Adequacy of Glycaemic Control and Knowledge of Diabetes Among Ambulatory Type 2 Diabetic Patients at Mbagathi Hospital, Nairobi

Abstract

Background: Diabetes mellitus is associated with high morbidity, premature mortality and socioeconomic burden globally. Knowledge of diabetes plays an integral role in attaining desirable diabetes self-care and clinical outcomes of patients. However, frequently diabetes is inadequately controlled in clinical practice despite provided diabetes self-management education and advances in treatment. Optimal glycaemic control prevents or delays diabetic complications, morbidity and premature mortality. Objectives: To determine the level of adequacy of glycaemic control and knowledge of diabetes among ambulatory T2DM patients at Mbagathi Hospital, Nairobi. Design: Cross-sectional descriptive study. Setting: Diabetes outpatient clinic, Mbagathi Hospital. Subjects: One hundred and sixty five patients with T2DM selected by random sampling, aged 40 years and above, each on one anti-diabetes regimen for a period of not less than 3 consecutive months. Methods: The study was undertaken over a period of six months from June 2015 during routine diabetes clinics. Glycaemic control was assessed using HbA1c assay, while knowledge of diabetes and adherence to medications were evaluated using the MDRTC diabetes knowledge test questionnaire and the 4-point modified Morisky Medication Adherence Scale respectively. Results: Of the 165 patients with T2DM recruited, 66.1% females. Mean age (±SD) was 55.7 ± 9.5 years. Level of glycaemic control was 25.5%, knowledge of diabetes was 90.9% and adherence to medication was 37.6%. Mean DKT score (±SD) was 64.3 ± 15.3%, which was satisfactory. Non-adherence to medication was high, at 62.4%. Literacy rate was 93.3%. The study population was largely of low socio-economic status. Sub-optimal glycaemic control was possibly due to low socio-economic status, which impacted on adherence to diabetic diet and medications. Glycaemic control was significantly associated with single (marital) status (p = 0.005), formal employment (p = 0.05), and diabetes education acquired over one year prior to study entry (p = 0.014). Association of glycaemic control and formal employment was attributed to the ability of the employed patients to meet costs of medical care, including medication, while association of glycaemic control and diabetes education acquired over one year prior to study entry was ascribed to possible adequately internalized and utilized gained knowledge of diabetes. Patient knowledge of diabetes was significantly associated with female gender (p= 0.025), and unemployment (p = 0.045), likely due to the postulated better health-

seeking habits of females and the unemployed availing time to acquire knowledge of diabetes. Knowledge deficits were identified in aspects related to diet, treatment of hypoglycaemia and effect of physical activity on blood glucose. Non-adherence to medication was significantly associated with low family income (p = 0.043), provision of medications by spouses (p = 0.030), patient diabetes education gained 7-12 months prior to the study entry (p = 0.031) and multiple anti-diabetes drug regimen (p = 0.004). Association of non-adherence to medications with low family income was possibly because of inability to buy medications, while association of non-adherence to medications with multiple anti-diabetes drug regimens was also likely due to inability to afford high cost of multiple anti-diabetes drug regimens. Association of non-adherence to medications with patient diabetes education gained 7-12 months prior to the study entry was probably due to less conceptualized and internalized knowledge of diabetes. There was no association between glycaemic control, knowledge of diabetes and adherence to medications (p >0.05). Conclusion: The proportions of patients with glycaemic control and adherence to medication in this study were low, while that of patients with knowledge of diabetes was high, evident of dissociation of glycaemic control and knowledge of diabetes. Barriers to glycaemic control and adherence to anti-diabetic medication and identified knowledge deficits should be promptly addressed, as re-enforcement of knowledge of diabetes is maintained.