BY: FARWA MOLOOU29/35723/2010

SUPERVISOR: DR AMUGUNE

INTRODUCTIONDiabetes growing epidemic threatening to overwhelm

health services and undermine economies, especially in the developing countries( WHO, 2008).

Diabetes is a chronic disorder characterized either by: inability of the pancreas to synthesize and secrete

insulin or properly utilize insulin resulting in chronic

hyperglycemia.

…….If diabetes is not managed appropriately,

complications can arise including:Skin infectionsGlaucomaCataractsDiabetic footDiabetic ketoacidosis

•Gastroparesis

•Hypertension

•Diabetic Neuropathy

•Stroke

INTRODUCTION…

To achieve optimum control of condition important

consideration on:

Compliance to pharmacological management

Compliance to non pharmacological management

Laboratory support: glucose , lipid and glycated hemoglobin level

measurements.

A pharmacist’s role crucial

STUDY RATIONALE

Studies show most health care workers in

developing countries aim only to provide the

patients with medications but without appropriate

information on: lifestyle, medications side effects importance of medication compliance.

a pharmacist can reduce prevalence by having an appropriate pharmaceutical plan for medication related problems

STUDY OBJECTIVESOverall objective

To evaluate the management of diabetic patients at the out- patient diabetic clinic in Kenyatta national hospital

Specific objectivesTo assess diabetic patients compliance to their anti-diabetic

medications.To determine the factors that lead to non compliance to anti-

diabetic therapy.To explore the various approaches that may be adapted by a

pharmacist to reduce non compliance.To determine the non- pharmacological support services provided

as part of the diabetes management plan.

METHODOLOGY

Study design: a mixture of:

retrospective-patients’ files were perused,

Prospective-participants interviewed using a questionnaire.

Study Site: KNH outpatient diabetic clinic

Study population: Patients mainly resided within Nairobi.

Sample size: 140 Informed and consented diabetic patients

participated.

Study approval: KNH- UON ERC

RESULTS AND DISCUSSION 70 % of the patients were type 2 diabetics that

lay in 51 to 60 years age range

RESULTS AND DISCUSSION…Most patients adhered to their medications but did not adhere to

strict diet and exercise regimes.

67% of the patients were obese and 60 % were on blood pressure

medications.

RESULTS AND DISCUSSION…

Some type two obese patients reported not attending regular counseling sessions and experienced problems such as: Visual disturbancesNumbness/ burning sensation on the

footHigh cholesterolKidney problemsAmputation of the toe

RESULTS AND DISCUSSION…

Type one diabetics reported challenges in: Measuring insulin doseCost of the insulinForgetting to inject at the right time.

Patients checked their blood sugar often and

could detect when they were hypoglycemic from the

symptoms they experienced

However, detection of the hyperglycemic state

seemed to pose a problem in 31 % of the patients.

RESULTS AND DISCUSSION…

Patients

Were familiar with the ideal meal plan for a diabetic

exercised daily but the intensity of exercise was reported to be

easy.

RESULTS AND DISCUSSION…

Alcohol and tobacco consumption was not observed as a

problem amongst participants.

33 % were on insulin, 36 % t on tablets and the rest were on

combination therapy (insulin and tablets).

RESULTS AND DISCUSSION…Low compliance observed 10 % of the participants

due to:Cost of the medicationsLack of drug informationIgnoranceForgetfulness in the old agedIrregularities in attending diabetic clinicsPill burdenSide effects of medicinesDifficulty in measuring the dose of insulinDifficulty in adhering to time due to work constraints

RESULTS AND DISCUSSION…

41% percent of patients had been sent for HbA1CBP, weight and blood glucose were checked at every

visitPatients regularity of getting cholesterol, urine and

eye tests depended on if they could afford it.

RESULTS AND DISCUSSION…

There was no pharmacist at the diabetic clinicPatients bought their medications from a separate

pharmacy.Aim at the pharmacy was to clear the long queue

rather then counsel patients.

CONCLUSION AND RECOMMENDATIONS

There is a correlation between non

compliance to pharmacological & non

pharmacological management of diabetes and

development of complications.

A pharmacist should be incorporated in the

medical team at the diabetic clinic in order to

reduce non compliance in patients.

RECOMMENDATIONSRole of the pharmacist be :

Choosing medications that require less frequent

administration with few or no side effects

Counseling patients on expected side effects and how to

minimize them

Educating patients to keep diaries/set reminders

Counseling patients on consequences of non compliance

and regular follow up

In the assessment, identification, education, referral and

monitoring of the condition.

THANK YOU