Compliance to Guidelines and Role of Patients in Management of Type 2 Diabetes Among Patients in Vihiga County Referral Hospital, Kenya

Abstract

Introduction: The incidence of diabetes is increasing in Kenya, and poor diabetic related outcomes such as complications, high blood sugar levels have resulted due to inadequate management of the condition. However, the majority of the rural population in Kenya are highly ignorant of the common aetiologies and risk factors for diabetes. Patient awareness and involvement in self-care is very critical in improving outcomes and this should be part of treatment plan offered to them. The health care team should adopt standard treatment guidelines that are practical, evidence based, valid and up-to date in management of diabetic patients. Objective: To asses’ compliance to guidelines, prevalence of diabetic complications and role of patients in management of Type 2 diabetes at a rural set up in Kenya. Methods: Two cross-sectional studies consisting of a retrospective audit of prescribing and monitoring practices and a prospective patient survey on self-practice were conducted. The target population was Type 2 diabetic patients attending medical outpatient clinic at Vihiga County Referral Hospital. Inferential statistics using t-test and Mann-Whitney test was done and bivariable logistic regression analysis carried out. Model building was done to come up with a parsimonious model using IBM SPSSR Statistics version 22 database. Results and Discussion: A total of 212 patient files were retrieved. The participants aged 50 – 69 years were 60% and females were the most in the study at 70.3%. Most (39.6%) had had diabetes for 1 to 5 years. Random blood Sugar test was the most used method of diagnosis (58.5%) whilst FBG was performed in 34% of the participants tested. Metformin was part of first line therapy with a compliance rate of 72.2%. Compliance to ICSI recommendations with regard to blood pressure, weight and cholesterol monitoring at initiation was 96.7, 1.4 and 6.1% respectively. Of the 141 patients that had their fasting blood sugar monitored, 113 (80.1%) had uncontrolled blood sugar levels. The median blood glucose for all patients tested with FBG was significantly higher than the target threshold of 7 mmol/L (median blood sugar = 8.9(IQR.7.4, 12.75) mmol/L; P=0.741). The prevalence of the major diabetic complications: neuropathy, retinopathy and nephropathy were 41, 33 and 0.9% respectively. There was an association between fasting blood glucose level and retinopathy and neuropathy. Total of 25 participants were recruited into the survey and most of them did not experiencing challenges in executing self-care behaviours to managing their condition. Use of treatment guidelines will help improve the quality of clinical decision made by healthcare workers, improve health outcomes. Diabetic patient education should also be encouraged to enhance and improve patient self-care behaviours. Conclusion: Patients were not adequately being diagnosed, managed and monitored as per the ICSI treatment guideline recommendations. There was high prevalence of retinopathy and neuropathy. Uncontrolled hypertension and fasting glucose levels were significant risk factors for complications. Patients lack on knowledge on nutritional interventions. Hence there is need to strengthen capacity to manage type 2 diabetes in this facilty.