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OBJECTIVE: This study aims to explore the perceptions and experiences of healthcare providers regarding the role of healthcare system factors on glycemic control among type 2 diabetes (T2D) patients in Fiji in 2018. METHODS: Nineteen healthcare providers (physicians and nurses) from three randomly selected urban healthcare centers in Suva, Fiji, were selected through purposive variation sampling to participate in three focus group discussions (FGDs). The participants in this study were healthcare providers working in diabetes clinics, and medical officers and nurse team leaders from the selected healthcare centers. The data were analyzed by means of thematic analysis using Attride-Stirling's thematic network analysis framework. RESULTS: The majority of the participants (52.6%) were nurses, most of them female (84.2%), with a mean age of 39 years (SD ±9.2). A large part of the participants had been working in the diabetes clinics for more than 5 years (52.6%) and had more than 10 years' experience (52.6%) in their current employment. Five main healthcare system factors that may affect glycemic control were identified during thematic analysis: 1. Healthcare workforce (shortage of staff, high workload). 2. Medicine, consumables, and equipment (regular stock-outs of basic diabetes medicines and consumables, poorly equipped diabetes clinics). 3. Service delivery (lack of effective diabetes service delivery, continuum of care). 4. Healthcare information system (inadequate, not fully functional, unreliable). 5. Infrastructure (lack of supportive diabetes clinic infrastructure and processes). CONCLUSIONS: Healthcare system factors influence glycemic control among T2D patients. Understanding these factors is important in order for healthcare providers to deliver an effective and efficient service for diabetes patients in Fiji.

Background Diabetes is a global health problem reaching pandemic proportions. In Fiji, diabetes has a prevalence rate of 15.6% in 2011which is estimated to rise to 19.3% in 2020. The aim of this study was to determine the proportion of poor glycaemic control level and its determinants among type 2 diabetes mellitus (T2DM) patients. Methods This retrospective study was conducted in three selected health centres in Suva, Fiji with the following inclusion criteria: adult T2DM ≥ 18 years old registered during 2011 to 2016; on treatment for > 1year; had > 4 clinic visits and; had a recent HbA1c result in 2017. Logistic regression analysis was performed and p < 0.05 considered as significant. Results There were 200 female (59.2%) and 138 male (40.8%) T2DM patients in this study with a mean age of 56.5 years (SD = ± 9.9). Most of T2DM patients have poorly controlled random blood sugar (RBS), 67.1% and fasting blood sugar (FBS), 63.0%. Two-thirds (65.4%) had associated medical conditions. The proportion of poor glycaemic control (HbA1c < 7%) was 77.2%. Mean HbA1c was 8.6% (± 2.04). RBS, FBS, cholesterol, estimated glomerular filtration rate (eGFR) and diastolic blood pressure (DBP) were significant (p < 0.05) determinants of poor glycaemic control. Conclusions Health care workers dealing with T2DM patients should consider the clinical determinants of poor glycaemic control for a more effective diabetes management.

Medicine. During COVID-19, he has led surveillance activity in the unit's General Population Cohort in southwestern Uganda. His research interests are primarily on the health and social issues affecting older people in low-and middle-income countries. References

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Background: Glycemic control is the centre in diabetes management. In patients with type 2 diabetes mellitus (T2DM), glycemic control is associated with clinical determinants. The aim of this study was to determine the proportion of poor glycemic control level and its clinical determinants among T2DM patients.Methods: This retrospective cross-sectional study was conducted on the medical records of T2DM patients attending diabetes clinics at the three selected health centres in Suva, Fiji. Patients who met the following criteria were included in the study: adult T2DM >18 years old registered during 2011 to 2016; on treatment for >1year; had >4 clinic visits and; had a recent HbA1c result in 2017. Logistic regression analysis was performed. A p value of <0.05 was considered as significant.Results: There were 200 female (59.2%) and 138 male (40.8%) T2DM patients included in this study with a mean age of 56.5 years (SD = + 9.9). Majority have poorly controlled random blood sugar (RBS), 67.1% and fasting blood sugar (FBS), 63.0%. Two-thirds (65.4%) had co-morbidities. The proportion of poor glycaemic control (HbA1c <7%) was 77.2% with mean HbA1c of 8.6% (+ 2.04). RBS, FBS, cholesterol, estimated glomerular filtration rate (eGFR) and diastolic blood pressure (DBP) were significant (p<0.05) determinants of poor glycaemic control.Conclusions: This study identified clinical determinants of T2DM patients that are highly associated with glycemic control. Health care workers managing T2DM patients should address these clinical determinants in order to achieve glycemic control.