Endocrine Abstracts

Introduction: Glycaemic control is still difficult to achieve despite advances in the pharmacotherapy of type 2 diabetes. Moreover, the COVID-19 crisis led to a disruption in medical consultations and in the access to medications. The aim of our study was to identify factors associated with poor glycaemic control in Tunisian type 2 diabetic patients during the COVID-19 crisis.

Methods: This is a cross-sectional study, carried out in December 2021, on type 2 diabetic patients followed up at the outpatient clinic of the department of endocrinology in Rabta University hospital. Three hundred patients with type 2 diabetes mellitus followed up for at least two years were included. Each patient underwent a clinical examination. Data on glycaemic control during 2019 and 2021 were collected from the medical file.

Results: Patients were 117 males and 183 females with a mean age of 61.6±9.7 years (22-91). One or more micro or macrovascular complications were present in 47.3%. Twenty-nine percent were previously infected with COVID-19 and 87% were vaccinated. More than half (52%) had poor socio-economic conditions and 46.7% were unable to buy their medications if unavailable in the public structures. The visits were irregular in one third of the patients, of whom 73.3% took regularly their medication. The mean annual HbA1c in 2021 was 8.2±1.8%. HbA1c was within the personalized targets in 42.7%. Uncontrolled diabetes was positively correlated with disease duration (P=10 ^-3), poly-medication (P=0.031), poor compliance to treatment (P=0.002), and the lack of drugs availability (P=0.002). No correlation was found with the gender (P=0.805) or the occurrence of a COVID-19 infection (P=0.204). In multivariate analysis, independent risk factors were a duration of the disease longer than 6.5 years (OR=3.83; P< 10^-3), poor compliance to treatment (OR=2.37, P=0.029), and a mean annual HbA1c in 2019 higher than 7% (OR=9.09; P< 10^-3).

Conclsion: The management of diabetes should be patient-centred and multifactorial. It is therefore necessary to work on socio-economic factors and therapeutic education in order to improve the health status of our patients and limit the early onset of vascular complications.