Processes of care, lifestyle advice, treatment and glycaemic control amongst patients with Type 2 diabetes attending the Johan Heyns Community Health Centre in Sedibeng District

[摘要] BackgroundThe combined influence of processes of care, lifestyle advice and drug treatment on glycaemic controlin Type 2 diabetes in primary care settings is not well documented.AimTo describe the provision of lifestyle advice, selected processes of care and drug treatment to, andassess the influence of these factors on glycaemic control in, a sample of adults with type 2 diabetesmellitus attending the Johan Heyns Community Health Centre in Sedibeng District, Gauteng.MethodsA cross-sectional design was used. Participants consisted of 200, consecutively chosen, adult volunteerswith type 2 diabetes. Information on demographics, reported receipt of lifestyle advice andanthropomorphic measurements was collected through questionnaire-based interviews. This wasfollowed by a record review of all participants’ clinic files for information on current drug management,co-morbid medical conditions and documentation of processes of care, in the preceding 12 months, inrespect of HbA1c, blood pressure (BP), weight, waist circumference (WC) and body mass index (BMI)monitoring. HbA1c values were used to ascertain glycaemic control. Performance of processes of carewas assessed in accordance with Society for Endocrinology, Metabolism and Diabetes of South Africa(SEMDSA) guidelines. Parsimonious models for glycaemic control were constructed through multivariatelogistic regression.ResultsMean age of the sample was 58 years with 58% in the 50-64 year age group. Blacks (88%) and females(63%) were in the majority.Over two-thirds had diabetes for under 10 years and 98% had at least one co-morbid condition, mainlyhypertension (92%). Obesity was noted in 65%, while 95% of females and 83% of males had a WC thatconferred substantial cardio-metabolic risk.Receipt of advice on any of diet, exercise or weight control from a health professional in the preceding12 months was reported by 79%, with 67% reporting receipt of advice on all three.Under 2% of patient records met the SEMDSA standard for processes of care for HbA1c, weight, WC andBMI monitoring, while 93% achieved the standard for BP monitoring.Exclusive oral treatment was prescribed in 62%, and the majority of these were on combined metforminand sulphonylurea; 5% were on insulin monotherapy.Optimal glycaemic control (HbA1c < 7%) was noted in only 25% of the sample.On multivariate analyses, the presence of CCF conferred higher odds of controlled glycaemia (OR = 3.17,P = 0.035). Compared with insulin monotherapy, treatment with either combined metformin and insulin(OR = 0.216, P = 0.02), or with the combination of all 3 drug classes ( metformin, sulphonylurea andinsulin) (OR = 0.185, P = 0.027), conferred lower odds of glycaemic control.ConclusionsThis study highlights substantial shortcomings in the compliance with key processes of care and theachievement of optimal glycaemic control for type 2 diabetes mellitus in the current research setting.An inverse association was noted between glycaemic control and the use of combined oral and insulindrug therapy. Measured processes of care and reported receipt of lifestyle advice showed no associationwith glycaemic control. CCF co-morbidity conferred improved odds of controlled glycaemia.

[发布机构] University of the Witwatersrand