Factors influencing glycaemic control in diabetics at three community health centres in Johannesburg
Date
2011-03-10
Authors
Timothy, Geraldine Antoinette
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Abstract
Introduction:
The complications associated with diabetes usually occur over a long period of time and
are mainly influenced by poor glycaemic control. Diabetic complications impact on the
individual, the healthcare delivery system, and also have high cost implications. A number
of studies have shown the management of diabetes to be sub-optimal in primary health
care settings. Barriers that impair a patients’ ability to achieve good glycaemic control can
be looked at from a patient, health facility and health professional perspectives. Good
glycaemic control will not only benefit the individual patient but will also have a positive
financial impact on South Africa’s already overstretched healthcare budget.
Methods:
In this cross sectional analytical study set in three Community Health Centres (CHCs) in
the Johannesburg Metropolitan Health District, 418 diabetic patients were selected. An
HbA1c test was conducted for every patient and was used to classify patients into a well
controlled glycaemic group (HbA1c < 7%) or a poorly controlled group (HbA1c ≥ 7%).
Differences between the two groups in terms of their risk factors for poor glycaemic control
were investigated. Patient related risk factors studied included, basic demographic,
treatment related, clinical, behavioural and lifestyle characteristics. Healthcare
professionals and facility managers were interviewed and patient records were reviewed to
describe health system challenges to providing optimal care. Univariate and multivariate
logistic regression models were used to determine patient related factors influencing
glycaemic control.
Results:
Of 394 patients with a measurable outcome (HbA1c), only 62 (15.7%) had well controlled
diabetes. The mean HbA1c was similar across the three CHCs studied (p=0.464). Good
glycaemic control was significantly associated with unemployment, shorter duration since
diabetes diagnosis, treatment with oral medication alone and normal LDL-cholesterol
levels (p<0.05). On multivariate analysis significant predictors of good glycaemic control
were found to be a shorter duration since diabetes diagnosis, treatment with oral
medication alone, being male, and those who were unemployed.
Numerous challenges to providing optimal diabetes care were reported by health
professionals including high patient to staff ratios, lack of working equipment as well as a
need to improve diabetes management skills. Record review revealed that only a limited
number of patients (16%) had ever had HbA1c testing.
Conclusions:
The majority (84.2%) of patients attending the selected facilities for diabetes care had poor
glycaemic control. Management of diabetes in these CHCs is suboptimal. Patients with a
shorter duration of diabetes, those who were male, Black African, unemployed and treated
with oral medication alone were more likely to have good glycaemic control. Although the
study concludes that patient related factors are at the forefront in terms of factors
influencing glycaemic control, improved strategies in all spheres can only improve diabetes
management at the CHCs.
Description
MMed, Community Health, Faculty of Health Sciences,University of the Witwatersrand
Keywords
glycaemic control, diabetes, diabetics, influencing factors