Sociodemographic predictors of glycaemic control among adults with type 2 diabetes mellitus in a Nigerian population: Implications for public health and service delivery

Background Type 2 diabetes mellitus (T2DM), presents a rising public health burden in Nigeria, with suboptimal glycaemic control leading to preventable chronic complications associated with high mortality. This study aimed to determine the prevalence of poor glycaemic control and identify the independent sociodemographic and clinical predictors among Nigerian adults with T2DM. Methods A retrospective, multi-centre, cross-sectional study was conducted using records from five specialist clinics in Enugu State, Nigeria, comprising N = 1,030 adults with T2DM. Glycaemic control was defined using the last recorded HbA1c value. Predictors were analysed using binary logistic regression and stratified analyses were performed by sex, disease duration, and comorbid hypertension status to test for effect modification. Result The prevalence of poor glycaemic control was 32.2%. Independent predictors in the overall model were female sex (AOR = 1.75, p < 0.001), older age (AOR = 2.15, p = 0.001), and longer diabetes duration (AOR = 5.77, p < 0.001). Stratified analyses demonstrated significant effect modification, with the risk associated with long duration being over three times greater for women (AOR = 9.56, p < 0.001) than for men (AOR = 3.06, p = 0.034), while comorbid hypertension was a significant predictor only among males (AOR = 3.09, p = 0.024). Also, poor glycaemic control in the early phase was driven by comorbid hypertension (AOR = 2.59, p = 0.011) and older age (AOR = 2.26, p = 0.004), whereas in the late phase it was driven by female sex (AOR = 2.89, p = < 0.001) and a trend towards low socioeconomic status (p = 0.051). No synergistic effect was observed between age and duration. Conclusion The drivers of poor glycaemic control are dynamic, shifting from clinical factors (age, hypertension) in the early stage to cumulative social and behavioural challenges (female sex, socioeconomic status) in long-standing disease. These findings highlight the need to move from generalised diabetes care to targeted interventions that address the unique sex- and duration-related vulnerabilities of patients in Nigeria.