1
|
Brennan AT, Lauren E, Bor J, George JA, Chetty K, Mlisana K, Dai A, Khoza S, Rosen S, Stokes AC, Raal F, Hibberd P, Alexanian SM, Fox MP, Crowther NJ. Gaps in the type 2 diabetes care cascade: a national perspective using South Africa's National Health Laboratory Service (NHLS) database. BMC Health Serv Res 2023; 23:1452. [PMID: 38129852 PMCID: PMC10740239 DOI: 10.1186/s12913-023-10318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Research out of South Africa estimates the total unmet need for care for those with type 2 diabetes mellitus (diabetes) at 80%. We evaluated the care cascade using South Africa's National Health Laboratory Service (NHLS) database and assessed if HIV infection impacts progression through its stages. METHODS The cohort includes patients from government facilities with their first glycated hemoglobin A1c (HbA1c) or plasma glucose (fasting (FPG); random (RPG)) measured between January 2012 to March 2015 in the NHLS. Lab-diagnosed diabetes was defined as HbA1c ≥ 6.5%, FPG ≥ 7.0mmol/l, or RPG ≥ 11.1mmol/l. Cascade stages post diagnosis were retention-in-care and glycaemic control (defined as an HbA1c < 7.0% or FPG < 8.0mmol/l or RPG < 10.0mmol/l) over 24-months. We estimated gaps at each stage nationally and by people living with HIV (PLWH) and without (PLWOH). RESULTS Of the 373,889 patients tested for diabetes, 43.2% had an HbA1c or blood glucose measure indicating a diabetes diagnosis. Amongst those with lab-diagnosed diabetes, 30.9% were retained-in-care (based on diabetes labs) and 8.7% reached glycaemic control by 24-months. Prevalence of lab-diagnosed diabetes in PLWH was 28.6% versus 47.3% in PLWOH. Among those with lab-diagnosed diabetes, 34.3% of PLWH were retained-in-care versus 30.3% PLWOH. Among people retained-in-care, 33.8% of PLWH reached glycaemic control over 24-months versus 28.6% of PLWOH. CONCLUSIONS In our analysis of South Africa's NHLS database, we observed that 70% of patients diagnosed with diabetes did not maintain in consistent diabetes care, with fewer than 10% reaching glycemic control within 24 months. We noted a disparity in diabetes prevalence between PLWH and PLWOH, potentially linked to different screening methods. These differences underscore the intricacies in care but also emphasize how HIV care practices could guide better management of chronic diseases like diabetes. Our results underscore the imperative for specialized strategies to bolster diabetes care in South Africa.
Collapse
Affiliation(s)
- Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Evelyn Lauren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jaya A George
- Wits Diagnostic Innovation Hub, University of the Witwatersrand, Johannesburg, South Africa
| | - Kamy Chetty
- National Health Laboratory Service, Johannesburg, South Africa
| | - Koleka Mlisana
- Academic Affairs, Research & Quality Assurance, National Health Laboratory Service, Johannesburg, South Africa
| | - Andrew Dai
- Department of Mathematics and Statistics, Boston University, Boston, USA
| | - Siyabonga Khoza
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Frederick Raal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Nigel J Crowther
- National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| |
Collapse
|
2
|
Garrib A, Njim T, Adeyemi O, Moyo F, Halloran N, Luo H, Wang D, Okebe J, Bates K, Santos VS, Ramaiya K, Jaffar S. Retention in care for type 2 diabetes management in Sub-Saharan Africa: A systematic review. Trop Med Int Health 2023; 28:248-261. [PMID: 36749181 PMCID: PMC10947597 DOI: 10.1111/tmi.13859] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Diabetes prevalence has risen rapidly in Sub-Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta-analysis to determine rates of retention in care of persons with type 2 diabetes. METHODS We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub-Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care. RESULTS From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow-up and 25 articles were of non-randomised studies of which 19 had 12 months or more of follow-up. A total of 11 studies (5 RCTs and 6 non-randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non-randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings. CONCLUSION Rates of retention in care of people living with diabetes are poor in primary care research settings.
Collapse
Affiliation(s)
- Anupam Garrib
- Department of Clinical SciencesLiverpool School of Tropical MedicineLiverpoolUK
| | - Tsi Njim
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Olukemi Adeyemi
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Faith Moyo
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Natalie Halloran
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Huanyuan Luo
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Duolao Wang
- Department of Clinical SciencesLiverpool School of Tropical MedicineLiverpoolUK
| | - Joseph Okebe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Katie Bates
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
- Department of Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Victor Santana Santos
- Department of MedicineFederal University of SergipeLagartoBrazil
- Health Science Graduate ProgramFederal University of SergipeAracajuBrazil
| | | | - Shabbar Jaffar
- UCL Institute for Global HealthUniversity College LondonLondonUK
| |
Collapse
|
3
|
Al-Sanaani EA, Ismail A, Abdul Manaf MR, Suddin LS, Mustafa N, Sukor N, Alabed AAA, Alkhodary AA, Aljunid SM. Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia. PLoS One 2022; 17:e0267897. [PMID: 35511889 PMCID: PMC9070921 DOI: 10.1371/journal.pone.0267897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Even in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients’ sociodemographic and economic factors.
Methods
A cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients’ sociodemographic characteristics and economic factors.
Results
Of 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of <RM5000. Two-thirds of participants (59.1%) spent RM100–500 for outpatient visits whilst 58.5% spent <RM100 on medicines per month (RM1 = USD0.244). Patients who visited a private facility had five times more likely to have insurance than patients who visited a public facility. Participants aged 18–49 years with higher education levels were 4.8 times more likely to be insured than participants aged ≥50 years with low education levels (2 times).
Conclusions
The majority of T2DM patients were uninsured. The main factors determining health insurance status were public facilities, age of ≥ 50 years, low education level, unemployment, and monthly expenditure on medicines.
Collapse
Affiliation(s)
- Essam Ali Al-Sanaani
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Ministry of Public Health and Population, Sana’a, Yemen
| | - Aniza Ismail
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Mohd Rizal Abdul Manaf
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Leny Suzana Suddin
- Faculty of Medicine, Department of Community Health, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Norlaila Mustafa
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Alabed Ali A. Alabed
- Faculty of Medicine, Department of Community Medicine, Lincoln University College, Kota Bharu, Malaysia
| | - Ahmed Abdelmajed Alkhodary
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
- Faculty of Public Health, Department of Health Policy and Management, Kuwait University, Kuwait, Kuwait
| |
Collapse
|
4
|
Cromwell GE, Hudson MS, Simonson DC, McDonnell ME. Outreach Method Predicts Patient Re-engagement in Diabetes Care During Sustained Care Disruption. Endocr Pract 2021; 28:2-7. [PMID: 34534679 PMCID: PMC8438798 DOI: 10.1016/j.eprac.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/23/2021] [Accepted: 09/03/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE During the COVID-19 pandemic, visits for diabetes care were abruptly canceled without predefined procedures to re-engage patients. This study was designed to determine how outreach influences patients to maintain diabetes care and identify factors that might impact the intervention's efficacy. METHODS A diabetes nursing team attempted outreach for patients who had a canceled appointment for diabetes between March 16, 2020, and June 19, 2020. Outreach status was defined as reached, message left, or no contact. Outcomes were defined as follows: (1) booking and (2) keeping a follow-up appointment. RESULTS Seven hundred eighty-seven patients were included (384 [49%] were reached, 152 (19%) were left a message, and 251 (32%) had no contact). Reached patients were more likely to book [odds ratio (OR) = 2.43, P < .001] and keep an appointment (OR = 2.39, P < .001) than no-contact patients. Leaving a message did not increase the odds of booking (OR = 1.05, P = .84) or keeping (OR = 1.17, P = .568) an appointment compared with no contact. Older age was a significant predictor of booking an appointment (OR = 1.014 for each year of age, P = .037). Patients on insulin were more likely to keep their appointment (OR = 1.70, P = .008). Patients with a higher hemoglobin A1C level were less likely to keep their appointment (OR = 0.87 for each 1.0% increase in the hemoglobin A1C level, P = .011). CONCLUSION These findings suggest that to optimize re-engagement during care disruption, 1-way communication is no better than no contact and that 2-way communication increases the likelihood that patients will maintain access to care. In addition, although higher-risk patients (eg, patients with older age or those on insulin) may be more incentivized to stay engaged, targeted outreach is needed for those with chronically poor glycemic control.
Collapse
Affiliation(s)
- Grace E Cromwell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Margo S Hudson
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Donald C Simonson
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
5
|
Okada A, Ono S, Yamaguchi S, Yamana H, Ikeda Kurakawa K, Michihata N, Matsui H, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. Association between nutritional guidance or ophthalmological examination and discontinuation of physician visits in patients with newly diagnosed diabetes: A retrospective cohort study using a nationwide database. J Diabetes Investig 2021; 12:1619-1631. [PMID: 33459533 PMCID: PMC8409872 DOI: 10.1111/jdi.13510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS/INTRODUCTION Discontinuation of diabetes care has been studied mostly in patients with prevalent diabetes and not in patients with newly diagnosed diabetes, whose dropout risk is highest. Because enrolling patients in a prospective study will influence adherence, we retrospectively examined whether guideline-recommended practices, defined as nutritional guidance or ophthalmological examination, can prevent patient discontinuation of diabetes care after its initiation. MATERIALS AND METHODS We retrospectively identified adults with newly screened diabetes during checkups using a large Japanese administrative claims database (JMDC, Tokyo, Japan) that contains laboratory data and lifestyle questionnaires. We defined discontinuation of physician visits as a follow-up interval exceeding 6 months. We divided the patients into those who received guideline-recommended practices (nutritional guidance or ophthalmology consultation) within the same month as the first visit and those who did not. We calculated propensity scores and carried out inverse probability of treatment weighting analyses to compare discontinuation between the two groups. RESULTS We identified 6,508 patients with at least one physician consultation for diabetes care within 3 months after their checkup, including 4,574 patients without and 1,934 with guideline-recommended practices. After inverse probability of treatment weighting, patients with guideline-recommended practices had a significantly lower proportion of discontinuation than those without (17.2% vs 21.8%; relative risk 0.79, 95% confidence interval 0.69-0.91). CONCLUSIONS This study is the first to show that after adjustment for both patient and healthcare provider factors, guideline-recommended practices within the first month of physician consultation for diabetes care can decrease subsequent discontinuation of physician visits in patients with newly diagnosed diabetes.
Collapse
Grants
- 19AA2007 Ministry of Health, Labor and Welfare, Japan
- 20K18957 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 20H03907 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 17H05077 Ministry of Education, Culture, Sports, Science and Technology, Japan
- Japan Diabetes Society
- Ministry of Health, Labor and Welfare, Japan
- Japan Diabetes Society
Collapse
Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Sachiko Ono
- Department of Eat‐loss MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hayato Yamana
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Nobuaki Michihata
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health EconomicsThe University of TokyoTokyoJapan
| | - Masaomi Nangaku
- Division of Nephrology and EndocrinologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and MetabolismGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsThe University of TokyoTokyoJapan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
- Toranomon HospitalTokyoJapan
| |
Collapse
|
6
|
Effectiveness of a multifaceted prevention programme for melioidosis in diabetics (PREMEL): A stepped-wedge cluster-randomised controlled trial. PLoS Negl Trop Dis 2021; 15:e0009060. [PMID: 34170931 PMCID: PMC8266097 DOI: 10.1371/journal.pntd.0009060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/08/2021] [Accepted: 06/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background Melioidosis, an often-fatal infectious disease caused by the environmental Gram-negative bacillus Burkholderia pseudomallei, is endemic in tropical countries. Diabetes mellitus and environmental exposure are important risk factors for melioidosis acquisition. We aim to evaluate the effectiveness of a multifaceted prevention programme for melioidosis in diabetics in northeast Thailand. Methodology/Principal findings From April 2014 to December 2018, we conducted a stepped-wedge cluster-randomized controlled behaviour change trial in 116 primary care units (PCUs) in Ubon Ratchathani province, northeast Thailand. The intervention was a behavioural support group session to help diabetic patients adopt recommended behaviours, including wearing rubber boots and drinking boiled water. We randomly allocated the PCUs to receive the intervention starting in March 2016, 2017 and 2018. All diabetic patients were contacted by phone yearly, and the final follow-up was December 2018. Two primary outcomes were hospital admissions involving infectious diseases and culture-confirmed melioidosis. Of 9,056 diabetics enrolled, 6,544 (72%) received a behavioural support group session. During 38,457 person-years of follow-up, we observed 2,195 (24%) patients having 3,335 hospital admissions involved infectious diseases, 80 (0.8%) melioidosis, and 485 (5%) deaths. In the intention-to-treat analysis, implementation of the intervention was not associated with primary outcomes. In the per-protocol analysis, patients who received a behavioural support group session had lower incidence rates of hospital admissions involving infectious diseases (incidence rate ratio [IRR] 0.89; 95%CI 0.80–0.99, p = 0.03) and of all-cause mortality (IRR 0.54; 95%CI 0.43–0.68, p<0.001). However, the incidence rate of culture-confirmed melioidosis was not significantly lower (IRR 0.96, 95%CI 0.46–1.99, p = 0.66). Conclusions/Significance Clear benefits of this multifaceted prevention programme for melioidosis were not observed. More compelling invitations for the intervention, modification of or addition to the behaviour change techniques used, and more frequent intervention may be needed. Trial registration This trial is registered with ClinicalTrials.gov, number NCT02089152. Melioidosis, an infectious disease caused by environmental bacterium Burkholderia pseudomallei, is endemic in tropical countries. Diabetes mellitus is the most important risk factor, and routes of infection include skin inoculation, ingestion and inhalation. Prevention guidelines recommend that residents, rice farmers and visitors should wear protective gear such as rubber boots when in direct contact with soil and environmental water, and consume only boiled or bottled water. Here, we conducted a cluster randomized controlled trial to evaluate effectiveness of a multifaceted prevention programme for melioidosis in diabetic patients in northeast Thailand. We enrolled 9,056 diabetic patients in 2014. We randomly allocated primary care units as the unit of randomization to receive the intervention starting in March 2016, 2017 and 2018. All diabetic patients were contacted by phone yearly. We found that diabetic patients who received a behavioural support group session had lower incidence rates of hospital admissions involving infectious diseases and of all-cause mortality, but not of culture-confirmed melioidosis. In conclusion, clear benefits of this multifaceted prevention programme for melioidosis were not seen. We propose that more compelling invitations for the intervention, modification of or addition to the behaviour change techniques used, and more frequent intervention may be needed.
Collapse
|
7
|
Alshahri BK, Bamashmoos M, Alnaimi MI, Alsayil S, Basaqer S, Al-Hariri MT, Vallaba Doss CA. Assessment of Self-Management Care and Glycated Hemoglobin Levels Among Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study From the Kingdom of Saudi Arabia. Cureus 2020; 12:e11925. [PMID: 33304711 PMCID: PMC7719482 DOI: 10.7759/cureus.11925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is increasing every year, along with its health and economic burden/impact. Achieving glycemic control remains challenging, and only 9-15% of diabetic patients manage to reach the optimal level. A few strategies have been found to improve diabetic control, including self-management care (SMC). This study aimed to explore the relationship between patient characteristics, SMC, and glycated hemoglobin (HbA1c) levels, as an indicator of optimal glycemic control. This was a cross-sectional study of 200 participants conducted at the King Fahd University Hospital (KFUH) in Saudi Arabia. A pre-structured questionnaire including sociodemographic data and aspects of diabetes self-management was distributed among patients at KFUH and the Family and Community Medicine Center (FAMCO) of Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia. HbA1c data were extracted from patients' records. Unfortunately, the majority of the participants (65%) were found to have poor glycemic control. Glucose management was better in patients having T2DM for more than five years (mean: 4.01; p<0.05). In addition, an income of less than 5,000 Saudi Riyals (SR) was associated with lower physical activity (mean: 2.95; p<0.05). The level of blood sugar was uncontrolled among the majority of surveyed patients. Our study found variables associated with SMC and HbA1c levels, which might help to guide future initiatives aiming to enhance the care of patients with T2DM.
Collapse
Affiliation(s)
| | | | | | | | - Shymaa Basaqer
- Medicine, King Fahd University Hospital/Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | | | | |
Collapse
|
8
|
Otufowora A, Liu Y, Varma DS, Striley CW, Cottler LB. Correlates related to follow-up in a community engagement program in North Central Florida. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2723-2739. [PMID: 32949042 PMCID: PMC7719614 DOI: 10.1002/jcop.22450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 05/04/2023]
Abstract
AIMS This analysis identifies the correlates of 60- and 120-day telephone-based study follow-ups among community-dwelling adults in North Central Florida. METHODS Six thousand three hundred and forty participants were recruited by Community Health Workers from the University of Florida's community engagement program with a face-to-face baseline and two phone follow-ups assessing indicators of health. RESULTS Physical disability versus none (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.2─1.9), high trust in research versus none (aOR, 1.5; 95% CI, 1.1─2.1), history of research participation versus none (aOR, 1.6; 95% CI, 1.3─2.0), having health insurance versus none (aOR, 1.4; 95% CI, 1.1─1.7), interest in research participation versus none (aOR, 1.8; 95% CI, 1.3─2.7), and no drug use versus drug use (aOR, 0.5; 95% CI, 0.3─0.9) significantly predicted completion of follow-up. CONCLUSIONS Health and social factors such as disability, insurance, history of and interest in research, trust and no drug use significantly predicted completing two follow-ups. These findings can facilitate efforts to minimize attrition in the research enterprise.
Collapse
Affiliation(s)
- Ayodeji Otufowora
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Catherine W Striley
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|