very difficult. We aim to determine the frequency of uncontrolled hypertension in hypertensive patients followed up as an outpatient at the campus university hospital of Lome (Togo) and to search for the associated factors. Methodology: The study was cross-sectional, descriptive and analytical, carried out from February (2022) to August 2022 in 260 hypertensive patients aged 22 years old, followed up (on an) as an outpatient for at least 3 months at the Lome University Hospital campus. A univariate then multivariate analysis were conducted in order to highlight the most common factors significantly linked to uncontrolled. Results: The mean age of hypertensives was 56.4 ± 12.7 years, the sex ratio (M/F) was 0.59. Prevalence of uncontrolled blood pressure was 42%. Associated Factors to poor blood pressure control in our study were age > 60 years (OR = 1.6 CI [1.17 - 2.50]), low socio-economic level (OR = 2.2 CI [1.96 - 4.33]), high cardiovascular risk level (OR = 3.1 CI [2.18 - 4.52]), non-adherence to regular blood pressure monitoring (OR = 3.3 CI [2.21 - 5.55]), low compliance to treatment (OR = 4.1 CI [2.33 - 6.76]) and a chronic renal failure (OR = 2.1 CI [1.21 - 3.10]). Conclusion: Nearly half of the hypertensives in our study had poorly controlled blood pressure by antihypertensive treatment medication. The factors of this poor control were age > 60 years, low socio-economic level, high or very high level of cardiovascular risk, low compliance to treatment, and renal failure.展开更多
Objective： Patients with poorly controlled diabetes have more medical complications and are more difficult to manage. The objective of the present study was to evaluate the clinical outcomes of successful implementat...Objective： Patients with poorly controlled diabetes have more medical complications and are more difficult to manage. The objective of the present study was to evaluate the clinical outcomes of successful implementation of an employer initiated community pharmacist-based disease management program for diabetic patients with poorly controlled diabetes. Methods： Employees with poorly controlled diabetes （glycosylated hemoglobin （A1 C） level 〉 7.5%） were identified fi＇om a large diabetes disease management program, in a rural setting in Texas, US. A longitudinal retrospective study was conducted, analyzing clinical indicators in the diabetes patients following the community pharmacist-based disease management program. The program involved a comprehensive drug therapy assessment and individualized disease management education. Primary outcome measured in the present study was A1C levels, assessed at the baseline visit and at the end of the intervention. Results： A total of 64 patients with poorly controlled diabetes were identified. Significant improvement in mean clinical outcome scores was achieved for A1C levels （p = 0.0011）. At the end of the 1 year longitudinal intervention, targeted body mass index and A1C goals were attained by 35.9% （p 〈 0.001） and 15.6% patients, respectively. The 10 patients reaching goal levels post intervention were in the group that had baseline A1C of 7.5 to 9%. However, patients with 〉 9% A1C levels at baseline had a significant reduction （mean 2.1, p 〈 0.001） post intervention. Conclusion： The community pharmacist-based diabetes disease management program improved A1C levels of patients with poorly controlled diabetes.展开更多
Objective: to study the overall effect of drug therapy for patients with "type 2 diabetes" who have poor blood glucose control by Dapagliflozin control. Methods: in order to control the patients' insulin...Objective: to study the overall effect of drug therapy for patients with "type 2 diabetes" who have poor blood glucose control by Dapagliflozin control. Methods: in order to control the patients' insulin, 120 patients with "type 2 diabetes" who visited our hospital from June 2019 to June 2020 were selected for this study. They were divided into the control group (conventional treatment method) and the observation group (based on conventional treatment, combined with Dapagliflozin for 12 months to track the therapeutic management effect). Compare the blood glucose index and adverse reactions before and after treatment. Results: through treatment, it was found that the patients in the observation group were significantly better than those in the control group in the observation of the average level, maximum fluctuation range, standard deviation and other aspects of blood glucose test, the overall treatment effect and the incidence of adverse reactions. The total effective rate of the patients in the observation group was significantly better than that of the control group, and the comparison effect and data difference between the two groups were statistically significant (P > 0.05). Conclusion: after systematic treatment of diabetic patients, Dapagliflozin is used to treat the blood glucose test level of "type 2 diabetes" patients, thus effectively controlling the adverse reactions such as blood glucose lowering index and hypoglycemia caused by blood glucose fluctuation.展开更多
Introduction: High blood pressure is a major public health issue affecting 1.28 billion people worldwide in 2019, making it the leading chronic disease. Blood pressure control remains particularly difficult, especiall...Introduction: High blood pressure is a major public health issue affecting 1.28 billion people worldwide in 2019, making it the leading chronic disease. Blood pressure control remains particularly difficult, especially in sub-Saharan Africa. The objective of our study was to identify factors associated with poor blood pressure control in hypertensive patients followed up at the cardiology department of the Dalal Jamm National Hospital. Patients and methods: This was a retrospective, descriptive and analytical, single-center cross-sectional study conducted over a 12-month period from January 1, 2021 to December 31, 2021, involving hypertensive patients followed for at least 3 months. The parameters studied were sociodemographic data, cardiovascular risk factors associated with high blood pressure, clinical signs, therapeutic compliance, therapeutic aspects, blood pressure control, and factors associated with poor control. The data were analyzed using RStudio 4.6 software. Result: High blood pressure represented 26.6% (n = 722) of the reasons for consultations and 109 patients were included in the study. We found a female predominance with a sex ratio of 0.48. The mean age of the population was 61.9 years ± 12. The predominant age group was 60 - 80 years representing 67% (n = 73) of patients. Diabetics represented 30% (n = 33) all type 2, 40% (n = 43) had dyslipidemia, 58 women had reached menopause. Sedentary lifestyle was found in 76% of patients, 61% (n = 67) had a family history of hypertension. In addition, 43.5% of the population studied had more than 3 risk factors in addition to hypertension. Patient follow-up was irregular in 21.1%. The mean systolic blood pressure was 162.4 ± 21 mm Hg and diastolic 96.16 ± 13.6 mm Hg. The mean heart rate was 77.84 ± 18.01 beats per minute. Dieulafoy signs were reported in 58% of patients. The low-sodium diet was respected by 77% of patients. Dual therapy was the most prescribed protocol with 42% (n = 46). Among the complications, heart failure was the most frequent (49%), followed by stroke (30%). The Girerd test was applied to assess therapeutic compliance, 30% of patients were good adherents, 43.5% had a minimal problem of adherence and 26.5% were not at all adherent. The blood pressure control rate was 53.20%. In bivariate analysis, sedentary lifestyle (p Conclusion: The management of high blood pressure encounters significant difficulties, resulting in inadequate control of blood pressure figures. Blood pressure was not controlled in almost half of the patients. The factor of poor blood pressure control identified was therapeutic non-compliance. It is imperative to make care more accessible and promote therapeutic education.展开更多
文摘<b><i><span>Background</span></i></b><span>: Achieving and maintaining glycemic targets </span><span>are</span><span> a challenge for health practitioners around the world. We aimed to study the factors associated with prolonged poor diabetes control in the cohort of T2DM patients monitored and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital in Ouagadougou in order to optimize therapeutic education in these patients. </span><b><i><span>Methodology</span></i></b><span>: This was a descriptive and analytical cross-sectional study combining retrospective data collection from the last year of patient follow-up and prospective collection of some information. The study included all diabetic patients, aged at least 18 years old, followed and treated in the Department of Internal Medicine at the Yalgado OUEDRAOGO Teaching Hospital between January 1, 2010 and December 31, 2018 following a systematic random sampling with a sampling step of 10. The variables collected were sociodemographic, anthropometric, lifestyle, cardiovascular risk factors and diabetes-related characteristics. To determine the risk factors associated with prolonged poor glycemic control, we performed modeling using logistic regression. All variables associated with prolonged poor glycemic control, in bivariate logistic regression with a p-value less than 0.20 were included in the full model. Later, we used a stepwise descending method to obtain the final model, which was then tested by a receiver operating characteristic (ROC) curve. The significance threshold was set at 5%. Raw and fitted Odds-Ratio (OR) and 95% confidence interval were presented. </span><b><i><span>Results</span></i></b><span>: 270 patients were included. Prolonged poor control of diabetes mellitus was observed in 73.70%. The mean age was 55.97 years (SD: ±11.52) and the sex ratio was 0.6 in favor of female. The mean time since diabetes mellitus diagnoses was 5.85 years (SD: ±5.15). A monthly gain of 92.62 USD (50.74%) for average diabetes mellitus care expenditures of 55.82 USD (SD: 28.25) was reported. An overweight (55.92%) and hypertension (41.85%) were reported. Diabetes mellitus was complicated in 68.15%. Patients were supported by their families in the management of their diabetes mellitus in 85.19%. In multivariate analysis with bivariate logistic regression, low level of formal education (OR = 8.34, 95% CI [1.97 - 35.22];</span><i><span>p</span></i><span> < 0.01), family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 - 0.94];</span><i><span>p</span></i><span> = 0.02), presence of abdominal obesity (OR = 2.27, 95% CI [1.08 - 4.77];</span><i><span>p</span></i><span> = 0.03), presence of a history of hospitalization (OR = 7.39, 95% CI [2.97 - 18.39];</span><i><span>p</span></i><span> < 0.01), poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 - 6.18];</span><i><span>p</span></i><span> < 0.01), and the presence of microangiopathy (OR = 5.05, 95% CI [2.36 - 10.81];</span><i><span>p</span></i><span> < 0.01) were the factors independently associated with prolonged poor control of T2DM, with a ROC curve of 0.88, which reflects a very good sensitivity and specificity of these factors. </span><b><i><span>Conclusion</span></i></b><b><span>: </span></b><span>The imbalance of T2DM is multifactorial. Lifestyle, family environment, and compliance seem to be essential to ensure good glycemic control. Healthcare practitioners should take these elements into account in their daily patient assessment. A predictive score would be a tool to help identify patients at risk of diabetes imbalance and would contribute to improv</span><span>ing</span><span> their management.</span>
文摘Introduction: Hypertension is a real public health issue and its control is very difficult. We aim to determine the frequency of uncontrolled hypertension in hypertensive patients followed up as an outpatient at the campus university hospital of Lome (Togo) and to search for the associated factors. Methodology: The study was cross-sectional, descriptive and analytical, carried out from February (2022) to August 2022 in 260 hypertensive patients aged 22 years old, followed up (on an) as an outpatient for at least 3 months at the Lome University Hospital campus. A univariate then multivariate analysis were conducted in order to highlight the most common factors significantly linked to uncontrolled. Results: The mean age of hypertensives was 56.4 ± 12.7 years, the sex ratio (M/F) was 0.59. Prevalence of uncontrolled blood pressure was 42%. Associated Factors to poor blood pressure control in our study were age > 60 years (OR = 1.6 CI [1.17 - 2.50]), low socio-economic level (OR = 2.2 CI [1.96 - 4.33]), high cardiovascular risk level (OR = 3.1 CI [2.18 - 4.52]), non-adherence to regular blood pressure monitoring (OR = 3.3 CI [2.21 - 5.55]), low compliance to treatment (OR = 4.1 CI [2.33 - 6.76]) and a chronic renal failure (OR = 2.1 CI [1.21 - 3.10]). Conclusion: Nearly half of the hypertensives in our study had poorly controlled blood pressure by antihypertensive treatment medication. The factors of this poor control were age > 60 years, low socio-economic level, high or very high level of cardiovascular risk, low compliance to treatment, and renal failure.
文摘Objective： Patients with poorly controlled diabetes have more medical complications and are more difficult to manage. The objective of the present study was to evaluate the clinical outcomes of successful implementation of an employer initiated community pharmacist-based disease management program for diabetic patients with poorly controlled diabetes. Methods： Employees with poorly controlled diabetes （glycosylated hemoglobin （A1 C） level 〉 7.5%） were identified fi＇om a large diabetes disease management program, in a rural setting in Texas, US. A longitudinal retrospective study was conducted, analyzing clinical indicators in the diabetes patients following the community pharmacist-based disease management program. The program involved a comprehensive drug therapy assessment and individualized disease management education. Primary outcome measured in the present study was A1C levels, assessed at the baseline visit and at the end of the intervention. Results： A total of 64 patients with poorly controlled diabetes were identified. Significant improvement in mean clinical outcome scores was achieved for A1C levels （p = 0.0011）. At the end of the 1 year longitudinal intervention, targeted body mass index and A1C goals were attained by 35.9% （p 〈 0.001） and 15.6% patients, respectively. The 10 patients reaching goal levels post intervention were in the group that had baseline A1C of 7.5 to 9%. However, patients with 〉 9% A1C levels at baseline had a significant reduction （mean 2.1, p 〈 0.001） post intervention. Conclusion： The community pharmacist-based diabetes disease management program improved A1C levels of patients with poorly controlled diabetes.
文摘Objective: to study the overall effect of drug therapy for patients with "type 2 diabetes" who have poor blood glucose control by Dapagliflozin control. Methods: in order to control the patients' insulin, 120 patients with "type 2 diabetes" who visited our hospital from June 2019 to June 2020 were selected for this study. They were divided into the control group (conventional treatment method) and the observation group (based on conventional treatment, combined with Dapagliflozin for 12 months to track the therapeutic management effect). Compare the blood glucose index and adverse reactions before and after treatment. Results: through treatment, it was found that the patients in the observation group were significantly better than those in the control group in the observation of the average level, maximum fluctuation range, standard deviation and other aspects of blood glucose test, the overall treatment effect and the incidence of adverse reactions. The total effective rate of the patients in the observation group was significantly better than that of the control group, and the comparison effect and data difference between the two groups were statistically significant (P > 0.05). Conclusion: after systematic treatment of diabetic patients, Dapagliflozin is used to treat the blood glucose test level of "type 2 diabetes" patients, thus effectively controlling the adverse reactions such as blood glucose lowering index and hypoglycemia caused by blood glucose fluctuation.
文摘Introduction: High blood pressure is a major public health issue affecting 1.28 billion people worldwide in 2019, making it the leading chronic disease. Blood pressure control remains particularly difficult, especially in sub-Saharan Africa. The objective of our study was to identify factors associated with poor blood pressure control in hypertensive patients followed up at the cardiology department of the Dalal Jamm National Hospital. Patients and methods: This was a retrospective, descriptive and analytical, single-center cross-sectional study conducted over a 12-month period from January 1, 2021 to December 31, 2021, involving hypertensive patients followed for at least 3 months. The parameters studied were sociodemographic data, cardiovascular risk factors associated with high blood pressure, clinical signs, therapeutic compliance, therapeutic aspects, blood pressure control, and factors associated with poor control. The data were analyzed using RStudio 4.6 software. Result: High blood pressure represented 26.6% (n = 722) of the reasons for consultations and 109 patients were included in the study. We found a female predominance with a sex ratio of 0.48. The mean age of the population was 61.9 years ± 12. The predominant age group was 60 - 80 years representing 67% (n = 73) of patients. Diabetics represented 30% (n = 33) all type 2, 40% (n = 43) had dyslipidemia, 58 women had reached menopause. Sedentary lifestyle was found in 76% of patients, 61% (n = 67) had a family history of hypertension. In addition, 43.5% of the population studied had more than 3 risk factors in addition to hypertension. Patient follow-up was irregular in 21.1%. The mean systolic blood pressure was 162.4 ± 21 mm Hg and diastolic 96.16 ± 13.6 mm Hg. The mean heart rate was 77.84 ± 18.01 beats per minute. Dieulafoy signs were reported in 58% of patients. The low-sodium diet was respected by 77% of patients. Dual therapy was the most prescribed protocol with 42% (n = 46). Among the complications, heart failure was the most frequent (49%), followed by stroke (30%). The Girerd test was applied to assess therapeutic compliance, 30% of patients were good adherents, 43.5% had a minimal problem of adherence and 26.5% were not at all adherent. The blood pressure control rate was 53.20%. In bivariate analysis, sedentary lifestyle (p Conclusion: The management of high blood pressure encounters significant difficulties, resulting in inadequate control of blood pressure figures. Blood pressure was not controlled in almost half of the patients. The factor of poor blood pressure control identified was therapeutic non-compliance. It is imperative to make care more accessible and promote therapeutic education.
