Social determinants of health and glycemic control in persons with type 2 diabetes mellitus attending a tertiary hospital in Nepal: A cross-sectional study
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Keywords

glycemic control
Nepal
social determinants of health
type 2 diabetes mellitus

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Adhikari, P., Sriyuktasuth, A., & Phligbua, W. (2023). Social determinants of health and glycemic control in persons with type 2 diabetes mellitus attending a tertiary hospital in Nepal: A cross-sectional study. Belitung Nursing Journal, 9(5), 489–497. https://doi.org/10.33546/bnj.2753
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Accepted for publication: 2023-09-05
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Abstract

Background: Diabetes mellitus (DM) is an emerging global public health challenge worldwide, including Nepal. Social determinants of health (SDOH) play a major role in glycemic control among persons with type 2 DM (T2DM). However, little is known about the association between SDOH and glycemic control among individuals with T2DM in Nepal.

Objective: This study aimed to identify the level of glycemic control and SDOH associated with glycemic control among Nepalese with T2DM.

Methods: This cross-sectional study was conducted at a tertiary hospital in Kathmandu, Nepal, among 135 Nepalese diagnosed with T2DM who attended follow-up appointments. Convenience sampling and inclusion criteria were utilized for participant selection. Data were collected from April to June 2021 using validated scales. Descriptive statistics, Chi-square test, and binary logistic regression were employed to analyze the data.

Results: The mean age of the participants in this study was 53.84 (SD = 11.78) years, and the average monthly household income was 567.64 (SD = 362.30) USD. The majority of the participants (77.8%) were literate and had no health insurance coverage (73.3%). Approximately 64.4% of the participants showed suboptimal glycemic control indicated by glycated hemoglobin (HbA1c) ≥7%. The significant determinants of good glycemic control included monthly household income of  >850 USD (odds ratio  [OR] = 12.20, 95% confident interval [CI] = 1.76–84.61, p = 0.011) and 341–600 USD (OR = 7.64, 95% CI 1.35–42.98, p = 0.021), being literate (OR = 6.37, 95% CI = 1.65–24.49, p = 0.007), having health insurance (OR = 5.82, 95% CI = 1.49–22.65, p = 0.011), sufficient health literacy (OR = 3.46, 95% CI = 1.10–10.83, p = 0.03), and high (OR = 16.17, 95% CI = 2.36–110.67, p = 0.005)  and moderate (OR = 7.02, 95% CI = 1.26–39.07, p = 0.026) food availability, respectively.

Conclusion: The study revealed suboptimal glycemic control in Nepalese with T2DM. This study presents essential social determinants of glycemic control in this population. Therefore, healthcare providers, particularly nurses, should pay more attention to assessing social determinants and provide targeted interventions to patients with T2DM who have low income, are illiterate, have no health insurance coverage, have insufficient health literacy, and have low resources for food availability.

https://doi.org/10.33546/bnj.2753
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Copyright (c) 2023 Prava Adhikari, Aurawamon Sriyuktasuth, Warunee Phligbua

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors have no conflict of interest to disclose.

Acknowledgment

The authors acknowledged the support of the Faculty of Nursing, Mahidol University, Thailand.

Authors’ Contributions

PA initiated the study, coordinated data collection, performed statistical analysis, and prepared the manuscript. AS contributed to the design of the study. AS and WP reviewed the data and contributed to the manuscript revision. All authors were accountable for the study processes and approved the final version of the manuscript.

Data Availability

The data presented in this study are available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

Nothing to declare.


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