Prevalence and Effects of Delayed Treatment Intensification and Its Predictors among Type 2 Diabetic Patients at The University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024: A Mixed Approach Study.

Abstract

Background: Timely treatment intensification is critical for managing type 2 diabetes mellitus but delays are common, especially in resource-limited settings like Ethiopia. Delayed treatment intensification contributes to poor glycemic control and increases the risk of chronic diabetic complications. However, the magnitude and contributing factors to delayed intensification are not well-documented locally. Objective: To determine the prevalence and assess the effects of delayed treatment intensification and predictors among type 2 diabetes mellitus at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Method: A mixed-method study was conducted from July 1 to November 1, 2024. Quantitative data were collected retrospectively from 420 type 2 diabetes mellitus patients, and multivariable logistic regression was used to identify factors associated with delayed treatment intensification. Qualitative data were collected through in-depth interviews with healthcare providers, and thematic analysis was applied to identify underlying barriers to timely treatment intensification. Results: The prevalence of delayed treatment intensification was 51.43% (95% CI: 46.6–56.2%), with a median delay of 14 months (IQR: 7.5–42 months). Among those with delayed treatment intensification, 43.06% developed chronic diabetic complications, including retinopathy (18.06%), neuropathy (14.35%), and nephropathy (6.02%). Significant predictors of delayed treatment intensification included longer duration of diabetes (AOR = 1.68; 95% CI: 1.13–2.5), comorbidities (AOR = 1.83; 95% CI: 1.04–3.2), and use of cardioprotective medications (AOR = 1.59; 95% CI: 1.04–2.43). Qualitative findings revealed additional barriers contributing to delayed treatment intensification, including financial limitations, insufficient patient awareness, healthcare professional fatigue, and inadequate healthcare infrastructure. Conclusion: This study found a high prevalence of delayed treatment intensification (51.43%), linked to risk factors and chronic complications. To reduce delays in treatment intensification, focus is needed on patients with long disease duration, co-morbidities, cardioprotective medications, and low awareness. Additionally, addressing healthcare provider fatigue and resolving infrastructure challenges are crucial for improving care delivery.