Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal

Abstract

Objective/introductionIt is known that knowledge, awareness, and practice influence diabetic control. We compared factors pertaining to healthy lifestyle (exercising, avoiding smoking), self-help (attending appointments, following treatment regimens), and diabetic awareness in high-risk patients for diabetic complications, specifically, those on insulin versus non-insulin treatment, and also those with a longer diabetic duration (≥5 years) versus a shorter duration.Methods200 consecutive patients with type 2 diabetes (52.0±11.6 years) attending diabetic clinic at a referral hospital in Nepal were recruited. A structured questionnaire explored non-clinical parameters including age, gender, diabetic duration, awareness about diabetes control, self-help, and lifestyle. Clinical data were also measured: HbA1c, fasting blood sugar (FBS), blood pressure, and treatment type (insulin, diet/tablet).ResultsA significantly higher proportion of patients on insulin (vs non-insulin) or with diabetic duration ≥5 years (vs <5 years) self-reported not doing regular exercise, forgetting to take medicine, and not knowing whether their diabetes was controlled (p≤0.005). HbA1c/FBS levels were significantly higher for patients on insulin or with a longer diabetic duration (p≤0.001). 92% of those on insulin (vs 31% on non-insulin) and 91% with diabetic duration ≥5 years (vs 28% of <5 years) self-reported to seeking medical help due to episodes of uncontrolled blood sugar in the last year (p<0.001).ConclusionPoor self-help/lifestyle and reduced knowledge/awareness about diabetic control was found in patients on insulin or with longer diabetic duration. This is a worrying finding as these patients are already at high risk for developing diabetic complications. The findings highlight need for targeting this more vulnerable group and provide more support/diabetic educational tools.

The profile of sight-threatening diabetic retinopathy in patients attending a specialist eye clinic in Hangzhou, China

“…It is well known that the control of diabetes is important for reducing the risk of sight-threatening DR (STDR), as suggested by several studies including the UK Prospective Diabetes Study and Diabetic Retinopathy Clinical Research 11–14. The role of self-help (taking medicine in time, not missing doctor’s appointments, monitoring blood sugar levels regularly)15 and improved awareness about diabetes in controlling sight-threatening complications of DR is less well documented. There is evidence in the literature to suggest that improving diabetic self-help, or knowledge/awareness about diabetes and its risk factors, plays an important role in the control of diabetes and DR 15–18.…”

“…The role of self-help (taking medicine in time, not missing doctor’s appointments, monitoring blood sugar levels regularly)15 and improved awareness about diabetes in controlling sight-threatening complications of DR is less well documented. There is evidence in the literature to suggest that improving diabetic self-help, or knowledge/awareness about diabetes and its risk factors, plays an important role in the control of diabetes and DR 15–18. A recent Cochrane review of 66 randomised clinical trials highlights the fact that interventions in the form of educational programmes to increase awareness about DR is vital in improving attendance for DR screening; more specifically, interventions provided in the form of education, reminders and promotion of self-care targeting patients, healthcare professionals or the healthcare system, were found to improve attendance for DR screening by 12% 19…”

Nurse-led continuum of care for people with diabetes and pre-diabetes in Nepal (NUCOD): study protocol for a cluster randomized controlled trial

“…In this proposed community-based intervention, the changes in the HbA1c levels (continuous outcome) was considered for calculating the sample size for the individuals with diabetes and the incidence of diabetes (binary outcome) was considered for calculating the sample size for the individuals with prediabetes respectively. For the individuals with diabetes, we aim to detect a clinically significant reduction in HbA1c levels from 7.6% to 6.5% (SD=1.5%) (based on our assumption, recommended effective diabetic management level, and results of previous studies) among the individuals with diabetes during the 12 months period [35,36] with medium effect size [37]. We expect a reduction of HbA1c to 7.0% in the control group, an optimal target level defined by American Diabetes Association (ADA) [38].…”

Assessment of Safety and Effectiveness of Glaritus&lt;sup&gt;&amp;reg;&lt;/sup&gt; (Wockhardt’s Insulin Glargine) in a Prospective, Multi-Centric Post Marketing Observational Study in Nepalese Having Type 2 Diabetes Mellitus

“…Amongst the diabetic population in Nepal, 8% -18% are on insulin [5] [6]. In a prospective study assessing the drug prescribing trend in 100 patients including 41 diabetic patients, insulin was included only in 2.5% of prescriptions [7].…”

“…In a prospective study assessing the drug prescribing trend in 100 patients including 41 diabetic patients, insulin was included only in 2.5% of prescriptions [7]. In a study conducted by Sapkota et al in 200 diabetic patients, 52% patients self-reported not knowing whether their diabetes was well-controlled and 42% had to seek help at least once within the last year for uncontrolled diabetes (in-Open Journal of Endocrine and Metabolic Diseases cluding hypo or hyperglycemia) [6]. The situation indicates towards potential for improving diabetes management by enhancing insulin utilization in Nepalese diabetic patients.…”