105Int J Diab Dev Ctries | April-June 2010 | Volume 30 | Issue 2
I have read with interest the article titled, ‘Educational
program for patients with type-1 diabetes mellitus
receiving free monthly supplies of insulin improves
knowl e d g e a nd at t i t ude, but not adhere nc e,’
Vimalavathini et al. The authors mention in the second
paragraph of introduction, “When a patient does not
respond to an appropriately prescribed medicine, the
reasons could be drug or patient-related factors”. I agree,
but at the same time I want to add that, the reasons could
also be communication-related factors. The authors
already mention in the third paragraph that, “Planned
interventional educat ion programs have shown to
provide a positive impact on improving the KAP scores
in diabetic patients”.
Education is a broad concept, which encompasses both
teaching and learning. Evidence-based studies show
that doctors’ interpersonal and communication skills
have a signicant impact on improved health outcomes.
[2-4] To provide comprehensive care, many key qualities
are essential, which include the ability to communicate
eectively with the patient, act in a professional manner,
cultivate an awareness of one’s own values and prejudices,
and provide care with an understanding of the cultural
and spiritual dimensions of the patient’s life.
Quality drugs, discipline, and diet (3D) are the principles
of diabetic management. However, patients’ adherence,
letteRs tO editOR
Educational program for patients with type-1 diabetes
mellitus receiving free monthly supplies of insulin
improves knowledge and attitude, but not adherence
compliance with medication, and disease outcome are
closely associated with the quality of communication
and a planned interventional education program.
Department of Medical Education, Universiti Kebangsaan
Malaysia, Correspondence to: Dr Abdus Salam,
Department of Medical
Education, Universiti Kebangsaan Malaysia, Jalan Yaacob
Latif, Bandar Tun Razak, Cheras,
56000 Kuala Lumpur, Malaysia.
1. Vimalavathini R, Agarwal SM, Gitanjali B. Educational program
for patients with type-1 diabetes mellitus receiving free monthly
supplies of insulin improves knowledge and aitude, but not
adherence. Int J Diab Dev Ctries 2008;28:86-90.
2. Salam A, Ahmad Faizal MP, Siti Harnida MI, Zulkii Z, Azian
AL, Soon Pheng NG, et al. UKM Medical Graduates’ Perception of
their Communication Skills during Housemanship. Med Health
3. Rider EA, Keefer CH. Communication skills competencies:
Denitions and a teaching tool box. Med Educ 2006;40:624-9.
4. Stewart MA. Eective physician-patient communication and health
outcomes: A review. CMAJ 1995;152:123-33.
5. Litzelman DK, Coingham AH. The new formal competency-based
curriculum in Indiana University School of Medicine: Overview
and ve year analysis. Acad Med 2007;82:410-21.
Dear Si r,
We fully agree with the view expressed by Dr. Abdus
Sa lam[ 1] on our artic le. Howeve r, we inc luded
communication-related factors within the category of
patient-related factors and not as a separate entity. The
fact that the patients' knowledge and aitude improved
(in our study), showed that the intervention and our
communication was effective. However, they were
unable to comply with, and practice what they knew,
because of the reasons we had outlined in the study.
Adherence is a rather complex phenomenon, especially
in chronic diseases, and to aribute poor adherence only
to poor communication is trying to simplify a rather
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