The impact of intensified clinical care on glycaemic control in patients with type 2 diabetes at Khayelitsha Community Health Centre,South Africa: Quasi-experimental study |
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| Institution: | 1. Department of Endocrinology, Odense University Hospital, Odense, Denmark;2. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;3. Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark;4. The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;5. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark;6. Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark;7. Department of Gynecology and Obstetrics, Hilleroed hospital, Hilleroed, Denmark;8. Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark;9. Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark;10. Medical Research Lab., Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;11. Section of Molecular Diabetes & Metabolism, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark;12. Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark |
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| Abstract: | AimThe aim was to evaluate the effect on glycaemic control of more intensive care for patients with very uncontrolled type-2 diabetes (HbA1c > 10%) at Khayelitsha Community Health Centre, South Africa.MethodsA pragmatic, quasi-experimental study. Patients with HBA1c > 10% were consecutively selected into a 6-month programme of intensified care involving monthly visits to a doctor, diabetes group education, escalation of treatment, and more frequent HbA1c testing by either point-of-care (POC) or laboratory. Participants were their own controls in a retrospective analysis of usual care during the previous year.ResultsAt baseline 236 patients had a mean HbA1c of 12.1%. The mean difference in HbA1c in the intervention group was ?1.1% (p < 0.001). The intervention group were exposed to group diabetes education (100% vs 0%), more visits (3.8 vs 3.2, p < 0.001), more HbA1c tests (2.2 vs 0.9, p < 0.001). There was no difference in increased dose of insulin between the groups or between POC and standard laboratory intervention sub-groups.ConclusionThe introduction of group diabetes education was the most likely explanation for improved glycaemic control in this poor, under-resourced, public sector, peri-urban setting. The study demonstrates a feasible approach to improving diabetes care in the South African context. |
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| Keywords: | Diabetes mellitus Diabetes group education Point-of-care testing Primary health care Primary care Patient education and counselling Guideline implementation |
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