Glycemic Control and Management in Pharmacist-Led Diabetic Clinic vs. Physician-Led Diabetic Clinic

Background and Objectives: Globally, diabetes Mellitus (DM) is a life-threatening disease that, if it remains uncontrolled, can lead to mortality or serious complications. Despite the noticeable benefits of clinical pharmacist in managing diabetes, some institutions in Saudi Arabia are reluctant to establish a pharmacist-led diabetic clinic for monitoring and follow-up. The objective of this study is to assess the glycemic control by comparing the reduction in hemoglobin A1c (HbA1c) percentage between patients followed in the pharmacist-led diabetic clinics vs. those followed in physician-led diabetic clinics. Materials and Methods: A retrospective observational study with a 12-month follow-up were used to detect the difference in the glycemic control by comparing the reduction in HbA1c percentage from the baseline, and average changes in HbA1c, fasting blood glucose (FBG), blood pressure (BP), and lipid panel between the two groups. The level of self-care was assessed by Summary of Diabetes Self-Care Activities (SDSCA) Questionnaire. Results: The study involved 52 patients who visited the diabetic clinic at a community teaching hospital. Exactly 24 patients were followed by the pharmacist-led diabetic clinics, while 28 were followed by physician-led diabetic clinics. HbA1c baseline was 8.7% and 8.4% for pharmacist and physician, respectively. The average difference in HbA1c for the pharmacist-led diabetic clinics vs. the physician-led diabetic clinics was not statistically significant (8.67 vs. 8.56; p = 0.77). Moreover, no difference in the glucose profile, lipid panel, and blood pressure were seen between the two groups. However, the median HbA1c change from baseline between the two groups significantly favored the pharmacist-led clinic (0.7 vs. 0.003; p = 0.04).The average of responses in all four aspects of the SDSCA (diet, exercise, blood sugar testing, and foot care) was also higher among patients in the pharmacist-led diabetic clinic. Conclusions: Pharmacist-led diabetic clinics for glycemic control and follow-up showed efficient results that encourage the comprehensive and integral inter-professional patient care.

Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients Attending the Diabetic Clinic of the University of Gondar Hospital, Northwest Ethiopia

Objective. To investigate the level of diabetic retinopathy in type 2 diabetes (T2DM) patients attending the University of Gondar Hospital (UGH) Diabetic Clinic, Northwest Ethiopia. Methods. An audit was carried out involving a total of 739 T2DM patients attending at the diabetic clinic of UGH. They represented approximately 90% and 50% of all T2DM patients under regular review at the urban and rural diabetic clinics of UGH, respectively. All were supervised by the same clinical team for a long period. Eye examinations were performed for visual acuity, cataract, and retinal changes (retinal photography and slit-lamp biomicroscopy). Body mass index (BMI) and HbA1c levels were measured. The presence or absence of hypertension was recorded. Results. Men constituted 41.5% of the group, the mean age at diagnosis of T2DM was 50.4 years, and 50.2% were hypertensive. The BMI was 25.0 ± 4.1 kg/m2, and HbA1c was 7.75 ± 1.63% (61.2 ± 17.8 mmol/mol) (mean ± SD, for BMI and HbA1c)). Severe visual impairment/blindness was reported in 10.6%, 15.2% had cataract, 16.0% had retinopathy, and 11.1% had maculopathy. The prevalence of retinopathy increased with time from diagnosis of T2DM (chi-square for trend, p < 0.001 ) and with increasing HbA1c level (chi-square for trend, p = 0.03 ). Conclusion. These results compare well with the most recent results in well-equipped, wealthier regions of the world and show the importance of stable healthcare infrastructure for chronic-disease management.

Effective monitoring of diabetic patients on progressive chronic kidney disease among patients attending diabetic clinic at Muhimbili National Hospital, Tanzania

Background: Diabetic Kidney Disease is a complication of Diabetes Mellitus (DM) following the natural history of diabetes. Worldwide up to 40 % of patients with diabetes mellitus will develop Diabetic Kidney Disease. Kidney Disease Outcome Quality Initiative (KDOQI) guidelines recommends monitoring for proteinuria, blood sugar, renal functions and blood pressure in the patients with DM so that progression to complications including renal failure is prevented. Our study aimed to audit on effective monitoring of progressive chronic kidney disease among patients attending diabetic clinic at Muhimbili National Hospital. Material and methods: This was a retrospective clinical audit which included patients who attended diabetic clinic at Muhimbili National Hospital in 1st January 2017 to 31st December 2017. Simple random sampling technique using software called OpenEpi Random Program was used to get the sample of 120 patients. Patients with missing clinical notes were excluded from the audit. Records of the clinical notes, socio-demographic characteristics and investigations of the selected patients were retrieved from the Jeeva system and recorded using a structured questionnaire. We analyzed our data using Statistical Package for Social Sciences (SPSS) version 20.0 Results: One hundred and fourteen DM patents records were reviewed. Around 79% of the patients involved in the study were aged above 45years, 60% were females. Majority had type 2 DM (76.3%). Minority i.e. 15/114 (13.2%) of the patients had their urine for protein checked in the year 2017 as well as serum creatinine in the last 3months. Seven percent had HbA1c test done i.e. 8/114 (7%). Blood pressure was monitored in 72.8% (83/114) of the patients. Only16 out of 66 patients (24.2%) had blood pressure controlled. Majority of the patients 10/15 (66.7%) who had renal functions records had normal eGFR. Findings on monitoring for proteinuria, renal functions, control of HbA1c and Blood pressure control were all below audit standards. Conclusion: Our study found that there is generally poor monitoring of diabetic outpatient for progressive chronic kidney disease when compared to the KDOQI standards which calls the health care providers to adhere on set SOPs according to the guidelines available aiming at improving services and quality of life to diabetic patient.

KNOWLEDGE AND SELF-CARE PRACTICES AMONG DIABETIC PATIENTS-A CASE STUDY OF THIKA LEVEL 5 HOSPITAL, KENYA

Purpose: The main aim of the study was to determine the level of self-care knowledge and practices among diabetic patients in Thika level 5 Hospital. Methodology: Cross-sectional study design was used in this study. The target population included patients living with diabetes seeking medical services at the diabetic clinic at Thika Level V hospital. Being the largest referral hospital that served patients form the entire Kiambu County, the hospital was purposely selected. Simple random sampling technique was used to select 190 respondents among patients visiting the diabetic clinic. Structured questionnaire that was interviewer administered was used to collect data. SPSS version 21 software was used for data analysis. Findings: The mean diabetes knowledge score was 7.7 out of a total of 14 and the mean self-care activities score was 7.6 out of a total of 14, indicating a deficit in a number of key areas in the knowledge and self-management of diabetes. There was statistical significant relationship between patient’s level of knowledge of diabetes self-care practices and age (χ2 (4, N=190) = 10.189, p = .037), education level, (χ2 (6, N=190) = 17.861, p = .007) and employment status, (χ2 (6, N=190) = 16.655, p = .011).Statistically significant association was also found between adherence to recommended diabetes self- care practices and age, χ2 (4, N=190) = 4.501, p = .034, education level, χ2 (6, N=190) = 15.616, p = .016, employment status, χ2 (1, N=190) = 3.830, p = .005. Pearson correlation between knowledge of diabetes self-care practices and adherence to diabetes self-care practices was weak in strength and statistically significant r (188) =0.367, p=< 0.01. This implies that the three factors are significant determinants of the level of self-care knowledge and practices among diabetic patients in Thika level V hospital. Unique contribution to theory, practice and policy: The research demonstrated gaps in self-care knowledge and adherence to self-care practices. Moreover patient’s level of knowledge hardly translated to good self-care practices. It is hence important to integrate behavioral change theories into the diabetes educational interventions which may facilitate problem solving skills that will enhance the application of acquired knowledge among the diabetic patients. In addition, more research is warranted to explore patients’ perceptions and attitude towards the effectiveness of their self-care management so the diabetic education can be tailored according to patients’ needs.