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Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial.
Guwatudde, David; Delobelle, Peter; Absetz, Pilvikki; Van, Josefien Olmen; Mayega, Roy William; Kasujja, Francis Xavier; De Man, Jeroen; Hassen, Mariam; Kiracho, Elizabeth Ekirapa; Kiguli, Juliet; Puoane, Thandi; Ostenson, Claes-Goran; Peterson, Stefan; Daivadanam, Meena.
  • Guwatudde D; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
  • Delobelle P; Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.
  • Absetz P; School of Public Health, University of the Western Cape, Cape Town, South Africa.
  • Van JO; Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
  • Mayega RW; Collaborative Care Systems Finland, Helsinki, Finland.
  • Kasujja FX; Faculty of Social Sciences, Tampere University, Tampere, Finland.
  • De Man J; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
  • Hassen M; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
  • Kiracho EE; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
  • Kiguli J; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
  • Puoane T; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
  • Ostenson CG; School of Public Health, University of the Western Cape, Cape Town, South Africa.
  • Peterson S; Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
  • Daivadanam M; Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
PLOS Glob Public Health ; 2(5): e0000425, 2022.
Article en En | MEDLINE | ID: mdl-36962331
ABSTRACT
Health systems in many low- and middle-income countries are struggling to manage type 2 diabetes (T2D). Management of glycaemia via well-organized care can reduce T2D incidence, and associated morbidity and mortality. The primary aim of this study was to evaluate the effectiveness of facility plus community care interventions (integrated care), compared to facility only care interventions (facility care) towards improvement of T2D outcomes in Uganda and South Africa. A pragmatic cluster randomized trial design was used to compare outcomes among participants with T2D and those at high risk. The trial had two study arms; the integrated care arm, and the facility care arm; and in Uganda only, an additional usual care arm. Participants were enrolled at nine primary health facilities in Uganda, and two in South Africa. Participants were adults aged 30 to 75 years, and followed for up to 12 months. Primary outcomes were glycaemic control among participants with T2D, and reduction in HbA1c > = 3 mmol/mol among participants at high risk. Secondary outcomes were retention into care and incident T2D. Adjusted analysis revealed significantly higher retention into care comparing integrated care and facility care versus usual care in Uganda and integrated care versus facility care in South Africa. The effect was particularly high among participants at high risk in Uganda with an incident rate ratio of 2.46 [1.33-4.53] for the facility care arm and 3.52 [2.13-5.80] for the integrated care arm. No improvement in glycaemic control or reduction in HbA1c was found in either country. However, considerable and unbalanced loss to follow-up compromised assessment of the intervention effect on HbA1c. Study interventions significantly improved retention into care, especially compared to usual care in Uganda. This highlights the need for adequate primary care for T2D and suggest a role for the community in T2D prevention. Trial registration number ISRCTN11913581.

Texto completo: 1 Banco de datos: MEDLINE Tipo de estudio: Clinical_trials / Diagnostic_studies Idioma: En Año: 2022 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Tipo de estudio: Clinical_trials / Diagnostic_studies Idioma: En Año: 2022 Tipo del documento: Article