Johnston, Leigh Clare2024-11-202024-11-202023Johnston, Leigh Clare. (2023). Determinants of sub-optimal glycaemic control among patients enrolled in a medicine dispensing programme in Kwazulu-Natal: A cohort study, 2018 – 2021 [Master’s dissertation PhD thesis, University of the Witwatersrand, Johannesburg]. WireDSpace. https://hdl.handle.net/10539/42780https://hdl.handle.net/10539/42780A Dissertation submitted in fulfillment of the requirements for the degree of Masters of Science in Field Epidemiology to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2023Background: 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.en© 2023 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.UCTDCCMDD programmeGlycaemic controlGlucose controlSurvival analysisLaboratory resultsUCTDSDG-3: Good health and well-beingDissertationUniversity of the Witwatersrand, Johannesburg