Educational program for patients with type-1 diabetes mellitus receiving free monthly supplies of insulin improves knowledge and attitude, but not adherence

Abstract

BACKGROUND:Though patients attending a diabetic clinic in a tertiary care hospital were given free monthly supplies of insulin, it was found that their glycemic control was poor.SETTINGS AND DESIGN:A prospective interventional study was carried out at the outpatient clinic in a tertiary care hospital.AIMS:To evaluate the effectiveness of a six month educational interventional program on the knowledge, attitude and practices (KAP) of type-1 diabetic patients receiving free monthly supplies of human insulin and to assess their adherence.METHODOLOGY:Sixty-seven type-1 diabetics, receiving free insulin vials each month, were recruited. The patients' baseline glycemic index, plasma insulin and KAP scores were determined using a validated questionnaire. The patients were educated about the disease and use of insulin for the next six months. In the seventh month, the KAP questionnaire was readministered and blood parameters measured.STATISTICAL ANALYSIS:Blood glucose, glycosylated hemoglobin and plasma insulin were compared by paired t tests. Mean KAP scores by Wilcoxon matched-pairs signed-ranks test. Difference in the proportion of patients answering the items was compared using test of proportions for dependant groups.RESULTS:The overall mean scores (± SE) increased from 30.8 ± 0.5 to 42.2 ± 0.4 (P < 0.001). The improvement in practice scores, though significant, was marginal, that is, from 17.7 ± 0.3 to 18.8 ± 0.3. In three out of the ten items under practice domain, only the manner in which vials were being stored at home showed significant improvement (P < 0.0001). The adherence to the insulin regimen increased from 82 to 86%, but was not significant. Patients cited financial reasons for nonadherence.CONCLUSION:The study showed that a planned educational intervention in type-1 diabetics, receiving monthly supplies of insulin free of charge, did not improve the key aspects of the practice component, even though the knowledge and attitude improved.

Quality of Life Differences in Pre- and Post-Educational Treatment in Type 1 Diabetes Mellitus During COVID-19

“… 31 Thus, many researchers want to evaluate the education of patients regarding T1DM. 32 , 33 They conclude that education is needed to control T1DM in children, adolescents, and adults.…”

“…Thus, educating patients with T1DM is essential to maintain patient adherence and its effect on patient QoL. 32 However, the study evaluating the efficacy of education to the improvement of the PedsQL score has not yet been conducted. This study found that QoL improvement was significant in all groups (parents and children).…”

“…Consistent with the study by Vimalavathini et al, education only improves knowledge and attitude but is not a practical component that composes adherence. 32 Treatment adherence is the most difficult to improve because it needs practical demonstration and mirroring from the doctor, which is limited due to the modularity of online education. 36 …”

Does one-to-one demonstration with insulin pads by health-care providers improves the insulin administration techniques among diabetic patients of a Tertiary Care Teaching Hospital in South India?

“…Studies conducted in South India reported that there is a poor knowledge on insulin use among the diabetes patients who were on insulin. [1013] Injection technique is critical to the therapeutic success of insulin and is highly operator-dependent. The correct administration technique will help in reducing the HbA1c levels.…”

“…Health education interventions were found to improve the knowledge and attitude domains profoundly; however, the improvement in the practice domain was relatively less. [10] One of the reasons could be that most patient education interventions did not provide hands-on training to the patient.…”