Evaluation of type 2 diabetes mellitus management at private primary health care facilities in Harare, Zimbabwe, 2023

Abstract

The global prevalence of diabetes mellitus increased from 8.5% in 2014 to 14% in 2022, mainly due to type 2 diabetes. Globally, diabetes mellitus causes serious complications which can be prevented or delayed through optimal diabetes management. In Africa, studies have shown low prevalence of good glucose control. However, most of the studies were conducted within the public health sector. This study evaluated optimal type 2 diabetes management within private primary healthcare facilities in Harare, Zimbabwe. A cross-sectional study design was conducted at eight private primary healthcare clinics. Secondary data was collected from electronic medical records for the period January 2023 to December 2023. Optimal diabetes management was evaluated in terms of period prevalence of blood glucose, blood pressure and blood lipids control, frequency of patient clinic visits, frequency of laboratory testing, and prevalence of complications. Factors associated with inadequate glycaemic control were determined using the multivariable logistic regression models. Odds ratios were calculated at 95% confidence intervals and 0.05 significance level. The sample size was 252 participants. The prevalence of adequate glycaemic control (HbA1c < 8%) was 42.7%, LDL cholesterol control (< 1.8 mmol/l) 25.2%, blood pressure control without nephropathy (BP < 140/90 mmHg) 64.3% and with nephropathy (BP < 130/80 mmHg) 32.9%. Only 109 of the 252 participants had all diabetes control indicators available of which 9% had optimal diabetes control (HbA1c, LDL cholesterol and BP indicators all controlled), 33.4% had nephropathy and 21% had neuropathy. Only 15% and 12% were screened for foot and eye complications, respectively. Factors associated with inadequate glycaemic control were age group 50–59 years (aOR 1.97, 95% CI 1.04 to 3.74, p = 0.039), urban residence (aOR 2.61, 95% CI 1.09 to 6.23, p = 0.031), insulin only medication (aOR 10.01, 95% CI 1.27 to 79.02, p = 0.029), and oral medication plus insulin (aOR 4.44, 95% CI 1.87 to 10.53, p = 0.001). Most participants had sub-optimal diabetes control in terms of blood glucose, blood lipids, and blood pressure control. Most participants were not screened for eye or foot complications during the study period. We recommend adherence to locally developed diabetes management guidelines to improve outcomes.