TY - JOUR
T1 - Prevention and management of type 2 diabetes mellitus in Uganda and South Africa
T2 - Findings from the SMART2D pragmatic implementation trial
AU - SMART2D Consortium
AU - Guwatudde, David
AU - Delobelle, Peter
AU - Absetz, Pilvikki
AU - Van, Josefien Olmen
AU - Mayega, Roy William
AU - Kasujja, Francis Xavier
AU - De Man, Jeroen
AU - Hassen, Mariam
AU - Kiracho, Elizabeth Ekirapa
AU - Kiguli, Juliet
AU - Puoane, Thandi
AU - Ostenson, Claes-Goran
AU - Peterson, Stefan
AU - Daivadanam, Meena
N1 - Copyright: © 2022 Guwatudde et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
KW - prevention
KW - management
KW - type 2 diabetes mellitus
KW - Uganda
KW - South Africa
UR - http://www.scopus.com/inward/record.url?scp=85191152665&partnerID=8YFLogxK
U2 - 10.1371/journal.pgph.0000425
DO - 10.1371/journal.pgph.0000425
M3 - Article
C2 - 36962331
VL - 2
SP - 1
EP - 19
JO - PLOS global public health
JF - PLOS global public health
SN - 2767-3375
IS - 5
M1 - e0000425
ER -