Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study
Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study
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Sushant Pokhrel, Sneha Shrestha, Alaska Timilsina, Manisha Sapkota, Mahendra Prasad Bhatt, Bashu Dev Pardhe Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, NepalCorrespondence: Bashu Dev PardheDepartment of Laboratory Medicine, Manmohan Grocery Memorial Institute of Health Sciences, P.O.Box No.15201, Kathmandu, NepalTel +977 1 4030781Email bashudev.
[email protected]: The patient believes in adherence to medication rather than to self-care adherence and lifestyle changes for the management of diabetes.This study was carried out to establish the association of self-care adherence and their barriers in poor glycemic control in our diabetic population.
Patients and methods: This cross-sectional study was conducted among 480 already diagnosed diabetes outpatients attended in our two hospitals.Glycaemic control was defined by levels of HbA1c.Socio-demographic data, lifestyle variables and anthropometric measurements were recorded using a standard questionnaire.Fasting blood glucose, HbA1c and lipid profiles were estimated using the manufacturer’s guideline.
Student’s t-test and one-way ANOVA were used for comparison between different groups and the correlation was established by Spearman correlation.Risk factors associated with poor glycaemic control were verified by logistic regression analysis.Results: The mean HbA1c of the study population was 7.4±1.
3% and 65.4% had poor glycaemic control with mean 8.0±1.1%.
Higher HbA1c levels were significantly associated with duration of diabetes, a number of drugs used, patient–physician relationship and knowledge about diabetes.The poor glycaemic control was significantly associated with low adherence of following the meal plan, regular medication and regular exercising (p<0.001).Among all the barriers, a too busy schedule for following the meal plan, taking medications and exercising regularly was significantly correlated with HbA1c levels.
Multivariable logistic regression analysis showed irregular meal plan (OR=5.27), irregular exercise (OR=2.25), number of medication used (OR= 0.19) and lesser extent patient–physician relationship (OR=2.
68) were independent risk factors for poor glycaemic control.Conclusion: The poor glycaemic control was associated with poor adherence to self-care adherence and their barriers in our diabetic population.Integrated knowledge on Goalie - Cages diabetes management should be targeted to improve glycaemic control in our communities.Keywords: type 2 diabetes mellitus, HbA1c, lifestyle variables, risk factors.