Barriers in preventing long-term complications among patients with type 2 diabetes mellitus at the Kenyatta National Hospital
Background: Diabetes mellitus and other non-communicable diseases have become a threat to global and national development. Scientific evidence shows that appropriate lifestyle modification decreases risks of getting diabetes in addition to decreasing and delaying diabetic long-.term complications. Patients' self-care is central in comprehensive diabetes management but patients face multiple barriers which may be related to individual lifestyle behavior, health status or healthcare system. However, these barriers are preventable once identified. Objective: The objective of this study was to determine barriers in preventing long-term complications among patients with Type 2 Diabetes Mellitus (T2DM) at the Kenyatta National Hospital (KNH). Methods: A descriptive cross-sectional survey involving 147 participants who had T2DM diagnosed at least one year prior to the study was done. Self-administered questionnaires were completed by the participants and a focused group discussion was carried out among nurses caring for diabetic patients in the clinic and the wards. Data analysis was done using SPSS software (version 17). Univariate descriptive analysis of demographic and social characteristics of study participants was done. Means and measures of dispersion including standard deviation and ranges were calculated for age, duration of illness and anthropometric measurements. Categorical variables were summarized using frequency tables and presented using tables, and graphs. The association between longterm complications and different demographic, social and clinical characteristics was estimated by calculating odds ratios at 95 percent confidence intervals. A p-value was estimated using the chi square test or Fisher's exact test. Statistical significance was based on a cut off value of 0.05. Results: Findings from this study provide evidence of barriers to prevention of long-term complications. Long distance (43%) and inadequate finances (66%) were barriers limiting access to the KNH healthcare services. In addition, high prevalence of comorbidity (91.8%), inadequate education on health diet, lack of regular checkups, non- adherence to treatment regimens and lack of standard physical activity. were barriers compromising optimum diabetes care. Further, lack of regular income (83.7%), high prevalence of psychological stress (91.8%) and obesity (47.6%) increased vulnerability among our study participants. Hypertension was the most common comorbid condition (63.3%) while eye (43.5%) and foot (41.1%) diseases were the most prevalent long-term complications identified. Conclusion and Recommendations: The findings from this study provide evidence of multiple barriers to optimal diabetic care and prevention of long-term complications. Diabetes Self-care Management Education (DSME) should be improved through partnerships between the healthcare providers and the patients to enhance sustainability of long-term care. Comprehensive diabetes care including patients' psychosocial screening and counseling should be done preferably under one setting. Capacity building among the healthcare system, subsidizing costs of diabetes care commodities and improving insurance cover will greatly ease the burden of healthcare finance among patients with T2DM.