Predictors of Suboptimal Glycemic Control in Adults with Type 2 Diabetes: A Prospective Study of Clinical, Behavioral and Public Health Factors

Abstract

 Objective: To examine clinical, behavioral and public health predictors of suboptimal 12-week glycemic control among adults with type 2 diabetes. Study Design: Prospective observational cohort framework. Place and duration of the study: Four tertiary-care settings in Punjab and Sindh, Pakistan, from 26 June to 26 September 2026. Methodology: A 640-record cohort was followed conceptually for 12 weeks. Of 600 complete records, outcome HbA1c ≥7% defined suboptimal control. Baseline clinical measures, treatment practices, self-care and access barriers were analyzed using univariable comparisons and multivariable logistic regression. Results: Among 600 complete records, 427 (71.2%) met the primary outcome (95% CI 67.4%-74.6%). Adjusted predictors included baseline HbA1c (aOR 1.85, 95% CI 1.47-2.33), duration ≥10 years (aOR 2.17), low medication adherence (aOR 2.10), physical inactivity (aOR 1.98) and low dietary adherence (aOR 1.51). Conclusion: Multidomain assessment may help prioritize glycemic management, but prospective clinical confirmation is required.