Sociodemographic predictors of glycaemic control among adults with type 2 diabetes mellitus in a Nigerian population: implications for public health and service delivery

Abstract

Type 2 diabetes mellitus (T2DM) represents a rising public health burden in Nigeria. Although its clinical impact is well documented, evidence on how sociodemographic characteristics relate to glycaemic outcomes in various Nigerian populations remain limited. This study therefore sought to identify the independent sociodemographic factors associated with poor glycaemic control among Nigerian adults with T2DM. A retrospective, multi-centre, cross-sectional study was conducted using records from five specialist clinics in Enugu State, Nigeria, comprising N = 1,030 adults with T2DM. Glycaemic control was defined using the last recorded HbA1c value, with poor control classified as ≥ 7.0%. Predictors were analysed using binary logistic regression and stratified analyses were performed by sex, disease duration, and comorbid hypertension status to test for effect modification. A p-value < 0.05 was considered statistically significant for all analyses. The prevalence of poor glycaemic control was 32.2%. Independent factors associated with poor glycaemic control in the overall model were female sex (AOR = 1.75), older age (AOR = 2.15), and longer diabetes duration (AOR = 5.77). Stratified analyses demonstrated that the association with long disease duration was markedly stronger for women than for men, while comorbid hypertension was a significant factor only among males. Also, poor glycaemic control in the early phase was significantly associated with comorbid hypertension (AOR = 2.59) and older age (AOR = 2.26), whereas in the late phase it was associated with female sex (AOR = 2.89) and a borderline association with low socioeconomic status (p = 0.051). No significant interaction was observed between age and diabetes duration. The factors related to poor glycaemic control differ according to disease duration, involving clinical factors in the early stage and social challenges in long-standing disease. These findings highlight the need to move toward targeted interventions, such as intensive early comorbidity management for men and sustained social support for women, to address the unique vulnerabilities of patients in Nigeria.