الفهرس 
Definition of Diabetes Mellitus (DM)Only 14 pages are availabe for public view
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Abstract
Diabetes mellitus is one of the most important public health challenges in the 21st century. It is one of the leading causes of disability and death in most of the countries and once for humans to catch diabetes, it becomes a permanent feature till the end of life and become a significant burden on the patient’s life. Thus, the proper practice of self-care should allow the patient to live a fruitful life and to effectively adapt to his illness with minimal problems. Self-care includes following a diet regimen, engaging in regular exercises, self monitoring of blood glucose, medication adherence, insulin self injection in addition to personal hygiene (caring for skin, feet and oral hygiene). Therefore, diabetic patients must have an understanding of the disease and should take a DM management training.
The present study aimed to explore the effect of an educational program on self-care practices developed and provided for diabetic patients at Damnhour Main Hospital. It also aimed to assess the diabetes related knowledge of diabetic patients, to evaluate the self- care practices of diabetic patients and identify factors influencing their knowledge and self- care practices. It was also designed to construct and implement an intervention program on diabetic patients with poor knowledge and self-care practices and to evaluate the impact of the program on knowledge and self-care practices on these patients.
The study included 400 adult patients above 20 years attending the medical outpatient clinics in Damnhour Main Hospital. It was conducted in two phases. The sample of the first phase was equally allocated from the two medical outpatient clinics, one for females and the other for males and constituted the preliminary assessment group.
The first phase was a cross-sectional approach to study the patterns of self-care among diabetic patients. The data was collected by the following tools:
• A structured questionnaire: For the execution of this phase 400 diabetic patients were interviewed to collect data about personal and socio-demographic characteristics, diabetes history, follow up visits, knowledge about diabetes signs and symptoms, normal levels of fasting and 2 hours post-prandial blood glucose, risk factors, acute complications, treatment regimen, physical exercise, dietary pattern, foot care and source of diabetes knowledge and practice including dietary pattern, treatment regimen, foot care, physical exercise, regular weighing, keeping candies or identification card, oral hygiene and regular eyes check up.
• An observation check-list: This was designed to observe patients’ performance related to preparation of insulin dose, insulin self-injection and self-urine glucose analysis.
• A Physical assessment sheet: This was designed to record the patient’s mouth and foot condition, height, weight and fasting blood glucose.
The second phase was a one group pre-post test design used to evaluate the impact of the intervention program on knowledge and practice of the sub-sample who had poor knowledge and/or practices. Evaluation of the effectiveness of the program was done through one-month later evaluation. A comparison between pre and post tests was done to find out the change in the level of knowledge and practices after application of the program.
After the completion of data collection of this phase, data were fed into the computer for tabulation and analysis and accordingly the group of low knowledge and practice of patients was identified to be 100 patients.
The study revealed the following results:
First phase
• The study sample included a total of 400 diabetic patients of both sexes. The mean age of patients was (49.7± 11.5) years, 45.0% of patients belonged to the middle socioeconomic level families, while 29.0% belonged to the low socioeconomic level families.
• The highest percentage of patients (44%) used insulin therapy, 32.7% used oral hypoglycemic drugs and 23.3% used both.
• The problem of overweight and obesity was prevalent among more than two thirds of patients, where 36.5% were overweight and 36.8% were obese.
• Most of the sample (91.3%) had fasting blood glucose level above normal.
• By observation, it was found that 52.3% of patients of both sexes had dental caries (50.0% for females versus 54.5% for males) and 27.0% of them had missing teeth. It was also found that most of the sample (90.2%) had foot problems.
• As regard regularity of follow up visits to the clinic, all of the patients had regular follow up visits.
• As regards total knowledge score, the highest percentage of patients (63.7%) had poor total score (76.5% of females versus 51.0% of males) and 36.3% had fair score.
• It was found that 51.5% of patients stated the correct answers about normal levels of fasting blood glucose, 44.7% of them for definition of diabetes and 27.5%, and for 2-hour postprandial glucose.
• It was found that more than half patients (58.2%) and 43.3% of the patients did not know the answers about the precautions that should be taken when practicing physical exercise and benefits of physical exercise for diabetic patients.
• All patients stated correct but incomplete answers about signs and symptoms, 94.2% about the importance of follow up, 78.7% about bad practices that increase the severity of the disease and 65.3% suitable diet for diabetic patients.
• The majority of patients (73.2%) stated that they did not know the correct answer concerning oral hypoglycemic agent. The lowest percentage of patients (34.8%) stated correct and complete answers about the sites of insulin injection and the highest percentage (70.2%) stated the” did not know” answers regarding timing of insulin injection in relation to meals.
• Regarding hypoglycemia, 29.0% of patients stated correct and complete answers for causes and only 8.0% stated correct and complete answer for symptoms and 32.0% didn’t know the management.
• A significant positive relationship was found between total knowledge and socio economic status, gender, onset of the disease, age and education.
• Logistic regression analysis revealed that age, disease onset and socioeconomic status were the factors affecting patients’ total knowledge score.
• As regards self-care practice score, the highest percentage of patients (62.0%) had poor score, 22.0% had fair score, and only 16.0% had good score. The mean practice score was 33.6 ± 12.9 for males and 24.7 ± 10.9 for females.
• About one fourth (23%) of patients had good dietary pattern score and 13% had good physical exercise score. On the other hand, 67% didn’t follow the practices to avoid complications.
• The majority of patients (and had unsatisfactory practice regarding insulin preparation (78.7%) and injection techniques (91.7%), only 20.8% injected themselves with insulin and none of them had satisfactory practice score regarding urine glucose testing and only 3.0% of the patients had good score for self blood glucose monitoring.
• A significant positive relationship was found between total practice score and socio economic status, gender, onset of the disease age sex and education.
• A significant positive relationship was found between knowledge and practice.
• Results of the multiple linear regression analysis revealed that age, disease onset, gender, marital status and socioeconomic status were the factors affecting patients’ self-care practice.
Second phase:
• As regards the impact of the educational program, it was found that there is an improvement for each domain of knowledge and practice measured for the intervention group. An overall pretest total knowledge score was (mean = 29.6±3.9) compared to posttest (mean=71.8±13.0) with a mean increase of 2.7 folds (P<0.05).
• There was a significant improvement in total practice score from pre to posttest score among the intervention group from (mean = 20.8±4.5) compared to (mean =59.9±7.0) with a mean increase of 2.01 folds (P<0.05).
Based on the previous findings the study recommended the following:
1- All health care team members should give more emphasis to their roles as health educators.
2- The developed illustrated booklet should be made available and distributed for each diabetic patient admitted to hospitals.
3- Active participation of diabetic patients in self-care practices should be motivated.
4- Keeping an identification card should be recommended.
5- Mass media should have an increasing role in diabetes education.
6- Further studies are highly needed to evaluate knowledge and practice of the diabetic patients regarding diabetes self-care in other Governorates in Egypt.