Adequacy of Glycaemic Control and Knowledge of Diabetes among Ambulatory Patients with Type 2 Diabetes at Mbagathi Hospital, Nairobi, Kenya

Abstract

Background: Diabetes mellitus is associated with high morbidity, premature mortality and socio- economic burden globally. Its complications, morbidity and premature mortality can be delayed or prevented by optimal glycaemic control. Knowledge of diabetes plays an integral role in attaining desirable diabetes self-care and clinical outcomes. However, despite Diabetes Self-Management Education (DSME) and advances in treatment, diabetes is often inadequately controlled in clinical practice.

Objective: To determine adequacy of glycaemic control and knowledge of diabetes among ambulatory patients with Type 2 Diabetes Mellitus (T2DM) at Mbagathi Hospital, Nairobi, Kenya.

Design: Cross-sectional descriptive study.

Setting: Diabetes outpatient clinic, Mbagathi Hospital, Nairobi, Kenya.

Subjects: One hundred and sixty five patients with T2DM, aged ≥ 40 years, selected by simple random sampling, each on one anti-diabetes regimen for a period of not less than 3 consecutive months.

Methods: The study was undertaken over a period of six months from June 2015 during routine diabetes clinics. Glycaemic control and knowledge of diabetes were assessed using HbA1c assay and MDRTC diabetes knowledge test questionnaire respectively. The 4-point modified Morisky Medication Adherence Scale was used to determine adherence to medication.

Results: Of the 165 patients with T2DM recruited, 66.1% were females. Mean age (±SD) was 55.7 ± 9.5 years. Literacy level was 93.3%. The study population was largely of low socio-economic status. Mean (± SD) HbA1c level was high, 9.5 ± 3.1%. Mean DKT score (±SD) was satisfactory, 64.3 ± 15.3%. Levels of glycaemic control and knowledge of diabetes were 25.5% and 90.9% respectively. Adherence to medication was low (37.6%). Knowledge deficits were identified in areas related to diet, treatment of hypoglycaemia and effect of physical activity on blood glucose. Glycaemic control was significantly associated with single (marital) status (p = 0.005), formal employment (p = 0.05), and diabetes education acquired over one year prior to study entry (p = 0.014). Knowledge of diabetes was associated with female gender (p = 0.025) and unemployment (p = 0.045). Adherence to medication was not associated with glycaemic control and knowledge of diabetes (p >0.05). However, there was association of non-adherence to medication with low family income (p = 0.043), provision of medication by spouses (p = 0.030), diabetes education gained 7-12 months prior to study entry (p = 0.031) and multiple anti-diabetes drug regimens (p = 0.004). Sub-optimal glycaemic control was possibly due to low socio-economic status, impacting on adherence to diabetic diet and medication. Association of glycaemic control and formal employment was attributed to ability of employed patients to afford cost of medical care, while association of glycaemic control and diabetes education acquired over one year prior to study entry was likely due to adequate exposure to diabetes education and appropriate use of internalized knowledge of diabetes. Knowledge of diabetes was associated with female gender probably due to the postulated better health-seeking habits of females. Association of knowledge of diabetes and unemployment may have been because the unemployed devoted ample time to acquire knowledge of diabetes. Non-adherence to medication was associated with low family income and multiple anti-diabetes drug regimens most likely due to inability to meet cost of medication. Association of non-adherence to medication with diabetes education gained 7-12 months prior to the study entry was probably due to inadequate knowledge of diabetes acquired.

Conclusion: There was evident dissociation of glycaemic control and knowledge of diabetes. Therefore it is essential that factors affecting glycaemic control and adherence to medication as well as the identified knowledge deficits should be promptly addressed, as re-enforcement of knowledge of diabetes is maintained.