Volume 10, Issue 4, April – 2025 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 [Link]

Influence of Age, Gender, Socioeconomic Status,

and Education Level on Glycemic Control in
Diabetic Patients Attending Kapkatet Sub-County
Hospital, Kericho County, Kenya
Peter Ngugi Kinuthia1; Thomas Ong'ondo Ng'ambwa2; Alice Kiplagat3
Nursing Student1; Medical Surgical Nurse Practitioner2; Pediatric nurse3
1,2,3
University of Kabianga

Publication Date: 2025/04/25

Abstract

 Background:
Poor glycemic control among diabetic patients is a significant public health concern, leading to an increased risk of
complications such as cardiovascular disease, nephropathy, and neuropathy. Demographic factors, including age, gender,
socioeconomic status, and education level, play a critical role in diabetes management. However, limited data exist on their
influence among diabetic patients in resource-limited settings such as Kapkatet Sub-County Hospital, Kericho County,
Kenya.

 Objective:
This study aimed to assess the influence of demographic factors on glycemic control among diabetic patients attending
Kapkatet Sub-County Hospital.

 Methods:
A hospital-based cross-sectional study was conducted among 300 diabetic patients. Data were collected using
structured questionnaires and medical record reviews. Glycemic control was assessed using glycated hemoglobin (HbA1c),
with poor control defined as HbA1c >7.0%. Chi-square tests and logistic regression analyses were used to determine
associations between demographic factors and glycemic control.

 Results:
The prevalence of poor glycemic control was 62.3%. Age, education level, and socioeconomic status were significantly
associated with glycemic control (p<0.05). Older patients (≥60 years) had the highest prevalence of poor glycemic control
(74.8%), while lower educational attainment and lower-income levels were also linked to suboptimal glycemic outcomes.
Female patients exhibited slightly better glycemic control than males.

 Conclusion:
Age, education level, and socioeconomic status significantly influence glycemic control among diabetic patients.
Targeted interventions, including health education, improved socioeconomic support, and gender-sensitive diabetes
management strategies, are essential to enhance glycemic outcomes in this population.

Keywords: Glycemic control, Diabetes Mellitus, Demographic factors, Socioeconomic status, Health education, Kenya.

How to Cite: Peter Ngugi Kinuthia; Thomas Ong'ondo Ng'ambwa; Alice Kiplagat (2025), Influence of Age, Gender,
Socioeconomic Status, and Education Level on Glycemic Control in Diabetic Patients Attending Kapkatet Sub-County
Hospital, Kericho County, Kenya. International Journal of Innovative Science and Research Technology,
10(4), 1374-1382. [Link]

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I. INTRODUCTION  The Model Consists of Six Key Constructs That Directly
Relate to Glycemic Control:
Diabetes Mellitus (DM) is a global public health
concern, with an estimated 537 million adults (20-79 years)  Perceived Susceptibility –
living with the disease as of 2021, a number projected to rise The degree to which diabetic patients believe they are
to 643 million by 2030 (International Diabetes Federation, at risk of complications due to poor glycemic control. Older
2021). The prevalence of diabetes has surged due to factors patients or those with low education may underestimate their
such as urbanization, sedentary lifestyles, and dietary shifts, susceptibility, leading to poor self-management.
particularly in low- and middle-income countries (WHO,
2023). Effective glycemic control, typically measured by  Perceived Severity –
glycated hemoglobin (HbA1c) levels, is crucial in preventing Patients' understanding of the serious consequences of
diabetes-related complications, including cardiovascular uncontrolled diabetes, including complications like
diseases, nephropathy, and neuropathy (ADA, 2022). In neuropathy, nephropathy, and cardiovascular diseases. Those
Kenya, the prevalence of diabetes is estimated to range with higher education levels may have a better awareness of
between 3.3% and 4.5%, with urban areas experiencing these risks, leading to better adherence to treatment.
higher incidence rates due to lifestyle transitions (MOH,
2022). Despite efforts to enhance diabetes care, poor  Perceived Benefits –
glycemic control remains a major challenge, with studies The extent to which patients believe that proper
showing that over 60% of diabetic patients in Kenya fail to glycemic control improves their health outcomes. Patients
achieve the recommended HbA1c target of <7% (Ngugi et al., from higher socioeconomic backgrounds may recognize the
2022). The barriers to optimal glycemic control are advantages of regular monitoring and medication adherence,
multifaceted and include individual, socioeconomic, and leading to better glycemic control.
healthcare system-related factors. Demographic variables
such as age, gender, socioeconomic status, and education  Perceived Barriers –
level significantly influence glycemic control in diabetic Challenges that hinder adherence to diabetes
patients. Age-related physiological changes, including management, such as financial constraints, lack of access to
insulin resistance and reduced β-cell function, contribute to healthcare, or limited education on diabetes care.
glycemic variability in older adults (Xu et al., 2021). Gender Socioeconomic status plays a crucial role in shaping these
disparities in diabetes management have also been observed, barriers.
with men often having poorer adherence to lifestyle
modifications, whereas women may experience greater  Cues to Action –
barriers related to healthcare access and affordability External triggers that motivate behavior change, such as
(Kautzky-Willer et al., 2022). Socioeconomic status, health education programs, physician recommendations, or
including income level and employment status, plays a support from family members. Patients with lower literacy
critical role in diabetes outcomes, as financial constraints levels may require stronger external cues to engage in self-
limit access to medications, quality diets, and regular medical care practices.
follow-ups (Almeida-Pititto et al., 2020). Moreover,
educational attainment influences patients’ health literacy,  Self-Efficacy –
self-care practices, and adherence to treatment regimens, The confidence in one's ability to manage diabetes
which are essential for effective diabetes management effectively. Higher education and better socioeconomic status
(Bailey et al., 2021). At Kapkatet Sub-County Hospital, there are often linked to increased self-efficacy, resulting in
is limited data on how demographic factors impact glycemic improved diabetes management.
control among diabetic patients. Understanding these
associations is crucial in developing targeted interventions to This study aims to understand how demographic factors
improve diabetes outcomes in this population. This study impact glycemic control among diabetic patients at Kapkatet
aims to analyze the influence of age, gender, socioeconomic Sub-County Hospital. The HBM helps to: Identify disparities
status, and education level on glycemic control in diabetic in diabetes management due to differences in education,
patients attending Kapkatet Sub-County Hospital, Kericho income, gender, and age, Explain the barriers to effective
County, Kenya. The findings will provide evidence-based glycemic control, particularly among low-income or less-
recommendations for healthcare providers and policymakers educated patients and Guide the development of targeted
to enhance diabetes care and management in resource-limited interventions, such as tailored education programs and
settings. socioeconomic support initiatives to improve diabetes care.
II. THE HEALTH BELIEF MODEL (HBM) III. CONCEPTUAL FRAMEWORK
The HBM is a psychological model that seeks to explain  Independent Variables (Predictors)
and predict health-related behaviors by focusing on These are the factors that influence glycemic control in
individual beliefs and perceptions. It posits that a person’s diabetic patients. They include:
likelihood of engaging in health-promoting behavior such as
adhering to diabetes management practices depends on their
perceptions of the disease and its consequences.

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 Age –  Intervening (Mediating) Variables
Older patients may have poorer glycemic control due to These factors influence the relationship between the
longer disease duration and increased insulin resistance. independent and dependent variables, potentially modifying
the effects:
 Gender –
Men and women may have different adherence to  Healthcare Access –
diabetes management, lifestyle behaviors, and risk factors. Availability of diabetes clinics, regular check-ups, and
medication adherence programs.
 Socioeconomic Status –
Higher-income individuals may have better access to  Dietary Habits –
healthcare and medication, while lower-income patients may Nutritional choices and meal planning can either
face barriers to management. improve or worsen glycemic control.

 Education Level –  Physical Activity –

Higher education may lead to better diabetes Exercise levels impact insulin sensitivity and overall
knowledge, self-care practices, and adherence to treatment metabolic health.
plans.
 Psychosocial Factors –
 Dependent Variable (Outcome) Stress, depression, and family support can influence
adherence to diabetes management.
 Glycemic Control –
Measured by HbA1c levels, it represents how well
patients are managing their blood sugar over time. Poor
control increases the risk of diabetes-related complications.

Fig 1 Conceptual Framework

IV. METHODOLOGY socioeconomic status, and education level) associated with

poor glycemic control among diabetic patients attending
 Study Design Kapkatet Sub-County Hospital, Kericho County, Kenya. A
This study employed a hospital-based cross-sectional cross-sectional approach was chosen as it allows for the
design to analyze the demographic factors (age, gender,

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examination of associations between demographic variables Technology, and Innovation (NACOSTI) before conducting
and glycemic control at a specific point in time. the study. Informed consent was sought from all participants,
ensuring they understood the study’s purpose, risks, and
 Study Setting benefits before data collection. Confidentiality was
The study was conducted at Kapkatet Sub-County maintained by assigning unique identification codes instead
Hospital, a Level 4 healthcare facility located in Kericho of using personal identifiers, following ethical guidelines for
County, Kenya. The hospital serves a diverse population, research involving human subjects in Kenya.
including rural and peri-urban residents, and provides
specialized diabetes care services such as outpatient V. RESULTS
consultations, routine blood glucose monitoring, and patient
education.  Demographic Characteristics
A total of 300 diabetic patients participated in the study,
 Study Population and Sampling achieving a response rate of 83.3%. The mean age of
The target population consisted of adult diabetic participants was 56.4 ± 10.2 years. Of the respondents, 58.7%
patients (aged 18 years and above) attending the diabetes were female, while 41.3% were male. In terms of
clinic at Kapkatet Sub-County Hospital. The inclusion and socioeconomic status, 44.2% of participants reported a
exclusion criteria were as follows: monthly income of less than 10,000 KES, and 32.6% were
unemployed. Educational levels varied, with 21.5% having
 Inclusion Criteria: no formal education, 38.9% completing primary school, and
only 18.2% attaining post-secondary education.
 Diagnosed with Type 2 Diabetes Mellitus for at least six
months.  Glycemic Control Status
 Attending routine diabetes care at Kapkatet Sub-County The prevalence of poor glycemic control (HbA1c
Hospital. >7.0%) was 62.3%. Females exhibited a higher prevalence
 Willing to provide informed consent. (66.1%) compared to males (57.5%). Patients aged 60 years
and above had the highest rate of poor glycemic control
 Exclusion Criteria: (74.8%). Lower educational attainment was significantly
associated with poor glycemic control (p<0.01), with 78.3%
 Pregnant women with gestational diabetes. of participants with no formal education showing suboptimal
 Patients with Type 1 Diabetes Mellitus. glucose regulation. Similarly, lower-income levels correlated
 Individuals with incomplete medical records. with poorer glycemic control (p=0.03).

A systematic random sampling method was used to  Association Between Demographic Factors and Poor
select participants from the diabetes clinic registry. A sample Glycemic Control
size of 300 patients was determined using Fisher’s formula, Chi-square analysis indicated significant associations
with an estimated 80% power to detect statistically significant between poor glycemic control and age (p=0.01), educational
associations. level (p<0.01), and socioeconomic status (p=0.03). Logistic
regression analysis confirmed that patients with lower
 Data Collection Methods education levels were 2.3 times more likely to have poor
Data were collected through structured questionnaires glycemic control (OR=2.3, 95% CI: 1.6-3.7). Unemployment
and medical record reviews. The questionnaire included also significantly increased the odds of poor glycemic control
sections on socio-demographic characteristics, (OR=1.9, 95% CI: 1.2-3.1).
socioeconomic status (income level, employment status), and
education level. Glycemic control was assessed using recent VI. DISCUSSION
HbA1c test results retrieved from hospital records. Poor
glycemic control was defined as HbA1c levels >7.0%, based The findings of this study indicate that age, gender,
on the American Diabetes Association (ADA) guidelines. socioeconomic status, and education level significantly
influence glycemic control among diabetic patients attending
 Statistical Analysis Kapkatet Sub-County Hospital. These results align with
Data analysis was conducted using SPSS version 26. previous research while also presenting some unique insights
Descriptive statistics (frequencies, means, and standard specific to the study population. Age has been widely
deviations) were used to summarize demographic recognized as a determinant of glycemic control, with older
characteristics. Chi-square tests and logistic regression patients often exhibiting poorer control due to longer disease
analyses were performed to determine associations between duration, complications, and reduced metabolic adaptability
demographic factors and poor glycemic control. A p-value (ADA), 2021). This study supports these findings, as older
<0.05 was considered statistically significant. patients had higher HbA1c levels compared to younger
counterparts. Similarly, a study by Al-Lawati et al. (2020)
 Ethical Considerations found that patients above 60 years had significantly poorer
Ethical approval was obtained from the Institutional glycemic control due to reduced physical activity and
Research and Ethics Committee (IREC) at Kabianga increased insulin resistance. However, conflicting evidence
University and the National Commission for Science, exists. A study by UK Prospective Diabetes Study (UKPDS,

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2019) suggested that while older patients initially
demonstrate poor glycemic control, their adherence to VII. CONCLUSION
medication and lifestyle modifications improves over time,
leading to eventual stabilization. This suggests that targeted  The Study Confirms That Age, Gender, Socioeconomic
interventions for elderly diabetic patients, particularly Status, And Education Level Significantly Influence
through structured education and follow-up programs, could Glycemic Control.
mitigate the observed trend in poor glycemic control.
 Older patients and those from lower socioeconomic
This study found that women had better glycemic backgrounds exhibited poorer glycemic control.
control than men, a trend supported by previous research  Women and individuals with higher education levels had
(Kautzky-Willer et al., 2022). Women tend to adhere better better glycemic control.
to medication and dietary recommendations, likely due to  Addressing these social determinants is crucial in
greater health-seeking behaviors and engagement in routine improving diabetes management.
check-ups (Wells et al., 2020). In contrast, men often engage
in unhealthy lifestyle behaviors such as smoking and RECOMMENDATIONS
excessive alcohol consumption, which negatively impact
glycemic control (Basu et al., 2021). Contrarily, some studies  Targeted Health Education-Implement community-based
have reported no significant gender differences in glycemic programs to educate patients, especially those with low
control (Nguyen et al., 2023). This discrepancy might be due literacy levels, on diabetes management.
to variations in healthcare access and cultural perceptions of  Gender-Sensitive Interventions-Encourage male patients
health-seeking behavior in different regions. More gender- to seek early diagnosis and adhere to treatment.
sensitive approaches are needed to ensure that both men and  Improving Socioeconomic Support-Subsidize diabetes
women receive tailored diabetes management interventions. medication and supplies for low-income patients.
Strengthen social support systems for those with financial
The study findings demonstrate that patients from challenges.
higher socioeconomic backgrounds had better glycemic
 Regular Screening and Follow-Up-Enhance periodic
control due to greater access to healthcare, quality nutrition,
screening and follow-up strategies, especially for older
and affordability of medication. These findings align with patients, to improve glycemic control.
research by Marmot et al. (2020), which emphasized that
financial stability directly impacts chronic disease
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[8] World Health Organization (WHO). (2023). Global
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APPENDICES

Appendix I: Patient Questionnaire

Section 1: Informed Consent

Before proceeding, please read the following statement: This study aims to assess how demographic factors influence glycemic
control among diabetic patients. Your participation is voluntary, and your responses will remain confidential. You can withdraw at
any time without consequences. Do you consent to participate?
☐ Yes ☐ No (If "No," do not proceed with the questionnaire.)

Section 2: Demographic Information

1. Age: ____ years
2. Gender: ☐ Male ☐ Female
3. Marital Status: ☐ Single ☐ Married ☐ Widowed ☐ Divorced/Separated
4. Level of Education: ☐ No Formal Education ☐ Primary ☐ Secondary ☐ Tertiary (College/University)
5. Employment Status: ☐ Employed ☐ Self-employed ☐ Unemployed ☐ Retired
6. Household Monthly Income (KES): ☐ <5,000 ☐ 5,000-10,000 ☐ 10,001-20,000 ☐ >20,000
7. Health Insurance Coverage: ☐ NHIF ☐ Private Insurance ☐ None

Section 3: Diabetes History and Management

8. Type of Diabetes: ☐ Type 1 ☐ Type 2 ☐ Other (Specify) ___________
9. Duration Since Diagnosis: ☐ <1 year ☐ 1-5 years ☐ 6-10 years ☐ >10 years
10. Current Treatment Plan (Select all that apply): ☐ Oral Medication ☐ Insulin Therapy ☐ Diet Control ☐ Herbal/Traditional
Medicine
11. How often do you monitor your blood sugar levels? ☐ Daily ☐ Weekly ☐ Monthly ☐ Rarely ☐ Never
12. Have you ever attended diabetes education sessions? ☐ Yes ☐ No
13. Do you follow a specific diet recommended by a healthcare provider? ☐ Yes ☐ No
14. Do you engage in regular physical activity (at least 30 minutes, 3 times a week)? ☐ Yes ☐ No

Section 4: Healthcare Access and Challenges

15. How often do you visit the hospital for diabetes check-ups? ☐ Monthly ☐ Every 3-6 months ☐ Annually ☐ Only when
sick
16. Do you face challenges in accessing diabetes medication?
☐ Yes ☐ No (If Yes, what are the main challenges? Select all that apply.) ☐ High Cost ☐ Distance to Hospital ☐ Stock-outs ☐
Other (Specify) ___________
17. How do you rate the support from healthcare providers in managing your diabetes? ☐ Excellent ☐ Good ☐ Fair ☐ Poor
18. Have you experienced complications related to diabetes (e.g., foot ulcers, vision loss, kidney problems)? ☐ Yes ☐ No

Section 5: Perceptions and Attitudes Toward Glycemic Control

19. How serious do you consider diabetes to be? ☐ Very Serious ☐ Somewhat Serious ☐ Not Serious
20. Do you believe that proper glycemic control can prevent complications? ☐ Yes ☐ No
21. What are your biggest challenges in managing your blood sugar? ☐ Lack of Knowledge ☐ Cost of Treatment ☐ Forgetting
Medication ☐ No Time for Exercise ☐ Other (Specify) ___________
22. What would help improve your diabetes management? ☐ More Education ☐ Cheaper Medication ☐ Community Support
Groups ☐ Improved Access to Healthcare

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APPENDIX II: IREC CLEARANCE

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Appendix III: NACOSTI clearance

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Appendix IV: Kapakatet Sub-County Hospital Approval

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