Determinants of Suboptimal Glycaemic Control in Type 2 Diabetic Patients on Insulin Therapy in Maiduguri, North East Nigeria

Background: Insulin therapy remains the cornerstone of glycaemic management in advanced type 2 diabetes, yet many patients fail to achieve optimal glycaemic control despite insulin use. Identifying the determinants of suboptimal control in the North East Nigerian context, characterised by unique socioeconomic and conflict-related factors, is essential for improving outcomes. This study examined determinants of suboptimal glycaemic control among type 2 diabetic patients on insulin therapy in Maiduguri. Methods: A cross-sectional analytical study was conducted among 240 type 2 diabetic patients on insulin at the University of Maiduguri Teaching Hospital diabetes clinic. Glycaemic control was assessed by HbA1c level, with suboptimal control defined as HbA1c above 7 percent. Multivariate regression analysis identified independent determinants of suboptimal control. Results: Suboptimal glycaemic control was present in 71 percent of patients. Independent determinants included insulin storage without refrigeration (OR 3.2), self-reported irregular insulin use (OR 2.9), food insecurity (OR 2.4), and poor self-monitoring of blood glucose (OR 1.8). Educational level was inversely associated with suboptimal control. Conclusion: Suboptimal glycaemic control in Maiduguri insulin-treated patients is driven by modifiable factors including storage conditions, food security, and monitoring behaviour. Integrated social support and patient empowerment programmes are essential alongside clinical interventions. Keywords: glycaemic control, type 2 diabetes, insulin therapy, Maiduguri, determinants