Factors associated with poor glycaemic control among adults with type 2 diabetes mellitus in Albania: a...

Poor glycaemic control is common among adults with type 2 diabetes mellitus (T2DM) in low- and middle-income settings in South-Eastern Europe, yet patient-level data on its correlates from Albania are scarce. We examined the demographic, clinical and treatment-related factors associated with poor glycaemic control (HbA1c ≥ 7%) in Albanian adults with T2DM.

Cross-sectional study of 176 consecutive adults with T2DM attending a hospital-based outpatient diabetes service in northern Albania. Poor glycaemic control was defined a priori as HbA1c ≥ 7% (53 mmol/mol). Sociodemographic characteristics, diabetes duration, insulin therapy and physician-confirmed comorbidities were recorded. Associations were assessed using univariate and multivariable logistic regression, estimating odds ratios (OR) with 95% confidence intervals (CI); comorbidity was modelled both as individual conditions (primary model) and as a comorbidity-burden index (sensitivity model). Model calibration and discrimination were evaluated using the Hosmer-Lemeshow test and the area under the ROC curve.

Mean age was 65 years, 51% were men and mean diabetes duration was 11 years. The prevalence of poor glycaemic control was 58.5% (95% CI 50.9-65.9%), and 54% were receiving insulin. In univariate analyses, poor control was more frequent with insulin therapy (OR 5.64, 95% CI 2.93-10.87), longer diabetes duration (OR 1.42 per 5 years, 1.09-1.85) and ischaemic heart disease (OR 2.10, 1.09-4.08). After mutual adjustment, insulin therapy was the only factor independently associated with poor control (adjusted OR 6.32, 95% CI 2.71-14.71); age, diabetes duration, hypertension, ischaemic heart disease and multimorbidity were not. Results were unchanged in the sensitivity model. The primary model was well calibrated (Hosmer-Lemeshow p = 0.96), with moderate discrimination (area under the ROC curve 0.74).

In this Albanian outpatient population, poor glycaemic control was common and insulin therapy was the only factor independently associated with it. This reflects confounding by indication rather than harm from insulin: insulin is initiated when oral therapy no longer maintains targets, so insulin-treated patients form a clinically identifiable subgroup with more advanced disease who warrant priority for structured treatment intensification and individualised follow-up. Prospective multicentre studies are needed to confirm these associations and their temporal direction.

Not applicable (observational, non-interventional study).