Compliance to Diabetes Self-Management in Rural El-Mina, Egypt

Article excerpt

SUMMARY

Background: Diabetes is a serious public health problem that threatens the quality of life of patiens with diabetes, the success of long-term maintenance therapy for diabetes depends largely on the patients' compliance with a therapeutic plan.

Aim of this study: to assess compliance of diabetic patients to diabetes self-Management in rural El Minia, and to determine the associated factors related to it.

Subjects and Method: Cross sectional analytic study. Rural adults identified as having previously diagnosed diabetes were recruited to participate in this study. A total of 206 rural community diabetics were randomly chosen and subjected to interview questionnaire on history of diabetes, type of medication, self-management of diabetes as glucose examination, dietary modification, and eye examination.

Results: Mean age of participants was 54±6.3 years and mean duration of diabetes was 12±8 years. Nearly one third of the patients used insulin and more than half used oral hypoglycemic. The results of this study revealed that good adherence to diabetes self-management was reported among 41.7% of adult diabetic patients who show good adherence to diet instructions, but only 21.4% to blood glucose test. There was no gender difference regarding self care of diabetes. Younger age group had more glycemic control than older age; longer duration of diabetes was significantly associated with poor glycemic control.

Conclusion: Compliance to self-management of diabetes is suboptimal among rural adult community diabetic.

Key words: adherence, diabetic self-care, blood glucose, diet

INTRODUCTION

Diabetes mellitus (DM) has become a problem of a great magnitude and major public health concern. In some countries, diabetes affects up to 10% of the population aged 20 years and older (1). Recent surveys show that its prevalence has been increasing in younger patients. A study done at a midwestern metropolitan area medical center showed that the incidence of type 2 diabetes increased 10- fold in their adolescent population between 1982 and 1994 (2).

Because of the magnitude of the burden of disease, the Healthy People 2010 objectives include goals of reducing diabetes-related deaths and increasing the monitoring frequency of glucose control and chronic complications (3).

Essential health care requirements and facilities for Selfmanagement of diabetes are often inadequate in Egypt and so action is needed at all levels of health care to bridge the gap and to improve health care delivery to people with diabetes. The major components of the treatment of diabetes are: diet (combined with exercise if possible), oral hypoglycemic, and insulin treatment (1).

Diabetes is a challenging disease to manage successfully. It has been reported that non adherence rates for chronic illness regimens and for lifestyle changes are 50%. As a group, patients with diabetes are especially prone to substantial regimen adherence problems. Significant patient involvement is necessary to achieve treatment goals, and diabetes care is almost always carried out by patients (4).

Adherence to the multi-component diabetic treatment regimen requires a daily care. Diabetics can live a relatively normal life but chronic complications (neuropathy, myocardial and foot ischemia, renal disease, retinopathy) can result in a substantial decline in quality of life. The Diabetes Control and Complications Trial (DCCT) confirmed that improved metabolic control was significantly associated with delayed onset and progression of microvascular complication, with a clear increasing risk related to poorer metabolic control (5).

To maintain adequate glycemic control, patients typically follow a self-management regimen involving frequent self monitoring of blood glucose (SMBG), dietary modifications, exercise, education, and medication administration. Collaboration and negotiation with health care providers, family members, and others is essential so that such behaviour changes are optimally supported and encouraged (6). …