Diabetic nephropathy in a tertiary care clinic in South Africa: a cross-sectional study

Ngassa, Patrick Piotie; Zyl, Danie G. Van; Rheeder, Paul

doi:10.1080/16089677.2015.1030858

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…Four studies in South Africa and East Africa made use of mobile testing vans in rural areas. This method was particularly useful in reaching younger male populations, who are known to typically not access health facilities in this region [35–38]. Three studies involved testing campaigns; one employed network based approaches to increase screening for at-risk individuals while another testing campaign was carried out by an independent humanitarian organisation to increase testing in vulnerable populations.…”

Section: Resultsmentioning

confidence: 99%

Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018)

Dave

Peter²,

Fogarty

et al. 2019

PLoS ONE

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Background Reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets to end the HIV epidemic relies on effective interventions that engage untested HIV+ individuals and retain them in care. Evidence on community-based interventions through the lens of the targets has not yet been synthesized, reflecting a knowledge gap. We conducted a systematic review and meta-analysis to shed light on successful community-based interventions that have been effective in contributing, directly or indirectly, towards the UNAIDS 90-90-90 targets: knowledge of HIV status, linkage to care/on treatment, and viral suppression. Linkage to care was also included in this review due to the limitations of studies. Methods We conducted a systematic review and meta-analysis of the period 2007–2018. Eleven databases were searched to identify community-based interventions designed to improve knowledge of HIV status (in particular HIV testing), linkage to care/on treatment, and/or viral suppression. Eligible studies were classified by intervention, population, country income level, outcomes and success. Success was defined as interventions demonstrating statistical significance between intervention and control group or that reached any target by proportion; 90% testing, 81% linked to care/on treatment and 73% viral suppression. Results Of 82 eligible studies, 51.2% (42/82) reported on HIV testing (first 90), 20.7% (17/82) on linkage to care/ on treatment (second 90), and 45.1% (37/82) on viral suppression (third 90). In all, 67.1% (55/82) of studies reported success; 21 studies on the first 90, 9 towards linkage to care/on treatment, and 25 towards the third. By strategies, 36.6% deployed community workers/peers, 22% used combined test and treat strategies, 12.2% used educational methods, 8.5% used mobile testing, 7.3% used campaigns and 13.4% used technology. For HIV testing/linkage, combined test/treat interventions were often used, for viral suppression, educational interventions and technologies were commonly deployed. Our pooled analysis suggested that deployment of community health care workers/peer workers significantly improved viral suppression (pooled OR: 1.40 95% CI 1.06–1.86). Of the studies published after 2014, 50.0% reported metrics aligned with UNAIDS targets. Conclusions Data on linkage to care/on treatment (second target) remained weak, because many studies reported successes on the first and third targets. Stratification by targets and country income levels is informative and guides adaptation of successful interventions in comparable settings. Consistent reporting of clear metrics aligned with UNAIDS targets will aid in synergy of study data with programmatic data that will help reportage. Exploration of innovative interventions, for engagement and linkage and deployment of community/ peer workers is strongly encouraged.

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Section: Resultsmentioning

confidence: 99%

Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018)

Dave

Peter²,

Fogarty

et al. 2019

PLoS ONE

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“…Ngassa Piotie et al demonstrated a similar outcome in their 2015 Pretoria-based study where 88.9% of their patients had HbA1c values exceeding 7%. 9 …”

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 Using albuminuria as a marker of diabetic nephropathy, Ngassa Piotie et al demonstrated a prevalence of 33.6%. 9 A Cape Town-based study showed a prevalence of stage 3–5 CKD in 23.9% of 1202 participants of mixed ancestry. Concomitant DM was identified in 26.4% of this cohort.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of chronic kidney disease among type 2 diabetes mellitus patients in central South Africa

Mhundwa

Joubert

Mofokeng

2023

South African Family Practice

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Background: Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD). The prevalence of CKD among T2DM patients in Africa is 22.0%. The cut-off age for dialysing diabetic patients in the resource-limited state sector in South Africa is 50 years. Type 2 diabetes mellitus patients who develop CKD are likely to be excluded from chronic dialysis and rely on control of risk factors, including blood pressure and blood glucose levels, to prevent CKD progression. We aimed to determine the prevalence of CKD among T2DM patients attending the diabetes clinic at Pelonomi Academic Hospital, Bloemfontein.Methods: In this retrospective cross-sectional study, medical records of patients (January 2016 and December 2018) were reviewed to collect demographic and clinical information.Results: In total, 244 records were reviewed. Sixty-one (25.0%, 95% confidence interval [CI]: 20% – 30.8%) T2DM patients had CKD. The rate of CKD was slightly higher in males (n = 24/81; 29.6%) compared with females (n = 37/163; 22.7%). Most patients with CKD (n = 58; 95.1%) were 50 years of age. Only 17.8% of patients achieved a glycosylated haemoglobin (HbA1c) of 7.0%. Blood pressure was controlled in 14.3% of hypertensive patients. Renin–angiotensin–aldosterone system inhibitors were used by 78.6% of patients.Conclusion: A high prevalence of clinically significant CKD among T2DM patients with poor prospects of chronic dialysis in a resource-limited setting was observed. The risk factors for CKD development and progression should be adequately managed in T2DM patients.Contribution: This study emphasises the need for further research and innovation to improve outcomes of T2DM patients with CKD in resource-constrained settings.

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“…At best, only approximately 1 out of every 4 patients with type 2 diabetes achieves HbA1c < 7%. [23][24][25][26][27][28][29][30][31][32][33][34] However, currently, there are few or no data on usual prescribing practices for patients with diabetes in South Africa.…”

Section: Introductionmentioning

confidence: 99%

Patterns of diabetes management in South Africa: baseline and 24-month data from the South African cohort of the DISCOVER study

Kok¹,

Hariram²,

Webb³

et al. 2021

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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To describe disease management patterns and associated outcomes in patients with type 2 diabetes initiating a second-line glucose-lowering therapy in routine clinical practice in South Africa. Design: Non-interventional observational study. Setting: General and specialist private practices. Subjects Patients with diabetes initiating second-line glucose-lowering therapy. Outcome measures: Variables collected at baseline and at 6-, 12-and 24-month follow-up visits included sociodemographics, first-and second-line glucose-lowering treatments and other medications, reasons for change in diabetes therapy, HbA1c target set by the attending clinician at the time of change, comorbidities and health-related quality of life (HRQoL). Results: Baseline data were collected for 519 patients (69% female). Mean age was 54.6 years and mean time since initial diagnosis was 7.5 years. Mean HbA1c at baseline was 9.0% and the most common second-line treatment approach was to combine metformin with a sulphonylurea. Median HbA1c and median fasting glucose measurements were marginally lower at 24 months than at baseline (8.0% vs. 8.4%, and 8.5 mmol/l vs. 8.8 mmol/l, respectively). Only approximately 5% of patients had had their diabetes medication changed at any time after the baseline visit. Conclusions: Management of type 2 diabetes mellitus in private practice in South Africa is suboptimal.

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Diabetic nephropathy in a tertiary care clinic in South Africa: a cross-sectional study

Cited by 6 publications

References 19 publications

Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018)

Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018)

The prevalence of chronic kidney disease among type 2 diabetes mellitus patients in central South Africa

Patterns of diabetes management in South Africa: baseline and 24-month data from the South African cohort of the DISCOVER study

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