Abstract
To evaluate management approach and outcome in two endocrinologist-managed clinics using data on treatment adherence, diabetes-specific parameters, prescribed medications and self-management practices among ambulatory type 2 diabetes patients. Opinion on cause(s) and perceived fear about diabetes were also explored. A cross-sectional prospective study using semi-structured interview among consented patients for eightweek, and a review of participants' case notes at 3-month post-interactive contact for details of diabetes-specific parameters and antidiabetes medications. The University College Hospital (UCH) and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in southwestern Nigeria. Adult patients with type 2 diabetes, on therapies for >3-month and who had average fasting blood glucose (FBG)>6.0mmol/L were enrolled. All patients with type 1 diabetes, and type 2 diabetes who decline participation were excluded. Out of 185 participants who were approached, 176(95.1%) consented and completed the study including 113(64.2%) from UCH and 63(35.8%) in OAUTHC. Mean FBG for patients were 9.6mmol/L in UCH and 11.0mmol/L in OAUTHC (p=0.03). Medication adherence among patients was 47(46.5%) in UCH and 31(52.5%) in OAUTHC (p=0.46). Prescribed antidiabetes medications between the clinics significantly differ. Practice of self-monitoring of blood glucose among participants was 26(23.0%) in UCH and 13(20.6%) in OAUTHC (p=0.72). Thirty-two participants (29.4%) in UCH and 33(43.4%) from OAUTHC (p=0.02) mentioned complications as perceived fear about type 2 diabetes. There are differences and similarities between the diabetes-specialty clinics with respect to diabetes management and outcome. This underscores the necessity for a protocol-driven treatment approach in ensuring improved diabetes care and outcome. None declared.
Highlights
Diabetes mellitus is a chronic disease with increasing prevalence worldwide.[1,2] It constitutes a significant health and socioeconomic burden for patients and the healthcare systems[3] and is the sixth leading cause of death in the United States.[4]
Study sites Endocrinology outpatient clinics of the University College Teaching Hospital (UCH), Ibadan, and Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, both located in south-western Nigeria
Ethical clearance and approval for the study was obtained from the joint University of Ibadan/University College Hospital (UI/UCH) Health Research and Ethics Committee (NHREC/05/91/2008a), and OAUTHC Ethics and Research Committee
Summary
Diabetes mellitus is a chronic disease with increasing prevalence worldwide.[1,2] It constitutes a significant health and socioeconomic burden for patients and the healthcare systems[3] and is the sixth leading cause of death in the United States.[4]. According to the “Rule of Halves” only half of people living with diabetes have been diagnosed and only half of those diagnosed receive professional care. Of the people receiving care, only half achieve their treatment targets and only half live a life free from diabetes-related complications.[8]. It is estimated that less than 40% of patients with diabetes receive medical care in accordance with established and recommended guidelines[9, 10] while only 6% manage to achieve glycaemic goals and avoid diabetes-related complications.[2, 11] www.ghanamedj.org Volume 50 Number 2 June 2016. The reasons for the disappointing performance of patients and the healthcare system with respect to diabetes has been adduced to lack of a systematic and organized approach to diabetes management and care.[11].
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