What drives glycemic control in a person living with diabetes

Glycemic control has remained an enigma despite a large number of anti-diabetic drugs being available. Clinical practice and guidelines have focussed largely on optimal and rational use of anti-diabetes drugs to achieve care goals. This study aims to delineate factors impacting glycemic control from real-world data. Retrospective, cross-sectional data comprising 15,689 prescriptions from 4647 people living with diabetes and attending an endocrine clinic over a 5-year period was extracted from EMR (electronic medical records) of the clinic. Data pertaining to drugs prescribed, glycemic control attained and patient behavioral factors like diet, drug and exercise adherence was analysed to delineate the contribution of patient or care team-dependent factors towards glycemic control. Factors related to patient behavior affected glycemic control linearly with statistically lower HbA1c in people with better adherence to diet, medications and exercise. People who did any self-monitoring of blood glucose at home had significantly better glycemic control. On the other hand, a number of medications were negatively associated with glycemic control. Hypoglycemia had no impact on glycemic control. A number of visits to treating physician were positively associated with glycemic control but impact plateaued after 6 visits. Patient behavior and activation-related factors are predominant drivers of glycemic control.