Assessment of treatment compliance amongst adult patients with type two diabetes mellitus at Kenyatta national hospital
Abstract
Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by absolute
or relative deficiency of insulin in the body. Type 2 diabetes mellitus (T2DM) accounts for more
than 90% of all the diabetic patients (CDC, 2003). Compliance to prescribed therapy is key to
glycemic control, which plays an important role in reducing chronic complications of T2DM to
include chronic renal failure, cardiovascular complications, neuropathy and erectile dysfunction.
Until recently diabetes mellitus (DM) was believed to be a disease occurring in the developed
countries. Recent findings reveal that there is a rise in the number of new cases of type 2 diabetes
mellitus with an earlier onset and associated complications in developing countries (Saurabh et
al, 2013). The main objective of this cross-sectional study was to assess the treatment
compliance among T2DM adult patients attending Kenyatta national hospital. The study mainly
evaluated compliance to drug therapy, nutrition, physical activities and self-monitoring of blood
glucose levels. A total of 199 participants were selected and interviewed. This sample size was
calculated using Fisher’s formula and the participants were selected using systematic sampling
method. A structured questionnaire was used to collect data from the participants. These
questionnaires were analyzed using SPSS computer soft-ware version 20. Statistical methods
used included chi-square, coefficient correlations, P- values, and percentages. The study found
out that 58.3% of the participants had HbA1c levels below 6.5%, while 41.7% had HbA1c above
6.5%. The study also showed that 61.8% had latest random blood sugar level below 10mmols/lit
while 38.2% was above 10mmols/l. Only 6.5% of the participants had their cholesterol levels
recorded in their files. Majority of the participants, 58.8% had their BP above 130/85 mmHg.
This study revealed that 73.36% of the respondents reported high compliance to pharmacological
treatment while 72.3% reported high compliance to nutrition. There was sub-optimal compliance
to SMBG and nutritional management. Only 35.6% n=71 reported high compliance to SMBG,
while 40.7% reported high compliance to physical activities. From the findings of the study, it
was noted that there’s no significant relationship between age, gender, marital status, education
level of T2DM patients at KNH and compliance to pharmacological treatment, SMBG, physical
activities, and nutrition (p > 0.1). In conclusion, a holistic approach needs to be embraced in
managing T2DM patients at KNH so as to have high scores of optimal glycemic control among
these patients. Health care providers need to encourage T2DM patients to adhere to all treatment
modalities because compliance to a few modalities alone nullifies any efforts put in care of the
diabetic patient. This leads to sub-optimal levels of glycemic control and DM complications in
the long run. As it is evident, majority of the participants have elevated blood pressure that is
likely to be accompanied by other silent complications. The researchers recommend that the
health care providers need to improve monitoring of cholesterol levels and re-educate T2DM
patients to monitor their blood glucose levels on a daily basis. Emphasis should be laid on
compliance to all modalities of DM treatment.
Publisher
University of Nairobi
Description
Masters