Assessment of Factors Associated With Non-Compliance to Self-Management Practices in People With Type 2 Diabetes.

Aim and objective Diabetes mellitus is a chronic metabolic disorder that requires continuous self-management practices. The aim of our study is to assess the factors resulting in non-compliance with self-management practices in people with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care center in Karachi, Pakistan, from March 2019 to May 2019. People with T2DM diagnosed for at least six months were included. A predesigned questionnaire was used to assess various components of self-management such as the use of oral hypoglycemic agents (OHAs) and insulin, self-monitoring of blood glucose (SMBG), physical activity, and daily foot care. Certified diabetes educators conducted interviews on a one-to-one basis. Data were entered and analyzed by using SPSS (version 20; IBM Corp., Armonk, NY). Results Better glycated hemoglobin (HbA1c) levels were observed in compliant persons and a statistically significant difference was noted in those who were compliant with insulin use. Good compliance with self-management was observed in people who were given diabetes education previously. A total of 205 people with T2DM were included in the study, with a mean age of 52.66 ± 11.2 years and a mean duration of diabetes of 8.9 ± 7.5 years. There were 62.9% males and 37.1% females. Oral hypoglycemic agents (OHAs) were prescribed to 62.9% while 33.9 % were on both OHAs and insulin. Non-compliance with the intake of OHAs was 33.3%, insulin injection 21%, SMBG 25.7%, physical activity 69.5%, and foot care practice 34.3%. Various reasons identified for non-compliance included forgetfulness (negligence) (88%), fear of hypoglycemia (10.6%), time constraints (48%), and lack of foot care knowledge (84.8%). Conclusion Non-compliance with T2DM self-management is multifactorial and needs continuous reinforcement of structured diabetes education sessions. The study showed that the provision of diabetes education is directly proportional to self-management compliance levels.

Achieving safer Ramadan fasting by keeping flexible glycemic targets during the day and tighter targets during the night in insulin treated people with type 2 diabetes.

AIM: To observe the effect of keeping flexible glycemic targets during fasting and tighter targets during non-fasting hours in insulin-treated people with type 2 diabetes during Ramadan. METHODS: This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology in 2014. People with T2DM on split mixed insulin therapy were recruited. The pre-Ramadan education given and insulin doses were adjusted before Ramadan. 24-hour telephonic helpline service was provided to achieve pre-determined glycemic targets and minimize complications. RESULTS: A total of 54 people with T2DM with a mean age of 54.65 ± 9.32 years were recruited. Mean glucose levels achieved were 183.50 ± 30.91 mg/dl and 179.20 ± 36.27 mg/dl during the day and night respectively. Mean HbA1c (p-value < 0.0001) and serum creatinine (p-value 0.0010) significantly improved at the end of Ramadan. 0.6% episodes of hypoglycemia including one major hypoglycemia while 30% of episodes of hyperglycemia were recorded. No hospitalization needed. CONCLUSION: By keeping flexible glycemic targets during the day and tighter targets during the night, safe fasting was feasible with significant improvement in overall glycemic control without significant major complications.

Impact of 24-hour helpline service for people with diabetes.

OBJECTIVE: To evaluate the impact and effectiveness of 24-hour helpline service in providing information and educating patients about self-management of diabetes. METHOD: The study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary diabetes care center, Karachi, Pakistan. People with diabetes attending the outpatient department from November 2012 to October 2014 were included in this study. After providing diabetes education, a helpline number was provided for emergency situations. Calls of registered patients were received by diabetes educators stationed at the BIDE around the clock. Data was collected through specially designed interface of HMS (health management system) in which the current complaint of caller and the advice of educator was recorded. RESULT: A total of 4842 calls were received. Out of those, 4268 (88%) were made by Type-2 diabetics and 526 calls (10%) were made by Type-1 diabetics. The average age of patients was 47.6 years. Three seventy-four calls (7.7%) were received with complaint of Hypoglycemia (72-80mg/dl). Six hundred and ninety-eight calls (14.4%) were received with complaint of hyperglycemia (>200mg/dl). Insulin dose was adjusted on 935 calls (19.3%). Calls regarding other special situations such as (insulin handling, technique, medicine information) 2014 (41.6%) were received. CONCLUSION: Station based 24-hour telephonic helpline service is an effective tool for providing continuous support to people with diabetes and their families, for the self-management of diabetes. It can help in the management of various acute complication of diabetes, thereby preventing unnecessary hospital visits and admission.

Evaluation of Diabetes Conversation Map™ Education Tools for Diabetes Self-Management Education.

Objective. To evaluate the efficacy of Diabetes Conversation Maps™ education tools for people with type 2 diabetes attending a diabetes self-management education program. Design and methods. This cross-sectional study was conducted with patients with type 2 diabetes who were recruited from Baqai Institute of Diabetology & Endocrinology, a tertiary care diabetes center of Karachi, Pakistan, from May 2010 to June 2011. Groups of 10-12 participants were given a pre-session questionnaire. Four sessions using Diabetes Conversation Maps™ education tools were conducted, and the same questionnaire was then completed again. Results. A total of 172 people (82 males, 90 females, mean age 60 years, average duration of diabetes 15 ± 4 years) participated in the study. Confidence in diabetes self-management: before the sessions, 52.3% of participants believed that the doctor is the most influential person in the management of their type 2 diabetes, whereas after the sessions, 97.1% acknowledged that they were responsible for diabetes self-management. Before, 15% said they knew what to do to manage their diabetes, whereas 75% indicated this after the sessions. Empowerment: before the sessions, 32% said they understood those aspects of their diabetes self-management that were in need of improvement, whereas 75.6% indicated this after the sessions. Willingness, ability, and preparedness for diabetes self-management: before the sessions, 22% said they understood the importance of diabetes self-management; this increased to 63.4% afterward. Before, 20.3% agreed that they will start making changes in their lives, whereas 65.7% agreed with this after the sessions. Satisfaction: 61% found the map sessions very effective, 72.1% found this format to be better than individual education, and 52.8% agreed that map tools helped in goal-setting. Conclusion. Diabetes Conversation Maps™ education tools are effective for diabetes self-management education and facilitating behavior change in people with type 2 diabetes. This, in turn, may improve patients' chances of attaining desirable diabetes control.

Leflunomide in Pakistani patients with rheumatoid arthritis: prospective study in daily rheumatology practice.

INTRODUCTION: Leflunomide is a disease-modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis (RA). It has been widely studied in the West but there is no available local Pakistani data. OBJECTIVE: To evaluate the efficacy and safety profile of leflunomide in Pakistani patients with RA, either alone or in combination with methotrexate. MATERIALS AND METHODS: A prospective, non-comparator, open-label study in a setting of 'care as usual' was performed. In this study, 63 consecutive RA patients on leflunomide were enrolled. Leflunomide dose was started with full loading in 5 (8%), half loading in 39 (62%) and without loading in 19 (30%) patients. Methotrexate was also used in 20 (32%) patients. Primary end-point was 20% improvement in American College of Rheumatology response criteria (ACR-20). Safety was assessed by adverse events and abnormalities in laboratory parameters. RESULTS: Out of 63 patients, 54 (85.7%) were female. Mean age was 46 ± 12.6 years. Mean disease duration was 5.1 ± 4.5 years. Fifty-two (86.6%) patients achieved ACR-20 response at 6 months; 32 (53%) achieved ACR-50 response at 6 months; 20% experienced at least one adverse event, which resolved by reducing leflunomide dose. Only seven (11%) had raised liver enzymes from baseline. CONCLUSION: This prospective study conducted in the setting of a daily rheumatology practice shows that leflunomide is an effective and safe DMARD in treatment of RA in Pakistani patients.