夸祖鲁-纳塔尔省药物配给项目中血糖控制不佳患者的决定因素：一项队列研究，2018-2021 年。

Determinants of sub-optimal glycemic control among patients enrolled in a medicine dispensing programme in KwaZulu-Natal: A cohort study, 2018-2021.

机构信息

South African Field Epidemiology Training Program, National Institute for Communicable Disease, A Division of the National Health Laboratory Service, Johannesburg Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg Non-Communicable Disease Directorate, National Department of Health, Pretoria.

出版信息

Afr J Prim Health Care Fam Med. 2024 May 31;16(1):e1-e12. doi: 10.4102/phcfm.v16i1.4336.

DOI:10.4102/phcfm.v16i1.4336

PMID:38832377

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11151363/

Abstract

BACKGROUND

The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme facilitates clinically stable patients to collect their chronic medication from community-based pick-up points.

AIM

We determined baseline glycaemic control and rates and predictors of becoming sub-optimally controlled for type 2 diabetes mellitus (T2DM) CCMDD-enrolled patients.

SETTING

The setting of the study was eThekwini, KwaZulu-Natal, South Africa.

METHODS

We performed a cohort study (April 2018- December 2021). We linked T2DM CCMDD-enrolled patients to glycated haemoglobin (HbA1c) data from the National Health Laboratory Service. We selected patients optimally controlled at their baseline HbA1c, with ≥ 1 repeat-test available. We used Kaplan-Meier analysis to assess survival rates and extended Cox regression to determine associations between time to sub-optimal control (HbA1c 7%) and predictors. Adjusted hazard ratios (aHRs), 95% confidence interval (CI), and p-values are reported.

RESULTS

Of the 41145 T2DM patients enrolled in the CCMDD programme, 7960 (19%) had a HbA1c result available. Twenty-seven percent (2147/7960) were optimally controlled at their baseline HbA1c. Of those controlled at baseline, 695 (32%) patients had a repeat test available, with 35% (242/695) changing to sub-optimal status. The HbA1c testing frequency as per national guidelines was associated with a lower hazard of sub-optimal glycaemic control (aHR: 0.46; 95% CI: 0.24-0.91; p-value = 0.024). Patients prescribed dual-therapy had a higher hazard of sub-optimal glycaemic control (aHR: 1.50; 95% CI: 1.16-1.95; p-value = 0.002) versus monotherapy.

CONCLUSIONS

The HbA1c monitoring, in-line with testing frequency guidelines, is needed to alert the CCMDD programme of patients who become ineligible for enrolment. Patients receiving dual-therapy require special consideration.Contribution: Addressing identified shortfalls can assist programme implementation.

摘要

背景

中央慢性病配药和分发（CCMDD）计划方便临床稳定的患者从社区取药点领取慢性病药物。

目的

我们旨在确定 2 型糖尿病（T2DM）CCMDD 登记患者的血糖控制基线水平以及血糖控制不佳的发生率和预测因素。

地点

本研究地点位于南非夸祖鲁-纳塔尔省的埃滕哈赫。

方法

我们进行了一项队列研究（2018 年 4 月至 2021 年 12 月）。我们将 T2DM CCMDD 登记患者与国家卫生实验室服务的糖化血红蛋白（HbA1c）数据相关联。我们选择了在基线 HbA1c 时得到最佳控制的患者，并且至少有一次重复测试结果。我们使用 Kaplan-Meier 分析评估生存率，并使用扩展 Cox 回归确定血糖控制不佳（HbA1c 7%）与预测因素之间的关联。报告调整后的风险比（aHR）、95%置信区间（CI）和 p 值。

结果

在 CCMDD 计划中登记的 41145 名 T2DM 患者中，有 7960 名（19%）患者的 HbA1c 结果可用。27%（2147/7960）的患者在基线 HbA1c 时得到最佳控制。在基线时得到控制的患者中，有 695 名（32%）患者有重复测试结果，其中 35%（242/695）转为血糖控制不佳。根据国家指南进行 HbA1c 检测的频率与血糖控制不佳的风险降低相关（aHR：0.46；95%CI：0.24-0.91；p 值=0.024）。与单药治疗相比，接受双联治疗的患者血糖控制不佳的风险更高（aHR：1.50；95%CI：1.16-1.95；p 值=0.002）。