Taniguchi Dawn, LoGerfo James, van Pelt Maurits, Mielcarek Bessie, Huster Karin, Haider Mahri, Thomas Bernadette
Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, Washington, United States of America.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2017 Sep 25;12(9):e0181582. doi: 10.1371/journal.pone.0181582. eCollection 2017.
Early detection and treatment for diabetes are essential for reducing disability and death from the disease. Finding effective screening and treatment for individuals living with diabetes in resource-limited countries is a challenge. MoPoTsyo, a Cambodian non-governmental organization, addressed this gap by utilizing a multi-pronged approach with community-based peer educators, access to laboratory procedures, local outpatient medical consultation, and a revolving drug fund. This study evaluated outcomes of MoPoTsyo's diabetes program in Takeo Province by assessing glycemic and blood pressure outcomes for individuals diagnosed with diabetes over a 24-month follow-up period between 2007-2013.
This is a retrospective cohort analysis of records without a comparison group. We calculated the mean fasting blood glucose (FBG) and blood pressure (BP) at regular intervals of follow-up. The proportion of patients reaching recommended treatment targets for FBG and BP was assessed.
Of the 3411 patients enrolled in the program, 2230 were included in the study. The cohort was predominantly female (68.9%) with a median age of 54 years. Median follow-up time in the program was 16 months (4.9-38.4 months). Mean FBG decreased 63.9 mg/dl in mean FBG (95% CI 58.5 to 69.3) at one year of follow-up (p<0.001). After one year, 45% (321/708) of patients achieved goal FBG < 126. Of the 41.6% (927/2230) with elevated BP at enrollment, systolic and diastolic BP levels significantly decreased (p<0.001) by 16.9 mmHg (95% CI 1.2 to 22.9) and 10 mm Hg (95% CI 0.7 to 12.9) respectively between enrollment and one year of follow-up. At one year of follow-up, 51.1%% (183/355) of these patients reached the BP goal < 140/90.
The improved outcome indicators of diabetes care for MoPoTsyo's Takeo program evaluation showed promise. The program demonstrated a reasonable and practical approach to delivering effective diabetes care in a rural area and may serve as a model for other low-income communities. Future prospective evaluations with more complete data are necessary for longer-term outcomes.
糖尿病的早期检测和治疗对于减少该疾病导致的残疾和死亡至关重要。在资源有限的国家为糖尿病患者找到有效的筛查和治疗方法是一项挑战。柬埔寨非政府组织“莫波乔”（MoPoTsyo）通过采用多管齐下的方法来应对这一差距，该方法包括社区同伴教育者、实验室检查、当地门诊医疗咨询以及循环药物基金。本研究通过评估2007年至2013年期间确诊为糖尿病的个体在24个月随访期内的血糖和血压结果，对莫波乔在茶胶省的糖尿病项目成果进行了评估。
这是一项无对照组的回顾性队列分析。我们在随访的固定时间间隔计算平均空腹血糖（FBG）和血压（BP）。评估达到FBG和BP推荐治疗目标的患者比例。
在该项目登记的3411名患者中，2230名被纳入研究。队列中女性占主导（68.9%），中位年龄为54岁。项目中的中位随访时间为16个月（4.9 - 38.4个月）。随访一年时，平均FBG下降了63.9mg/dl（95%CI 58.5至69.3）（p<0.001）。一年后，45%（321/708）的患者达到FBG目标<126。在登记时血压升高的患者中，41.6%（927/2230），收缩压和舒张压水平在登记至随访一年期间分别显著下降（p<0.001），收缩压下降16.9mmHg（95%CI 1.2至22.9），舒张压下降10mmHg（95%CI 0.7至12.9）。随访一年时，这些患者中有51.1%（183/355）达到血压目标<140/90。
莫波乔茶胶项目评估中糖尿病护理改善的结果指标显示出前景。该项目展示了在农村地区提供有效糖尿病护理的合理且实用的方法，可能成为其他低收入社区的典范。未来需要更完整数据的前瞻性评估以获取长期结果。
