Perception And Support For Uncontrolled Diabetes Mellitus Patients: Study Among The Population At Rural Setting In Malaysia

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GRF 2nd One Health Summit 2013: Presentation by RAHMAN, Dr. Zairina, UNIVERSITI SAINS ISLAM MALAYSIA

GRF 2nd One Health Summit 2013: Presentation by RAHMAN, Dr. Zairina, UNIVERSITI SAINS ISLAM MALAYSIA

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  • 1. Perception and Support for Uncontrolled Diabetes Mellitus Patients: Study among the Population at Rural Setting in Malaysia Dr. Zairina A. Rahman (MD, MPH) Faculty of Medicine & Health Sciences Universiti Sains Islam Malaysia (USIM)
  • 2. INTRODUCTION • Diabetes mellitus is a chronic debilitating disease • Reached epidemic proportions in Asia and globally and prevalence are expected to be increasing. • 347 million people worldwide have diabetes 1 1 Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet, 2011, 378(9785):31–40.
  • 3. Malaysia
  • 4. Prevalence of Diabetes in Malaysia from NHMS 14.9 16 14 percentages 12 10 8.3 6.3 8 6 4 2 0 NHMS 1 (1986) NHMS II (1996) NHMS III (2006)
  • 5. Uncontrolled Diabetes Uncontrolled diabetes mellitus status (HbA1c more than 7%) in Malaysia: • Suhaiza et.al (2004) : 73% • Mafauzy (2006) : 80% • Hasimah et.al (2011) : 85% 1 Suhaiza et.al. Glycemic control among type 2 diabetic patient in Kelantan. 2004. NCD 2 Hasimah et.al. Control of glycosylated haemoglobin (hba1c) among Type 2 diabetes mellitus patients attending an urban health clinic in malaysia. 2011. Medical and Health Siences Journal 3 Mafauzy. Diabetes Mellitus in Malaysia Editorial. Medical Journal of Malaysia. 2006.61 (4);
  • 6. Social support for diabetic patients • Social support plays and important role in diabetes management (Kadirvelu et al. 2012). • MOH Malaysia implemented self-care among diabetes patients: – The empowerment on diabetes care focused on patients and family – enhanced patients and their family to be more proactive and responsible about their disease condition – need to be adequately educated on diabetes care and control.
  • 7. Negeri Sembilan 14 states in Malaysia: diabetes prevalence was highest in the state of Negeri Sembilan 15.3%
  • 8. RESEARCH OBJECTIVE • Explore patients’ perception towards their understanding on diabetes care and control • Assess social support from family and health care personnel.
  • 9. METHODS Ethical approval: Ethical Committee Ministry of Health Malaysia Location: – Rural setting – 5 health district government clinic (covering about 50,000 population each clinic) – Clinics funded by government of Malaysia
  • 10. METHODS Sample characteristics: • Diabetic patients attending four government Health Care clinic at District of Tampin, Negeri Sembilan • Randomly selected from list of uncontrolled diabetes patients in the clinic (blood HbA1c level ≥ 6.5%) Clinical Practice Guidelines, Management of Type 2 Diabetes Mellitus (Ministry of Health Malaysia, 2009)
  • 11. Government Health clinic
  • 12. In the clinic
  • 13. METHODS Inclusion criteria: • Type-2 uncontrolled diabetes mellitus • age ≥ 30 years • diagnosed with type-2 diabetes at least one year
  • 14. METHODS Data collection: • Voluntary basis and written consent • Face to face interview by trained interviewer • Guided by standardised questionnaire: – sociodemographic profile – perception about diabetes (“agree” or “do not agree”) – social and emotional support • blood HbA1c result from patient’s clinic record (at least 6 months)
  • 15. RESULTS
  • 16. RESULTS • Total of 346 respondents • Mean (SD) of age was 59.2(8.9)
  • 17. AGE GROUPS 50 43.4 45 40 33.2 35 30 25 20 15 11.9 9.2 10 5 2.3 0 30-40 41-50 51-60 61-70 >70
  • 18. RESULTS GENDER MALE 35% FEMALE 65%
  • 19. MARITAL STATUS Single 0.3 Marital Status Divorced 3.8 Widowed 11.6 Married 84.4 0 20 40 60 Percentages 80 100
  • 20. HbA1c Level Percentages of patients 43 45 40 35 30 25 20 15 10 5 0 32 25 6.5-8.0 8.0-10.0 HbA1c level (%) Mean (SD) of HbA1c: was 9.1 (1.8)% >10.0
  • 21. DURATION DIABETES • Median (IQR) of duration of having diabetes was 6 (7) years. • There was a significant positive correlation between HbA1c level and duration of suffering from diabetes (r=0.27, p<0.001) • 49.1% monitored their blood glucose level
  • 22. UNDERSTANDING DIABETES UNDERSTANDING ABOUT DIABETES AGREE % I understand the importance of diabetic medication in controlling blood glucose level 78.6 DO NOT AGREE % 21.4 I understand how to prevent from developing hyperglycemic 50.3 49.7 I understand how to control my diabetes diet 72.0 28.0
  • 23. FAMILY SUPPORT FAMILY SUPPORT My family members give support and help me to follow my diabetes diet My family members encourage and remind me on medication intake My family members accompany me for clinic follow-up My family members support me to deal with my emotion when thinking about my disease AGREE % 84.7 DO NOT AGREE % 15.3 81.6 18.4 83.6 16.4 87.8 12.2
  • 24. ADDED VALUE TO ONE HEALTH APPROACH • Diabetes patients at the rural area may face problems of lack of medical consultation by doctors as the number of doctors smaller compared to urban area and number of patients are big • Rural people should have equal opportunity and availability for good healthcare services as the people in urban area.
  • 25. CONCLUSION & RECOMMENDATION • need for holistic diabetes management approach with family participation-patients claimed received good support from their family members in dealing with their disease. • This positive situation should be taken as opportunity for better diabetes management by engaging their family members to support patients’ care.
  • 26. CONCLUSION & RECOMMENDATION • Need to explore how the family support patients in their diabetic management • Qualitative research to explore diabetic education
  • 27. THANK YOU