Objective: This study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa as well as factors associated with time to achieve control. South Africa’s estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%. Research design, methods and findings: The data of 511781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1c of <=7 was reported as normal, >7 - <=9 as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1c status and variables listed above. The Kaplan Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (aHR=1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR=1.99; 95% CI:1.92-2.06; p<0.001). Conclusion: This study highlights poor adherence to guidelines for diabetes monitoring.

The authors have declared no competing interest.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Human Research Ethics Committee (HREC)(Medical), at the University of the Witwatersrand (M1911163).

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