الفهرس 
Types of diabetesOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is a chronic medical condition that places serious constraints on the patient activities. The incidence of diabetes is increasing and the prevalence of diabetes is approaching epidemic proportion in many developing countries in the Eastern Mediterranean Region.
There is a need for extensive lifestyle changes that must incorporate careful dietary planning, eventual use of medications and blood glucose monitoring techniques. Maintaining the HRQOL of people with diabetes is an important challenge in diabetes treatment. For health care providers, a key goal in treating diabetes is to improve the HRQOL of the patients by identifying and addressing diabetes related issues. This could be achieved through educational interventions.
The aim of this work is to study the effect of implementation of a health education program on glycemic control and HRQOL of type 2 diabetic patients.
The study was carried out in two family health units at Wasat district in Alexandria. The target population was type 2 diabetic patients aged above 18 years attending El-Hadara Qebly and Abis 7 family health units for treatment and follow up. The required sample was selected systematically from attendants of the outpatient clinics of the selected family health units. A total of 100 type 2 diabetic patients attending the previously mentioned two family health units were randomly selected to participate in the present study, 50 patients in each group.
Data were collected using a pre-designed structured interviewing questionnaire composed of 4 sections (personal, medical history, care characteristics and knowledge about diabetes mellitus). HRQOL of type 2 diabetic patients was measured using the 20 item short form (SF-20). The level of HbA1c was assessed as a baseline for the entire selected sample. Patient records were reviewed for coexisting illnesses such as hypertension, liver disease and heart disease; also for presence of acute complications and chronic complications.
The educational sessions were held at the family club room, in selected family health units. The intervention group (n=50) was divided into smaller groups each about 12 patients. Four months after the end of the intervention program, measurement of HbA1c, assessment of knowledge and HRQOL using the SF20 questionnaire for both the intervention and the control groups was done to assess the effect of the program on HRQOL of type 2 diabetic patients. The collected data were revised, coded and analyzed using the appropriate statistical methods.
The study revealed the following results:
• The age of the studied groups ranged between 24 and 72 years.
• The majority of the studied patients were females.
• About 3 quarters of the cases were married.
• The duration of diabetes was 5 years or more in 68% of the experimental group and 58% of the control group.
• About two thirds (68%) of the experimental group and 58% of the control group had positive family history of diabetes.
• Seventy percent of the experimental group and 74% of the control group were on oral hypoglycemics.
• Half of the experimental group and 38% of the control group did not check their blood glucose level monthly.
• Regarding the presence of coexisting illness, 48% of the experimental group and 40% in the control group were suffering from hypertension.
• As regards acute complications, 38% of the experimental group, 46% of the control group suffered from diabetic ketoacidosis. Sixty two percent of the experimental group and 52% of the control group suffered from hypoglycemia.
• Results of the current study showed that peripheral neuropathy was the most common chronic complication suffered (78% in the experimental group and 66% in the control group). Also, 62% of diabetics in the experimental group and 52% of diabetics in the control group suffered from visual problems.
• Regarding referral of patients to a specialist, 68% of the patients in the experimental group and 78% of the patients in the control group were referred to a specialist when needed. The cause of referral was performing investigations in 58.8% of the patients in the experimental group and in 69.2% of the patients in the control group.
• Seventy percent in the experimental group and 62% in the control group had good knowledge about diabetes symptoms and management of diabetes. Thirty eight percent of studied patients had poor knowledge regarding the nature of diabetes.
• The mean total score of knowledge increased from 77.2±15.2 in the initial assessment to 93.2±5.4 in the first assessment and slightly decreased to 92.0± 9.9 in the second assessment.
• Regarding the mean total HRQOL score before the intervention, it was 48.41± 20.50 in the experimental group and 49.40 ± 15.97 in the control group. After the intervention the total mean score percent of HRQOL was 57.07±17.71 in the experimental group and 52.79±17.67 in the control group.
• Multiple regression analysis of the results of the current study showed a significant association between DM and HRQOL. Health insurance, knowledge score, residence, age, gender, duration of diabetes, family history of diabetes, history of hospital admission and complication of DM (visual problems and heart disease) were independent risk factors for majority of the domains of HRQOL.
• A significant reduction in the mean values of HbA1c in the experimental group following the intervention program from 10.02±2.02 before the intervention to 9.23 ± 1.84 after the intervention.
It can be concluded from the study that:
Using an interactive approach in education was effective in management of DM and improved the metabolic control and HRQOL. Significant changes in knowledge, HbA1c and HRQOL occurred during the 4 months period.
The following are the main recommendations of the study:
• A team composed of a diabetologist, a nurse, a health educator, a nutritionist (and a psychologist if needed) must take the responsibility of the treatment of diabetics.
• Documenting all aspects of patient education practice is essential to support the quality of patient education services.
• Patients must be encouraged to join the integrated care program and to register in both a primary care practice and a nominated secondary centre committed for referral policy of family health practice.
• HbA1c must be provided free of charge for all diabetics attending primary health care units, at least twice yearly to give an indication about their glycemic control.
• Quality of life questionnaire must be one of the forms to be fulfilled for each diabetic patient for early detection of psychological troubles, and as a periodic routine assessment of the patient. It must be adopted for local culture and values.
• Educational sessions must be expanded to include all diabetic patients and their family members to train them about control of diabetes, contribution in management of diabetes and communication with patients with possible depressive symptoms or complications.
• Using additional techniques to improve coping with diabetes management especially for adherence to diet and exercise such as the use of reminders, memory aids, goal setting techniques and self-monitoring.
• Covering the psychological aspects of QOL, in cooperation with mental health specialists. These aspects include:
1. Monitoring diabetes-related distress.
2. Helpinog patients to overcome stressful situations by training them on stress management (relaxation techniques, deep breathing, friends, physical activity, etc).
3. Referring patients who face major psychological problems to a psychologist.
• Developing educational programs focused on the prevention and delay of diabetes and its complications via behavior modification, exercise, diet, and weight management in both school-age and urban adult populations.
• Creating and training a support group for both families and patients so that they can interchange experiences, feelings and remain motivated to comply with different aspects of self management. This should be done in cooperation with non governmental organizations.
• Additional studies are needed after implementation of the health education program with the previous modifications to assess its effect on HRQOL of type 2 diabetics.
• Further studies are needed to evaluate the real situation of blood pressure control in diabetics in primary care units in order to be able to lower the risk of cardiovascular events among them.
• Studies are needed to investigate the effect of financing methods on the quality of care provided under the Egyptian Health Sector Reform Program