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Percentage of people who are able to self-monitor their blood-glucose level at home

Percentage of people who are able to self-monitor their blood-glucose level at home

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Background: The prevalence of diabetes in sub-Saharan Africa has increased rapidly over the last years. Self-management is a key element for the proper management, but strategies are currently lacking in this context. This systematic review aims to describe the level of self-management among persons living with type 2 diabetes mellitus in sub-Saha...

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Context 1
... studies reported on patients' be- havior regarding monitoring of blood glucose. The vast majority of respondents from Nigeria [24] and Zimbabwe [25] reported to not be aware of SMBG. Thirteen studies observed how many of the study partic- ipants had the possibility to self-monitor their blood glu- cose level and had access to a glucometer at home (Fig. 2). The results indicate a very low degree of SMBG, ranging from a study from Uganda, where none of the patients had access to a glucose meter at home [41] to one study from Nigeria with 43% of all patients doing glucose testing at home [40]. On average only 15% of all patients were able to test his or her blood glucose level at home ...
Context 2
... studies reported on patients' be- havior regarding monitoring of blood glucose. The vast majority of respondents from Nigeria [24] and Zimbabwe [25] reported to not be aware of SMBG. Thirteen studies observed how many of the study partic- ipants had the possibility to self-monitor their blood glu- cose level and had access to a glucometer at home (Fig. 2). The results indicate a very low degree of SMBG, ranging from a study from Uganda, where none of the patients had access to a glucose meter at home [41] to one study from Nigeria with 43% of all patients doing glucose testing at home [40]. On average only 15% of all patients were able to test his or her blood glucose level at home ...

Citations

... Health education and self-management (SM) are among key strategies for T2D and HTN management according to the WHO [7], aimed at reducing disease complications. Self-management however, is considered poor in Sub-Saharan Africa [8] and challenging in South Africa [9]. Physiological benefits to patients in SM programmes are documented but harm can occur if SM is not patient-specific [10]. ...
... As such, individuals with diabetes need to acquire sufficient knowledge and skills about, and positive attitudes towards diabetes self-management. Unfortunately, ample researches have shown that individuals with diabetes, especially those with newly diagnosed diabetes, had suboptimal self-management knowledge and competence [6]. ...
Article
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Background International guidelines advocate providing prompt structured education to individuals with diabetes at diagnosis. However, among the few eligible structured education programs, heterogeneous intervention regimens and inconsistent findings were reported. Eligible programs for Chinese individuals with diabetes are lacking. This study aimed to investigate the effects of a nurse-led integrative medicine-based structured education program on self-management behaviors, glycemic control and self-efficacy among individuals with newly diagnosed type 2 diabetes. Methods Employing a randomized controlled trial, 128 individuals with type 2 diabetes diagnosed in the preceding three to nine months were recruited from four university-affiliated tertiary hospitals in Xi’an City, Northwest China, and randomly allocated to the intervention or control groups after baseline assessments. Participants in the intervention group received a 4-week nurse-led integrative medicine-based structured education program, which is theoretically based on the Health Belief Model and Self-Efficacy Theory, in line with updated diabetes management guidelines, and informed by relevant systematic reviews. Participants in the control group received routine care. Self-management behaviors and self-efficacy were measured with the Summary of Diabetes Self-Care Activities and the Diabetes Management Self-Efficacy Scale at baseline, immediate post-intervention and 12 weeks following the intervention while Glycated Hemoglobin A was measured at baseline and the 12th-week follow-up. The intervention effects were estimated using the generalized estimating equation models. Results Participants in the intervention group exhibited significantly better self-management performance in specific diet regarding intake of fruits and vegetables at both follow-ups (β = 1.02, p = 0.011 and β = 0.98, p = 0.016, respectively), specific diet regarding intake of high-fat foods at the immediate post-intervention follow-up (β = 0.83, p = 0.023), blood glucose monitoring at the 12th-week follow-up (β = 0.64, p = 0.004), foot care at both follow-ups (β = 1.80, p < 0.001 and β = 2.02, p < 0.001, respectively), and medication management at both follow-ups (β = 0.83, p = 0.005 and β = 0.95, p = 0.003, respectively). The intervention also introduced significant improvements in Glycated Hemoglobin A (β = − 0.32%, p < 0.001), and self-efficacy at both follow-ups (β = 8.73, p < 0.001 and β = 9.71, p < 0.001, respectively). Conclusions The nurse-led integrative medicine-based structured education program could produce beneficial effects on multiple diabetes self-management behaviors, glycemic control and self-efficacy. Trial registration This study was retrospectively registered in the ClinicalTrials.gov . on 25/08/2017; registration number: NCT03261895 .
... These five selfcare behaviours were based on the key indicators for self-care behaviour as suggested by the IDF and AADE [9,10]. Furthermore, these domains of self-care were also assessed by several review studies on self-care among people with T2DM in other settings [11,[22][23][24][25]. Studies not mentioning the type of diabetes examined, studies based on the same data set, and studies without a full-text publication available were excluded. ...
... A data extraction template similar to the one used in the systematic review of Stephani et al. [24] was developed in Microsoft Excel to collect information from the selected studies for the analysis. Information on the primary author, publication year, country, study design, sample size, demographic characteristics of the population (eg, age, gender, and other contextual information), and reported self-care behaviours were extracted. ...
... Adherence to self-care behaviour prevents T2DM-associated morbidities and mortalities [14,15]. The systematic reviews that included studies from Ethiopia [22,23], Sub-Saharan Africa [24], and LMICs [25] reported the poor practice of self-care behaviours among the people with T2DM and stressed the need for developing and implementing interventions to improve self-care behaviour. South Asians are at higher risk of developing NCDs, including type 2 diabetes [5], and the health care resources in this region are limited [128,129]. ...
Article
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Background: The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia. Methods: Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM. Results: The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%). Conclusions: Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.
... knowledge about general complications of uncontrolled diabetes [23,24]. Therefore, studies conducted among T2DM patients in Ghana have focused on medical compliance [25], factors that affect patients' compliance to self-care activities [26], and a combination of both medication adherence and self-care behaviours [24]. ...
Article
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The promotion of Diabetes Self-Management (DSM) practices, education, and support is vital to improving the care and wellbeing of diabetic patients. Identifying factors that affect DSM behaviours may be useful to promote healthy living among these patients. The study assessed the determinants of DSM practices among Type 2 diabetes mellitus (T2DM) patients using a model-based social cognitive theory (SCT). This cross-sectional study comprised 420 (T2DM) patients who visited the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana. Data was collected using self-structured questionnaires to obtain socio-demographic characteristics, T2DM-related knowledge, DSM practices, SCT constructs; beliefs in treatment effectiveness, level of self-efficacy, perceived family support, and healthcare provider-patient communication. Path analysis was used to determine direct and indirect effects of T2DM-related knowledge, perceived family support, and healthcare provider service on DSM practices with level of self-efficacy mediating the relationships, and beliefs in treatment effectiveness as moderators. The mean age of the participants was 53.1(SD = 11.4) years and the average disease duration of T2DM was 10 years. Most of the participants (65.5%) had high (>6.1mmol/L) fasting blood glucose (FBG) with an average of 6.93(SD = 2.41). The path analysis model revealed that age ( p = 0 . 176 ), gender ( p = 0 . 901 ), and duration of T2DM ( p = 0 . 119 ) did not confound the relationships between the SCT constructs and DSM specified in the model. A significant direct positive effect of family and friends’ support ( Critical ratio (CR) = 5 . 279 , p < 0 . 001 ) on DSM was observed. Self-efficacy was a significant mediator in this relationship ( CR = 4 . 833 , p < 0 . 001 ). There were significant conditional indirect effects (CIE) for knowledge of T2DM and family and friends’ support at medium and high levels of belief in treatment effectiveness (p < 0 . 05) via level of self-efficacy on DSM practices. However, no evidence of moderated-mediation was observed for the exogenous variables on DSM. Diabetes-related knowledge of T2DM, family and friends’ support, level of self-efficacy, and belief in treatment effectiveness are crucial in DSM practices among Ghanaian T2DM patients. It is incumbent to consider these factors when designing interventions to improve DSM adherence.
... Type 2 diabetes (T2D) is the most common type of diabetes that highly affects low-and middle-income countries (LMICs). 1 According to the International Diabetes Federation (IDF), an estimated 537 million adults aged 20-79 are living with diabetes while about 240 million have undiagnosed diabetes worldwide. 2 Even though self-care practice is a key component of diabetes management to prevent patients' morbidity and premature death, 3 it is affected by patients, health care providers, and system-related barriers. 4 Moreover, prolonged hyperglycemia increased the risk of chronic complications. ...
Article
Full-text available
Background: Diabetes, together with its complications, has a considerable negative influence on people's quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia. Methods: A hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤0.05. Results: One or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications. Conclusion: The burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.
... There was some variability in the quality of T2D [19]. These aspects all need to be improved on and should be considered in guideline development, as self-management is essential to reduce complications of T2D. ...
... 1 However, a recent systematic review indicated that self-management of DM in sub-Saharan Africa is poor. 2 People living with DM in South Africa reportedly have insufficient knowledge regarding the management of their disease, and low levels of adherence to exercise, a balanced diet and medication. [3][4][5] Exercise, in particular, was the least-employed component of DM self-management, with between 6% and 35% of DM patients reported to exercise regularly. ...
Article
Full-text available
Background: Self-management of type 2 diabetes mellitus (T2DM) in South Africa (SA) is sub-optimal, with exercise reported to be the least employed modality of self-management. This study aimed to evaluate the knowledge, attitudes and perceptions of T2DM patients regarding T2DM self-management, and to explore participants' awareness and acceptance of the role of biokineticists in the management of T2DM. Methods: This cross-sectional, descriptive study was conducted in October 2019 at an urban, district hospital in South Africa. A validated questionnaire was administered to T2DM outpatients. Participants' knowledge was evaluated by true/false questions, and their attitudes and perceptions on a five-point Likert scale. Results: Reported adherence to prescribed diabetes medication by participants (n = 150) was high, at 96%. However, only 60% of participants reported exercising regularly; 47.3% followed a recommended diet for T2DM; and 32.7% took appropriate care of their feet. Responses given by the participants regarding their knowledge and perceptions indicated good insight into the role of exercise in the management of T2DM (94.7%). There was low awareness of the field of biokinetics, with 74% of participants admitting no knowledge of 'biokinetics'. However, after receiving information on the role of the biokineticist in T2DM, 92% of participants were willing to work with a biokineticist to manage their T2DM. Conclusion: There was low reported adherence to exercise, diet and foot care among participants, despite good knowledge about, and attitudes to, the modalities of T2DM self-management. Majority of participants (92%) expressed a willingness to work with a biokineticist to manage their T2DM. However, there is a need for greater awareness and employment of biokineticists in the multidisciplinary team to help improve the uptake of exercise by patients with T2DM.
... However, the burden is still high [21,22]. In sub-Saharan Africa (SSA), diabetic patients hardly practice the advised diet and also 33% to 87% of patients had a poor level of knowledge about diabetes-related complications [23]. As a result, sugar-sweetened beverages (SSB) were highly consumed and pointedly contributed to total sugar and energy consumption in SSA [21]. ...
Article
Full-text available
Background: Diabetic patients' dietary practice is critical to improve glycemic, lipid, and blood pressure control. However, a significant number of patients had poor dietary practice. In Ethiopia, more than half of diabetic patients were not practicing a healthy dietary approach. Therefore, this study assessed variables that were hardly addressed in previous studies. The aim of this study was to assess dietary practice and associated factors among patients with type 2 diabetes. Methods: A facility-based cross-sectional study was performed among patients with type 2 diabetes in Arba Minch General Hospital from April 21 to May 20, 2020. A systematic sampling technique was used to select 352 patients. The data were entered into EpiData version 3.1 and exported to SPSS version 21 for cleaning and analysis. Descriptive statistics were performed. All variables in bivariate analysis with p-value <0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a p-value of less than 0.05. Results: The prevalence of poor dietary practice was found to be 40.6% (95%CI (35.7-46.0)). After adjusting for other variables in multivariable analysis, not attending formal education (AOR = 3.0; 95%CI (1.6-5.5)), being at primary education level (AOR = 2.2; 95%CI (1.1-4.4)), being moderately food insecure (AOR = 5.3; 95%CI (2.8-9.9)), having depression (AOR = 5.9; 95%CI (3.0-11.4)), and not having nutrition education (AOR = 2.2; 95% (1.1-4.6)) were factors associated with poor dietary practice. Conclusions: A significant proportion of patients had poor dietary practice. The poor dietary practice was significantly higher among those with no formal education, at the primary education level, from the moderately food-insecure household, having depression, and not having nutrition education. The results imply the need for strengthening health information dissemination concerning healthy dietary practice in the form of a package.
... Some felt cured and discontinued their medication after months of treatment, whereas others used herbal medicine. This is in line with a recent review done in Sub-Saharan Africa revealed that many patients had a misperception about diabetes treatment, and used herbal medicines are good treatment and opted as one alternative therapy, 75 whereas a study in southern India indicated that nearly half of them perceived that diabetes is a curable disease. 76 A study conducted in Taiwan identified misperceptions that insulin affects the kidneys and eating vegetables can regulate blood glucose. ...
Article
Full-text available
Background: All types of diabetes can damage the heart, blood vessels, eyes, kidneys, nerves and increase the overall risk of disability and premature death. Diabetes mellitus requires a range of self-care practices, scientifically recommended to control the glycemic level and maintain the patient's health. However, perceived barriers that hinder patients from fully implementing these diabetes self-care practices and obstacles have not been thoroughly explored. Therefore, this study aimed to explore the barriers to diabetes patients' self-care practices from the perspective of health care providers in two public hospitals in Harar City, Eastern Ethiopia. Methods: Researchers conducted an exploratory qualitative study among 26 health care providers working in two public hospitals from March to June 2021. The study participants were recruited from different disciplines working on diabetes care. Interviews were conducted in the Amharic language until the saturation point was reached. The interviews were tape-recorded, transcribed, and translated to English. Each transcript was read, re-read, and then exported to ATLAS.ti 7 software for coding. Field notes were used to supplement verbatim transcriptions. Initial codes were generated. The consistency between the two coders and their alignment with research questions were checked and applied to all subsequent transcripts after reached on consensus. The thematic analysis was employed in line with the primary set research question. Results: Researchers identified barriers to diabetes patients' self-care practices such as system, health care providers, and patient-level. These barriers were categorized under three main themes: lack of organized diabetes care services, limited collaborative care practices, and perceived lack of knowledge on self-care practices. In addition, the lack of multidisciplinary team care, lack of training for health care providers on diabetes self-care practices, and availability of laboratory tests and diabetes medication were prominent barriers. Conclusion: Multi-level barriers to diabetes patients' self-care practices such as system, health care providers, and patients were identified. Therefore, interventions targeting proper service integration, building providers' and patients' capacity on diabetes self-care practices, and ensuring the sustainability of laboratory tests and medication supplies are essential. These interventions need to be accomplished through multi-level stakeholders' engagement and one-to-one or group interventions covering the multi-level challenges.
... In particular patients do not engage, or are aware in some cases, of risk reducing behaviours such as physical activity, reducing salt-intake and good foot care. 11 Furthermore, the DSME described in these studies do not meet the standards set-out by the National Institute of Clinical Excellence in the UK, that is, that they include certain components, 9 for example; ► An evidence-base. ► Suits the needs of the person. ...
Article
Full-text available
Background Globally, there are estimated 425 million people with type 2 diabetes (T2D) with 80% from low-middle income countries (LMIC). Diabetes self-management education (DSME) programmes are a vital and core component of the treatment pathway for T2D. Despite LMIC being disproportionally affected by T2D, there are no DSME available that meet international diabetes federation criterion. Methods The aims were to test the feasibility of delivering a proven effective and cost-effective approach used in a UK population in two urban settings in Malawi and Mozambique by; (1) developing a culturally, contextually and linguistically adapted DSME, the EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND) programme; (2) using a mixed-method approach to evaluate the delivery of training and the EXTEND programme to patients with T2D. Results Twelve healthcare professionals were trained. Ninety-eight participants received the DSME. Retention was high (100% in Mozambique and 94% in Malawi). At 6 months HbA1c (−0.9%), cholesterol (−0.3 mmol/L), blood pressure (−5.9 mm Hg systolic and −6.1 mm Hg diastolic) improved in addition to indicators of well-being (problem areas in diabetes and self-efficacy in diabetes). Conclusion It is feasible to deliver and evaluate the effectiveness of a culturally, contextually and linguistically adapted EXTEND programme in two LMIC. The DSME was acceptable with positive biomedical and psychological outcomes but requires formal testing with cost-effectiveness. Challenges exist in scaling up such an approach in health systems that do not have resources to address the challenge of diabetes.