Qutubuddin Muhammad, Abdul Rahman Rabia, Ghafoor Erum, Riaz Musarrat
Internal Medicine: Diabetes and Endocrinology, Bolan Medical Complex Hospital (BMCH), Quetta, PAK.
Diabetes Education, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, PAK.
Cureus. 2021 Oct 20;13(10):e18918. doi: 10.7759/cureus.18918. eCollection 2021 Oct.
Aim and objective Diabetes mellitus is a chronic metabolic disorder that requires continuous self-management practices. The aim of our study is to assess the factors resulting in non-compliance with self-management practices in people with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care center in Karachi, Pakistan, from March 2019 to May 2019. People with T2DM diagnosed for at least six months were included. A predesigned questionnaire was used to assess various components of self-management such as the use of oral hypoglycemic agents (OHAs) and insulin, self-monitoring of blood glucose (SMBG), physical activity, and daily foot care. Certified diabetes educators conducted interviews on a one-to-one basis. Data were entered and analyzed by using SPSS (version 20; IBM Corp., Armonk, NY). Results Better glycated hemoglobin (HbA1c) levels were observed in compliant persons and a statistically significant difference was noted in those who were compliant with insulin use. Good compliance with self-management was observed in people who were given diabetes education previously. A total of 205 people with T2DM were included in the study, with a mean age of 52.66 ± 11.2 years and a mean duration of diabetes of 8.9 ± 7.5 years. There were 62.9% males and 37.1% females. Oral hypoglycemic agents (OHAs) were prescribed to 62.9% while 33.9 % were on both OHAs and insulin. Non-compliance with the intake of OHAs was 33.3%, insulin injection 21%, SMBG 25.7%, physical activity 69.5%, and foot care practice 34.3%. Various reasons identified for non-compliance included forgetfulness (negligence) (88%), fear of hypoglycemia (10.6%), time constraints (48%), and lack of foot care knowledge (84.8%). Conclusion Non-compliance with T2DM self-management is multifactorial and needs continuous reinforcement of structured diabetes education sessions. The study showed that the provision of diabetes education is directly proportional to self-management compliance levels.
目的和目标 糖尿病是一种慢性代谢紊乱疾病，需要持续的自我管理措施。我们研究的目的是评估导致2型糖尿病（T2DM）患者不遵守自我管理措施的因素。方法 这项横断面研究于2019年3月至2019年5月在巴基斯坦卡拉奇的三级护理中心巴凯糖尿病与内分泌研究所（BIDE）进行。纳入诊断为T2DM至少六个月的患者。使用预先设计的问卷来评估自我管理的各个方面，如口服降糖药（OHAs）和胰岛素的使用、血糖自我监测（SMBG）、体育活动和日常足部护理。认证的糖尿病教育者进行一对一访谈。数据使用SPSS（版本20；IBM公司，纽约州阿蒙克）录入和分析。结果 依从性好的患者糖化血红蛋白（HbA1c）水平更佳，且在胰岛素使用依从性好的患者中观察到统计学上的显著差异。先前接受过糖尿病教育的患者自我管理依从性良好。共有205名T2DM患者纳入研究，平均年龄为52.66±11.2岁，糖尿病平均病程为8.9±7.5年。男性占62.9%，女性占37.1%。62.9%的患者开具了口服降糖药（OHAs），33.9%的患者同时使用OHAs和胰岛素。OHAs摄入不依从率为33.3%，胰岛素注射不依从率为21%，SMBG不依从率为25.7%，体育活动不依从率为69.5%，足部护理不依从率为34.3%。确定的不依从的各种原因包括健忘（疏忽）（88%）、低血糖恐惧（10.6%）、时间限制（48%）和足部护理知识缺乏（84.8%）。结论 T2DM自我管理不依从是多因素的，需要持续加强结构化糖尿病教育课程。研究表明，糖尿病教育的提供与自我管理依从水平成正比。
