School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
Health Policy Unit, Department of Public Health, Institute of Tropical Medicine (Antwerp), Antwerp, Belgium.
JMIR Public Health Surveill. 2023 Jun 22;9:e41902. doi: 10.2196/41902.
Cambodia has seen an increase in the prevalence of type 2 diabetes (T2D) over the last 10 years. Three main care initiatives for T2D are being scaled up in the public health care system across the country: hospital-based care, health center-based care, and community-based care. To date, no empirical study has systematically assessed the performance of these care initiatives across the T2D care continuum in Cambodia.
This study aimed to assess the performance of the 3 care initiatives-individually or in coexistence-and determine the factors associated with the failure to diagnose T2D in Cambodia.
We used a cascade-of-care framework to assess the T2D care continuum. The cascades were generated using primary data from a cross-sectional population-based survey conducted in 2020 with 5072 individuals aged ≥40 years. The survey was conducted in 5 operational districts (ODs) selected based on the availability of the care initiatives. Multiple logistic regression analysis was used to identify the factors associated with the failure to diagnose T2D. The significance level of P<.05 was used as a cutoff point.
Of the 5072 individuals, 560 (11.04%) met the definition of a T2D diagnosis (fasting blood glucose level ≥126 mg/dL and glycated hemoglobin level ≥6.5%). Using the 560 individuals as the fixed denominator, the cascade displayed substantial drops at the testing and control stages. Only 63% (353/560) of the participants had ever tested their blood glucose level in the last 3 years, and only 10.7% (60/560) achieved blood glucose level control with the cutoff point of glycated hemoglobin level <8%. The OD hosting the coexistence of care displayed the worst cascade across all bars, whereas the OD with hospital-based care had the best cascade among the 5 ODs. Being aged 40 to 49 years, male, and in the poorest category of the wealth quintile were factors associated with the undiagnosed status.
The unmet needs for T2D care in Cambodia were large, particularly in the testing and control stages, indicating the need to substantially improve early detection and management of T2D in the country. Rapid scale-up of T2D care components at public health facilities to increase the chances of the population with T2D of being tested, diagnosed, retained in care, and treated, as well as of achieving blood glucose level control, is vital in the health system. Specific population groups susceptible to being undiagnosed should be especially targeted for screening through active community outreach activities. Future research should incorporate digital health interventions to evaluate the effectiveness of the T2D care initiatives longitudinally with more diverse population groups from various settings based on routine data vital for integrated care.
International Standard Randomized Controlled Trials Number (ISRCTN) ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/36747.
在过去的 10 年中，柬埔寨 2 型糖尿病（T2D）的患病率有所上升。目前，全国公共医疗体系正在扩大三种主要的 T2D 护理措施：医院护理、医疗中心护理和社区护理。迄今为止，尚无实证研究系统评估这些护理措施在柬埔寨整个 T2D 护理连续体中的表现。
本研究旨在评估这 3 种护理措施的表现（单独或共存），并确定与柬埔寨未能诊断 T2D 相关的因素。
我们使用级联护理框架来评估 T2D 护理连续体。级联是使用 2020 年进行的一项基于人群的横断面调查的原始数据生成的，该调查涉及 5072 名年龄≥40 岁的个体。该调查在 5 个基于操作区（OD）进行，这些操作区是根据护理措施的可用性选择的。采用多因素逻辑回归分析确定与未能诊断 T2D 相关的因素。P<.05 的显著性水平被用作截止点。
在 5072 名个体中，有 560 名（11.04%）符合 T2D 诊断的定义（空腹血糖水平≥126mg/dL 和糖化血红蛋白水平≥6.5%）。以 560 名个体为固定分母，级联在检测和控制阶段出现了明显的下降。仅有 63%（353/560）的参与者在过去 3 年内检测过血糖水平，仅有 10.7%（60/560）的患者达到了糖化血红蛋白水平<8%的血糖控制标准。同时提供共存护理的 OD 在所有条目中的级联表现最差，而提供医院护理的 OD 在 5 个 OD 中具有最佳的级联表现。年龄在 40 至 49 岁之间、男性和财富五分位数中最贫穷的类别是与未确诊状态相关的因素。
柬埔寨 T2D 护理的未满足需求很大，特别是在检测和控制阶段，这表明该国需要大幅提高 T2D 的早期发现和管理水平。在公共卫生机构迅速扩大 T2D 护理服务，以增加 T2D 人群接受检测、诊断、接受护理和治疗的机会，并实现血糖控制，这对卫生系统至关重要。应特别针对易被漏诊的特定人群进行筛查，通过积极的社区外联活动进行主动筛查。未来的研究应结合数字健康干预措施，根据常规数据对 T2D 护理措施进行纵向评估，这些数据对于综合护理至关重要，纳入更多来自不同环境的多样化人群。
国际标准随机对照试验编号（ISRCTN）ISRCTN41932064；https://www.isrctn.com/ISRCTN41932064。
国际注册报告标识符（IRRID）：RR2-10.2196/36747。
