Aim: The aim was to evaluate the effect on glycaemic control of more intensive care for patients with very uncontrolled type-2 diabetes (HbA1c>10%) at Khayelitsha Community Health Centre, South Africa.
Methods: A pragmatic, quasi-experimental study. Patients with HBA1c>10% were consecutively selected into a 6-month programme of intensified care involving monthly visits to a doctor, diabetes group education, escalation of treatment, and more frequent HbA1c testing by either point-of-care (POC) or laboratory. Participants were their own controls in a retrospective analysis of usual care during the previous year.
Results: At baseline 236 patients had a mean HbA1c of 12.1%. The mean difference in HbA1c in the intervention group was -1.1% (p<0.001). The intervention group were exposed to group diabetes education (100% vs 0%), more visits (3.8 vs 3.2, p<0.001), more HbA1c tests (2.2 vs 0.9, p<0.001). There was no difference in increased dose of insulin between the groups or between POC and standard laboratory intervention sub-groups.
Conclusion: The introduction of group diabetes education was the most likely explanation for improved glycaemic control in this poor, under-resourced, public sector, peri-urban setting. The study demonstrates a feasible approach to improving diabetes care in the South African context.
Keywords: Diabetes group education; Diabetes mellitus; Guideline implementation; Patient education and counselling; Point-of-care testing; Primary care; Primary health care.
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