Defaulters. Are they worse off? Analysing reasons for this phenomenon amongst patients with diabetes with and without HIV infection

Abstract

Background: Ideal control of diabetes mellitus (DM) remains elusive globally. Identifying defaulting reasons in diabetes clinics can provide potential interventional areas. Methods: Data of patients booked for the Edendale Hospital diabetes clinic (attendees and defaulters) between August 2019 and February 2020 were used to determine whether control in defaulters differed from attendees and to analyse defaulting reasons. Results: A total of 581 patients living with diabetes (PLWD) attended; 213 defaulted (defaulting rate 26.79%). Defaulters (1) had poorer glycaemic and lipid control; (2) with HIV infection and type 2 DM (T2DM) had inferior glycaemic control; (3) performed more self-monitoring of blood glucose (SMBG). Substantially more females defaulted across all categories. They had poorer glycaemia and lipid control with higher body mass index. The commonest defaulting reasons were forgetting appointments, too many clinics (TMC), patient sick and work commitments (44.3% vs. 24.5% vs. 13.1% vs. 10.8%). Within HIV-infected defaulters, reasons ranged from TMC, work commitments and other reasons to forgot appointment (57.7% vs. 26.1% vs. 23.8% vs. 13.8%). A significant number of HIV-infected and patients on antiretroviral therapy, of both sexes, with T2DM, defaulted secondary to TMC. Patients with hypertension and chronic kidney disease (CKD) defaulted due to TMC. Bivariate analysis revealed that being a pensioner, increased age, employment and presence of T2DM were significantly associated with being sick. Older patients defaulted in poor weather while younger patients specified school/work commitments. Patients who complained of TMC had higher creatinine levels. Conclusions: The defaulting rate in PLWD remains high. Defaulters had sub-optimal glycaemic and lipid control. TMC proved to be significant for patients with chronic diseases (HIV infection, hypertension and CKD) highlighting the need for combined communicable and non-communicable diseases clinics. Defaulting females and HIV-infected PLWD had high prevalence of cardiovascular risk factors. Afternoon clinics might assist with work/school commitments. Wireless uploading of SMBG results and teleconsultation is an option.