Prevention and management of type 2 diabetes mellitus in Uganda and South Africa: Findings from the SMART2D pragmatic implementation trial.

Autor:	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.; School of Public Health, University of the Western Cape, Cape Town, South Africa.; Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium., Absetz P; Collaborative Care Systems Finland, Helsinki, Finland.; Faculty of Social Sciences, Tampere University, Tampere, Finland., Van JO; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium., Mayega RW; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda., Kasujja FX; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda., De Man J; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium., Hassen M; School of Public Health, University of the Western Cape, Cape Town, South Africa., Kiracho EE; Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda., Kiguli J; Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda., Puoane T; School of Public Health, University of the Western Cape, Cape Town, South Africa., Ostenson CG; Department of Molecular Medicine & Surgery, Diabetes & Endocrine Unit, Karolinska Institutet, Stockholm, Sweden., Peterson S; Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.; International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden.; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden., Daivadanam M; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.; International Child Health & Nutrition Research Group, Uppsala University, Uppsala, Sweden.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 May 02; Vol. 2 (5), pp. e0000425. Date of Electronic Publication: 2022 May 02 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000425
Abstrakt:	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. Competing Interests: The authors have declared that no competing interests exist. (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.)
Databáze:	MEDLINE
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