SELF-CARE PRACTICES AMONG PATIENTS WITH TYPE 2 DIABETES IN EASTERN ETHIOPIA: EXTENTS, CORRELATES, AND CONSEQUENCES

Abstract

Introduction: Poor self-care practices and poor glycemic control increase the risk of diabetes associated chronic complications. Despite previous studies determining the extent and correlates of self-care practice, they relied merely on data extracted from the patients’ perspectives as well as lacked a specific focus on patients with Type 2 diabetes (T2D). T2D is the most prevalent, which has modifiable risk factors, and needs a unique management modality. Moreover, chronic complications have not been comprehensively established in various specific contexts. This study intended to explore these using mixed methods. Evidence generated from this study is so vital for designing tailored strategies that enhance overall diabetes care of patients with T2D, for prevention and control programs, and delaying the burden of chronic complications. Objective: To investigate the extent and associated correlates of self-care practices, glycemic control, and chronic complications among patients with T2D on follow-up in two public hospitals in Harar, Eastern Ethiopia. Methods: This study used a mixed method. The quantitative data was collected through interview and record review to determine the extent and correlates of self-care practices, glycemic control, and chronic complications among adult patients with T2D. A generalized Poisson regression model was used to examine the extent and correlates of self-care practices and chronic complications. A linear regression model was used to find correlates of glycemic control. Qualitative data was collected using an in-depth interview with health providers from diverse disciplines to explore the barriers to diabetes patients’ self-care practices. ATLAS.ti 7 software was used for coding and thematic analysis of the qualitative study. Results: The overall mean (SD) of self-care practice among patients with T2D was 3.7±1.1 days a week. Tertiary educational level, moderate to high perceived self-efficacy, high to marginal food security, and receiving dietary advice were statistically significantly correlated with the self-care practices whereas inadequate diabetes knowledge, and a history of hospital admission was associated with decreases in the number of days of self-care practices. Multilevel barriers including patients, healthcare providers, and healthcare systems were identified. Suboptimal glycemic control was found in 76% of patients with T2D (95% CI:73.41,79.04). Khat consuming, comorbidity and poor level of self-care practices were found to be correlated with glycemic control. xiv One or more chronic complications were experienced by 43% of patients with T2D (95%CI: 39.65, 46.19). Urban residence, low wealth status, diabetes duration for five or more years, and inadequate self-care practice were negatively associated with the number of chronic complications. Conclusion: The findings suggested that diabetes patients’ self-care was practiced below the recommended number of days, indicating poor self-care practices. Similarly, the glycemic control was suboptimal, and the magnitude of chronic complications was substantial among patients with T2D in Eastern Ethiopia. Multiple factors were found to be associated with self-care practices, sub-optimal glycemic control, and diabetes related complications. Integrated and multidisciplinary interventions which prioritize the promotion of self-care practices, optimizing glycemic control and healthy lifestyles for prevention and delay of chronic complications are recommended. Moreover, strategies that strengthen the health care system capacities to provide adequate treatment and care for diabetes, in general, and complications, in particular, are deemed necessary.