An evaluation of insulin therapy initiation among patients with type 2 diabetes attending a public health facility in South Africa

Mayet, Leila; Naidoo, Soornarain S

doi:10.1080/20786204.2012.10874287

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…Table 2 presents the sociodemographic factors with respect to their relationship with glycaemic control. Five studies assessed the relationship between increasing age and glycaemic control [ 27 , 31 , 34 , 58 , 61 ], two found that it was negatively associated with glycosylated haemoglobin [ 31 , 61 ], and one found that it was associated with good glycaemic control [ 57 ]. Older age was associated with poor glycaemic control in twelve studies [ 22 , 29 , 32 , 36 , 39 , 65 , 68 , 69 , 73 , 77 , 83 , 86 ].…”

Section: Resultsmentioning

confidence: 99%

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

Lubaki

Omole

Francis

2022

Diabetol Metab Syndr

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Background There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo. Methods We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2. Results A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6–32.9). The glycaemic control prevalence ranged from 10–60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control. Conclusion Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

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Section: Resultsmentioning

confidence: 99%

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

Lubaki

Omole

Francis

2022

Diabetol Metab Syndr

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“…In South Africa there is little research on PIR, despite strong evidence that few patients with T2DM requiring insulin actually escalate therapy (23,24). We found two studies, one assessed insulin aversion among a small sample of uncontrolled patients of Indian descent on maximum oral treatment (25).…”

Section: Introductionmentioning

confidence: 97%

Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP)

Piotie

Wood

Webb

et al. 2020

Diabetes Research and Clinical Practice

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“… 16 Consequently, people with T2D often remain on maximum oral glucose-lowering therapy despite suboptimal glycaemic control, and people who have transitioned to insulin do not often intensify their insulin therapy. 15 South African doctors are similar to doctors from other settings. Rushforth et al 17 conducted a systematic review and found that primary care clinicians struggle to meet evolving treatment targets with limited time and resources.…”

Section: Introductionmentioning

confidence: 70%

“…12 In practice, this is not always feasible. Besides the reported resistance of both healthcare providers and people with T2D to start insulin, 13 – 15 most primary healthcare clinics lack doctors and diabetes dedicated nurses, and nurses have a heavy workload which limits their capacity to attend comprehensively to patients with T2D. 9 In primary healthcare, many South African doctors feel they do not know enough or have enough experience of the insulin therapy guidelines.…”

Section: Introductionmentioning

confidence: 99%

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Piotie

Wood

Webb

et al. 2021

Therapeutic Advances in Endocrinology

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Background: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. Methods: We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. Results: This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. Conclusion: The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.

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An evaluation of insulin therapy initiation among patients with type 2 diabetes attending a public health facility in South Africa

Cited by 9 publications

References 28 publications

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP)

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

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