Determinants of sub-optimal glycemic control among patients enrolled in a medicine dispensing programme in KwaZulu-Natal: A cohort study, 2018–2021
African Journal of Primary Health Care & Family Medicine
| Field | Value | |
| Title | Determinants of sub-optimal glycemic control among patients enrolled in a medicine dispensing programme in KwaZulu-Natal: A cohort study, 2018–2021 | |
| Creator | Johnston, Leigh C. Ngassa Piotie, Patrick Maposa, Innocent Singh, Sandhya Kuonza, Lazarus De Voux, Alex | |
| Description | Background: The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme facilitates clinically stable patients to collect their chronic medication from community-based pick-up points.Aim: We determined baseline glycaemic control and rates and predictors of becoming sub-optimally controlled for type 2 diabetes mellitus (T2DM) CCMDD-enrolled patients.Setting: The setting of the study was eThekwini, KwaZulu-Natal, South Africa.Methods: We performed a cohort study (April 2018- December 2021). We linked T2DM CCMDD-enrolled patients to glycated haemoglobin (HbA1c) data from the National Health Laboratory Service. We selected patients optimally controlled at their baseline HbA1c, with ≥ 1 repeat-test available. We used Kaplan–Meier analysis to assess survival rates and extended Cox regression to determine associations between time to sub-optimal control (HbA1c 7%) and predictors. Adjusted hazard ratios (aHRs), 95% confidence interval (CI), and p-values are reported.Results: Of the 41145 T2DM patients enrolled in the CCMDD programme, 7960 (19%) had a HbA1c result available. Twenty-seven percent (2147/7960) 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 to sub-optimal status. The HbA1c testing frequency as per national guidelines was associated with a lower hazard of sub-optimal glycaemic control (aHR: 0.46; 95% CI: 0.24–0.91; p-value = 0.024). Patients prescribed dual-therapy had a higher hazard of sub-optimal glycaemic control (aHR: 1.50; 95% CI: 1.16–1.95; p-value = 0.002) versus monotherapy.Conclusions: The HbA1c monitoring, in-line with testing frequency guidelines, is needed to alert the CCMDD programme of patients who become ineligible for enrolment. Patients receiving dual-therapy require special consideration.Contribution: Addressing identified shortfalls can assist programme implementation | |
| Publisher | AOSIS | |
| Date | 2024-05-31 | |
| Identifier | 10.4102/phcfm.v16i1.4336 | |
| Source | African Journal of Primary Health Care & Family Medicine; Vol 16, No 1 (2024); 12 pages 2071-2936 2071-2928 | |
| Language | eng | |
| Relation |
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:
https://phcfm.org/index.php/phcfm/article/view/4336/7225
https://phcfm.org/index.php/phcfm/article/view/4336/7226
https://phcfm.org/index.php/phcfm/article/view/4336/7227
https://phcfm.org/index.php/phcfm/article/view/4336/7228
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