Suboptimal control for patients with type 2 diabetes in the Central Chronic Medicine Dispensing programme in South Africa

Abstract

Background: In South Africa, the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme allows stable patients with non-communicable diseases, including type 2 diabetes mellitus (T2DM), to collect their medication from a pick-up location near their home, thus avoiding long waiting times and travel expenses. The CCMDD programme aims at improving patient retention and adherence through better access to medicines, resulting in better health outcomes.Aim: We assessed whether patients with T2DM enrolled in CCMDD achieved the recommended targets for glycaemic, blood pressure (BP) and lipid control.Setting: City of Tshwane, South Africa.Methods: We reviewed the records of 198 T2DM patients enrolled in CCMDD and assessed their control of haemoglobin A1c (HbA1c), BP and lipids.Results: Most of the records reviewed belonged to women (64.7%), African (89.9%), hypertensive (82.7%) and to patients exclusively on oral antidiabetic agents (98.5%). Patients were, on average, 57.7 (s.d. = 12.1) years old and had participated in the CCMDD programme for, on average, 2 years. The mean HbA1c was 8% (s.d. = 2). Glycaemic control was achieved by only 29.2% of patients, and 49% of patients had HbA1c between 7% and 9%. Ninety-three patients (66%) had achieved the total cholesterol target, 57.4% achieved BP targets and 6.9% had achieved the low-density lipoprotein cholesterol target.Conclusion: A small group of patients achieved the targets for glycaemic, BP and lipid control. Despite improved accessibility to medication, the CCMDD is not synonymous of improved clinical outcomes. Future research should ascertain the factors associated with suboptimal control for these patients.

Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study

“…To date, South Africa has experienced alarming rates of T2DM, which have tripled from 4.5% in 2010 to 12.7% in 2019, and are currently estimated at 4.58 million people (aged 20 and 79 years) living with T2DM, of which 52.4% are undiagnosed [9], and 65% of T2DM cases [10]. In 2014, the Centralised Chronic Medicine Dispensing and Distribution Programme (CCMDD) was launched by the South African National Department of Health to improve access to medication and patient adherence [11]. However, gaps in the T2DM management programme showed that only 29% of patients had acceptable blood glucose levels [11].…”

“…In 2014, the Centralised Chronic Medicine Dispensing and Distribution Programme (CCMDD) was launched by the South African National Department of Health to improve access to medication and patient adherence [11]. However, gaps in the T2DM management programme showed that only 29% of patients had acceptable blood glucose levels [11]. Furthermore, effective as of 1 April 2017, the South African government has implemented a sugar tax, subjecting sugar-sweetened beverages to a tax based on their sugar content [12].…”

Measuring the impact of community-based interventions on type 2 diabetes control during the COVID-19 pandemic in Cape Town – A mixed methods study

“…In 2012, Amod reported that two-thirds of diabetic patients in South Africa had HbA1c levels above 7.5%, 21 and in a recently published study, Piotie et al showed that amongst diabetic patients on the chronic medication programme in Tshwane, only 29.2% achieved control, although this study used an HbA1c cut-off of 7.0% to determine control based on the 2017 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines. 22 …”

Compliance of medical practitioners with diabetic treatment guidelines in West Rand, Gauteng

“…13,14 Treatment gaps have been found in various other studies regarding the management of DM among patients locally and abroad, and they have also been found to be associated with poor compliance with clinical guidelines. 15,16 In Norway and Switzerland, the researchers discovered significant discrepancies between the laid-down clinical guidelines and the practices of healthcare practitioners. 17,18 In addition, the Diab-Africa project, done across six countries in sub-Saharan Africa, has found that less than half of patients had glycaemic levels and monitoring parameters assessed in the study year.…”

“… 13 , 14 Treatment gaps have been found in various other studies regarding the management of DM among patients locally and abroad, and they have also been found to be associated with poor compliance with clinical guidelines. 15 , 16 …”