Faculty of Health Sciences (ETDs)

Permanent URI for this communityhttps://hdl.handle.net/10539/37925

Browse

Filters

20232

Settings

Subject: search.filters.subject.Glycaemic control

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Developing a framework to improve glycaemic control among patients with type 2 diabetes mellitus in Kinshasa, democratic republic of the Congo
    (University of the Witwatersrand, Johannesburg, 2023) Lubaki, Jean-Pierre Fina
    Diabetes mellitus is a significant problem globally with a higher impact in developing countries. Glycaemic control is one of the main goals of type 2 diabetes treatment, as it delays or avoids the occurrence of diabetes related complications. In sub-Saharan Africa, including the Democratic Republic of the Congo, glycaemic control rates are sub optimal. This study aimed to develop a framework to improve glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo. This project comprises four sub-studies. The first sub-study was a systematic review and meta-analysis of studies published from 2012 to 2022 on the prevalence and factors driving glycaemic control in sub-Saharan Africa. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance at follow-up visits, and medication adherence were associated with good glycaemic control. The second sub-study was a concurrent parallel mixed methods cross-sectional analytical study among a total of 643 patients with type 2 diabetes — 23 in the qualitative phase and 620 in the quantitative phase — on factors associated with poor glycaemic control in Kinshasa. Five themes were identified as explanations for poor glycaemic control: financial constraints, limited social and relational support, difficulties with lifestyle changes, beliefs and practices about diabetes, and ability to adapt to caring for the illness. The quantitative phase showed that about two-thirds of the participants (67.8%; n=420) had poor glycaemic control and more than half were on insulin monotherapy (53.9%; n=334). No sociodemographic or lifestyle characteristics were associated with poor glycaemic control. Participants on monotherapy with insulin (AOR: 1.72 (95%CI:1.17-2.55)) had increased odds of poor glycaemic control compared to participants on oral hypoglycaemic drugs. In contrast, participants having and those having uncontrolled blood pressure (AOR: 0.60 (95%CI:0.39-0.92)) were less likely to have poor glycaemic control compared to participants having controlled blood pressure. The third sub-study was a qualitative study on the perspectives of 16 healthcare providers and 10 patients with type 2 diabetes on improving glycaemic control in Kinshasa. From the healthcare providers statements regarding improving glycaemic control, three themes were identified: strengthening the healthcare system, supporting persons with diabetes/population, and adopting supportive health policies. From the persons with diabetes perspectives three themes were also identified: need for support for caring of the illness, need for enhanced knowledge about diabetes, and the need for better communication with healthcare providers. Using the results of the first three studies, the fourth sub-study, a Delphi study, brought together 36 experts on the management of diabetes, who developed and agreed on the following strategies for improving glycaemic control in Kinshasa: strengthening the healthcare system, enhancing the awareness of diabetes, alleviating the financial burden of diabetes, enhancing the adoption of lifestyle modifications, and reducing the proportion of undiagnosed diabetes. These five strategies included a total of 39 potential interventions. Strengthening the healthcare system for better care promotes better organization and provision of services for diabetes care. Enhancing the awareness of diabetes among the population/patients stresses the need to develop and share information about diabetes through the most appreciated channels by the population. Alleviating the financial burden of diabetes targets for the long-term the need for universal health coverage, and meanwhile, encouraging the development of community-based health insurance. It also includes the search for a reduction in costs of diabetes medicines and materials through public-private partnerships. Enhancing the adoption of lifestyle modifications in our setting passes through the provision of accurate information on the content of lifestyle changes, and developing realistic exercise and dietary plans. Reducing the proportion of undiagnosed patients with diabetes needs to increase the detection of diabetes by targeting high risk groups at the level of primary care settings. This study highlighted the need to ensure that patients with type 2 diabetes benefitted from the full package required for diabetes care in a broader framework of managing non-communicable diseases in Kinshasa
  • Thumbnail Image
    Item
    Determinants of sub-optimal glycaemic control among patients enrolled in a medicine dispensing programme in Kwazulu-Natal: A cohort study, 2018 – 2021
    (University of the Witwatersrand, Johannesburg, 2023) Johnston, Leigh Clare
    Background: In South Africa, type 2 diabetes mellitus (T2DM) is a growing public health problem, thus, by 2030, 50% of T2DM patients, receiving treatment, must achieve optimal glycaemic control (haemoglobin A1c (HbA1c) ≤7%). The CCMDD (Central Chronic Medicines Dispensing and Distribution) programme allows glycaemically-stable patients to collect their medication from community-based pick-up points. While the CCMDD is a large public health programme, there is a paucity in stakeholder’s knowledge of T2DM patients glycaemic control over time. We determined glycaemic control for CCMDD-enrolled T2DM patients in eThekwini, South Africa from 2018-2021, as well as the rate and predictors of becoming sub-optimally controlled. Methods: We performed a cohort study, linking HbA1c data from the National Health Laboratory Service to CCMDD-enrolled patients in eThekwini, South Africa from 2018–2021. We included patients optimally controlled at their baseline HbA1c, and having ≥1 repeat test available. We used Kaplan Meier analysis to assess survival rates and Cox regression to determine associations between time to sub-optimal control (HbA1c > 7%) and several factors. Adjusted hazard ratios (aHR), 95% confidence interval (95% CI), and p-values are reported. Results: Of 41145 T2DM patients enrolled in the CCMDD, 7960 (19%) had an available HbA1c result over the study period. A quarter of patients (2147/7960; 27%) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing their status to sub-optimal control. Patients prescribed dual-therapy had a higher risk of sub-optimal glycaemic control (aHR: 1.503; 95% CI: 1.16–1.95; p-value=0.002) compared to those on monotherapy. HbA1c testing frequency per national guidelines (aHR: 0.46; 95% CI: 0.24–0.91; p-value=0.024) was associated with a lower hazard of sub-optimal glycaemic control. Conclusions: HbA1c monitoring, in line with testing frequency guidelines, is needed to flag sub- optimally controlled patients who become ineligible for CCMDD enrolment. Patients receiving dual-therapy may require special consideration. Addressing these shortfalls can assist planning and implementation to achieve 2030 targets.