Evaluation of Diabetes Care Performance in Cambodia Through the Cascade-of-Care Framework: Cross-Sectional Study (Preprint)

Abstract

BACKGROUND Cambodia has seen an increase in the prevalence of type 2 diabetes (T2D) over the last ten years, with a prevalence of 9.6% among the adult population aged 18-69 in 2016. Nevertheless, the T2D care continuum contains significant gaps for the population at risk and people living with T2D in the country. Amid the dominant role of private providers in the T2D care provision, three main care models for the T2D are currently being scaled up in the public health care system across Cambodia: (1) hospital-based care, (2) health centre-based care, and (3) community-based care. To date, no empirical study has systematically assessed the performance of these care models in Cambodia. OBJECTIVE This study aims to assess the performance of the above-mentioned three care models – individually or in co-existence – and determine the factors associated with the failure to diagnose the T2D in Cambodia. METHODS We used the test-treat-retain cascade of care to assess the T2D care continuum. The cascades were generated using primary data of a cross-sectional population-based survey conducted in 2020, with a total sample size of 5,072 individuals aged 40 years and above in five operational districts (ODs) selected based on presence of particular care models. An overall T2D cascade for all the selected ODs as well as individual T2D cascades for each OD were generated. Bivariate analysis was used to compare the proportion of undiagnosed T2D patients by the participants’ characteristics. Then, multiple logistic regression analysis was employed to identify the factors associated with the failure to diagnose the T2D. The significance level of 0.05 was used as a cut-off point. RESULTS Of the total 5,072 individuals, 614 (12.11%) had a raised blood glucose (FBG ≥126 mg/dl) and 560 (11.04%) met the definition of having the T2D (FBG ≥126 mg/dl AND HbA1c level ≥6.5%). Using the 560 individuals as the fixed denominator, we observed that two bars—ever tested and under-control—displayed a significant drop. Only 63% (n=353) of participants had ever tested their blood glucose in the last three years; 55% (n=309) had ever been diagnosed as having the T2D; 50% (n=279) received care in the past 12 months; 49% (n=273) received insulin or anti-diabetic medication in the past two weeks, and only 11% (n=60) achieved the blood glucose control with the cut-off point of HbA1c < 8%. The factors associated not being diagnosed included being aged 40-49 years, male, and part of the poorest category. CONCLUSIONS The unmet need for T2D care across the country was large, in particular, in the testing stage and control stage. Therefore, scale up of the different components of the T2D care continuum at the public health facilities is recommended to increase the chance of being tested and diagnosed. CLINICALTRIAL International Standard Randomised Controlled Trials Number (ISRCTN) registry, number 37447 (first date of publication 3 February 2020) ISRCTN - ISRCTN41932064: Scale up diabetes and hypertension care for vulnerable people in Cambodia, Slovenia and Belgium INTERNATIONAL REGISTERED REPORT RR2-10.2196/36747