The magnitude of non-adherence and contributing factors among adult outpatient with Diabetes Mellitus in Dilla University Referral Hospital, Gedio, Ethiopia

Introduction The global prevalence of Diabetes Mellitus (DM) has increased alarmingly over the last two decades. On top of this, the issues of non-adherence to the prescribed medicines further fuel the DM- related complications to become one of the top causes of mortality and morbidity. Despite the considerable efforts in addressing the poor adherence issues, there are still plenty of problems ahead of us yet to be addressed. The objective of this study was to determine the extent of non-adherence and its contributing factors among diabetic patients attending the medical Referral clinic of Dilla University Referral Hospital. Methods The institutional-based descriptive cross-sectional study was carried out among patients with diabetes mellitus attending the medical referral clinic of Dilla University Referral Hospital. A systematic random sampling method was used to recruit study participants, and tool was adopted to assess for adherence. A pretested semi-structured questionnaire was used to collect information on factors influencing non-adherence to the diabetic medications, and in-depth interview questionnaire was used for key informant interviews for the qualitative part. Data analysis was carried out using SPSS-20. Results The overall prevalence of non-adherence to diabetic treatment regimen among the study participants was 34.0%. The study revealed that cost of transport to the hospital and taking alcohol were significantly associated with non-adherence to the diabetic treatment regimen with the (AOR = 6.252(13.56, 28.822); p < 0.000) and (AOR = 13.12(8.06, 44.73); p<0.002) respectively. Conclusions The study revealed that significant numbers of participants were non-adherent to the Diabetes Mellitus treatment regimens. Intensive counseling, and health education on the importance of good adherence and negative consequences of poor adherence need to be discussed with the patients before starting the medications, and amidst follow up.

Download Full-text

Nonadherence and Contributing Factors among Ambulatory Patients with Antidiabetic Medications in Adama Referral Hospital

Journal of Diabetes Research ◽

10.1155/2014/617041 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 17

Author(s):

Belayneh Kefale Gelaw ◽

Abdela Mohammed ◽

Gobezie Temesgen Tegegne ◽

Amsalu Degu Defersha ◽

Muluneh Fromsa ◽

...

Keyword(s):

Diabetes Mellitus ◽

Drug Regimen ◽

Structured Interview ◽

Cross Sectional Study ◽

Referral Hospital ◽

Diabetic Patients ◽

Contributing Factors ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Difference

The objective of this study was to determine the magnitude of nonadherence and its contributing factors among diabetic patients attending the diabetic clinic in Adama Hospital.Methods.This descriptive cross-sectional study was carried out among patients with diabetes mellitus attending the diabetes mellitus clinic of Adama Referral Hospital. Every other patient was selected and data regarding their medication adherence was collected using a structured interview. Data analysis was carried out using SPSS-16.Result.The response rate from this study was 98.3%. A total of 270 patients were interviewed; 51.5% were males. A total of 68.1% of the patients included in the study were married. 14% were younger than 40 years, and 50% were between 40 and 60 years. 21.8% of the participants ascribed their nonadherence to forgetting to take their medications. Patients with duration of diabetes≤5 years (82.07%) were more compliant to their medication than those with>5 years (60.8%), which was found to be statistically significant(P=0.003). Insulin, 47%, and glibenclamide plus metformin, 43.7%, were the most commonly prescribed mono- and combination therapies, respectively. Common comorbid conditions include hypertension, 148 (54.82%), and visual impairment, 89 (32.96%). The proportion of male patients adherent to their antidiabetic medications was found to be lower than 69.78% compared to the female patients (74.81%), but the difference was not statistically significant(P>0.05).Conclusion.Most diabetic patients are currently being managed with the most effective available drugs. However the result from this study indicates that the desired blood sugar level could not be controlled and maintained adequately. This was because of poor adherence to the prescribed drug regimen and poor knowledge and practice of successful self-management.

Download Full-text

Analisis Profil dan Faktor-Faktor yang Memengaruhi Perilaku Kepatuhan Pengobatan untuk Pasien Diabetes Mellitus Lanjut Usia

Jurnal Kefarmasian Indonesia ◽

10.22435/jki.v9i2.405 ◽

2019 ◽

pp. 114-125

Author(s):

Andi Makkulawu ◽

Adji Prayitno Setiadi ◽

Tri Budi Wahyuni Rahardjo ◽

Eko Setiawan

Keyword(s):

Diabetes Mellitus ◽

Support Groups ◽

Health Workers ◽

Profile Analysis ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Contributing Factors ◽

Related Factors ◽

Cross Sectional ◽

Adherence Behaviour

Adherence with medication is one of the important factors in controlling blood glucose levels in patients with diabetes mellitus (DM), which in turn also determines the risk of diabetic complications. The profile and factors that influence adherence behaviour in the use of medication in elderly diabetic patients in Indonesia, especially in East Surabaya, are not yet known. The purpose of this study was to identify profiles and factors that influence the behavior of drug use adherence in elderly DM patients. A cross-sectional study was conducted in 32 Karang Werda or support groups for elderly in East Surabaya. Identification of the respondent’s level of adherence was carried out using the Adherence to Refill and Medication Scale (ARMS) questionnaire while the contributing factors towards adherence behaviour were identified using a published questionnaire. Both questionnaires have been validated in elderly people living in Surabaya. Result of adherence profile analysis was expressed in terms of percentage while determinant factors analysis was identified by using the highest mean among 14 sub-domains included in the questionnaire. In total, 281 elderly diabetic patients were recruited in this study. It was identified that 67.26% of the respondents were classified as non-adherence patients. The dominant factors that contribute to the behavior of medication adherence in elderly diabetic patients were social support, product-related factors, health workers, and emotional factors. Appropriate interventions to optimize the use of medications in elderly diabetic patients need to be identified and implemented according to the identified contributing factors.

Download Full-text

Echocardiographic evaluation of diastolic dysfunction in diabetes mellitus without covert cardiac involvement

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180941 ◽

2018 ◽

Vol 5 (2) ◽

pp. 289

Author(s):

Nalin Kumar Mahesh ◽

Anil Kumar ◽

Niket Verma ◽

Keshavamurthy Ganapathy Bhat ◽

Dharmender Kumar

Keyword(s):

Diabetes Mellitus ◽

Diastolic Dysfunction ◽

Systolic Dysfunction ◽

Tertiary Care ◽

Armed Forces ◽

Diabetic Patients ◽

Care Hospital ◽

Cross Sectional ◽

Army Personnel ◽

Study Participants

Background: Diabetic patients develop systolic and diastolic dysfunction without even associated coronary artery disease. But diastolic dysfunction is more prevalent in diabetic patients than systolic dysfunction and usually occurs before onset of symptoms. Recognition of early diastolic dysfunction is likely to make management better and avoids progression of cardiac dysfunction. This study was conducted in patients of Diabetes mellitus without other comorbidities.Methods: The present study which is cross sectional and was carried out among outpatients and inpatients of tertiary care hospital of Armed forces and involved army personnel and their dependents and sample size was 100 patients.Results: The prevalence of diastolic dysfunction among our study participants was found to be 36%. Diastolic dysfunction was found to be significantly higher among elderly individuals (60%) when compared to young study participants. (p<0.0001). Prevalence of diastolic dysfunction was found to be non-significantly higher among males and with longer duration of diabetes as compared to lesser duration and female gender.Conclusions: Diastolic dysfunction, evaluated by echocardiography, was found to be fairly prevalent (36%; 95% CI = 27-45%) among individuals with type 2 diabetes mellitus. Poor Glycaemic control and increasing age were found to be significantly associated with presence of diastolic dysfunction among individuals with diabetes mellitus.

Download Full-text

Chronic Kidney Disease and Associated Risk Factors Assessment among Diabetes Mellitus Patients at A Tertiary Hospital, Northwest Ethiopia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v28i6.3 ◽

1970 ◽

Vol 28 (6) ◽

Author(s):

Shewaneh Damtie ◽

Belete Biadgo ◽

Habtamu Wondifraw Baynes ◽

Sintayehu Ambachew ◽

Tadele Melak ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Older Age ◽

Diabetic Patients ◽

Study Participants

BACKGROUND: The prevalence of chronic kidney disease, particularly in diabetic patients, is increasing rapidly throughout the world. Nowadays, many individuals in developing nations are suffering from diabetes which is one of the primary risk factors of chronic kidney disease.METHODS: Institution based cross-sectional study was conducted at the University of Gondar Hospital from February to April 2016. A total of 229 study participants were selected using systematic random sampling technique. Urine sample was collected for albumin determination by dipstick. The Simplified Modification of Diet in Renal Disease study equation was used to estimate glomerular filtration rate. Binary logistic regression model was used to identify risk factors.RESULTS: Of the total 229 study participants, 50.2% were females and the mean age was 47±15.7 years. Among study participants, the prevalence of chronic kidney disease (CKD) was found to be 21.8% (95% CI: 16% - 27%). Of all study participants, 9(3.9%) had renal impairment (eGFR < 60 ml/min/ 1.73 m2) and 46 (20.1%) had albuminuria. Older age (AOR: 5.239, 95% CI: 2.255-12.175), systolic blood pressure ≥140mmHg (AOR: 3.633, 95% CI: 1.597-8.265), type 2 diabetes mellitus (AOR: 3.751, 95% CI: 1.507-9.336) and longer duration of diabetes (AOR: 3.380, 95% CI: 1.393-8.197) were independent risk factors of CKD.CONCLUSIONS: The study identified high prevalence (21.8%) of CKD among diabetic adults. CKD was significantly associated with older age, systolic blood pressure, type 2 DM and longer duration of DM. Thus, DM patients should be diagnosed for chronic kidney disease and then managed accordingly.

Download Full-text

Blood Pressure Control among Hypertensive Diabetic Patients on Follow-Up at Chronic Clinic of Nekemte Referral Hospital in West Ethiopia

International Journal of Hypertension ◽

10.1155/2020/7526257 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Mohammed Gebre Dedefo ◽

Dureti Bayisa Gemechu ◽

Ginenus Fekadu ◽

Tesfa Tekle Dibessa

Keyword(s):

Blood Pressure ◽

Cigarette Smoking ◽

Statistical Significance ◽

Multivariable Analysis ◽

Referral Hospital ◽

Multivariable Logistic Regression Analysis ◽

Diabetic Patients ◽

Modifiable Factors ◽

Study Participants

Background. Hypertension is a prevalent comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age. Adults with diabetes historically have two or three times higher rate of cardiovascular disease (CVD) than adults without diabetes. Objective. The aim of this study was to assess blood pressure (BP) control and its predictors among hypertensive diabetic patients on follow-up at the chronic clinic of Nekemte Referral Hospital (NRH) in West Ethiopia. Methods. A cross-sectional study was conducted among hypertensive adult patients comorbid with diabetes taking antihypertensive drugs for at least one year in NRH. Both bivariable and multivariable analyses were done. The odds ratio, along with 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multivariable logistic regression analysis. The level of statistical significance was declared at p value <0.05 levels. The patient’s written informed consent was obtained after explaining the purpose and procedures of the study. Results. A total of 186 study participants were included in this study. The mean age of the participants was 51.2 ± 12.2 years. Blood pressure and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. In the multivariable analysis, age ≥60 years (AOR = 4.537, 95% CI = 1.142–18.024, p=0.032), duration with hypertension ≥5 years (AOR = 3.534, 95% CI = 1.062–11.760, p=0.040), cigarette smoking (AOR = 7.697, 95% CI = 2.356–25.146, p=0.001), nonadherence (AOR = 6.584, 95% CI = 2.337–18.553, p<0.001), and uncontrolled glycaemia (AOR = 21.630, 95% CI = 8.057–58.070, p<0.001) were independent predictors of uncontrolled blood pressure. Conclusion. Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions on modifiable factors should be done to improve BP control of patients’ comorbid with diabetes.

Download Full-text

Prevalence and Distribution of Diabetes Mellitus in a Maximum Care Hospital: Urgent Need for HbA1c-Screening

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0043-112653 ◽

2017 ◽

Vol 126 (02) ◽

pp. 123-129 ◽

Cited By ~ 6

Author(s):

Johannes Kufeldt ◽

Marketa Kovarova ◽

Michael Adolph ◽

Harald Staiger ◽

Michael Bamberg ◽

...

Keyword(s):

Diabetes Mellitus ◽

Hospital Stay ◽

Diabetes Prevalence ◽

University Hospital ◽

Diabetic Patients ◽

Diabetes Diagnosis ◽

Care Hospital ◽

Negative Consequences ◽

Number Needed To Screen ◽

The University

Abstract Objective Diabetes mellitus affects almost one in 10 individuals in Germany. So far, little is known about the diabetes prevalence in maximum care hospitals. We assessed the diabetes prevalence, proportion of undiagnosed cases, the effectiveness of diabetes screening in a university hospital, the consequences for hospital stay and acquired complications. Research Design and Methods Over a 4 week period we determined HbA1c from 3 733 adult patients which were hospitalized at the university hospital of Tuebingen and had an available blood sample. Diabetes diagnosis was defined as HbA1c≥6.5% and/or previously documented diabetes diagnosis, prediabetes was defined as HbA1c≥5.7% and <6.5% without history of previous diabetes. Results 23.68% of the patients had prediabetes and 22.15% had diabetes with a high variation between the specialised departments (range 5–43%). The rate of unknown diabetes was 3.7%, the number needed to screen was 17 in patients older than 50 years. Patients with diabetes had a prolonged hospital stay compared to the mean length of stay for their diagnosis related group (diabetes: 1.47±0.24 days; no diabetes: −0.18±0.13 days, p=0.0133). The prevalence of hospital acquired complications was higher in diabetic patients (diabetes: 197 of 630; no diabetes: 447 of 2 459, p<0.0001). Conclusions Every fourth patient in the university hospital had diabetes and every second had either prediabetes or diabetes. It is also worthwhile to screen for unknown diabetes in patients over the age of 50. The high prevalence and negative consequences of diabetes require screening and intensified specialized diabetes treatment in hospitals.

Download Full-text

Identification and resolution of drug-related problems among diabetic patients attending a referral hospital: a prospective observational study

Journal of Pharmaceutical Policy and Practice ◽

10.1186/s40545-021-00332-9 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Tadesse Sheleme ◽

Tamiru Sahilu ◽

Desalegn Feyissa

Keyword(s):

Observational Study ◽

Drug Treatment ◽

Prospective Observational Study ◽

Diabetes Duration ◽

Referral Hospital ◽

Multivariable Logistic Regression Analysis ◽

Diabetic Patients ◽

Drug Related Problems ◽

Contributing Factors ◽

Observational Study Design

Abstract Background People living with diabetes are more vulnerable to drug-related problems due to the presence of multiple diseases. This study aimed to identify drug-related problems and contributing factors among diabetic patients. Methods This study used a prospective observational study design. The study was conducted among diabetic patients during follow-up at Mettu Karl Referral Hospital from 15 April to 09 August 2019. The consecutive sampling was utilized to collect data. The identification of drug-related problems was performed using the Pharmaceutical Care Network Europe version 8.03. Following data collection, data were entered into Epidata manager version 4.4.2 and exported to the SPSS version 24.0 for analysis. Multivariable logistic regression analysis was done to identify predictors of drug-related problems. Results A total of 330 people with diabetes were included in the study, among whom 279 (84.5%) had at least one drug-related problem. A total of 455 drug-related problems were identified. Effects of drug treatment not being optimal (52.7%) and untreated symptoms or indications (30.1%) were the most commonly identified drug-related problems. About 865 interventions were provided for identified drug-related problems and 79.8% was accepted. Diabetes duration $$\ge 7$$ ≥ 7 years [AOR = 2.02; 95% CI (1.06, 3.85); p = 0.033] and the presence of comorbidity [AOR: 2.33; 95% CI (1.18, 4.60); p = 0.015] were factors identified as predictors of drug-related problems. Conclusion The present study identified that drug-related problems are common among diabetic patients. Effects of drug treatment not being optimal and untreated symptoms or indications were the most commonly identified drug-related problems. Longer diabetes duration and the presence of comorbidities were predictors of drug-related problems.

Download Full-text

Thyroid dysfunction in patients with diabetes mellitus at Puducherry, India: a retrospective study

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20182445 ◽

2018 ◽

Vol 5 (4) ◽

pp. 822

Author(s):

K. Shaik Anwar Hussain

Keyword(s):

Diabetes Mellitus ◽

Retrospective Study ◽

Thyroid Dysfunction ◽

Diabetic Patients ◽

Type Ii ◽

Patients With Diabetes ◽

Study Participants ◽

Type 1 Dm

Background: There is a complex interrelationship in the co-existence of thyroid dysfunction among diabetic patients and may be related to the development of cardiovascular diseases and other complications of long term metabolic derangements. The prevalence of thyroid dysfunction varies from 10 to 24% among diabetic patients. The objective of the present study was to determine the prevalence of thyroid dysfunction among the patients with diabetes mellitus in a tertiary care hospital at Puducherry, India.Methods: This retrospective study was conducted during June 2018 analysing the records of diabetes patients attending to the diabetes OPD, Department of General Medicine in the past one year and their association with thyroid dysfunction was studied.Results: Among the study participants (n=200), 14.5% (n=29) were Type I diabetics and 85.5% (n=171) were type II Diabetes patients. The prevalence of Thyroid Dysfunction (TD) among the study participants was 28.5% (n=57). The proportion of TD was higher among type 1 DM compared to type 2 (p<0.001). The prevalence of subclinical hypothyroidism was more (n=7, 24.1%) among type 1DM compared to type II DM patients (p=0.05).Conclusions: There was a higher prevalence of TD among the diabetics. TD was more frequent among type 1 DM compared to Type 2 DM patients and the most frequent TD associated with diabetes was subclinical hypothyroidism.

Download Full-text

Magnitude of pancreatic exocrine insufficiency and associated factors among adult diabetic patients attending Madda Walabu University Goba referral hospital, south east Ethiopia, 2019

10.21203/rs.3.rs-51768/v1 ◽

2020 ◽

Author(s):

Tadele Regasa Gemechu ◽

Minale Fekadie Baye ◽

Gesese Bogale Awgichew ◽

Behonegn Birhan Chekole ◽

Zegeye Regassa Gemechu ◽

...

Keyword(s):

Referral Hospital ◽

Diabetic Patients ◽

Pancreatic Exocrine Insufficiency ◽

Type 2 Diabetic Patients ◽

Exocrine Insufficiency ◽

Pancreatic Exocrine ◽

Study Participants ◽

Type 2 Diabetic

Abstract Background: Diabetes mellitus is a group of metabolic disorders which is characterized by increased blood glucose level. It causes a lot of systemic complications including pancreatic atrophy that leads to pancreatic exocrine insufficiency. It is more common among type 1 diabetic than type 2 diabetic patients. The aim of this study was to assess magnitude of pancreatic exocrine insufficiency and associated factors among diabetic patients attending Madda Walabu University Goba referral hospital, 2019.Materials and method: An institution based cross sectional study was conducted on 286 diabetic patients during study period. The study participants were selected by systematic random sampling technique among diabetic patients attending Madda Walabu University Goba referral hospital internal medicine department. The demographic data of the study participants were collected by face to face interview. Serum and urine samples were collected from each patient and analyzed to check pancreatic exocrine insufficiency and factors associated with it. The raw data were entered in to Epi Data V 3.0.2 and exported in to SPSS V 25 for analysis. Descriptive analysis and multiple logistic regression was done and variables with 95% confidence interval and p-value less than 0.05 were used to declare statistical significance. Results: The study participants were 250 (87.4%) type 2 diabetic and 36 (12.6%) type 1 diabetic patients. Among them 21.3% suffered from pancreatic exocrine insufficiency. Amylase insufficiency found in 44.4% of type 1 and 16.0% in type 2 diabetics. But, lipase insufficiency was seen in 41.7% of type 1 and 16.0% in type 2 diabetics. The pancreatic exocrine insufficiency was higher among type 1 (44.44%) than type 2 (18.0%). Smoking habit, alcohol consumption, duration of disease, usage of hypoglycemic agents, ketosuria and type of diabetics were significantly associated with pancreatic exocrine insufficiency. Conclusion: There was an alteration of pancreatic exocrine enzyme secretion among both type 1 and type 2 diabetic patients. The habit of alcohol consumption, smoking and increase in the duration of the disease intensify the pancreatic insufficiency.

Download Full-text

Risk factor and Outcomes of Diabetic Foot Ulcer among Diabetes Mellitus Patients Admitted to Nekemte Referral Hospital, Western Ethiopia:Prospective cohort study

10.21203/rs.2.12896/v1 ◽

2019 ◽

Author(s):

Firomsa Bekele ◽

Legese Chelkeba ◽

Ginenus Fekadu ◽

Kumera Bekele

Keyword(s):

Diabetes Mellitus ◽

Logistic Regression ◽

Risk Factor ◽

Cohort Study ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Referral Hospital ◽

Foot Ulcers ◽

Diabetic Patients

Abstract Background:Foot problems are very common in people with diabetes affecting up to 15% of diabetic patients during their lifetime throughout the world. Foot ulcers significantly contribute to morbidity and mortality of patients with diabetes mellitus. The diabetic patients with foot ulcers require long-term hospitalization and carry the risk of limb amputation. Despite this, no study has been done on risk factor and outcomes of diabetic foot ulcer in NRH. Methods: A general prospective cohort study of diabetes mellitus patients who had diabetic foot ulcer was conducted among diabetes patients of Nekemte referral hospital (NRH) from March15 to June 15, 2018. The Wagner classification of diabetic foot ulcer was used to assess the severity of foot ulcers. Multivariate logistic regression was used to analyze the associations between dependent variable and independent variables. Results: Over the study period, 115 diabetes foot ulcer patients were admitted to the Nekemte referral hospital; of these patients, 35(30.43%) were under gone (minor and major amputations) and 80(69.57%) were healed. Grade of diabetic foot ulcerAOR=1.7; 95% CI: 1.604, 4.789,inappropriate antibioticsAOR = 2.526; 95% CI: 1.767, 8.314, Overweight AOR = 2.767; 95% CI: 1.827, 9.252, obesity AOR = 3.020; 95% CI: 2.556, 16.397,blood glucose controlAOR = 2.592; 95% CI: 1.937, 7.168, and neuropathy AOR = 1.565; 95% CI: 1.508, 4.822 were found to be a risk factor for amputation in multivariable logistic regression analysis. Conclusion: Blood glucose level, higher body mass index (BMI), inappropriate antibiotics given, neuropathy, and advanced grade of diabetic foot ulcer were independent predictors of amputation. Provision of special emphasis for patients having neuropathy and advanced grade of diabetic foot ulcer, decreasing excessive weight gain, managing hyperglycemia, and appropriate antibiotics prescription practice would decrease outcomes of diabetic foot ulcer. Key words:Diabetic Foot Ulcer, Risk Factors, Outcomes,Nekemte Referral hospital

Download Full-text