Tip 2 Diyabet Mellitus Hastalarının Yaşadığı Kendini İzleme ve İlaç Engellerinin HbA1c Düzeylerine Etkisi

Year 2022, Volume: 3 Issue: 1, 53 - 63, 12.03.2022

Aysun Türe , Nilüfer Demirsoy , Özge Gödek

https://doi.org/10.48176/esmj.2022.50

Abstract

Giriş: Birçok kanıt, diyabetin ilerleyici bir hastalık olduğunu ve karmaşık tedavi algoritmalarının hastanın kendi kendine yönetimini ve eğitimini içeren sürekli, özel ve protokole dayalı tıbbi bakım gerektirdiğini göstermektedir. Araştırma, Tip 2 diyabetli hastaların kendini izleme engellerinin tedavinin başarıya ulaştığının en önemli göstergesi olan HbA1c seviyesine etkisini incelemek amacıyla yapılmıştır.
Yöntemler: Tanımlayıcı ve kesitsel nitelikteki çalışmanın örneklemini özel bir hastanenin endokrinoloji polikliniğine başvuran Tip 2 diyabetli 332 hasta oluşturmuştur. Araştırma verileri, demografik değişkenlerin sorgulandığı Kişisel Bilgi Formu, Tip 2 Diyabet hastalarında Diyabette Engeller Ölçeğinin Kendini İzleme Engelleri ve İlaç Engelleri ile toplanmıştır.
Bulgular: HbA1c’nin yaş (p=0,001), tanı süresi (p=0,013) ve ilaç engelleri boyutunu (p=0,028) etkilediği ve %12 oranında açıkladığı belirlenmiştir. Bu bağımsız değişkenlerin oto korelasyonun olmadığı yani bir birbirlerini etkilemediği belirlenmiştir. Regresyon modelinin geçerliliğine ilişkin F değerinin de (F=8.599 p=0.000) anlamlı olduğu gözlenmiştir (p<0.05).
Sonuç: Hastaların HbA1c düzeyleri ile ilaç engelleri ölçek puanı ve kendini izleme engelleri ölçek puanı değişkenleri arasında orta düzeyde bir ilişki olduğu belirlenmiştir. Tip 2 diyabetli hastaların tedavisinde başarılı sonuçlara ulaşmak için; hastaların yaşadıkları engeller belirlenmeli ve hastaların ihtiyaçlarına göre tedavi planlanmalı, hasta merkezli eğitim verilmelidir.  

Keywords

Tip 2 diyabet, kendini izleme, HbA1c, diyabet yönetimi

The Effects of Type 2 Diabetes Mellitus Patients on The HbA1c Levels of Self-Monitoring And Drug Barriers

Abstract

Introduction: Much evidence indicates that diabetes is a progressive disease and that complex treatment algorithms require ongoing, tailored, and protocol-based medical care that includes patient self-management and education. The study, it was aimed to investigate the relationship the self monitoring obstaclelevels of patients with Type 2 Diabetes to their HbA1c levels.
Methods: The sample of the descriptive and cross-sectional study consisted of 332 patients with Type 2 diabetes who applied to the endocrinology outpatient clinic of a private hospital. The data of the study were collected Personal Information Form, Self-Monitoring Barriers and Drug Barriers Scale, which are the "The Diabetes Obstacles Questionnaire (DOQ)".
Results: According to the regression model established, it was determined that HbA1c affected the age (p=0.001), duration of diagnosis (p=0.013) and the size of drug barriers (p=0.028) and explained it by 12%. It was determined that these independent variables do not have auto correlation, that is, they do not affect each other. It was observed that the F value (F = 8.599 p = 0.000) related to the validity of the established regression model was also significant (p <0.05).
Conclusion: It was found that there was a moderate relationship between the HbA1c levels of the patients and the drug barrier scale score and self-monitoring barrier scale score variables. To achieve successful results in the treatment of patients with type 2 diabetes; the obstacles experienced by the patients should be identified and treatment should be planned according to the needs of the patients and patient-centered education should be provided.

Keywords

Type 2 Diabetes, Self-Monitoring, HbA1c, Diabetes Management

References

• 1- International Diabetes Federation.(2019). Diabetes Atlas,9.ed. Available at https://www.diabetesatlas.org/en/sections/worldwide-toll-of-diabetes.html
• 2- https://www.saglik.gov.tr/TR,2643/diyabete-goz-yumma.html
• 3- WHO (2013). 10 Facts about Diabetes. http://www.who.int/features/factfiles/ diabetes/en/index.html. 2013.
• 4- International Diabetes Federation.(2017). Guideline on self-monitoring of blood glucose in non-insulin treated type 2 diabetes. Available at https://www.idf.org/e-library/guidelines/85-self-monitoring-of-blood-glucose-in-non-insulin-treated-type-2-diabetes.html
• 5- Chatterjee S, Khunti ., Davies M.J.(2017). Type 2 diabetes. The Lancet, 389(10085) 2239-2251. https://doi.org/10.1016/S0140-6736(17)30058-2
• 6- Zhuo X, Zhang P, Barker L, et al.(2014). The lifetime cost of diabetes and its implications for diabetes prevention. Diabetes Care, 37(9),2557-64. doi:10.2337/dc13-2484. https://doi.org/10.2337/dc13-2484
• 7- Wu Y, Goldman, D. P. (2016). Impact of type 2 diabetes medication cost sharing on patient outcomes and health plan costs. Am J Manag Care, 22(6), 433-440.
• 8- Nakao, M, Hara Y, Ishihara Y.(2016). Psychological impacts from expectation ofworsening conditions and obstacles to life planning are affected by glycemic control, self-reported symptoms, and drug therapy in patients with type 2 diabetes mellitus. J Diabetes Investig, 7, 420–428. https://doi.org/10.1111/jdi.12419
• 9- Schnell O, Hanefeld M, Monnier L.(2014). Self-monitoring of blood glucose: a prerequisite for diabetes management in outcome trials. Journal of Diabetes Science and Technology, 8(3), 609-614.
• 10- Guo J, Long Q, Li J, et al. (2020). Barriers and facilitators of self-monitoring of blood glucose engagement among women with gestational diabetes mellitus in China: A mixed-methods study. Midwifery, 90, 102797.
• 11- Ong W.M, Chua S.S, Ng C.J.(2014). Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Preference and Adherence, 8,237. https://doi.org/10.2147/PPA.S57567.
• 12- Higgins T.(2013). HbA1c for screening and diagnosis of diabetes mellitus. Endocrine, 43(2),266e73. https://doi.org/10.1007/s12020-012-9768-y
• 13- Stratton I.M, Adler A.I, Neil H.A.W, et al.(2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ, 321(7258),405-412. https://doi.org/10.1136/bmj.321.7258.405
• 14- Diyabet Tanı ve Tedavi Rehberi- TURKDİAB. (2019). Ulusal Diyabet Konsensus Grubu,Türkiye Diyabet Vakfı,İstanbul. https://turkdiab.org/admin/PICS/files/Diyabet_Tani_ve_Tedavi_Rehberi_2019.pdf
• 15- American Diabetes Association (2011). Standards of medical care in diabetes-2011. Diabetes Care, 34,S11e61. https://doi.org/10.2337/dc11-S011
• 16- Allemann S, Houriet C, Diem P, et al.(2009). Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Current Medical Research and Opinion, 25(12),2903-2913. https://doi.org/10.1185/03007990903364665
• 17- Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi Ve İzlem Kılavuzu. (2018). Türkiye Endokrinoloji ve Metabolizma Derneği, Ankara. http://temd.org.tr/admin/uploads/tbl_kilavuz/20180814161019-2018tbl_kilavuz6c373c6010.pdf
• 18- Martin S, Schneider B, Heinemann L. et al.(2006). Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study. Diabetologia, 49,271-278. https://doi.org/10.1007/s00125-005-0083-5
• 19- Peel E, Parry O, Douglas M, et al.(2004). Blood glucose selfmonitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients’ perspectives. Br J Gen Pract, 54,183- 188. https://doi.org/10.1136/bmj.39302.444572.DE
• 20- International Diabetes Federation. (2011). Guideline for Management of Postmeal Glucose in Diabetes. Brussels, Belgium: IDF. https://www.idf.org/e-library/guidelines/82-management-of-postmeal-glucose.html
• 21- Rydén L, Grant P.J, Anker S.D. et al.(2013). ESC Guidelines on diabetes,pre-diabetes, and cardiovascular diseases developed incollaboration with the EASD: the Task Force on diabetes, prediabetes,and cardiovascular diseases of the European Societyof Cardiology (ESC) and developed in collaboration with theEuropean Association for the Study of Diabetes (EASD). Eur Heart J, 34,3035-3087. https://doi.org/10.1177/1479164114525548.
• 22- American Diabetes Association.(2013). Standards of medical care indiabetes—2013. Diabetes Care, 36,S11-S66. https://doi.org/10.2337/dc13-S011
• 23- Blonde L, Aschner P, Bailey C, et al.(2017). Global Partnership for Effective Diabetes Management. Gaps and barriers in the control of blood glucose in people with type 2 diabetes. Diabetes and Vascular Disease Research, 14(3),172-183. https://doi.org/10.1177/1479164116679775
• 24- The Action to Control Cardiovascular Risk in Diabetes Study Group (2008). Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med, 358, 2545–2559. https://doi.org/10.1056/NEJMoa0802743
• 25- Patel A, MacMahon S, Chalmers J, et al.(2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med, 358, 2560–2572. https://doi.org/10.1056/NEJMoa0802987
• 26- Duckworth W, Abraira C, Moritz T, et al.(2009). Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med, 360, 129–139. https://doi.org/10.1056/NEJMoa0808431
• 27- Hearnshaw H, Wright K, Dale J, et al.(2007). Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes. Diabetic Medicine, 24(8),878-882. https://doi.org/10.1111/j.1464-5491.2007.02137.x
• 28- Vandekerckhove M, Vermeire E, Weeren A, Van Royen P.(2009). Validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with type 2 diabetes in a Belgian population. Primary Care Diabetes, 3(1), 43-47. https://doi.org/10.1016/j.pcd.2009.02.003
• 29- Soon S.S, Goh S.Y, Bee Y.M, Poon J.L, Li S.C, Thumboo J, Wee H.L.(2010). Audit of Diabetes-Dependent Quality of Life (ADDQoL) [Chinese Version for Singapore] questionnaire: reliability and validity among Singaporeans with type 2 diabetes mellitus. Appl Health Econ Health Policy, 8(4),239-49. https://doi.org/10.2165/11313920-000000000-00000
• 30- Pilv L, Vermeire E, Rätsep A, et al.(2016). Development and validation of the short version of the diabetes obstacles questionnaire (DOQ-30) in six European countries. Eur J Gen Pract,22(1),16-22. https://doi.org/10.3109/13814788.2015.1093619
• 31- Kahraman G, Tavsanli N.G, Baydur H, et al.(2016). Tip-2 diyabet hastalarında Diyabette Engeller Ölçeğinin geçerlilik ve güvenilirlik çalışması. Anadolu Psikiyatri Dergisi, 17(S1),33-45. https://doi.org/10.5455/apd.184116
• 32- Welch G, Garb J, Zagarins S, et al.(2010). Nurse diabetes case management interventions and blood glucose control: results of a meta-analysis. Diabetes Research and Clinical Practice, 88(1), 1-6. https://doi.org/10.1016/j.diabres.2009.12.026
• 33- Aliha J.M, Asgari M, Khayeri F, et al. (2013). Group education and nurse-telephone follow-up effects on blood glucose control and adherence to treatment in type 2 diabetes patients. International Journal of Preventive Medicine, 4(7),797.
• 34- Glasgow R.E, Anderson R.M.(1999). In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. Diabetes Care,22,2090–2. https://doi.org/10.2337/diacare.22.12.2090
• 35- Raine C.I. (2003).Self-monitored blood glucose: a common pitfall. Endocrine Practice, 9, 137-39. https://doi.org/10.4158/EP.9.2.137
• 36- Muchmore D, Springer J, Miller M. (1994). Self-monitoring of blood glucose in overweight type 2 diabetic patients. Acta Diabetol, 31, 215-19. 25. https://doi.org/10.1007/bf00571954
• 37- Bergenstal R, Pearson J, Cembrowski G, et al.(2000). Identifying variables associated with inaccurate self-monitoring of blood glucose of blood glucose:proposed guidelines to improve accuracy. Diabetes Educ, 26, 981-89. https://doi.org/10.1177/014572170002600610
• 38- Al-Elq A.H.(2009). Current practice in the management of patients with type 2 diabetes mellitus in Saudi Arabia. Saudi Med J, 30(12),1551-1556.
• 39- Eledrisi M, Alhaj B, Rehmani R, et al.(2007). Quality of diabetes care in Saudi Arabia. Diabetes Research and Clinical Practice, 78(1),145-146. https://doi.org/10.1016/j.diabres.2007.02.017
• 40- Al-Hussein F.A.(2008). Diabetes control in a primary care setting: a retrospective study of 651 patients. Annals of Saudi medicine, 28(4),267-271. https://doi.org/10.5144/0256-4947.2008.267
• 41- Diabetes DE, Deutscher Gesundheitsbericht Diabetes 2013. Deutsche Diabetes-Hilfe, Berlin. https://www.diabetesde.org/system/files/documents/diabetes_gesundheitsbericht_2013.pdf
• 42- Durai V, Samya V, Akila G.V, et al. (2021). Self-care practices and factors influencing self-care among type 2 diabetes mellitus patients in a rural health center in South India. Journal of Education and Health Promotion, 10(1), 151.
• 43- Alhariri A, Daud F, Almaiman A, et al. (2017). Factors associated with adherence to diet and exercise among type 2 diabetes patients in Hodeidah city, Yemen. Life, 7(3), 264-271.
• 44- Marinho F.S, Moram C, Rodrigues P.C, Leite N.C, Salles G.F, Cardoso C.R. (2018). Treatment adherence and its associated factors in patients with type 2 diabetes: results from the Rio de Janeiro type 2 diabetes cohort study. Journal of diabetes research, 1-9.
• 45- Schmitt A, Reimer A, Hermanns N, et al.(2016). Assessing diabetes self-management with the Diabetes Self-Management Questionnaire (DSMQ) can help analyse behavioural problems related to reduced glycaemic control. PLoS One, 11(3). https://doi.org/10.1371/journal.pone.0150774
• 46- Tai J.C.J, Wong L.Z, Richardson A. (2021). Self-Monitoring of Blood Glucose for Patients With Type 2 Diabetes in Primary Care: A Single-Centre, 10-Year Retrospective Analysis. Cureus, 13(6).
• 47- Hou Y.Y, Li W, Qiu J.B, et al.(2014). Efficacy of bloodglucose self-monitoring on glycemiccontrol in patientswithnon-insulin-treatedtype 2 diabetes: A meta-analysis. International Journal of Nursing Sciences,1(2),191-195. https://doi.org/10.1016/j.ijnss.2014.05.003
• 48- McGovern A, Tippu Z, Hinton W, et al. (2018). Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta‐analysis. Diabetes, Obesity and Metabolism, 20(4), 1040-1043.