Prevalence of Glycemic Control and Factors Associated With Poor Glycemic Control: A Systematic Review and Meta-analysis

The primary method for preventing health and health-related problems in diabetic people is glycemic control. Numerous studies have documented the importance of glycemic control and the factors that influence it. However, the results are dispersed. This study sought to identify the prevalence of poor glycemic control and associated factors in Ethiopia. Findings will be crucial to reduce the burden of poor glycemic control. Comprehensive search was performed from databases: PubMed, Global Health, CINAHL, IRIS, and FSTA. Gray literature sources were also explored. This document was prepared based on the PRISMA flowchart. The protocol is registered in PROSPERO (ID: CRD42022296583). STATA software was used for data analyses and I2 test with Cochrane Q statistics, and forest plot were used to verify heterogeneity. When the I2 value was higher than 50% and the p-value was 0.05, heterogeneity was deemed significant. To confirm publication bias, a funnel plot with an Egger's regression test was performed. The factors related to poor glycemic control were reported using pooled odds ratios (POR) and a 95% confidence interval. In this study, 46 papers totaling 15 457 people were used to calculate the pooled estimates. It was determined that 32.6% (95% CI: 28.3, 36.9) and 61.92% (95% CI: 57.92, 65.92) of the subjects, respectively, had good and poor glycemic control. Being male protected against poor glycemic control, while poor diet adherence, lack of exercise, poor adherence to anti-diabetic medications, and smoking increased the likelihood of poor glycemic control. Lack of formal education, no family history of diabetes, lack of glucometer for blood glucose monitoring, comorbidity, being overweight and prolonged length of stay with diabetes all contributed to poor glycemic control. Ethiopia had a fairly high rate of poor glycemic control. The main determinants are lifestyle factors. Therefore, it is important to focus on behavioral interventions.

Self-care practice and its associated factors among diabetic patients attending public hospitals in Gurage zone southwest, Ethiopia

Background

Diabetes is a chronic disease that requires lifelong medical treatment and lifestyle modifications. Even though patients often neglect their own needs, self-care is an important factor in preventing and delaying complications related to diabetes. There are limited studies about self-care practice, and most of the studies conducted in Ethiopia focused on some parts of the recommended self-care practice. Therefore, this study aimed to assess the self-care practice and associated factors among diabetic patients in Gurage zone, south Ethiopia.

Methods

An institution-based cross-sectional study was conducted from February 6 to March 29, 2021. A systematic sampling method was employed to select 420 study participants. The data were collected using a pretested interviewer-administered questionnaire. All variables with P < 0.25 in the bi-variable logistic regression analysis were entered into multivariable logistic regression analysis. The statistical significance was declared at a p-value < 0.05.

Results

A total of 384 diabetes patients participated with a response rate of 91.4%. This study showed that more than half (60.4%) of the study participants had poor self-care practices. Being female (AOR: 2.40; 95% CI:1.31–4.40), rural residence (AOR:7.16;95% CI: 3.31–15.46), duration of diabetes treatment 5–10 years (AOR: 0.03; 95% CI: 0.1–0.11), duration of diabetes treatment ≥ 10 years (AOR:0.8; 95% CI: 0.03–0.21), haven’t social support (AOR: 0.10; 95% CI: 0.05–0.23), haven’t got health education (AOR: 0.17,95%CI 0.09–0.32) were factors significantly associated with self-care practice.

Conclusions

Despite, the importance of diabetes self-care practice for the management of diabetes and preventing its complications, a high number of diabetes patients had poor self-care practices. Female, rural residence, duration of diabetes mellitus, lack of social support, and not get of health education were significantly associated with poor self-care practice. Therefore, health care providers should give attention to diabetic patients with the aforementioned factors that affect diabetic patients’ self-care practices.

Health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description

BACKGROUND

Healthcare providers play a key role in supporting people with chronic low back pain to self-manage their condition. The study aimed at exploring how health care providers understand and conceptualize self-management and how they provide self-management support for people with chronic low back pain in Ethiopia.

METHODS

Health care providers who have supported people with low back pain, including medical doctors and physiotherapists, were approached and recruited from three hospitals in Ethiopia. This study employed an interpretive descriptive approach using semi-structured interviews.

FINDINGS

Twenty-four participants (7 women; 17 men) with a median age of 28 (range 24 to 42) years and a median of 9.5 years (range 1 to 11 years) of helping people with chronic low back pain were interviewed. Seven major themes related to health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia emerged. The findings show that self-management was a new concept to many and health care providers' had a fragmented understanding of self-management. They used or suggested several self-management support strategies to help people with CLBP self-manage their condition without necessarily focusing on enhancing their self-efficacy skills. The participants also discussed several challenges to facilitate self-management support for people with chronic low back pain. Despite the lack of training on the concept, the providers discussed the potential of providing self-management support for people with the condition.

CONCLUSIONS

Self-management was a new concept to health care providers. The providers lack the competencies to provide self-management support for people with chronic low back pain. There is a need to enhance the health care providers' self-management support competencies through training.

Knowledge and practice on medication adherence among Type II diabetes mellitus patients

This study aimed to survey the level of knowledge and practice on medication adherence among Type II diabetes mellitus (DM) patients. A cross-sectional study was conducted with a total of 220 DM patients by using a convenience sampling method. It was found that 64.5% of studied participants have a high level of knowledge with good practice toward medication adherence. There was a significant association between sociodemographic characteristics with the level of knowledge and practice toward medication adherence. This study finding provides information to health care providers to improve their patient's care by playing their important role in promoting the importance of knowledge on medication adherence for a better quality of life to the DM patients. Not only a physician but also the nurse could enhance health education for their patient on medication adherence during the follow-up appointment.

Diabetic Foot Self-Care Practices Among Adult Diabetic Patients: A Descriptive Cross-Sectional Study

BACKGROUND

Adequate foot care and regular foot examinations along with optimal glycemic control are effective strategies to prevent foot ulceration.

AIM

The aim of this study was to describe the patterns of foot self-care practice among diabetic patients attending an ambulatory clinic.

METHODS

A descriptive cross-sectional study was conducted at the ambulatory clinic of Jimma Medical Center. A consecutive sampling technique was used. The data were analyzed by SPSS version 20 and descriptive statistics were used to describe the findings.

RESULTS

A total of 370 diabetic patients (55.9% male and 68.4% type 2) were interviewed. The mean (±SD) age of the patients was 46.47±13.63 years. Over one-third (35.7%) of the patients had a previous history of foot ulcer. The majority of the patients self-inspect (92.5%) and wash (82.7%) their foot at least daily, respectively. In this study, 12.2% of the patients never inspected the inside of their footwear before putting them on and 42.4% of the patients never dry between their toes after washing. Most (63.5%) of patients never used moisturizing creams to lubricate the dry skin. In this study, 23.0% and 27.6% of the patients walk in sandals/slippers and in shoes without socks most of the time, respectively. Only 27.3% of the patients changed their socks daily. Majority (78.4% and 86.5%) of the patients never walk barefoot around and outside their house, respectively, and 75.1% of the patients never put their feet near the fire.

CONCLUSION

Diabetic patients were not adequately self-inspect and wash their foot at least daily, dry after wash and moisturize the dry skin. They walk barefoot, in sandals/slippers, and in shoes without socks. Therefore, clinicians should counsel every diabetic patient about the importance of foot self-inspection, foot hygiene, and the risk of walking barefoot, wearing sandals/slippers, and shoes without socks at every follow-up visit.

Level of self-care practice among diabetic patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Diabetes Mellitus (DM) is increasingly become a serious global public health concern in developed and developing countries including Ethiopia. It imposes significant burden of care on the individual, health care professionals and health system. As the result, immense need of self-care behaviors in multiple domains like food choices, physical activity, foot care, and blood glucose monitoring is required. However, there is no national study on diabetic self-care practices in Ethiopia. This meta-analysis, therefore, aims to estimate the pooled level of self-care practice among individuals living with diabetes mellitus in Ethiopia.

METHODS

The systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the databases: PubMed /MEDLINE, EMBASE, Google Scholar, and Science Direct for studies conducted in Ethiopia about self-care practice of diabetes patients. We have included all cross-sectional studies, which were published until August 20th,2019. Data were analyzed using STATA™ version 14.1 software, and the pooled prevalence with 95% confidence intervals (CI) were presented using tables and forest plots. The presence of statistical heterogeneity within the included studies was evaluated using I-squared statistic. We used Higgins and Egger's test to identify evidence of publication bias. The random-effects meta-analysis model was employed to estimate the pooled proportion of good diabetic self-care practices.

RESULTS

We included 35 studies (with 11,103 participants) in this meta-analysis. The overall pooled prevalence of good diabetes self-care behavior among diabetic patients was 49% (95% CI:43, 56%). When categorized by the major domains of diabetes self-care, the pooled estimate of dietary practice was 50% (95% CI:42, 58%), for self- monitoring of blood glucose was 28% (95% CI:19, 37%), for recommended physical activity was 49% (95% CI:38, 59%), and for diabetic foot-care was 58% (95% CI: 41, 74%).

CONCLUSION

More than half of diabetic patients in Ethiopia had poor diabetes self-care practice. High percentage of diabetic patients also had poor dietary practice, self- monitoring of blood glucose, physical activity, and diabetic foot care. Therefore, intervention programs should focus on improving the knowledge level of diabetic patients to improve the self-care practice of diabetic patients.