Abstract
ObjectiveTo assess the level and determinants of practice in diabetes self-management at primary health care centers (PHCCs) and to analyze the association of self-management with the level of glycemic control.MethodA cross-sectional study was conducted among patients with type 1 and type 2 diabetes, aged ≥ 17 years, and being followed at PHCCs in Jeddah, Saudi Arabia, from December 1, 2019, to December 30, 2019. A multistage cluster sampling technique was used to select 350 participants from five PHCCs. The level of practice in self-management was assessed using the Arabic version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The tool was administered as a face-to-face interview, followed by the collection of sociodemographic and relevant clinical data. In addition, blood was collected to measure fasting blood glucose (FBG) and HbA1c levels. The association of the overall SDSCA score with diabetes control was analyzed using linear regression and the receiver operator characteristics (ROC) curve. Multivariate binary logistic regression was carried out to analyze independent factors of inadequate practice.ResultThe overall mean (SD) SDSCA score was 3.13 (1.13)/7. Of the five dimensions of self-care, medication adherence yielded the highest score (mean=5.39 days per week), followed by diet (2.83) and blood glucose monitoring (2.78), while footcare had the lowest level of practice (2.26). The SDSCA score showed a negative correlation with the level of HbA1c, with a correlation coefficient r-squared =0.530 and regression coefficient B=-0.648 (p <0.001). ROC curve analysis showed that optimal glycemic control was associated with SDSCA score cutoff ≥3.5 with 82.0% sensitivity and 77.0% specificity, and the model showed that 38.0% of participants had adequate practice in self-management. Inadequate practice in diabetes self-management was independently associated with age >50 years (OR=2.00 [95%CI=1.02, 3.89]), rental accommodation (OR=0.42 [95%CI=0.23, 0.76]), independent job (OR=3.98 [95%CI=1.66, 9.57]), and longer duration of diabetes (≥8 years) (OR=4.25 [95%CI=1.82, 9.92]).ConclusionThere are low levels of diabetes self-management among patients being followed at Jeddah PHCCs. This is associated with suboptimal glycemic control among the majority of the patients, indicating the importance of self-management to improve diabetes control. Patient health literacy and education for self-management should be considered the standard of care for diabetic patients in all PHCCs, with specific attention to subcategories of patients with the lowest levels of practice in self-management such as those with a longer duration of diabetes and the elderly.
Highlights
Half of the patients with diabetes are reported to have suboptimal or poor glycemic control, both at the national level and the global level [1,2]
There are low levels of diabetes self-management among patients being followed at Jeddah primary health care centers (PHCCs). This is associated with suboptimal glycemic control among the majority of the patients, indicating the importance of self-management to improve diabetes control
The level of practice was linearly correlated with the hemoglobin A1c (HbA1c) level, and Summary of Diabetes Self-care Activities (SDSCA) ≥3.5 was associated with optimal glycemic control (HbA1c ≤7%) with 82.0% sensitivity and 77.0% specificity
Summary
Half of the patients with diabetes are reported to have suboptimal or poor glycemic control, both at the national level and the global level [1,2]. Uncontrolled diabetes represents the major factor for diabetes-related morbidity. Cardiovascular complications increase the number of hospitalizations and related health expenditures [3,4,5]. The level of hemoglobin A1c (HbA1c) is linearly associated with. How to cite this article Alqahtani A H, Alzahrani A S, Alzahrani S H, et al (June 25, 2020) Levels of Practice and Determinants of Diabetes Self-Care in Primary Health Care in Jeddah City, Saudi Arabia. Uncontrolled diabetes was associated with 13.6% all-cause mortality, 17.9% for CHD, and 2.7% for stroke hospitalization [6]. A local study estimated that each unit increase in HbA1c level is independently associated with a 40% and 11% increase in the odds of microvascular and macrovascular complications, respectively [7]
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