Original Research

Determinants of sub-optimal glycemic control among patients enrolled in a medicine dispensing programme in KwaZulu-Natal: A cohort study, 2018–2021

Leigh C. Johnston, Patrick Ngassa Piotie, Innocent Maposa, Sandhya Singh, Lazarus Kuonza, Alex De Voux
African Journal of Primary Health Care & Family Medicine | Vol 16, No 1 | a4336 | DOI: https://doi.org/10.4102/phcfm.v16i1.4336 | © 2024 Leigh C. Johnston, Patrick Ngassa Piotie, Innocent Maposa, Sandhya Singh, Lazarus Kuonza, Alex De Voux | This work is licensed under CC Attribution 4.0
Submitted: 19 October 2023 | Published: 31 May 2024

About the author(s)

Leigh C. Johnston, South African Field Epidemiology Training Program, National Institute for Communicable Disease, A Division of the National Health Laboratory Service, Johannesburg Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg Non-Communicable Disease Directorate, National Department of Health, Pretoria, South Africa
Patrick Ngassa Piotie, Diabetes Research Centre, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
Innocent Maposa, Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Sandhya Singh, Non-Communicable Disease Directorate, National Department of Health, Pretoria, South Africa
Lazarus Kuonza, South African Field Epidemiology Training Program, National Institute for Communicable Disease, A Division of the National Health Laboratory Service, Johannesburg Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Alex De Voux, Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme facilitates clinically stable patients to collect their chronic medication from community-based pick-up points.

Aim: We determined baseline glycaemic control and rates and predictors of becoming sub-optimally controlled for type 2 diabetes mellitus (T2DM) CCMDD-enrolled patients.

Setting: The setting of the study was eThekwini, KwaZulu-Natal, South Africa.

Methods: We performed a cohort study (April 2018- December 2021). We linked T2DM CCMDD-enrolled patients to glycated haemoglobin (HbA1c) data from the National Health Laboratory Service. We selected patients optimally controlled at their baseline HbA1c, with ≥ 1 repeat-test available. We used Kaplan–Meier analysis to assess survival rates and extended Cox regression to determine associations between time to sub-optimal control (HbA1c > 7%) and predictors. Adjusted hazard ratios (aHRs), 95% confidence interval (CI), and p-values are reported.

Results: Of the 41145 T2DM patients enrolled in the CCMDD programme, 7960 (19%) had a HbA1c result available. Twenty-seven percent (2147/7960) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing to sub-optimal status. The HbA1c testing frequency as per national guidelines was associated with a lower hazard of sub-optimal glycaemic control (aHR: 0.46; 95% CI: 0.24–0.91; p-value = 0.024). Patients prescribed dual-therapy had a higher hazard of sub-optimal glycaemic control (aHR: 1.50; 95% CI: 1.16–1.95; p-value = 0.002) versus monotherapy.

Conclusions: The HbA1c monitoring, in-line with testing frequency guidelines, is needed to alert the CCMDD programme of patients who become ineligible for enrolment. Patients receiving dual-therapy require special consideration.

Contribution: Addressing identified shortfalls can assist programme implementation


Keywords

CCMDD programme; glucose control; survival analysis; type 2 diabetes; eThekwini; glycaemic control

Sustainable Development Goal

Goal 3: Good health and well-being

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