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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 2022

See all articles by Alana T. Brennan

Alana T. Brennan

Boston University - Department of Global Health

Evelyn Lauren

Boston University - Department of Biostatistics

Jacob Bor

Boston University - Department of Global Health

Nigel Crowther

National Health Laboratory Services (NHLS) - Department of Chemical Pathology

Jaya George

National Health Laboratory Services (NHLS) - Department of Chemical Pathology

Kamy Chetty

National Health Laboratory Services (NHLS)

Koleka Mlisana

University of KwaZulu-Natal - Department of Medical Microbiology

Andrew Dai

Boston University - Department of Mathematics and Statistics

Siyabonga Khoza

National Health Laboratory Services (NHLS) - Department of Chemical Pathology

Sydney Rosen

Boston University - Department of Global Health

Andrew C. Stokes

Boston University - Department of Global Health

Frederick Raal

University of the Witwatersrand - Faculty of Health Sciences

Patricia Hibberd

Boston University - Department of Global Health

Sara M. Alexanian

Boston University - Boston Medical Center

Matthew P. Fox

Boston University - Department of Global Health

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Abstract

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

Suggested Citation

Brennan, Alana T. and Lauren, Evelyn and Bor, Jacob and Crowther, Nigel and George, Jaya and Chetty, Kamy and Mlisana, Koleka and Dai, Andrew and Khoza, Siyabonga and Rosen, Sydney and Stokes, Andrew C. and Raal, Frederick and Hibberd, Patricia and Alexanian, Sara M. and Fox, Matthew P., 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. Available at SSRN: https://ssrn.com/abstract=4216695 or http://dx.doi.org/10.2139/ssrn.4216695

Alana T. Brennan (Contact Author)

Boston University - Department of Global Health ( email )

Evelyn Lauren

Boston University - Department of Biostatistics ( email )

Jacob Bor

Boston University - Department of Global Health ( email )

Nigel Crowther

National Health Laboratory Services (NHLS) - Department of Chemical Pathology ( email )

Jaya George

National Health Laboratory Services (NHLS) - Department of Chemical Pathology ( email )

Kamy Chetty

National Health Laboratory Services (NHLS) ( email )

Modderfontein Road
Sandringham, Johannesburg
South Africa

Koleka Mlisana

University of KwaZulu-Natal - Department of Medical Microbiology ( email )

Andrew Dai

Boston University - Department of Mathematics and Statistics ( email )

Siyabonga Khoza

National Health Laboratory Services (NHLS) - Department of Chemical Pathology ( email )

Sydney Rosen

Boston University - Department of Global Health ( email )

Andrew C. Stokes

Boston University - Department of Global Health ( email )

Frederick Raal

University of the Witwatersrand - Faculty of Health Sciences ( email )

Patricia Hibberd

Boston University - Department of Global Health ( email )

Sara M. Alexanian

Boston University - Boston Medical Center ( email )

One Boston Medical Center Place
Boston, MA 02118
United States

Matthew P. Fox

Boston University - Department of Global Health ( email )

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