HbA1c awareness and its association with glycemic control among patients with diabetes mellitus: a cross-sectional study

Diabetes mellitus is a major public health burden in Pakistan, where poor glycemic control is associated with high rates of complications. HbA1c is the recommended marker of long-term glycemic control, yet patient awareness of its relevance remains poor. This study assessed HbA1c awareness among adult diabetic patients in Mardan, Pakistan, and its association with glycemic control; evaluated patients’ knowledge of recommended HbA1c targets and perceived-versus-actual glycemic status; and identified independent predictors of poor glycemic control. A cross-sectional study enrolled 400 adult patients with diabetes attending an outpatient tertiary care hospital between June–September 2024. Sociodemographic, clinical, and, HbA1c awareness data were collected using structured interviews, with HbA1c obtained from records. The primary outcome was poor glycemic control (HbA1c ≥ 8%). Analyses included chi-square testing, Pearson correlation, multivariable logistic regression. A p -value < 0.05 was considered statistically significant. Poor glycemic control was present in 34.8% of patients. While 62.0% had heard of HbA1c, only 8.25% knew the recommended target, and more than half (53.3%) misjudged their glycemic status. Younger age (AOR = 0.94; p < 0.001), longer diabetes duration (AOR = 1.09; p = 0.013), higher BMI (AOR = 1.10; p = 0.002), lack of HbA1c awareness (AOR = 14.46; p < 0.001), and absence of diabetes education (AOR = 7.14; p = 0.003) independently predicted poor control. The model showed high discriminative ability (AUC = 0.932), interpreted cautiously given the single-center design and modest sample size. Poor HbA1c awareness and limited diabetes education are strongly associated with poor glycemic control. Structured patient education may represent a modifiable target, though longitudinal studies are needed to confirm a causal impact on outcomes.