Glycemic control, medication adherence, and injection practices among diabetic patients treated in the 3 tertiary referral hospitals in Bhutan: a call for more action

Abstract

Background The burden of diabetes has increased rapidly with an increasing cost of treatment. Objectives To describe the glycemic control, injection practices, and treatment adherence among diabetic patients treated with insulin. Methods This cross-sectional study was conducted using a convenience sampling method at the 3 tertiary referral hospitals in Bhutan. Sociodemographic, injection practices, and clinical details were collected. Good glycemic control was defined as glycated hemoglobin A (HbA1c) <7% if available or fasting blood sugar 70–130 mg/dL and 2 h postprandial blood sugar <180 mg/dL if HbA1c values were unavailable. Medication adherence was assessed using the Morisky, Green and Levine (MGL) scale. The injection technique was assessed using a 10-item checklist. Results We studied 207 patients. Good glycemic control was achieved by only 58 (28.0%) of patients. Using the MGL scale score, the objective adherence with insulin therapy was mostly low to medium and a gross discordance was with self-declared adherence (P < 0.001). The injection technique was fair to poor in half of the participants. Those with good injection techniques also had good adherence to medication (P = 0.025, adjusted odds ratio = 4.4, 95% confidence interval 1.2–16.4). The majority (154, 74.4%) had self-injected insulin, while the remaining were dependent on their home caregivers. Forty percent of the participants used storage practices that were not recommended. The disposal of the used insulin needles was generally unsafe. Conclusions Glycemic control and adherence to insulin administration recommendations were poor. The injection technique needs to be improved and standardized, and methods of safe disposal of sharps need to be developed.

Prevalence and determinants of self-medication practices among general population: A cross-sectional study in Thimphu, Bhutan and Chattogram, Bangladesh

“…Aligned to our findings, other studies have reported that self-medications were common for ailment of general minor diseases like cough and cold, headache, gastric problems and fever. 31 , 32 Likewise, top three common reasons for self-medication in Chattogram and Thimphu reported in this study were- lack of seriousness of disease, common illness and previous experience with the diseases, which is compatible with many other studies. 19 , 31 The participants of Thimphu mentioned the most common source of information for self-medication as family and friends followed by previous prescriptions; this is comparable with previously conducted studies.…”

Care of type II diabetes in older adults: untapped opportunities and remaining challenges

“…Treatment must be individualized. The article by Dorji et al in this issue demonstrates that glycemic control and adherence to insulin injection techniques need to be improved in developing countries like Bhutan [12]. The opportunities to improve health and quality of life from good control of diabetes mellitus abound; health providers in the health system and patients have to work hand in hand to overcome the remaining challenges.…”