Assessment of treatment compliance amongst adult patients with type two diabetes mellitus at Kenyatta national hospital

Abstract

Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by absolute or relative deficiency of insulin in the body. Type 2 diabetes mellitus (T2DM) accounts for more than 90% of all the diabetic patients (CDC, 2003). Compliance to prescribed therapy is key to glycemic control, which plays an important role in reducing chronic complications of T2DM to include chronic renal failure, cardiovascular complications, neuropathy and erectile dysfunction. Until recently diabetes mellitus (DM) was believed to be a disease occurring in the developed countries. Recent findings reveal that there is a rise in the number of new cases of type 2 diabetes mellitus with an earlier onset and associated complications in developing countries (Saurabh et al, 2013). The main objective of this cross-sectional study was to assess the treatment compliance among T2DM adult patients attending Kenyatta national hospital. The study mainly evaluated compliance to drug therapy, nutrition, physical activities and self-monitoring of blood glucose levels. A total of 199 participants were selected and interviewed. This sample size was calculated using Fisher’s formula and the participants were selected using systematic sampling method. A structured questionnaire was used to collect data from the participants. These questionnaires were analyzed using SPSS computer soft-ware version 20. Statistical methods used included chi-square, coefficient correlations, P- values, and percentages. The study found out that 58.3% of the participants had HbA1c levels below 6.5%, while 41.7% had HbA1c above 6.5%. The study also showed that 61.8% had latest random blood sugar level below 10mmols/lit while 38.2% was above 10mmols/l. Only 6.5% of the participants had their cholesterol levels recorded in their files. Majority of the participants, 58.8% had their BP above 130/85 mmHg. This study revealed that 73.36% of the respondents reported high compliance to pharmacological treatment while 72.3% reported high compliance to nutrition. There was sub-optimal compliance to SMBG and nutritional management. Only 35.6% n=71 reported high compliance to SMBG, while 40.7% reported high compliance to physical activities. From the findings of the study, it was noted that there’s no significant relationship between age, gender, marital status, education level of T2DM patients at KNH and compliance to pharmacological treatment, SMBG, physical activities, and nutrition (p > 0.1). In conclusion, a holistic approach needs to be embraced in managing T2DM patients at KNH so as to have high scores of optimal glycemic control among these patients. Health care providers need to encourage T2DM patients to adhere to all treatment modalities because compliance to a few modalities alone nullifies any efforts put in care of the diabetic patient. This leads to sub-optimal levels of glycemic control and DM complications in the long run. As it is evident, majority of the participants have elevated blood pressure that is likely to be accompanied by other silent complications. The researchers recommend that the health care providers need to improve monitoring of cholesterol levels and re-educate T2DM patients to monitor their blood glucose levels on a daily basis. Emphasis should be laid on compliance to all modalities of DM treatment.