Assessing compliance with national guidelines in diabetes care: A study leveraging data from south Africa's National Health Laboratory Service (NHLS).

Autor:	Brennan AT; Faculty of Health Sciences University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg, South Africa.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., Kileel EM; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., Fox MP; Faculty of Health Sciences University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg, South Africa.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., George JA; Wits Diagnostic Innovation Hub, University of the Witwatersrand, Johannesburg, South Africa.; National Health Laboratory Service, Johannesburg, Gauteng, South Africa., Khoza S; National Health Laboratory Service, Johannesburg, Gauteng, South Africa.; Faculty of Health Sciences, Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa., Rosen S; Faculty of Health Sciences University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg, South Africa.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Raal F; Faculty of Health Sciences, Department of Internal Medicine, Division of Endocrinology and Metabolism, University of the Witwatersrand, Johannesburg, South Africa., Hibberd P; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America., Chetty K; National Health Laboratory Service, Johannesburg, Gauteng, South Africa., Mlisana K; National Health Laboratory Service, Johannesburg, Gauteng, South Africa.; Academic Affairs, Research and Quality Assurance, National Health Laboratory Service, Johannesburg, South Africa., Bor J; Faculty of Health Sciences University of the Witwatersrand, Health Economics and Epidemiology Research Office, Johannesburg, South Africa.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America., Crowther NJ; National Health Laboratory Service, Johannesburg, Gauteng, South Africa.; Faculty of Health Sciences, Department of Chemical Pathology, University of the Witwatersrand, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Sep 03; Vol. 4 (9), pp. e0003014. Date of Electronic Publication: 2024 Sep 03 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0003014
Abstrakt:	Diabetes 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. 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. Among patients with 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% for those presenting 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. 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. Competing Interests: Professor Frederick Raal has received research grants, honoraria, and consulting fees for professional input and/or delivered lectures from Amgen, MSD, Novartis, Sanofi, Regeneron, Ultragenyx and LIB Therapeutics unrelated to the manuscript. All other authors have declared that no competing interests exist. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials. (Copyright: © 2024 Brennan 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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