Gender differences and factors associated with glycaemic control among adults with type 2 diabetes mellitus in Madhesh Province, Nepal: a cross-sectional study.

INTRODUCTION

Glycaemic control (GC) is crucial for preventing complications of type 2 diabetes mellitus (T2DM) and remains a major public health challenge in Nepal, particularly in Madhesh Province. Evidence on gender differences in GC and their associated factors is limited. This study examined gender-specific variations in GC and determinants of good GC among adults with T2DM.

METHODS

A cross-sectional study was conducted among adults with physician-diagnosed T2DM in Madhesh Province. GC was assessed using fasting plasma glucose (FPG). Good GC was defined as FPG 80-130 mg/dL and poor GC as >130 mg/dL, following American Diabetes Association criteria. Descriptive statistics were used to summarise participant characteristics, and gender-stratified binary logistic regression analyses identified factors associated with good GC.

RESULTS

A total of 492 individuals with T2DM (256 males and 236 females) were included. Overall, 59.3% achieved good GC, with a slightly higher proportion among males than females (60.5% vs 58.1%). Among females, good GC was significantly associated with age ≥35 years (adjusted OR (aOR) 20.81; 95% CI 8.96 to 48.28; p<0.05), normal body weight (aOR 4.76; 95% CI 1.38 to 16.36; p<0.05), antihypertensive medication use (aOR 6.94; 95% CI 2.48 to 19.42; p<0.05), regular physician visits (aOR 4.81; 95% CI 1.48 to 15.56; p<0.01), adequate sleep duration (>8 hours/day) (aOR 2.57; 95% CI 1.01 to 6.62; p<0.05), regular physical activity (≥30 minutes/day) (aOR 3.89; 95% CI 1.45 to 10.36; p<0.01) and health insurance coverage (aOR 2.96; 95% CI 1.06 to 8.34; p<0.05). Being a housewife was not significantly associated with good GC (aOR 3.66; 95% CI 0.50 to 6.96; p=0.187).Among males, primary-level education compared with higher education was negatively associated with good GC (aOR 0.34; 95% CI 0.15 to 0.76; p=0.009), and retirement status was also negatively associated with good GC (aOR 0.30; 95% CI 0.11 to 0.85; p<0.05). Regular physical activity (aOR 15.42; 95% CI 2.80 to 85.08; p=0.002), adherence to dietitian-recommended diets (aOR 10.85; 95% CI 1.70 to 69.65; p<0.05) and health insurance coverage were significantly associated with good GC among males.

CONCLUSIONS

Less than two-thirds of adults with T2DM achieved recommended GC. Gender-specific sociodemographic, behavioural and healthcare-related factors influence GC, highlighting the need for gender-responsive diabetes interventions.