Frontiers in Clinical Diabetes and Healthcare · 3 authors, 2 centres
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This cross-sectional study of 620 adults with type 2 diabetes in Kinshasa found that 67.8% had poor glycaemic control (HbA1c ≥7%). Insulin monotherapy and treatment duration ≥7 years increased the odds of poor control, while overweight and uncontrolled blood pressure were unexpectedly associated with better control. These findings highlight the need for tailored diabetes management strategies in sub-Saharan Africa.
**Background:** Type 2 diabetes is a growing burden in sub-Saharan Africa, yet data on glycaemic control in Kinshasa, Democratic Republic of the Congo (DRC), are limited. This study aimed to assess the prevalence and factors associated with poor glycaemic control to inform interventions.
**Methods:** A cross-sectional study was conducted from November 2021 to September 2022. Participants were recruited from 20 randomly selected health facilities in Kinshasa. Inclusion criteria: age ≥18 years, receiving diabetes treatment for ≥6 months, and consent. Exclusion: pregnancy, mental disability. Data were collected via structured questionnaires, physical measurements, and HbA1c assays (immunoassay method). Poor glycaemic control was defined as HbA1c ≥7%. Multivariable logistic regression was used to identify associated factors.
**Key Results:** Of 620 participants (median age 60 years, IQR 53.5-69; 66.1% female; 76.4% below poverty line; 92.1% uninsured), 67.8% (n=420) had poor glycaemic control. Factors associated with increased odds of poor control: insulin monotherapy (AOR=1.64, 95%CI 1.10-2.45) and treatment duration ≥7 years (AOR=1.45, 95%CI 1.01-2.08). Factors associated with decreased odds: being overweight (AOR=0.47, 95%CI 0.26-0.85) and uncontrolled blood pressure (AOR=0.65, 95%CI 0.48-0.90). Sub-analysis showed the protective effect of overweight was significant only in non-insulin users (AOR=0.28, 95%CI 0.10-0.80).
**Clinical Implications:** The high prevalence of poor glycaemic control underscores urgent need for improved diabetes care in Kinshasa. The paradoxical protective associations of overweight and uncontrolled blood pressure may reflect unique disease characteristics in sub-Saharan Africa, possibly due to treatment patterns (e.g., insulin-induced weight gain in better-controlled patients) or increased healthcare attention for comorbidities. Interventions should address insulin therapy optimization, treatment adherence, and regular monitoring, while considering local socioeconomic barriers.