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Gaps in the Type 2 Diabetes Care Cascade and How HIV and/or Active Tuberculosis Disease Impact Movement Through its Stages: A National Perspective Using South Africa's National Health Laboratory Service (NHLs) Database
17 Pages Posted: 12 Sep 2022More...
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 and/or tuberculosis(TB) impact 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 and 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 remaining-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 HIV and/or TB infection.
Findings: Of the 373,889 patients tested for diabetes, 42.8% had an HbA1c or blood glucose measure indicating a diabetes diagnosis. Amongst those with lab-diagnosed diabetes, 30.5% remained-in-care and 8.6% reached glycaemic control by 24-months. Irrespective of TB infection, prevalence of lab-diagnosed diabetes in PLWH was 28.3% versus 46.9% in HIV-uninfected individuals. Among those with lab-diagnosed diabetes, 34.2% of PLWH remained-in-care versus 29.9% HIV-uninfected. Among people remaining in care, 33.7% of PLWH reached glycaemic control over 24-months versus 28.1% of HIV-uninfected individuals.
Interpretation: In a national cohort of patients undergoing lab-based screening for diabetes, only 30.5% of those with diabetes remained-in-care and <10% achieved glycaemic control 24-months post diagnosis. PLWH versus HIV-uninfected had a lower prevalence of diabetes and were more likely to complete the cascade stages, possibly because of differences in access to medical care.
Funding: National Institute of Diabetes and Digestive and Kidney Diseases 1K01DK116929-01A1.
Declaration of Interest: We declare no competing interests.
Ethical Approval: Approval for analysis of de-identified NHLS data was granted by Boston University’s Institutional Review Board(protocol No.H-31968), Human Research Ethics Committee of the University of the Witwatersrand(protocol No.M200851) and NHLS Academic Affairs and Research Management System(protocol No.PR20270).
Keywords: type 2 diabetes mellitus, HIV/AIDS, tuberculosis, South Africa, care cascade
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