This study assessed predictors of poor glycemic control among adults attending a peri-urban diabetic clinic in Wakiso district, Uganda using modified Poisson regression analysis. Overall, 67.8% of the participants had poor glycemic control, indicating a substantial burden of uncontrolled diabetes among patients attending Kasangati Health Centre IV. This prevalence is comparable to findings from other studies conducted in sub-Saharan Africa, where poor glycemic control among patients with diabetes has ranged between 60% and 80% [13, 14].

The high prevalence of poor glycemic control observed in this study may reflect the combined influence of socioeconomic barriers, limited continuity of chronic care, inadequate lifestyle modification support, psychosocial challenges, and rising treatment burden among patients with diabetes in low-resource settings. In peri-urban communities such as Wakiso district, rapid urbanization, changing dietary patterns, sedentary lifestyles, and increasing out-of-pocket healthcare expenditures may further complicate diabetes self-management and long-term glycemic control. In addition, health systems in many low- and middle-income countries remain largely oriented toward acute care delivery, which may limit the effectiveness of long-term chronic disease management services such as regular monitoring, adherence counseling, and psychosocial support for patients with diabetes [15].

Older age was independently associated with poor glycemic control. Participants aged 40–64 years and those aged ≥65 years were more likely to experience poor glycemic control compared to younger participants. This finding may be attributed to progressive pancreatic beta-cell dysfunction, longer duration of disease, increasing treatment burden, and the presence of age-related comorbidities that complicate diabetes management. Older adults may also experience challenges related to reduced physical activity, cognitive decline, and adherence difficulties associated with multiple medications. Similar findings have been reported in studies conducted in Ethiopia and Nigeria, where older age groups were significantly associated with suboptimal glycemic outcomes [16, 17].

Low income level was a strong predictor of poor glycemic control. Participants with low income were significantly more likely to have uncontrolled blood glucose levels compared to those with higher income. Socioeconomic disadvantage can negatively affect diabetes management through inability to afford medications, transportation to health facilities, recommended diabetic diets, and routine laboratory investigations. Financial hardship may also reduce access to health information and supportive diabetes care services. Similar associations between low socioeconomic status and poor glycemic control have been reported in studies from low- and middle-income countries [18]. This finding highlights the broader structural inequalities that influence chronic disease outcomes beyond individual patient behaviors alone.

Polypharmacy was significantly associated with poor glycemic control. Participants taking two or more concurrent medications were more likely to have uncontrolled glycemia compared to those taking fewer medications. Multiple medications may increase treatment complexity, polypharmacy, medication fatigue, and forgetfulness, ultimately affecting adherence. In addition, patients requiring multiple medications are often those with more advanced disease or multiple comorbid conditions, which further complicate glycemic management. Similar findings have been reported in studies among patients with diabetes in resource-limited settings where increasing medication burden was associated with reduced adherence and poor treatment outcomes [18, 19, 20].

Non-adherence to regular clinic follow-up was also identified as a significant predictor of poor glycemic control. Patients who failed to attend their routine clinical follow-ups had poor glycemic outcomes as compared to those who attended their clinical follow-ups. Regular follow-up is essential for monitoring glycemic trends, adjusting treatment regimens, reinforcing adherence counseling, and identifying diabetes-related complications early. In other words, missing scheduled clinic appointments could result in delayed treatment optimization, poor continuity of care, and inadequate self-management support. Similar findings have been reported in previous studies conducted in Ethiopia and Kenya where non-attendance of clinic follow-ups was found to predict poor glycemic outcomes among patients with diabetes mellitus [21, 22].

Medication side effects were independently associated with poor glycemic control. Participants who experienced side effects were more likely to have uncontrolled glycemia compared to those without side effects. Medication-related adverse effects may discourage continued medication use, contribute to irregular dosing practices, or reduce adherence due to fear of worsening symptoms. This finding underscores the importance of routine assessment, counseling, and management of adverse drug effects during diabetes care. Similar findings have been documented in studies examining treatment adherence among diabetic patients [23, 24].

Lifestyle-related factors including physical inactivity and failure to follow recommended dietary plans were significantly associated with poor glycemic control. Participants who did not engage in regular physical exercise and those not adhering to dietary recommendations had increased likelihood of uncontrolled glycemia. Physical activity improves insulin sensitivity and glucose utilization, while healthy dietary practices remain central to diabetes management. Failure to sustain these lifestyle modifications may therefore contribute to persistent hyperglycemia. Similar findings have been reported in previous studies where sedentary behavior and poor dietary adherence were strongly linked to poor glycemic outcomes [25, 26]. These findings reinforce the importance of strengthening lifestyle counseling within routine diabetes care services.

Factors related to psychosocial wellbeing and the treatment process also had a considerable impact on glycemic status. Participants who believed that treatment regimen complexity impaired adherence were more likely to experience poor glycemic control. Complex treatment regimens may increase pill burden, dosing confusion, treatment fatigue, and forgetfulness, particularly among patients with limited health literacy or inadequate counseling support. In low-resource settings, regimen complexity may further worsen adherence where patients already face financial barriers, inconsistent medication access, and limited continuity of care. Poor adherence resulting from complex medication schedules may consequently contribute to persistent hyperglycemia and suboptimal glycemic outcomes. Similar findings have been reported in studies linking medication regimen complexity, poor adherence, and uncontrolled glycemia among patients with type 2 diabetes [27, 28].

Similarly, participants who perceived stress as affecting their glycemia had increased likelihood of poor glycemic control. Psychological stress may negatively affect glycemic outcomes through both physiological where stress-related hormonal responses involving cortisol and catecholamine release may contribute to elevated blood glucose levels where and behavioral where stress may also reduce adherence to medications, disrupt dietary practices, impair sleep, and limit engagement in physical activity. In low-resource settings, psychosocial stress may be further compounded by financial insecurity, chronic medication costs, and long-term disease burden, which may collectively undermine diabetes self-management practices. This finding highlights the importance of integrating mental health screening, psychosocial counseling, and patient support interventions into routine diabetes care services. Similar associations between psychosocial stress, diabetes distress, and poor glycemic outcomes have been reported in previous studies among patients with diabetes [29, 30].

Lack of access to peer support groups was independently associated with poor glycemic control. These groups are likely to benefit those with diabetes by providing emotional support, common experiences, education, motivation, and reinforcement of self-management skills. In settings where resources are inadequate, peer networks might provide additional help with dealing with the stigma, frustration, and stress associated with their condition, as well as limited access to counseling. Patients without such support systems may therefore experience reduced adherence, poorer coping mechanisms, and suboptimal glycemic outcomes. Similar findings have been reported in a studies from Uganda demonstrating that social support and peer-based interventions can improve diabetes self-management and treatment adherence among patients with chronic disease [31].

Financial barriers to accessing diabetes care were significantly associated with poor glycemic control. Participants who experienced costs related to transportation, medications, laboratory investigations, and clinic attendance were more likely to have uncontrolled glycemia. Unlike acute illnesses, diabetes requires lifelong treatment, regular monitoring, continuous medication use, and sustained lifestyle modification, all of which may impose substantial financial burden on patients and households in low-resource settings. In peri-urban communities where out-of-pocket health expenditures remain high, financial constraints may compromise treatment adherence, continuity of care, and timely access to monitoring services. This finding highlights the broader influence of socioeconomic inequalities on chronic disease outcomes and underscores the need for policies that improve affordability and accessibility of diabetes care services. Similar findings have been reported in studies from sub-Saharan Africa where healthcare costs negatively affected diabetes treatment adherence and glycemic outcomes [32, and 33].