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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.
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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. |
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