PLOS Global Public Health · 16 authors, 16 centres
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A pragmatic cluster randomized trial in Uganda and South Africa tested facility-only care versus integrated facility plus community care for type 2 diabetes. The study found no improvement in glycaemic control but significantly improved retention into care for both intervention arms compared to usual care in Uganda.
The SMART2D study was a pragmatic cluster randomized trial conducted at primary health facilities in Uganda and South Africa. It compared two interventions: optimized facility-only care and integrated care adding community peer support to facility care. Usual care was an additional arm in Uganda only. The primary outcomes were glycaemic control for participants with T2D and a reduction in HbA1c of at least 3 mmol/mol for participants at high risk of T2D. The study found no significant improvement in either primary outcome for either country. However, both intervention arms significantly improved retention into care compared to usual care in Uganda, with an incident rate ratio of 2.46 for facility care and 3.52 for integrated care among high-risk participants. Retention was also improved for integrated care versus facility care in South Africa. The authors note that considerable and unbalanced loss to follow-up compromised the assessment of the intervention effect on HbA1c, reducing statistical power. The study highlights the need for adequate primary care for T2D and suggests a role for community support in T2D prevention.
