Comparative Study of Compliance Between Hospital and Primary Care Diabetic Patients

Abstract

Modern day chronic diseases such as diabetes are related with the lifestyle, especially unhealthy diet and physical inactivity. This study aims to determine the level of compliance of diabetic patients with their doctors' advice about diet and physical activity, comparing ambulatory patients with those who were recently hospitalized. We developed a combined database of the two studies. Both studies were cross-sectional studies using systematic random sampling comprising patients of T2DM, and including the following variables: health facility used by the patient; age; gender; marital status; education; whether the patient received health education in the past; patient's weight and height and presence of other diseases; family history of diabetes; current smoking; dietary habits; and exercise. We used the SPSS data reduction method factor analysis to summarize the data on these two dimensions (diet and exercise) into a single summary variable each. The total number of diabetic patients included in this study was 442. Prevalence of smoking was 7.2% (6.3% among PHC patients and 9.4% among hospital patients; p=0.16). A little more than one third of the PHC patients and nearly three fourth of hospital patients had hypertension, coronary artery disease (CAD) or both (p<0.001). Similarly, a significantly greater proportion of the hospital patients had a family history of diabetes (p<0.001). Obesity was significantly higher among the PHC patients (p=0.011). The prevalence of unhealthy diet was significantly higher among hospital patients (p<0.001). Percentage of patients having unhealthy diet was significantly higher in among hospital patients in both sexes (p < 0.05), and in the 40-59 age-group; having secondary and higher level education, the prevalence of unhealthy diet was several times higher among hospital patients (p < 0.001); same was true among married patients, where the percentage of unhealthy diet was almost twice among hospital patients (p < 0.001). Finally, the prevalence of unhealthy diet was significantly higher among non-obese hospital patients than the non-obese PHC patients (p = 0.001). The prevalence of physical inactivity among male hospital patients was significantly higher than the male PHC patients (p=0.028). In the age 60 years and above, physical inactivity was significantly higher among hospital patients (p < 0.001). Similarly, among patients having less than secondary school education, physical inactivity was significantly higher among hospital patients (p = 0.002). Prevalence of unhealthy diet is significantly higher among hospital patients. We conclude that health care providers in Saudi Arabia should put greater emphasis on health education about diet and exercise. with T2DM.