Management of Diabetes Mellitus

Added on - 10 Aug 2021

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1. Introduction
Diabetes mellitus is a complex, chronic non- communicable disease, which is becoming a
rapidly escalating epidemic in the developing and developed countries throughout the world,
due to the increasing prevalence of obesity and growing older population(Gunathilake et,al
2017).A high prevalence of diabetes and its microvascular and macrovascular complications constitute a
significant burden on healthcare systems. Self-management through patient education contributes to
reduce the burden of uncontrolled diabetes(Cooray et,al. 2017 ). This has become a major problem in
low and middle socioeconomic countries where it has a significant influence on productivity and the
overall economic output that leads to a considerable burden on health care and welfare system (Cooray
et,al 2017). Problems associated with DM can be minimized by early diagnosis and proper management.
The primary aim of management of DM is to delay the macro and microvascular complications by
achieving optimal glycemic control. This involves lifestyle modification, including regular exercise,
healthy diet and weight loss, and drug therapy (Herath et,al 2017 ).According to the World Health
Organization, non-compliance with long-term medication for chronic illnesses like diabetes is a
common problem that leads to compromised health benefits and serious economic consequences
in terms of wasted time, money and uncured disease ( Bartels D. 2004).
Patients presenting with type 2 diabetes mellitus are initially encouraged to maintain a
healthy diet and exercise regimen, followed by early medication that generally includes one or
more oral hypoglycemic agents and later may include an injectable treatment. To prevent the
complications associated with type 2 diabetes, therapy frequently also includes medications for
control of blood pressure, dyslipidemia and other disorders, since patients often have more than
three or four chronic conditions(Luis-Emilio García-Pérez2013 )As a result, hyperglycemia and
long-term complications increase morbidity and premature mortality, and lead to increased costs
to health services.(Luis-Emilio García-Pérez2013)Diabetes requires constant attention to diet,
exercise, glucose monitoring, and medication to achieve good glycemic control. Self-
management and proper compliance for treatment regimen is highlighted recently in the long-
term management of diabetes (Gunathilake et,al 2017)
Background
Diabetes mellitus (DM) is a leading cause of death in industrialized and developing
countries. Alsairafi Z.K,et.al.2016). Bailey C.J. said that, in 2011, all studies done in UK,
affirm that, a significant proportion of type 2 diabetes patients exhibit poor compliance that will
contribute to less than desired control.A Study was done in Chennai in 2007, shows that
knowledge of complication was poor among diabetic population. InEgypt,health awareness of
patients with diabetes is an important determinant of health behavior, and the study hasfound
that a majority of diabetic patients (90.0%) had poor knowledge about the disease, 83.7% had
poor knowledge about the complications associated with diabetes and 96.3% had poor awareness
of how to control the disease.(Kamel NM, et. Al)The Iraqi diabetic patients have inadequate
self-management behaviors. Diabetes self-management behaviors are necessary to ensure
optimum glycemic control, but the main barrier to self-management practices was the lack of
knowledge.Mikhae E. M.et. al,2018).
Knowledge and lack of health awareness about the proper management of the disease, and its
seriousness, were reported in several Middle East countries. For example, one study in Libia,
reported that patients had poor knowledge about the effects of diabetes on the eye and kidney.
(Roaeid R.B, 2007).According toBasker J., et.al , 1n 2016, pooradherence in diabetic patients
have been educational; with the presupposition that knowledge in south Asia.Malaysian
Diabetes patients knowledge regarding diabetes might affect patients’ compliance to their
treatment regimen.(HarithK.H.et al.,2011)According to world health organization, the
compliance to long-term therapy for chronic illnesses in developed countries averages 50% in
2003. In developing countries, the rates are even lower. It is undeniable that many patients
experience difficulty in following treatment recommendations. Patient dissatisfaction is a major
factor contributing to medicine misuse and non- adherence (World Health Organization, 2003.)
Diabetes mellitus (DM) is a rapidly growing health concern in Sri Lanka.Despite
understanding the importance of dietary control and physical activity in the management of
diabetes, adherence to practices were poor, mainly due to lack of clarity of information
provided(Ranasinghe P. et al.2015)The majority of patients with diabetes can significantly
reduce the chances of developing long-term complications by improving self-care activities.
Despite this fact, compliance or adherence to these activities has been found to be low,in both
India and Sri Lanka(Shrivastava S.R.B.L.et al.2013). Most of the vascular complications can be
prevented with good glycaemic control and to achieve this, compliance to medication is
essential. Similar to most of the other chronic diseases, drug compliance has been poor among
patients with diabetes.(GunathilakeG. et al.2017) Despite having good health care fascilties,
awareness and knowledge of diabetes mellitus are inadequate among patient of Colombo suburb
Jayawickrama W., Perera K 2016)
According toHerath H.M.M.in,2017even though the majority (77%) had moderate or above
moderate knowledge on diabetes in southern province, their attitudes towards diabetes was poor
(88%). It appears that the higher knowledge on diabetes did not translate into good practices as
over 50% of study subjects did not involve with any preventive measures. Patients’ knowledge
about their illness is considered important in controlling diabetes and preventing complications.
Although overall knowledge about diabetes among our patients was adequate there were critical
gaps in knowledge. In particular, knowledge about the management of diabetes and diabetic
complications was poor.(D.P. Perera,1 R.E.E. De Silva, W.L.S.P. Perera,2013)
Justification and significant
Diabetes self-management education is a cornerstone of diabetes care. The management of
diabetes mellitus (DM) largely depends on patients' ability to self-care in their daily lives, and
therefore, patient education is always considered an essential element of DM management.
Studies have consistently shown that improved glycemic control reduces the rate of
complications and evidence suggests that(Shrivastava et al., 2015).Improvement of the disease
awareness is the key to reduce the disease burden by early diagnosis and appropriate treatment
andeffective management of diabetesthat will minimize disease related complications of these
patients ( Rowley W.R et al., 2012).(Islam et al., 2015).Even though knowledge with regard to
risk factors of type-2 diabetes mellitus was observed to be better among the patients, they were
significantly lagging in terms of self-care practices in the same domains.(Katulanda et al., 2011)
Many studies reported that patients had poor knowledge about the effects ofdiabetes on the
eye and kidney. It has been found that patients lack the awareness about the symptoms of
hypoglycemia and its treatment. Self-monitoring of blood glucose levels and responding to hypo-
and hyperglycemic episodes are an integral part of the management of diabetes by insulin. Only
a small proportion of patients have been found regularly to monitor their blood glucose levels.
Reasons included not understanding its importance, not knowing how to do it, or lacking the
desire to do so(Elliott et al.) (Alsairafi et al., 2014). Assessment of the level of knowledge on
diabetes among persons with diabetes can assist in targeting public health efforts to reduce
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