Nutritional status, glycemic control and barriers to treatment compliance among patients with type 2 diabetes attending diabetes clinics in Maseru, Lesotho

[摘要] English: In 2013, 382 million people suffered from diabetes, with 80% of cases occurring in low-and-middle income countries. Diabetes and diabetes-related complications is the fourth most treated disease in Lesotho hospitals, incurring high medical costs which are largely subsidized by the Government. This study aimed to evaluate the socio-economic factors, nutritional status, medical history, glycemic control, and barriers to treatment compliance among Basotho out-patients with T2DM.A quantitative descriptive study was conducted among 124 consenting patients with T2DM who attended Domiciliary and LDF Clinics in urban Maseru between October 2012 and March 2013. Information were recorded via questionnaires administered by structured one-on-one interviews with the participants; information from patient files and by anthropometrical measurements. Activity was assessed with the validated International Physical Activity Questionnaire.Most participants were married (72.6%); employed (42.7%) or self-employed (26.6%); but 52.4% earned only M0.300 �?M1500 per month; and most had only a primary (29.8%) or a high school (49.2%) education. Most were 40 - 60 years old, with almost 50% of the males being �?0 years. Most participants were female, and females also had the lowest income and education levels.Most (53.2%) had been diagnosed with T2DM for �? years, and 67.7% were on oral glucose-lowering therapy, which 99.2% believed to be effective, and 98.4% reported strictly adhering to. All visit the clinics only every third month (61.3% for free and the rest for �?M15.00 per visit), while 40% reported that they sometimes failed to attend due to lack of money (75.8% travelled to the clinic by taxi).Most (82.9%) believed that overweight causes diabetes, yet based on BMI, 89.2% were overweight/obese; and based on WC, WHtR, and BAI, 98.3%, 96.8% and 64.5% were at risk for diabetes-related complications. Almost all were knowledgeable about prudent dietary and lifestyle guidelines and the importance thereof for the management of T2DM, and reported that they had received information on these subjects at the clinics, albeit for 92% never as written, individualized instructions from a dietician/nutritionist.Most participants also did not meet the daily recommendations for intakes of milk and dairy products (92.7%), fruits (65.3%) and vegetables (78.2%); and mostly relied on maize porridge (91.9%) and brown bread (71%) as daily staples. Most cited financial constraints (65.3%) and poor self-control (90.3%) as reasons for non-compliance to dietary guidelines. Most (98%) were moderately active; 78.2% reported abstaining from alcohol, but 52% of the males reported taking 4-6 units of alcohol, mostly commercial beer, per session; and approximately 10% were current tobacco users.None of the participants performed self-monitoring of blood glucose and 90.3% were ignorant about normal reference values. HbA1c measurements done by the researcher indicated suboptimal glucose control in 36.3%. Most (94.4%) suffered from hypertension, which remained uncontrolled despite receiving anti-hypertension drugs from the clinics. Participants were not screened for retinopathy, neuropathy, nephropathy or dyslipidemia at the clinics, and few had HbA1c measurements recorded in their files.Despite the services falling short of international recommendations for the management of patients with T2DM, 98.4% of participants were satisfied with the services rendered and 82.0% were happy with the communication between patient and health care professional at the clinics. Most (75.8%) however felt that the services took too long, and 17.7% reported that the clinic did not always have all their medications available.None of the participants believed that diabetes was due to witchcraft or punishment from God, or reported preferring to consult traditional healers. Few used traditional medicines (mostly 'Haelale); 'home remedies including cinnamon, garlic, ginger and green tea; or nutritional supplements; mostly in addition to (85.7%) rather than instead of, their prescribed medications.In summary, this study identified shortcomings in the health services rendered to patients with T2DM at government-supported clinics in Maseru, as well as various barriers to compliance to dietary and lifestyle recommendations, which need to be addressed: in recognition of patients' right to quality treatment, and to prevent diabetes-related complications which imparts a heavy financial burden on the health care system of a developing country like Lesotho.

[发布机构] University of the Free State