Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial
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 c...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021626/?tool=EBI |
| _version_ | 1797696264363573248 |
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| author | David Guwatudde Peter Delobelle Pilvikki Absetz Josefien Olmen Van Roy William Mayega Francis Xavier Kasujja Jeroen De Man Mariam Hassen Elizabeth Ekirapa Kiracho Juliet Kiguli Thandi Puoane Claes-Goran Ostenson Stefan Peterson Meena Daivadanam |
| author_facet | David Guwatudde Peter Delobelle Pilvikki Absetz Josefien Olmen Van Roy William Mayega Francis Xavier Kasujja Jeroen De Man Mariam Hassen Elizabeth Ekirapa Kiracho Juliet Kiguli Thandi Puoane Claes-Goran Ostenson Stefan Peterson Meena Daivadanam |
| author_sort | David Guwatudde |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T03:23:54Z |
| format | Article |
| id | doaj.art-4096a994095045339dc32a5f8b5b002a |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T03:23:54Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-4096a994095045339dc32a5f8b5b002a2023-09-03T13:44:02ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752022-01-0125Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trialDavid GuwatuddePeter DelobellePilvikki AbsetzJosefien Olmen VanRoy William MayegaFrancis Xavier KasujjaJeroen De ManMariam HassenElizabeth Ekirapa KirachoJuliet KiguliThandi PuoaneClaes-Goran OstensonStefan PetersonMeena DaivadanamHealth 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.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021626/?tool=EBI |
| spellingShingle | David Guwatudde Peter Delobelle Pilvikki Absetz Josefien Olmen Van Roy William Mayega Francis Xavier Kasujja Jeroen De Man Mariam Hassen Elizabeth Ekirapa Kiracho Juliet Kiguli Thandi Puoane Claes-Goran Ostenson Stefan Peterson Meena Daivadanam Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial PLOS Global Public Health |
| title | Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial |
| title_full | Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial |
| title_fullStr | Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial |
| title_full_unstemmed | Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial |
| title_short | Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial |
| title_sort | prevention and management of type 2 diabetes mellitus in uganda and south africa findings from the smart2d pragmatic implementation trial |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021626/?tool=EBI |
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