Thesis (M.Fam.Med.)--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Background
The combined influence of processes of care, lifestyle advice and drug treatment on glycaemic control
in Type 2 diabetes in primary care settings is not well documented.
Aim
To describe the provision of lifestyle advice, selected processes of care and drug treatment to, and
assess the influence of these factors on glycaemic control in, a sample of adults with type 2 diabetes
mellitus attending the Johan Heyns Community Health Centre in Sedibeng District, Gauteng.
Methods
A cross-sectional design was used. Participants consisted of 200, consecutively chosen, adult volunteers
with type 2 diabetes. Information on demographics, reported receipt of lifestyle advice and
anthropomorphic measurements was collected through questionnaire-based interviews. This was
followed by a record review of all participants’ clinic files for information on current drug management,
co-morbid medical conditions and documentation of processes of care, in the preceding 12 months, in
respect of HbA1c, blood pressure (BP), weight, waist circumference (WC) and body mass index (BMI)
monitoring. HbA1c values were used to ascertain glycaemic control. Performance of processes of care
was assessed in accordance with Society for Endocrinology, Metabolism and Diabetes of South Africa
(SEMDSA) guidelines. Parsimonious models for glycaemic control were constructed through multivariate
logistic regression.
Results
Mean age of the sample was 58 years with 58% in the 50-64 year age group. Blacks (88%) and females
(63%) were in the majority.
Over two-thirds had diabetes for under 10 years and 98% had at least one co-morbid condition, mainly
hypertension (92%). Obesity was noted in 65%, while 95% of females and 83% of males had a WC that
conferred substantial cardio-metabolic risk.
Receipt of advice on any of diet, exercise or weight control from a health professional in the preceding
12 months was reported by 79%, with 67% reporting receipt of advice on all three.
Under 2% of patient records met the SEMDSA standard for processes of care for HbA1c, weight, WC and
BMI monitoring, while 93% achieved the standard for BP monitoring.
Exclusive oral treatment was prescribed in 62%, and the majority of these were on combined metformin
and sulphonylurea; 5% were on insulin monotherapy.
Optimal glycaemic control (HbA1c < 7%) was noted in only 25% of the sample.
On multivariate analyses, the presence of CCF conferred higher odds of controlled glycaemia (OR = 3.17,
P = 0.035). Compared with insulin monotherapy, treatment with either combined metformin and insulin
(OR = 0.216, P = 0.02), or with the combination of all 3 drug classes ( metformin, sulphonylurea and
insulin) (OR = 0.185, P = 0.027), conferred lower odds of glycaemic control.
Conclusions
This study highlights substantial shortcomings in the compliance with key processes of care and the
achievement of optimal glycaemic control for type 2 diabetes mellitus in the current research setting.
An inverse association was noted between glycaemic control and the use of combined oral and insulin
drug therapy. Measured processes of care and reported receipt of lifestyle advice showed no association
with glycaemic control. CCF co-morbidity conferred improved odds of controlled glycaemia.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/15310 |
| Date | 27 August 2014 |
| Creators | Kalain, Aswin |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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