Trajectories of fasting plasma glucose levels among persons with pre-diabetes, and those with type 2 diabetes in Eastern Rural Uganda: A perspective of Hierarchical modelling with repeated measures

Abstract

Background: The burden of diabetes in Uganda according to recent studies is high and seems to be on the upward trend. The aim of this study was to evaluate the trajectories of fasting plasma glucose (FPG) among newly diagnosed individuals with pre-diabetes and those with diabetes. Method: Linear mixed effects models were used to analyze secondary data from the Ugandan site SMART2D trial which used a clustered randomized design with repeated FPG measurements. The study included 424 patients with type 2 diabetes and 379 individuals with pre-diabetes. The significance level was 0.05. Results: A heterogenous variance function intercept and slope models with unstructured covariance structure for individuals with diabetes and exchangeable for pre-diabetes individuals provided better fit. The age, waist circumference (WC), time and WC interaction, diet diversity and time interaction, and time and age interaction were significantly associated with the FPG measurement progression among patients with diabetes. Among individuals with pre-diabetes, interaction effects of time and health facility level, and time and WC interaction were associated with the FPG measurement progression. There was variability between health facilities and among individuals with in the same facility. Conclusion: Individuals with diabetes and those with pre-diabetes having abnormal obesity WC were associated with poor glucose control as compared to those with normal WC. Patients with diabetes on low diet diversity as compared to those on moderate and high diet diversity were associated with poor glucose control. Therefore, eating recommended diet and having recommended WC can improve glucose control among patients with diabetes.