Adherence to Lifestyle Advice and Treatments in Pakistani Patients with Type 2 Diabetes Mellitus

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy are shown to improve blood glucose levels, lipid abnormalities and blood pressure. It is not known how many patients adhere to advice and drugs prescribed. This study aimed to determine adherence to lifestyle and therapeutic advice. Methods: A cross sectional hospital based study was conducted among patients attending the diabetic clinic at the Aga Khan University Hospital, using a structured questionnaire. Adult patients with T2DM and with at least one year duration of diabetes were included in the study. Results: Participants were aged between 32 and 92 years old with a mean age of 55.7 years old (SD ± 10.7). Mean duration of diabetes was 10.7 years old (SD ± 7.7). Majority (94%) of the patients were literate. Around half (47.3%) of the patients have had achieved glycemic target (HbA1c < 7%). Above target glycemic control was more common among patients with ischemic heart disease (68.1%), neuropathy (64.8%) and those on insulin (62.5%). Self-reported non-adherence for blood sugar monitoring (9.5%), physi-* Corresponding author. S. Malik et al. 50 cal activity (61.7%), tobacco use (43.4%) and foot care (43.9%) were noted. About 25% of the participants were not fully adherent to dietary advice. None of the patients from our study reported non-adherence to medications. Good adherence to physical activity was found in males with college degree. The highest percentage of tobacco use (33.3%) was reported among businessmen. Conclusion: We noted low adherence to advice for physical activity, tobacco use and SMBG, but a high adherence to prescribed medications and insulin. This was a selected group visiting a teaching hospital. This will need to be studied further in the community and efforts are required to motivate patients.

Impact of Diabetes-related Self-management on Glycemic Control in Type II Diabetes Mellitus

“…The proportion is higher as compared to other local literature. In a study by Athar et al, 45% were reported to have HbA1c >8% and in a study by Malik et al, 53% had HbA1c >7% [15][16]. However, in a study by Bukhsh et al, as many as 83% PWD had poor glycemic control (HbA1c >7%) [11].…”

Assessment of Barriersto Self-Management Among Patients With Type 2 Diabetes Mellitus at Specialized Medical Hospital in Mansoura University

“…This considered as a majorbarriersin controlling blood glucose level, there is a needto increase awareness ofpatients about importance of adherenceto diabetic diet.This agree with study conducted in Egypt by Ibrahim et al (2010) (30) who found that only 2.2% of the respondents adhered with dietary regimen andalsoIkombele, 2011 (17) who foundsthat the most of patientswere not following a controlled, planned diet and only 0.9%were following a controlled plan diet. Inconsistent with Malik et al (2016) (31) who found that lower percentage of participants were not fully adherent to dietary advice.…”

“…Concerning physical activity ,The present study revealed that the most of studied sample don't perform any sort of physical exercises, this probably due to lack of motivation and inadequate knowledge about importance of regular physical activity, lack of time ,feeling tired due to advanced age , so itis considera significant barrier to diabetes treatment ,self-managements and it's importanttoanalysis barriers to PA is before planning any strategy to increase motivation and adherence to the initiation and participation in exercise program to diabetic patients.This is supported by Prabhu et al, (2013) (29) who found that commitment with exercise has been shown to be very poor especially in developing countries., other study conduct in Egypt by Ibrahim et al (2010) (30) showed that no one reported regular adherence with exercise regimen this finding may be due to lack of knowledge about importance of regular physical activity Malik et al, (2016) (31) who reported deficient knowledge about exercise.…”

Assessment of Barriersto Self-Management Among Patients With Type 2 Diabetes Mellitus at Specialized Medical Hospital in Mansoura University.

“…This agree with study conducted in Egypt by Ibrahim et al (2010) (30) who found that only 2.2% of the respondents adhered with dietary regimen and also Ikombele, 2011 (17) who founds that the most of patients were not following a controlled, planned diet and only 0.9%were following a controlled plan diet. Inconsistent with Malik et al (2016) (31) who found that lower percentage of participants were not fully adherent to dietary advice.The result also revealed that most of patients can't choose appropriate foods between basic meals ,this finding may be due to lack of knowledge about healthy meal and inadequate income this may significant barriers especially for patient with low income which can't get enough ,appropriate healthy food this supported by Chan et al(2015) (32) ;byHolt (2012) (33) . The present study revealed that around nearly half of the patients were not examine their feet regularly this finding due to they hadn't know the importance for foot examination and lack of adequate knowledge to specific diabetic foot care barrier to foot care, for diabetes managements .This agree with study conducted in Saudi Arabia by Dikeukwu et al , 2012 (34) who revealed that more than half of the diabetics checked their feet regularly, while nearly half didn't check it regularly.…”

“…Concerning physical activity ,The present study revealed that the most of studied sample don't perform any sort of physical exercises, this probably due to lack of motivation and inadequate knowledge about importance of regular physical activity, lack of time ,feeling tired due to advanced age , so its consider significant barrier to diabetes treatment ,self-managements and it's important to analysis barriers to PA is before planning any strategy to increase motivation and adherence to the initiation and participation in exercise program to diabetic patients. This is supported by Prabhu et al, (2013) (29) who found that commitment with exercise has been shown to be very poor especially in developing countries., other study conduct in Egypt by Ibrahim et al (2010) (30) showed that no one reported regular adherence with exercise regimen this finding may be due to lack of knowledge about importance of regular physical activity Malik et al, (2016) (31) who reported deficient knowledge about exercise.…”