Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Rafael Perez-Escamilla

Second Advisor

Nicola Hawley


Background: There has been a growing prevalence of diabetes in rural populations in low and middle income countries. Over a third of Ecuador’s population lives in rural areas, which tend to experience poorer health outcomes than urban areas. Therefore, the objective of this study was to examine potential risk factors associated with diabetes management in this region.

Methods: A sample of 150 diabetes patients from the Futuro Valdivia clinic in Santa Elena, Ecuador were surveyed and tested for HbA1c. The interview collected data on a variety of risk factors including diet, exercise, eating habits, food insecurity, medication usage, medication adherence, mental health, sleep, and social support. Chi-square tests and multivariate logistic regression analysis were used to identify the risk factors associated with poor diabetes management (HbA1c >7.0%) in those that had a valid HbA1c reading (n=148). Backwards elimination was used to generate a final reduced model.

Results: Nearly three quarters of the study population had poor glycemic control. 58.8% were female, 85.8% had a grade school education or less, and the mean age was 56.8 years. A majority of patients (78.4%) were taking diabetes medication and over half paid for their medications out of pocket. Over one-third (37.7%) reported severe food insecurity. Adjusted odds of severe food insecurity (OR= 3.45, 95%CI 1.05, 11.37) and using medications (OR=6.02 95%CI 1.48, 24.57) were greater in those with poor diabetes management after adjusting for covariates.

Conclusion: Findings indicate that individuals with severe food insecurity and those that use diabetes medications have higher odds of poor management. The high proportion of patients with poor diabetes management signals a need for better care and support for self-management of diabetes in this region of Ecuador.


This is an Open Access Thesis.

Open Access

This Article is Open Access