ArticleBMC health services research2023
Gaps in the type 2 diabetes care cascade: a national perspective using South Africa's National Health Laboratory Service (NHLS) database.
Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 10 citations in OpenAlex.
- Barriers and strategies in care delivery for type 1 diabetes in Sub-Saharan Africa: a scoping review.BMC public health · 2026Article
- Gaps in the Type 1 Diabetes Mellitus care cascade: a national perspective using South Africa's National Health Laboratory Service (NHLS) database.medRxiv : the preprint server for health sciences · 2025Article
- Article
- Enhancing tuberculosis (TB) case detection among hospitalized patients through lay health worker led screening: a before-and-after study in KwaZulu-Natal, South Africa.Scientific reports · 2025Article
- Gaps in hypertension and diabetes treatment among people living with and without HIV: Findings from a prospective cohort study in Kenya, Nigeria, Tanzania, and Uganda, 2013-2023.PLOS global public health · 2025Article
- Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa.Journal of multimorbidity and comorbidityArticle
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15 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundResearch out of South Africa estimates the total unmet need for care for those with type 2 diabetes mellitus (diabetes) at 80%. We evaluated the care cascade using South Africa's National Health Laboratory Service (NHLS) database and assessed if HIV infection impacts progression through its stages.
methodsThe cohort includes patients from government facilities with their first glycated hemoglobin A1c (HbA1c) or plasma glucose (fasting (FPG); random (RPG)) measured between January 2012 to March 2015 in the NHLS. Lab-diagnosed diabetes was defined as HbA1c ≥ 6.5%, FPG ≥ 7.0mmol/l, or RPG ≥ 11.1mmol/l. Cascade stages post diagnosis were retention-in-care and glycaemic control (defined as an HbA1c < 7.0% or FPG < 8.0mmol/l or RPG < 10.0mmol/l) over 24-months. We estimated gaps at each stage nationally and by people living with HIV (PLWH) and without (PLWOH).
resultsOf the 373,889 patients tested for diabetes, 43.2% had an HbA1c or blood glucose measure indicating a diabetes diagnosis. Amongst those with lab-diagnosed diabetes, 30.9% were retained-in-care (based on diabetes labs) and 8.7% reached glycaemic control by 24-months. Prevalence of lab-diagnosed diabetes in PLWH was 28.6% versus 47.3% in PLWOH. Among those with lab-diagnosed diabetes, 34.3% of PLWH were retained-in-care versus 30.3% PLWOH. Among people retained-in-care, 33.8% of PLWH reached glycaemic control over 24-months versus 28.6% of PLWOH.
conclusionsIn our analysis of South Africa's NHLS database, we observed that 70% of patients diagnosed with diabetes did not maintain in consistent diabetes care, with fewer than 10% reaching glycemic control within 24 months. We noted a disparity in diabetes prevalence between PLWH and PLWOH, potentially linked to different screening methods. These differences underscore the intricacies in care but also emphasize how HIV care practices could guide better management of chronic diseases like diabetes. Our results underscore the imperative for specialized strategies to bolster diabetes care in South Africa.
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