# Characteristics associated with optimal blood sugar in individuals living with type 2 diabetes in hard-to-reach rural communities: results of a cross-sectional study in Esmeraldas, Ecuador

## TL;DR

This study finds that men, older people, and those in urban areas are more likely to have optimal blood sugar levels in a rural Ecuadorian population with type 2 diabetes.

## Contribution

The study identifies gender, age, urbanization, and employment as key factors linked to optimal glucose control in a hard-to-reach rural population with T2DM.

## Key findings

- Only 18.1% of participants had optimal fasting glucose levels.
- Men were nearly four times more likely to have optimal glucose than women.
- Urban residence and older age were positively associated with optimal glucose levels.

## Abstract

Type 2 diabetes mellitus (T2DM) is a pressing public health challenge in Latin America, with an increasing prevalence and negative impacts on population health. Achieving optimal blood glucose levels is critical for preventing complications, yet significant socioeconomic inequities persist in disease management and optimal glucose control. We aimed to investigate the patient characteristics associated with optimal fasting capillary glucose in individuals living with T2DM in a hard-to-reach setting in Esmeraldas, Ecuador.

We carried out a cross-sectional study of individuals with T2DM in the Eloy Alfaro health district of Esmeraldas, using a complex sample design with some limitations. Data collection took place between October 2020 and May 2022 and involved face-to-face interviews to collect sociodemographic and clinical data and a Fasting Capillary Blood Glucose test. Perceived social support was measured with the Multidimensional Scale of Perceived Social Support (MSPSS). We estimated the prevalence of optimal glucose levels according to patient characteristics and calculated odds ratios (OR) with 95% confidence intervals using multivariable logistic regression.

Of the 474 participants surveyed, only 18.1% (86; 95%CI: 14.9–21.9) had optimal fasting capillary glucose levels. In this sample, optimal glucose was nearly four times more frequent among men compared to women (aOR = 3.92, 95%CI: 2.08–7.40, p < 0.001). Furthermore, older age (aOR = 1.03, 95%CI: 1.01–1.05, p = 0.006), living in an urbanised setting (aOR = 2.04, 95%CI: 1.22–3.40, p = 0.006) and unemployment (aOR = 0.48, 95%CI: 0.25–0.94, p = 0.031) were also linked to optimal blood glucose levels. While perceived social support in this population was moderate (median = 2.33, on a scale of 1 to 4), high family support appeared to reduce optimal glycaemic levels (aOR = 0.35, 95%CI: 0.18–0.70, p = 0.003).

The intricate interplay of factors influencing diabetes management and optimal blood sugar suggests that targeted, context-specific and gender-sensitive public health strategies may be needed to address diabetes disparities in vulnerable populations.

The online version contains supplementary material available at 10.1186/s12889-025-22324-z.