Lifestyle advice, processes of care and glycaemic control amongst patients with type 2 diabetes in a South African primary care facility.

Aswin Kalain,Olufemi B Omole

doi:10.4102/phcfm.v12i1.2163

Abstract

BackgroundThe influence of processes of diabetes care on glycaemic control is understudied in primary health care (PHC).AimTo explore the influence of lifestyle advice, drug regimen and other processes of care on glycaemic control.SettingJohan Heyns Community Health Centre, Vanderbijlpark, South Africa.MethodsIn a cross-sectional study involving 200 participants with type-2 diabetes, we collected information on sociodemography, comorbidity, processes of diabetes care, drug regimen and receipt of lifestyle advice. Anthropometric measures and glycosylated haemoglobin (HbA1c) were also determined.ResultsParticipants’ mean age was 57.8 years and most were black people (88%), females (63%), overweight or obese (94.5%), had diabetes for < 10 years (67.9%) and hypertension as comorbidity (98%). Most participants received lifestyle advice on one of diet, exercise and weight control (67%) and had their blood pressure (BP) checked (93%) in the preceding 12 months. However, < 2% had any of HbA1c, weight, waist circumference or body mass index checked. Glycaemic control (HbA1c < 7%) was achieved in only 24.5% of participants. Exclusive insulin or oral drug was prescribed in 5% and 62% of participants, respectively. Compared to insulin monotherapy, participants on combined metformin and insulin or metformin, sulphonylurea and insulin were less likely to have glycaemic control. Comorbid congestive cardiac failure (CCF) significantly increased the likelihood of glycaemic control.ConclusionThere is substantial shortcomings in the implementation of key processes of diabetes care and glycaemic control. Strategies are needed to prompt and compel healthcare providers to implement evidence-based diabetes guidelines during clinic visits in South African PHC.

Highlights

The prevalence of type-2 diabetes is high worldwide and, in 2015, an estimated 7.0% of those 20–79 years of age in South Africa were affected by the disease, amounting to about 2.3 million people.[1]
Have several studies reported a pattern of suboptimal glycaemic control, they have found that healthcare providers across settings often do not optimally comply with recommended processes of care.[1,6,7,8,9]
This article aims to describe the provision of lifestyle advice, selected processes of care and drug treatment and assess the influence of these factors on glycaemic control in adults with type 2 diabetes mellitus (DM) in a large community health centre (CHC), south of Johannesburg

Summary

Introduction

The prevalence of type-2 diabetes is high worldwide and, in 2015, an estimated 7.0% of those 20–79 years of age in South Africa were affected by the disease, amounting to about 2.3 million people.[1] Data projections suggest that this number will increase by 140% in the African region by 2040, double the expected global increase by this time.[2]. A cornerstone in the management of type 2 DM is glycaemic control and the processes for achieving this have been well articulated in several guidelines,[1,5] where clearly defined sets of drug and non-drug processes are recommended. Have several studies reported a pattern of suboptimal glycaemic control, they have found that healthcare providers across settings often do not optimally comply with recommended processes of care.[1,6,7,8,9]. The influence of processes of diabetes care on glycaemic control is understudied in primary health care (PHC)

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