Diabetic control and compliance using HbA1C testing guidelines in public healthcare facilities of Gauteng province, South Africa

Abstract

ABSTRACTObjectiveThis study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa as well as factors associated with time to achieve control. South Africa’s estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%.Research design, methods and findingsThe data of 511781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1c of ≤7 was reported as normal, >7 - ≤9 as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1c status and variables listed above. The Kaplan Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values.Data is reported for 511781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (aHR=1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR=1.99; 95% CI:1.92-2.06; p<0.001).ConclusionThis study highlights poor adherence to guidelines for diabetes monitoring.Author(s) summary-Worldwide, diabetes mellitus is an escalating public health crisis and, the second among the top ten leading natural causes of death in South Africa.-With most patients exhibiting poor control using HbA1C testing, this study undertook an audit to check the percentage of patients who follow testing guidelines for monitoring diabetes in the public healthcare facilities of Gauteng province, South Africa.-Overall, the guidelines for monitoring diabetes are not followed.-The study highlights the need to find innovative ways to improve monitoring of diabetic patients in an effort to curb complications of the disease.