Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study.

Hdl Handle:
http://hdl.handle.net/10144/83737
Title:
Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study.
Authors:
Raguenaud, Marie-Eve; Isaakidis, Petros; Reid, Tony; Chy, Say; Keuky, Lim; Arellano, Gemma; Van Damme, Wim
Journal:
BMC Medicine
Abstract:
BACKGROUND: Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. METHODS: We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG), hemoglobin A1c (HbA1c), blood pressure (BP), and body mass index (BMI) at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. RESULTS: Of 4404 patients enrolled, 2,872 (65%) were still in care at the time of the study, 24 (0.5%) had died, and 1,508 (34%) were lost to follow-up. Median age was 53 years, 2,905 (66%) were female and 4,350 (99%) had type 2 diabetes. Median (interquartile range (IQR)) follow-up was 20 months (5 to 39.5 months). A total of 24% (51/210) of patients had a HbA1c concentration of <7% and 35% (709/1,995) had a RBG <145 mg/dl within 1 year. There was a significant drop of 109 mg/dl (95% confidence interval (CI) 103.1 to 114.3) in mean RBG (P < 0.001) and a drop of 2.7% (95% CI 2.3 to 3.0) in mean HbA1c (P < 0.001) between baseline and month 6. In all, 45% (327/723) and 62% (373/605) of patients with systolic or diastolic hypertension at baseline, respectively, reached = 130/80 mm Hg within 1 year. There was a drop of 13.5 mm Hg (95% CI 12.1 to 14.9) in mean systolic blood pressure (SBP) (P < 0.001), and a drop of 11.7 mm Hg (95% CI 10.8 to 12.6) in mean diastolic blood pressure (DBP) (P < 0.001) between baseline and month 6. Only 22% (90/401) patients with obesity at baseline lowered their BMI <27.5 kg/m2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. CONCLUSION: Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.
Affiliation:
Médecins Sans Frontières, Phnom Penh, Cambodia. eve_raguenaud@hotmail.com
Issue Date:
15-Aug-2009
URI:
http://hdl.handle.net/10144/83737
DOI:
10.1186/1741-7015-7-33
PubMed ID:
19602220
Language:
en
ISSN:
1741-7015
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorRaguenaud, Marie-Eveen
dc.contributor.authorIsaakidis, Petrosen
dc.contributor.authorReid, Tonyen
dc.contributor.authorChy, Sayen
dc.contributor.authorKeuky, Limen
dc.contributor.authorArellano, Gemmaen
dc.contributor.authorVan Damme, Wimen
dc.date.accessioned2009-10-07T13:09:36Z-
dc.date.available2009-10-07T13:09:36Z-
dc.date.issued2009-08-15-
dc.identifier.citationTreating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study. 2009, 7:33notBMC Meden
dc.identifier.issn1741-7015-
dc.identifier.pmid19602220-
dc.identifier.doi10.1186/1741-7015-7-33-
dc.identifier.urihttp://hdl.handle.net/10144/83737-
dc.description.abstractBACKGROUND: Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. METHODS: We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG), hemoglobin A1c (HbA1c), blood pressure (BP), and body mass index (BMI) at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. RESULTS: Of 4404 patients enrolled, 2,872 (65%) were still in care at the time of the study, 24 (0.5%) had died, and 1,508 (34%) were lost to follow-up. Median age was 53 years, 2,905 (66%) were female and 4,350 (99%) had type 2 diabetes. Median (interquartile range (IQR)) follow-up was 20 months (5 to 39.5 months). A total of 24% (51/210) of patients had a HbA1c concentration of <7% and 35% (709/1,995) had a RBG <145 mg/dl within 1 year. There was a significant drop of 109 mg/dl (95% confidence interval (CI) 103.1 to 114.3) in mean RBG (P < 0.001) and a drop of 2.7% (95% CI 2.3 to 3.0) in mean HbA1c (P < 0.001) between baseline and month 6. In all, 45% (327/723) and 62% (373/605) of patients with systolic or diastolic hypertension at baseline, respectively, reached = 130/80 mm Hg within 1 year. There was a drop of 13.5 mm Hg (95% CI 12.1 to 14.9) in mean systolic blood pressure (SBP) (P < 0.001), and a drop of 11.7 mm Hg (95% CI 10.8 to 12.6) in mean diastolic blood pressure (DBP) (P < 0.001) between baseline and month 6. Only 22% (90/401) patients with obesity at baseline lowered their BMI <27.5 kg/m2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. CONCLUSION: Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.en
dc.language.isoenen
dc.rightsArchived with thanks to BMC Medicine and Open Access.en
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAged, 80 and overen
dc.subject.meshBlood Glucoseen
dc.subject.meshBlood Pressureen
dc.subject.meshBody Mass Indexen
dc.subject.meshCambodiaen
dc.subject.meshData Interpretation, Statisticalen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDiabetes Mellitusen
dc.subject.meshFemaleen
dc.subject.meshHemoglobin A, Glycosylateden
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPrevalenceen
dc.subject.meshRural Populationen
dc.subject.meshTreatment Outcomeen
dc.titleTreating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study.en
dc.contributor.departmentMédecins Sans Frontières, Phnom Penh, Cambodia. eve_raguenaud@hotmail.comen
dc.identifier.journalBMC Medicineen

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