FACTORS INFLUENCING ADHERANCE TO SELF-MONITORING OF BLOOD GLUCOSE SCHEDULES AMONG DIABETIC PATIENTS.pdf (original) (raw)
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Longitudinal Study of Type-2-Diabetes: A Profile Analysis at the Ketu-South Municipality
Journal of Biology Agriculture and Healthcare, 2014
The main purpose of the study is to investigate the change in Fasting Blood Sugar (FBS) level over time and the effect of some plausible factors on this change for Type-2-Diabetes (T2D) patients on treatment. Retrospective data from the Ketu-South Municipal Hospital, Diabetes Unit, in Ghana in which patients' FBS level and demographic data were monitored regularly every three months was used for the study. Profile analysis was used to study the pattern of change in the FBS level. The MANOVA test of parallelism showed at 5% significance level that religion was not parallel because there was significant differential in the pattern of change of the FBS level. The other covariates: gender, marital status, drug and education did not significantly differ at the 5% significance level and hence their profiles were tested for parallelism. The parallelism tests revealed that they were parallel and equal but deviated from flatness The analysis revealed that although the treatment remained effective, the trend of FBS level over time was cubic, indicating that initially the FBS level usually increases and then eventually declines with time, only to rise again. The cubic profile trend obtained was = 0.089 − 1.469 + 6.793t with a quadratic rate of change in FBS level given as = 0.267 − 2.938 + 6.793
2010
CHAPTER 1 1.1: INTRODUCTION Diabetes mellitus is a silent, but serious disease. This disease is not only the most common cause of non traumatic amputations and a leading cause of blindness but also accounts for a significant proportion of end stage renal disease requiring dialysis and transplantation. It is estimated to be the 5 th leading cause of death in the year 2000, accounting for 5.2% of all deaths globally {Wild et al, 2004}. Patient adherence to oral hypoglycaemic agents is integral to reducing the health care costs and chronic complications of diabetics {Lee and Taira, 2005}. Identifying which patients are at the greatest risk for non adherence to oral hypoglycaemic agents is an important first step toward developing interventions that improve adherence {Lee and Taira, 2005}. Matlala district hospital is a 288 bed hospital with outreach to seven primary health clinics, located in the heart of Tsimanyane in Sekhukhune district, Limpopo. This hospital serves a population of 74,867 people from various surrounding rural settlements. An average of 120 patients attends the outpatient department daily. More than 34% of these patients are on chronic medication {excluding patients on antipsychotics} of which hypertension is top on the list, followed by diabetic mellitus {7.6%}. An average of 139 patients with diabetes mellitus is seen monthly in the hospital. This average was calculated from statistics gathered from April 2008 to March 2009. Of this number, an average of eight newly diagnosed diabetes patients is seen monthly. Many of the admissions into the medical wards are due to complications of the diabetes, a likely consequence of poor or non adherence to treatment. Socio-demographic variables have been found to be predictive of entry into the healthcare system, but have not been predictive of adherence level once treatment commenced {Chatterjee, 2006}. The low incidence of patients with diabetes in the hospital could be explained by patients' behaviour. Many people choose to employ the services of traditional healers rather than visiting the hospital for help. The impact of this health seeking behaviour on adherence should not be underestimated. 5 developing countries, arising from growth and the ageing of the population, as well as urbanization associated with increasing trends towards unhealthy diets and obesity and sedentary lifestyles, resulting in late onset diabetes {Bradshaw et al,2007}. 2.2.2: LOCAL BACKGROUND Based on available epidemiology data, approximately 1-1.5 million South Africans are considered to have diabetes {Bradshaw et al, 2007}. The international diabetes federation {IDF} diabetes atlas reported a prevalence figure of 3.4% for the 24 million South Africans between the ages of 20 and 79 in 2003, with an expected increase to 3.9% by 2025 {Rheeder, 2003}. The increase in diabetes is linked to the worldwide increase in obesity. Figures from the South African demographics and health survey published in 2002, show that 29.2% of men were overweight or obese {kg/m²} compared to 56.6% of South African women {Rheeder, 2003}. SEMDSA put the prevalence of type2 diabetes between 3% and 28.7%. Studies carried out in South Africa, that compared prevalence of type2 diabetes, reported the highest prevalence in the Indian population, followed by the coloured and lest in the black population {Bradshaw et al, 2007}. This is slightly different from the findings of SEMDSA, which found the highest prevalence in the coloured community of Cape Town {28.7%}, followed by the Indian population of Durban {13%}, then the blacks, with values ranging between 4.8 % in the rural community of QwaQwa, 8% in an urban settlement of Cape Town and the Caucasians in Durban with a prevalence of 3%. Recent studies indicated that the prevalence of type2 diabetes is an increasing health concern in black South Africans {Nthangeni, Steyn and Albert, 2001}. 2.2.3: TREND OF DIABETES IN SOUTH AFRICA A number of epidemiological studies were conducted in selected communities in South Africa in the 1980s and 1990s {Bradshaw et al, 2007}. These studies revealed a clear rural-urban gradient, with higher prevalence in urban settings, in addition to a gradient
Background: Diabetes is one of the most widespread chronic disease. In Ethiopia, it has been endemic and it is widely distributed. The aim of this paper was to address the determinant factors of diabetes patients blood glucose level over time with respect to different covariates. Methods: Institution based longitudinal retrospective study was done to explore the factors affecting the change of blood glucoseof diabetes patients by taking the routinely collected information from the patients card at FelegeHiwot referral hospital, Bahir Dar, Ethiopia. To analyze the data, generalized estimating equation was used and data was entered in SPSS version21 and analyzed with SAS 9.2. Results: Records of 180 diabetic patients enrolled from 2014 September to 2015 August were analyzed. The results revealed that the blood glucose level (mg/dl)was decreased over time, there is an interaction effect between the treatment sex and follow up time and the rate is statistically different for male and female diabetic patients. Conclusions: The blood glucose rate of change of female is less than that of males; this may be due to different reasons like, maternity, stress and hormonal changes. The blood glucose is decreasing overtime if diabetic patients adhered properly. Background Diabetes is a group of diseases characterized by high blood glucose (blood sugar). When a person has diabetes, the body either does not produce enough insulin or is unable to use its own insulin effectively. Glucose builds up in the blood and causes a condition that, if not controlled, can lead to serious health complications and even death. The risk of death for a person with diabetes is twice the risk of a person of similar age who does not have diabetes[1]. Diabetes, a lifelong disease that increases sugar levels in the blood, affects over 366 million people in the globe. Paul Madden, Project Hope's senior advisor for non-communicable diseases, reported thatthe disease is rapidly spreading throughout sub-Saharan Africa, and even other developing countries around the world, mainlybecause of lifestyle changes. The prevalence of diabetic in the world was estimated to be 4% in the year 1995 and estimated to be 5.4% by the year 2025. Abouteighty percent of diabetes deaths occur in low and middle income countries. At 2011, around fourteen million adults in the Africa Region are estimated to have diabetes, with a regional prevalence of 3.8%[1].
The Professional Medical Journal, 2011
Objective: To assess awareness about the role of lifestyle changes in the management of diabetes among diabetics. Patients and Methods: Settings: Diabetic clinics of Jinnah Postgraduate Medical Centre and Kidney Centre. Karachi. Study Period: From April 7, 2008 to August 31, 2008. Study Design: Cross Sectional. Sampling Technique: Convenient. Sample Size: 200 diabetic patients. Results: A total of 200 diabetics were interviewed. Their mean age was 48.8 years. Of these 92 (46%) were males and 108 (54%) were females. Diabetes was under control of 38% and 57% were taking regular treatment. Education sessions were attended by only 11%, counseling for lifestyle modification was done with 16%, 30% followed diet chart and 18% of the study participants were doing regular / irregular exercise. Majority of them (68%) needed social and family support to cop up the disease. Conclusions: There was a lack of awareness about the role of lifestyle changes in the management of diabetes among these d...
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2020
Background: Diabetes mellitus is a group of common metabolic disorders that share the phenotype of hyperglycemia, and are caused by a complex interaction of genetics and environmental factors. Diabetes mellitus produces change in the blood vessels and therefore affects almost every part of the body. Methods: A hospital-based unmatched case control study was conducted from February 2018 to April 2018 at Debre Markos Referral Hospital. Data were collected from 204 individuals, 136 controls and 68 cases using an interviewer-administered questionnaire and patient chart. Data were entered into EPI-data 3.1 software and exported to SPSS version 21 for analysis. Descriptive analysis including mean, median and proportions was carried out. In bivariate analysis, variables below 0.25 significance level were selected for multivariable analysis. For multivariable analysis, a backward model was selected and 95% confidence interval variables with P-values below 0.05 in multivariable analysis were declared as significant variables. Results: Of the total respondents, 68 were cases and 136 were controls, with an overall response rate of 98.55%. Of these respondents, 57.4% and 57.8% were males and type 1 diabetic patients, respectively. This study found that ages of 38-47 (AOR= 5.60 (1.62-19.38)) and >47 (AOR=4.81 (1.32-17.5)), income of 1000-1499 (AOR=3.10 (1.05-9.08)), self-reported drug adherence (AOR=5.146 (1.651-16.04)), FBS of 70-130 mg/dL 0.095 (0.022-0.414) and ≥131 mg/dL (0.05 (0.011-0.223)) and type 1 diabetic mellitus (AOR=4.73 (1.765-12.72)) were significantly associated with diabetes mellitus complications. Conclusion and Recommendations: The study identified important determinants of diabetic complications. Poor glycemic control, poor adherence, and income were found to be modifiable determinants; on the other hand, age and type of diabetic mellitus are nonmodifiable determinants of diabetic complications. Clinicians should implement a comprehensive care plan that will address patients' adherence and glycemic control problems.
PubMed, 2021
Introduction: optimal management of diabetes involves interplay between patients' understanding of their disease and medication adherence, which would eventually influence glycemic control. However, there is scant published literature on the interconnection of patient related factors that impact on optimal management of diabetes in resource-limited settings such as Kenya. Methods: a hospital based cross-sectional survey involving 270 freely consenting adult diabetics investigated the interconnection between diabetes knowledge, medication adherence and glycemic control. Data on the patient´s knowledge and medication adherence was collected using validated tools whilst glycemic control was evaluated using the patients' glycated haemoglobin values. Data analysis was carried out using STATA version 13 statistical software, employing the chi square test for association and simple linear regression for prediction, with p ≤0.05 considered significant. Results: participants´ level of knowledge on diabetes was significantly associated with the academic achievement (p=0.001), while their medication adherence was significantly associated with family support (p=0.001) and duration of disease since diagnosis (p=0.019). On linear regression, family support occasioned by the nature of participants' household setup, had a strong positive correlation [r=0.99 (CI 0.60-1.00)] with optimal glycemic control. Conclusion: family support is an important determinant of medication adherence and optimal glycemic control among diabetic patients. Clinicians should team up with family members of diabetic patients for optimal glycemic control.
Today, diabetes Mellitus is one of the chronic diseases prevalence in Ghana. This study assessed the factors that contribute to non-adherence to medication among diabetic patients undergoing therapy in Dormaa Hospital. The study used convenience and purposive sampling technique to sample 130 respondents comprising 123 diabetic patients and 7 health professionals from the Dormaa Presby Hospital. A standardized questionnaire was used to collect the data. Data was coded and analyzed with Stata 12.0. Most participants (57%) had a family history of diabetes and were at age 51 and above that most people were diagnosed with the disease. The level of diabetics' adherence to diabetic treatment regimen was satisfactory and higher (68.5%). The majority of diabetics (69.23%) visited health facilities on monthly basis for review which involves testing of blood glucose level as well. Though most of diabetics surveyed were illiterate, they were, however, knowledgeable on the importance of treatment regimen as they disclosed that treatment regimen sought to prevent progression of the disease stage to associated complications, co-morbidities, and early death. Polyuria, polydipsia, and sweating were some of the commonest sign and symptoms mentioned by the patients. The majority of the patients (57%) had no idea of the normal range of fastening blood sugar level. Finances (25.6%), forgetfulness (45.5%), busy schedules (18.2%) and poor family support (2.5%) were some factors that affect better treatment adherence. Most diabetics called for a government subsidy to the drugs, continuous health education on the diseases and family support. The study recommends a much more focused preventive healthcare services to identify risk factors and early detection. Research on the burden of chronic diseases on the health facilities should be considered in the future.
African Journal of Food Agriculture Nutrition and Development
Type 2 Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia due to relative insulin secretion deficiency and insulin resistance. It is a global public health concern with increasing prevalence each year. Social demographic, lifestyle and metabolic characteristic, play a crucial role in development and progression of Type 2 diabetes mellitus. Poor glycemic control worsens the condition, leading to complications that are very costly to treat. This calls for a need to explore the relationship between patient characteristics and glycemic control (HbA1c). One hundred and fifty three (153) participants with Type 2 diabetes mellitus aged 20-79 years and attending the Thika Level Five Hospital were enrolled in the study. Sociodemographic, clinical and lifestyle data were obtained using questionnaires. The nutrition status was determined by anthropometry. Lipid profile that included total cholesterol, (TC); high density lipoprotein-cholesterol, (HDL-c); low density lipoprotein cholesterol, (LDL-c) and triglyceride, (TG,) were determined by enzymatic method while glycated hemoglobin (HbA1c) and fasting blood sugar (FBS) were determined using high-performance liquid chromatography (HPLC) and glucose oxidase methods, respectively. Blood pressure of the patients was also determined. Overall sample size was 153 (40.5% men and 59.5% women). The overall mean age of patients was 56.07 years, and the mean age of patients with poor glycemic control (HbA1c>7%) was 56.79 years. The prevalence of the poor glycemic control (HbA1c>7%) was 77.8%. Participants with HbA1c > 7% showed statistically significant higher means for FBG, TC, and LDL-c than their counterparts with good glycemic control [11.71±3.11mmol/l vs. 8.54±3.19; 5.11±1.21mmol/l vs. 4.48±1.16 and 2.66±1.07 mmol/l vs. 2.22±1.04, respectively, (P<0.005; 0.000, 0.008 and 0.034, respectively]. The study showed a significant strong positive correlation between HbA1c and FBG (r=0.679, p<0.01); family history of diabetes, (FHD) (r=0.165, p<0.05); systolic blood pressure, (SBP) moderated with FHD (r=0.168, p<0.05); and diastolic blood pressure (DBP) moderated with FHD(r=0.181, p<0.05). In conclusion, poor glycemic control is associated with high/ blood pressure, high blood glucose and dyslipidemia, which are risk factors for macrovascular, microvascular and cardiovascular complications.
Non Adherence to Diabetic Medication Among Diabetic Patients, a Case Study of Dormaa Hospital Ghana
Today, diabetes Mellitus is one of the chronic diseases prevalence in Ghana. This study assessed the factors that contribute to non-adherence to medication among diabetic patients undergoing therapy in Dormaa Hospital. The study used convenience and purposive sampling technique to sample 130 respondents comprising 123 diabetic patients and 7 health professionals from the Dormaa Presby Hospital. A standardized questionnaire was used to collect the data. Data was coded and analyzed with Stata 12.0. Most participants (57%) had a family history of diabetes and were at age 51 and above that most people were diagnosed with the disease. The level of diabetics' adherence to diabetic treatment regimen was satisfactory and higher (68.5%). The majority of diabetics (69.23%) visited health facilities on monthly basis for review which involves testing of blood glucose level as well. Though most of diabetics surveyed were illiterate, they were, however, knowledgeable on the importance of treatment regimen as they disclosed that treatment regimen sought to prevent progression of the disease stage to associated complications, co-morbidities, and early death. Polyuria, polydipsia, and sweating were some of the commonest sign and symptoms mentioned by the patients. The majority of the patients (57%) had no idea of the normal range of fastening blood sugar level. Finances (25.6%), forgetfulness (45.5%), busy schedules (18.2%) and poor family support (2.5%) were some factors that affect better treatment adherence. Most diabetics called for a government subsidy to the drugs, continuous health education on the diseases and family support. The study recommends a much more focused preventive healthcare services to identify risk factors and early detection. Research on the burden of chronic diseases on the health facilities should be considered in the future.