Suboptimal control and failure to intensify therapy for South Africans with type 2 diabetes : an audit of diabetes management at primary health care facilities

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dc.contributor.author Ngassa Piotie, Patrick
dc.contributor.author Webb, Elizabeth M.
dc.contributor.author Rheeder, Paul
dc.date.accessioned 2024-08-30T10:10:46Z
dc.date.available 2024-08-30T10:10:46Z
dc.date.issued 2024
dc.description.abstract BACKGROUND : The management of people living with type 2 diabetes (T2D) in primary care in a South African district was audited, focusing on glycaemic, cholesterol, and blood pressure (BP) control to identify gaps in care and evidence of clinical inertia. METHODS : A cross-sectional retrospective review was conducted of medical records belonging to patients with T2D seen at 23 primary health care facilities between February and May 2019. Fieldworkers collected patient demographics, BP, laboratory measurements such as HbA1c (two most recent values), total cholesterol (TC) and LDL cholesterol (LDL-C), and which glucose-lowering drug each patient was on, as well as the dosage. RESULTS : The mean (SD) age of patients was 58 (11.8) years and 64% of them were women. Most patients had hypertension (83%) and were using statins (78%). Most patients (46%) were on second-line therapy and less than a quarter of patients were on insulin (22%). Only 23% (CI: 18.9–27.9%) of patients met the HbA1c target of < 7% with a mean HbA1c of 8.8%. Over half of patients (56%) had achieved the BP target (< 140/90 mmHg) and only 15% (CI: 8.1–23.9%) of the 88 patients with LDL-C values met the LDL target. Healthcare providers failed to intensify oral treatment for most patients who had suboptimal glycaemic control, and most patients who were on maximum oral drugs were not initiated on insulin. CONCLUSIONS : In most patients, diabetes control targets were not met, and treatment was not intensified when needed, suggesting clinical inertia. en_US
dc.description.department Internal Medicine en_US
dc.description.department School of Health Systems and Public Health (SHSPH) en_US
dc.description.librarian hj2024 en_US
dc.description.sdg SDG-03:Good heatlh and well-being en_US
dc.description.uri https://www.tandfonline.com/loi/oemd20 en_US
dc.identifier.citation Piotie, P.N., Webb, E.M. & Rheeder, P. 2024, 'Suboptimal control and failure to intensify therapy for South Africans with type 2 diabetes : an audit of diabetes management at primary health care facilities', Journal of Endocrinology, Metabolism and Diabetes of South Africa, vol. 29, no. 1, pp. 37-42, doi : 10.1080/16089677.2024.2311497. en_US
dc.identifier.issn 1608-9677 (print)
dc.identifier.issn 2220-1009 (online)
dc.identifier.other 10.1080/16089677.2024.2311497
dc.identifier.uri http://hdl.handle.net/2263/97942
dc.language.iso en en_US
dc.publisher NISC (Pty) Ltd, Medpharm Publications, and Informa UK Limited en_US
dc.rights © 2023 The Author(s). Open Access article distributed under the terms of the Creative Commons License [CC BY-NC-ND 4.0]. en_US
dc.subject Clinical inertia en_US
dc.subject Cross-sectional audit en_US
dc.subject Glycaemic control en_US
dc.subject Primary care en_US
dc.subject Type 2 diabetes mellitus (T2DM) en_US
dc.subject SDG-03: Good health and well-being en_US
dc.title Suboptimal control and failure to intensify therapy for South Africans with type 2 diabetes : an audit of diabetes management at primary health care facilities en_US
dc.type Article en_US


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