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Assessing Compliance with National Guidelines in Diabetes Care: A Study Leveraging Data from the National Health Laboratory Service (NHLS)

18 Pages Posted: 22 Nov 2023

See all articles by Alana T. Brennan

Alana T. Brennan

Boston University - Department of Global Health

Emma M. Kileel

Boston University - School of Public Health

Matthew P. Fox

Boston University - Department of Global Health

Jaya George

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

Siyabonga Khoza

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

Sydney Rosen

Boston University - Department of Global Health

Frederick Raal

University of the Witwatersrand - Faculty of Health Sciences

Patricia Hibberd

Boston University - Department of Global Health

Kamy Chetty

National Health Laboratory Services (NHLS)

Koleka Mlisana

National Health Laboratory Services (NHLS)

Jacob Bor

Boston University - Department of Global Health

Nigel Crowther

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

More...

Abstract

Background: Diabetes mellitus is a major global health issue. We evaluated compliance to laboratory-based management guidelines for diabetes (type 1 and 2), essential for effective treatment and reducing diabetes-related morbidity and mortality.

Methods: Our study utilized South Africa's National Health Laboratory Services (NHLS) data, focusing on patients from birth to age 80 years who underwent initial diabetes laboratory testing between January 1, 2012-January 1, 2016. Patients were categorized into type 1 (<30 years) or type 2 (>30-80 years) diabetes based on age at first diabetes test. National diabetes guidelines recommend blood glucose to be checked every three-six months post laboratory-diagnosis. We employed a sharp regression discontinuity design to estimate the effect of a laboratory-diagnosis of diabetes on the likelihood of having a follow-up laboratory test 24 months post-diagnosis.

Results: Among patients aged >30-80 years (type 2 diabetes), the probability of a diabetes follow-up laboratory test within 24 months was 52.4% for patients presenting above the diabetes diagnosis threshold vs 31.1% just below. Although the likelihood of repeat testing rose with higher HbA1c and glucose levels, at the diagnostic threshold there was no clinically meaningful difference (risk difference:-2.2%, 95% CI: -3.3%,-1.2%). These results were consistent among patients with type 1 diabetes, those living with and without HIV and healthcare setting.

Interpretation: In a national laboratory cohort, diabetes laboratory-diagnosis did not lead to increased monitoring as recommended in national guidelines. Strategies to improve patient education, healthcare provider communication, and healthcare system support are essential to enhance guideline compliance and overall diabetes management.

Funding: This work was supported by grant 1K01DK116929-01A1 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Declaration of Interest: Authors 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-41152), Human Research Ethics 11 Committee of the University of the Witwatersrand (protocol no. M200851) and NHLS Academic Affairs and Research Management System (protocol no. PR2232386).

Keywords: type 1 diabetes mellitus, type 2 diabetes mellitus, HIV/AIDS, South Africa, diabetes management, guidelines compliance, regression discontinuity design

Suggested Citation

Brennan, Alana T. and Kileel, Emma M. and Fox, Matthew P. and George, Jaya and Khoza, Siyabonga and Rosen, Sydney and Raal, Frederick and Hibberd, Patricia and Chetty, Kamy and Mlisana, Koleka and Bor, Jacob and Crowther, Nigel, Assessing Compliance with National Guidelines in Diabetes Care: A Study Leveraging Data from the National Health Laboratory Service (NHLS). Available at SSRN: https://ssrn.com/abstract=4638314 or http://dx.doi.org/10.2139/ssrn.4638314

Alana T. Brennan (Contact Author)

Boston University - Department of Global Health ( email )

Emma M. Kileel

Boston University - School of Public Health ( email )

Boston, MA
United States

Matthew P. Fox

Boston University - Department of Global Health ( email )

Jaya George

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

Siyabonga Khoza

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

Sydney Rosen

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 )

Kamy Chetty

National Health Laboratory Services (NHLS) ( email )

Modderfontein Road
Sandringham, Johannesburg
South Africa

Koleka Mlisana

National Health Laboratory Services (NHLS) ( email )

Modderfontein Road
Sandringham, Johannesburg
South Africa

Jacob Bor

Boston University - Department of Global Health ( email )

Nigel Crowther

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

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