Factors influencing glycaemic control in diabetics at three community health centres in Johannesburg
Year: 2011
Type: dissertation
Study design: Observational Study
Abstract: Introduction: \nThe complications associated with diabetes usually occur over a long period of time and \nare mainly influenced by poor glycaemic control. Diabetic complications impact on the \nindividual, the healthcare delivery system, and also have high cost implications. A number \nof studies have shown the management of diabetes to be sub-optimal in primary health \ncare settings. Barriers that impair a patients’ ability to achieve good glycaemic control can \nbe looked at from a patient, health facility and health professional perspectives. Good \nglycaemic control will not only benefit the individual patient but will also have a positive \nfinancial impact on South Africa’s already overstretched healthcare budget. \nMethods: \nIn this cross sectional analytical study set in three Community Health Centres (CHCs) in \nthe Johannesburg Metropolitan Health District, 418 diabetic patients were selected. An \nHbA1c test was conducted for every patient and was used to classify patients into a well \ncontrolled glycaemic group (HbA1c < 7%) or a poorly controlled group (HbA1c ≥ 7%). \nDifferences between the two groups in terms of their risk factors for poor glycaemic control \nwere investigated. Patient related risk factors studied included, basic demographic, \ntreatment related, clinical, behavioural and lifestyle characteristics. Healthcare \nprofessionals and facility managers were interviewed and patient records were reviewed to \ndescribe health system challenges to providing optimal care. Univariate and multivariate \nlogistic regression models were used to determine patient related factors influencing \nglycaemic control. \nResults: \nOf 394 patients with a measurable outcome (HbA1c), only 62 (15.7%) had well controlled \ndiabetes. The mean HbA1c was similar across the three CHCs studied (p=0.464). Good \nglycaemic control was significantly associated with unemployment, shorter duration since \ndiabetes diagnosis, treatment with oral medication alone and normal LDL-cholesterol \nlevels (p<0.05). On multivariate analysis significant predictors of good glycaemic control \nwere found to be a shorter duration since diabetes diagnosis, treatment with oral \nmedication alone, being male, and those who were unemployed. \nNumerous challenges to providing optimal diabetes care were reported by health \nprofessionals including high patient to staff ratios, lack of working equipment as well as a \nneed to improve diabetes management skills. Record review revealed that only a limited \nnumber of patients (16%) had ever had HbA1c testing. \nConclusions: \nThe majority (84.2%) of patients attending the selected facilities for diabetes care had poor \nglycaemic control. Management of diabetes in these CHCs is suboptimal. Patients with a \nshorter duration of diabetes, those who were male, Black African, unemployed and treated \nwith oral medication alone were more likely to have good glycaemic control. Although the \nstudy concludes that patient related factors are at the forefront in terms of factors \ninfluencing glycaemic control, improved strategies in all spheres can only improve diabetes \nmanagement at the CHCs.
Author: Geraldine Antoinette Timothy
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2260940024