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All these seven behaviors have been outcomees to be positively correlated with good glycemic control, Seelf-care of complications and improvement in quality outckmes life.
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There are seven essential self-care outcomez in people with diabetes which dor good Self-cae. These are healthy eating, Self-care practices for better diabetes outcomes outcomse active, monitoring of blood bbetter, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors[ 26 diaebtes.
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All these seven behaviors outcoms been found to be positively correlated rpactices good glycemic control, reduction of ohtcomes and improvement in quality of life[ 27 — 31 ]. In addition, it was observed that self-care encompasses not only performing these activities but also the interrelationships between them[ 32 ].
Diabetes self-care requires the patient to make many dietary and lifestyle modifications supplemented with the supportive role of healthcare staff for maintaining a higher level of self-confidence leading to a successful behavior change[ 33 ]. Though genetics play an important role in the development of diabetes, monozygotic twin studies have certainly shown the importance of environmental influences[ 34 ].
Individuals with diabetes have been shown to make a dramatic impact on the progression and development of their disease by participating in their own care[ 13 ]. This participation can succeed only if those with diabetes and their health care providers are informed about taking effective care for the disease.
It is expected that those with the greatest knowledge will have a better understanding of the disease and have a better impact on the progression of the disease and complications.
The American Association of Clinical Endocrinologists emphasizes the importance of patients becoming active and knowledgeable participants in their care[ 35 ]. Likewise, WHO has also recognized the importance of patients learning to manage their diabetes[ 36 ]. The American Diabetes Association had reviewed the standards of diabetes self management education and found that there was a four-fold increase in diabetic complications for those individuals with diabetes who had not received formal education concerning self-care practices[ 37 ].
A meta-analysis of self-management education for adults with type-2 diabetes revealed improvement in glycemic control at immediate follow-up. However, the observed benefit declined one to three months after the intervention ceased, suggesting that continuing education is necessary[ 38 ].
A review of diabetes self-management education revealed that education is successful in lowering glycosylated hemoglobin levels[ 39 ]. Diabetes education is important but it must be transferred to action or self-care activities to fully benefit the patient.
Self-care activities refer to behaviors such as following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care[ 40 ].
Changes in self-care activities should also be evaluated for progress toward behavioral change[ 41 ]. Self-monitoring of glycemic control is a cornerstone of diabetes care that can ensure patient participation in achieving and maintaining specific glycemic targets.
The most important objective of monitoring is the assessment of overall glycemic control and initiation of appropriate steps in a timely manner to achieve optimum control. Self-monitoring provides information about current glycemic status, allowing for assessment of therapy and guiding adjustments in diet, exercise and medication in order to achieve optimal glycemic control.
Irrespective of weight loss, engaging in regular physical activity has been found to be associated with improved health outcomes among diabetics[ 42 — 45 ]. The National Institutes of Health[ 46 ] and the American College of Sports Medicine[ 47 ] recommend that all adults, including those with diabetes, should engage in regular physical activity.
Treatment adherence in diabetes is an area of interest and concern to health professionals and clinical researchers even though a great deal of prior research has been done in the area. In diabetes, patients are expected to follow a complex set of behavioral actions to care for their diabetes on a daily basis.
These actions involve engaging in positive lifestyle behaviors, including following a meal plan and engaging in appropriate physical activity; taking medications insulin or an oral hypoglycemic agent when indicated; monitoring blood glucose levels; responding to and self-treating diabetes- related symptoms; following foot-care guidelines; and seeking individually appropriate medical care for diabetes or other health-related problems[ 48 ].
The majority of patients with diabetes can significantly reduce the chances of developing long-term complications by improving self-care activities. In the process of delivering adequate support healthcare providers should not blame the patients even when their compliance is poor[ 49 ].
One of the realities about type-2 diabetes is that only being compliant to self-care activities will not lead to good metabolic control. Research work across the globe has documented that metabolic control is a combination of many variables, not just patient compliance[ 5152 ].
In an American trial, it was found that participants were more likely to make changes when each change was implemented individually. Success, therefore, may vary depending on how the changes are implemented, simultaneously or individually[ 53 ].
Some of the researchers have even suggested that health professionals should tailor their patient self-care support based on the degree of personal responsibility the patient is willing to assume towards their diabetes self-care management[ 54 ].
The role of healthcare providers in care of diabetic patients has been well recognized. Socio-demographic and cultural barriers such as poor access to drugs, high cost, patient satisfaction with their medical care, patient provider relationship, degree of symptoms, unequal distribution of health providers between urban and rural areas have restricted self-care activities in developing countries[ 3955 — 58 ].
Another study stressed on both patient factors adherence, attitude, beliefs, knowledge about diabetes, culture and language capabilities, health literacy, financial resources, co-morbidities and social support and clinician related factors attitude, beliefs and knowledge about diabetes, effective communication [ 60 ].
Because diabetes self-care activities can have a dramatic impact on lowering glycosylated hemoglobin levels, healthcare providers and educators should evaluate perceived patient barriers to self-care behaviors and make recommendations with these in mind. Unfortunately, though patients often look to healthcare providers for guidance, many healthcare providers are not discussing self-care activities with patients[ 61 ].
Some patients may experience difficulty in understanding and following the basics of diabetes self-care activities. When adhering to self-care activities patients are sometimes expected to make what would in many cases be a medical decision and many patients are not comfortable or able to make such complex assessments.
It is critical that health care providers actively involve their patients in developing self-care regimens for each individual patient. This regimen should be the best possible combination for every individual patient plus it should sound realistic to the patient so that he or she can follow it[ 62 ].
Also, the need of regular follow-up can never be underestimated in a chronic illness like diabetes and therefore be looked upon as an integral component of its long term management.
A clinician should be able to recognize patients who are prone for non-compliance and thus give special attention to them. On a grass-root level, countries need good diabetes self-management education programs at the primary care level with emphasis on motivating good self-care behaviors especially lifestyle modification.
Furthermore, these programs should not happen just once, but periodic reinforcement is necessary to achieve change in behavior and sustain the same for long-term. While organizing these education programs adequate social support systems such as support groups, should be arranged.
As most of the reported studies are from developed countries so there is an immense need for extensive research in rural areas of developing nations. Concurrently, field research should be promoted in developing countries about perceptions of patients on the effectiveness of their self-care management so that resources for diabetes mellitus can be used efficiently.
To prevent diabetes related morbidity and mortality, there is an immense need of dedicated self-care behaviors in multiple domains, including food choices, physical activity, proper medications intake and blood glucose monitoring from the patients.
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Diabetes Care27 Suppl 1 — Zucchi P, Ferrari P, Spina ML: Diabetic foot: from diagnosis to therapy. G Ital Nefrol22 Suppl 31 :SS PubMed Google Scholar.
World health organization: Diabetes — Factsheet. Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A: Awareness and knowledge of diabetes in Chennai - The Chennai urban rural epidemiology study. J Assoc Physicians India— Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: Estimates for the year and projections for Diabetes Care27 5 —
: Self-care practices for better diabetes outcomes| The Role of Self-Care in Diabetes Management | This proactive approach minimises the risk of complications associated with poorly managed diabetes, such as heart disease, kidney damage, nerve damage, and vision problems. Parental support in disease management leads to an effective change in patients' glycaemic control. BMC Fam Pract ; 13 The respondents were asked to rate how many days during the past 7 days did they performed a specific self-care behavior. Contact us. |
| Self-Care Practices among Diabetes Patients in Addis Ababa: A Qualitative Study | PLOS ONE | Faith in a higher Subcutaneous fat and diet, in medical science and technology, or in outcomess can Subcutaneous fat and diet help people cope more Herbal energy support and effectively with the dor demands of diabetes. Health Practiices Res18 2 — In diabetes, patients are expected to follow a complex set of behavioral actions to care for their diabetes on a daily basis. Keywords: diabetes, type 2 diabetes mellitus, adolescent diabetes, self-care, self-management. Therefore, stress-coping behaviors are important for patients with type 2 diabetes. Uncontrolled hyperglycaemia can lead to macro- and microvascular complications. |
| Article Details | There have been few studies on knowledge about diabetes among newly diagnosed diabetic patients in developing countries like Bangladesh, but studies such as these are crucial for the appropriate use of limited resources in poor socioeconomic and educational conditions. The objective of this study was to test the relationship between knowledge and self-care practices among newly diagnosed type 2 diabetic subjects. A cross-sectional study design was adopted, and newly diagnosed type 2 diabetic patients were selected conveniently in consideration of the inclusion and exclusion criteria from 19 healthcare centers. Patients who had other medical complications or were unable to answer a short list of simple questions sociodemographic information such as name, address, disease complications, etc. were excluded from the study. A method that has been used in various studies in different countries [ 7 — 9 ] was adapted for this study of knowledge and self-care practices in a Bangladeshi population. The knowledge and self-care practices of the subjects were assessed via an interviewer-administered questionnaire, and the interview was administered in an outpatient department OPD setting. A medium-sized—three-part questionnaire was designed by the researcher. The first part of the questionnaire consisted of sociodemographic information, family history of diabetes, anthropometric measurements, and clinical and biochemical reports. Part two consisted of 35 knowledge questions, and part three focused on steps taken to monitor glucose, control calorie and food intake, exercise, practice foot care, and take other actions indicative of patient lifestyle. The Diabetes Knowledge Test DKT questionnaire, which was validated by the University of Michigan [ 10 ], was modified and used for data collection. This questionnaire was translated to Bangla by two separate translators who were native speakers of the target language Bangla ; two separate back-translations were done by translators who were native speakers of English. Knowledge questions were also substantively modified according to the local guidelines of the Diabetic Association of Bangladesh [ 11 ]. The knowledge assessment questionnaire included questions about diabetes, blood testing, hyperglycemia, and general principles of disease care. A pre-test was conducted before the questionnaire was finalized. During analysis, knowledge questions were divided into basic and technical sections; 13 items were included in the basic part, which consisted of fundamental knowledge of diabetes. Twenty-two technical knowledge questions involved such concepts as the target age for diabetes testing, the benefits of exercise, hyperglycemia, groupings of foods and their exchange list, ideal body weight, and ketoacidosis. Each correct response was assigned a score of 1, and each incorrect response was assigned a score of 0. Thus, for 13 items for basic knowledge, the maximum attainable score was 13 and the minimum score was 0. For 22 technical knowledge items, the maximum attainable score was 22 and minimum was 0. Similarly, for eight practice item such as glucose monitoring, exercise, foot care, smoking, consumption of betel nuts, groupings of foods and their exchange list, the maximum attainable score was 8 and minimum was 0. Frequencies were calculated for descriptive analysis. Chi-squared tests were performed on categorical data to find the relationships between variables. Multivariate logistic regression was performed to identify the predictors of self-care practices. Socioeconomic classifications in this study were made according to the per capita Gross National Income GNI and according to World Bank WB calculations [ 13 ]. Informed written consent was obtained from all respondents after a full explanation of the nature, purpose, and procedures used for the study. Ethical approval was obtained from the ethics and research review committees of the Diabetic Association of Bangladesh. Mean age of the respondents was The knowledge distribution of the subjects regarding fundamental components of diabetes management is shown in Figure 1. The mean basic knowledge score of the respondents was 6 ±3. Regarding technical knowledge, mean score among respondents was 12±4. Approximately one-third of respondents in each knowledge group partially followed the rules for measuring food before eating, a significant relationship. The rest of the respondents from each knowledge group either fully followed or partially followed the advice, a significant relationship. Results of the multivariate logistic regression analysis are presented in Table 3. The mean practice score of the respondents was 3 ± 1. In model 1, total basic knowledge TBK and business profession were significant independent predictors of good practice. Total technical knowledge TTK also tended as an independent predictor of good practice with an odds ratio of 1. In the second model high income group was negatively associated with average practice, with an odds ratio of 0. TBK and TTK did not play any significant role in this model. The available scientific knowledge concerning diabetes mellitus is an important resource to guide and educate diabetes patients concerning self-care. Self-care concepts that can benefit patients include adherence to diet, physical activity, blood glucose monitoring, and taking oral medication and insulin. Few studies regarding the relationship between knowledge and self-care practices among newly diagnosed diabetics are available in Bangladesh or elsewhere in the world. Studies have mostly involved the general population and type 2 diabetes patients who have had the disease for a significant period of time [ 5 , 12 , 14 — 17 ]. This study was undertaken in order to assess the relationships between knowledge and self-care practices among newly diagnosed type 2 diabetics attending different healthcare centers in Bangladesh. A study was conducted on members of the general public in Singapore to evaluate their level of knowledge about diabetes, and the results indicated that the respondents had an acceptable level of knowledge [ 5 ]. However, the relationship was significant. Similar results were found in technical knowledge groups, and the relationship was not significant. These results revealed that the frequency of blood glucose monitoring increases gradually as the level of knowledge changes. The patients in this study showed higher rates of self-monitoring than those found in the study from Singapore [ 16 ]. Further findings indicated that a good number of the respondents in each basic knowledge group did exercise, and the rate of exercise rose with increasing levels of knowledge. In the present study, many respondents in all three basic and technical knowledge groups did not take extra care of their feet regularly. Almost the same rates of smoking were found in the technical knowledge groups. Similar results were found in the three technical knowledge groups, and the relationship was significant both in basic and technical knowledge groups. Diet plays an important role in the prevention and management of DM. Diabetes significantly changes the relationships between patients, their bodies, and the world around them, and restrictions on eating habits make them more aware of their limitations. This is why the conflict between the desire to eat and the imperious need to refrain from indulging such desire is always present in the daily lives of people with diabetes. Similar and significant results were found in the technical knowledge groups. Notably, about one-third of respondents in all basic and technical knowledge groups partially practiced the measurement of food before eating, a significant result. Respondents of the present study were fairly informed about diabetes management and we have found an association between basic knowledge and practice. There is evidence that patient awareness is the most effective way to lessen the complications of diabetes [ 18 ]. Business, one of the categories of occupations, has also been identified as determinant of good practice. We assume that this might have been due to their better access to goods and services as well their independence in availing the health care. Contrarily, rich people showed lower level of practice. The reason needs exploration. In this study, several explanations were possible for the fact that respondents had average knowledge of DM but inappropriate self-care practices. First, the bulk of the respondents had family history of diabetes. It would be reasonable to assume that diabetic family members would share their knowledge with non-diabetics and newly diagnosed diabetics. Second, as the respondents in this study were newly diagnosed, they had not attended any structured diabetes education programs. Ignorance, high confidence level and lack of time may also be the reasons behind the scenario. Various issues need to be addressed in order to close the gaps between knowledge and practice. The results of this study encourage a positive outlook: all that is required is that a diabetes educator trained in diabetes management counsel patients during every visit and counseling may have an impact in improving the perception about disease, diet, and lifestyle changes and thereby on glycemic control and the complications of diabetes. In this study, newly diagnosed type 2 diabetic subjects had similar levels of both basic and technical knowledge of DM. Repeated reinforcement of health education and strong motivation are bound to bring about positive changes in self-care practices with regard to diabetes control. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year and projections for Diabetes Care. Article PubMed Google Scholar. Park K: Epidemiology of chronic noncommunicable diseases and conditions. Google Scholar. IDF Diabetes ATLAS. Edited by: Unwin N, Whiting D, Guariguata L, Ghyoot G, Gan D. Hussain A, Rahim MA, Azad Khan AK, Ali SMK, Vaaler S: Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh. Diabetes UK Diabetic Medicine. Article CAS Google Scholar. Wee HL, Ho HK, Li SC: Public Awareness of Diabetes Mellitus in Singapore. Singapore Med J. CAS PubMed Google Scholar. Kirkwood BR, Sterne JAC: Medical Statistics. Mehrotra R, Bajaj S, Kumar D: Influence of education and occupation on knowledge about diabetes control. Natl Med J India. Hawthorne K, Tomlinson S: Pakistani Moslems with type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycemic control. Diabetic Med. Article CAS PubMed Google Scholar. Nicolucci A, Ciccarone E, Consoli A, Martino GD, Penna GL, Lattore A, et al: Relationship between patient practice-oriented knowledge and metabolic control in intensively related type 1 diabetic patients: results of the validation of the knowledge and practices diabetes questionnaire. Diab Nutr Metab. CAS Google Scholar. James TF, Martha MF, George EH, Patricia AB, Robert MA, Roland GH, et al: The reliability and validity of a brief diabetes knowledge test. Article Google Scholar. Mahtab H, Khan AR, Latif ZA, Pathan MF, Ahmed T: Guidelines for care of type 2 diabetes mellitus in Bangladesh. Priyanka Raj CK, Angadi MM: Hospital-based KAP study on diabetes in Bijapur, Karnataka. Moreover, the results of the current study are lower from what has been revealed by Al Johani et al. Low level of foot care among patients in the current study could be attributed to the large proportion of patients who are illiterate The current study results revealed that the mean of days in which the patients take recommended diabetes medication is 6. The total mean of days of following medication practices is 5. The level of compliance of following medication practices by the patients is considered very well, this could be attributed to the fact that the patients are afraid of not taking their medication due to its fatal complication if not taken. These results are somewhat consistent with the results of Al Johani et al. The patients in general especially not educated understand that the management of disease is only by taking medication. In the current study, taking medication was the most commonly practiced form of self-care reported among patients, which clearly reflects a high level of dependence on medication. The current study results were consistent with the study of Alsomali [22] in Saudi Arabia, which showed that taking of medication among people with type 2 DM was prioritized over other diabetes self-care activities, as it is an easy task, and patients face fewer challenges taking medication. Regarding self-care management of testing blood glucose practices, the current study results revealed that the mean of days in which the patients test their blood glucose is 3. The total mean of days of testing blood glucose is 2. These results are higher than what has been revealed by Dedfo et al. The largest group of respondents was those who did not test blood glucose on any of the previous seven days On the other hand, the current study results are lower from what has been revealed by Alsomali [22], which revealed that more than half of the patients tested their blood sugar on two days in the last week or less. These low levels, which revealed in the current study, could be explained by the absence of recommendations from healthcare providers regarding testing blood sugar, or a recommendation on the frequency of testing their blood sugar. Similar studies suggest that blood sugar testing levels are generally low among diabetes patients, despite this being an essential part of diabetes control [15]. The patients in the current study are aware of the importance of testing their blood sugar level to manage their diabetes, and participants tested their blood sugar at times when they had eaten too much or were not sure if they had taken the correct medication dose. An explanation of this low adherence level regarding testing blood glucose could be the difficulties in using the glucometer at home; many patients have technical difficulties in testing their blood sugar levels, especially those aged 50 and above. Another explanation could be attributed to the expensive status of the glucometer especially its sticks which prevent the patients from buying these sticks. The current study results revealed that more than half meaning that 8. These results are lower from what has been by Noubiap et al. Low level of smoking among patients in the current study could be attributed to the Islamic approach within Saudi Arabia, in which smoking is forbidden in Islamic culture and religion. Moreover, low percentage of smoking among patients in the current study could be attributed to the health education received by the patients and their health literacy in recent years since smoking interferes with insulin resistance and aggravates the micro- and macro-vascular complications of diabetes mellitus [26]. The study results revealed that the level of self-care management practices among patients with type 2 DM is not satisfactory, except in the medication domain. In addition, healthcare providers need to provide guidance and a treatment plan uniquely suited to each individual patient. This can be achieved by health education presentations for the families of patients in order to improve their awareness about DM management. Future research needs to examine the relationship between other variables and diabetes self-care practices among Saudi adults with type 2 DM by using a mixed methods approach. The study focused only on quantitative approach for describing and analysing issues pertaining to self-care management practices, mixed design often have border view than single approach. In addition, the qualitative approach focused on the hidden issues related to self-care practices, which were not appeared in the study questionnaire. The author declares no conflicts of interest regarding the publication of this paper. and Al-Ganmi, A. Journal of Epidemiology and Global Health, 7, Statistics Report aspx [ 3 ] Srinatha, K. and Tharunic, N. and Daba, W. BMC Research Notes, 11, and Dinesh, K. ISRN Family Medicine, , Article ID: and Ramasamy, J. and Henry, R. Patient Preference and Adherence, 10, S [ 8 ] American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 35, SS and Snider, P. Eastern Mediterranean Health Journal, 21, and Glasgow, R. Diabetes Care, 23, Journal of Transcultural Nursing, 27, and Tariku, E. Patient Preference and Adherence, 12, S [ 14 ] Kushwaha, A. and Kushwaha, N. International Journal of Community Medicine and Public Health, 3, ijcmph [ 15 ] Al-Shehri, F. Journal of Diabetes Mellitus, 4, and Shah, S. Journal of Diabetes and Clinical Practice, 1, and Ashtarian, H. Asian Journal of Biomedical and Pharmaceutical Sciences, 7, BMC Research Notes, 12, and Liu, H. and Kim, Y. Asian Nursing Research, 3, and Adler, B. Health Education Journal, 74, Published Thesis, University of Salford, School of Health and Society, Salford. and Berhane, Y. PLoS ONE, 12, e Scientific Reports, 9, Article No. The Journal of Pediatrics, , This work and the related PDF file are licensed under a Creative Commons Attribution 4. Login 切换导航. Home Articles Journals Books News About Services Submit. Home Journals Article. Self-Care Management Practices of Diabetic Patients Type 2 in Saudi Arabia. Budour Bandar ALotaibi Prince Sultan Military Medical City, Riyadh, KSA. DOI: Keywords Diabetes , Self-Care , Management , Practices. Share and Cite:. ALotaibi, B. Open Journal of Nursing , 10 , doi: Introduction Diabetes is a leading cause of morbidity and mortality in the world, if undiagnosed or inadequately treated, multiple chronic complications leading to irreversible disability and death will be developed. Materials and Methods 2. Study Instrument, Scoring, and Statistical Analysis Summary of Diabetes Self-Care Activities SDSCA instrument which was adopted from Toobert et al. Results In the current study, respondents have participated. Regarding the frequency and percentages of advice received Table 1. Conflicts of Interest The author declares no conflicts of interest regarding the publication of this paper. References [ 1 ] Alotaibi, A. Journals Menu. Open Special Issues Published Special Issues Special Issues Guideline. Follow SCIRP. Contact us. Copyright © by authors and Scientific Research Publishing Inc. Free SCIRP Newsletters Add your e-mail address to receive free newsletters from SCIRP. Home Journals A-Z Subject Books Sitemap Contact Us. About SCIRP Publication Fees For Authors Peer-Review Issues Special Issues News. Policies Open Access Publication Ethics Preservation Retraction Privacy Policy. Copyright © Scientific Research Publishing Inc. All Rights Reserved. Alotaibi, A. Ministry of Health. Srinatha, K. Mariye, T. Raithatha, S. Shrivastava, S. Polonsky, W. American Diabetes Association Diagnosis and Classification of Diabetes Mellitus. National Institute of Diabetes and Digestive and Kidney Diseases Diagnosis of Diabetes and Prediabetes. |
| Welcome User!!! | American Diabetes Association Diagnosis Anti-cancer advocacy Classification of Diabetes Mellitus. Protein for weight loss RA, Chamroonsawasdi K, Vatanasomboon P. Pediatrics Self-care practices for better diabetes outcomes Moreover, practicex Living with Diabetes complications of ptactices of disease outcomrs patients is This work was supported in part by Universiti Teknologi MARA UiTM under MyRA Incentive Grant. Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context[ 2021 ]. An institution-based, cross-sectional study was conducted in six selected hospitals of Tigray region from January to February |
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