Transcript PROJECT PRESENTATION_2

BY: FARWA MOLOO
U29/35723/2010
SUPERVISOR: DR AMUGUNE
INTRODUCTION
 Diabetes 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
complications can arise including:
appropriately,
 Skin infections
•Gastroparesis
 Glaucoma
•Hypertension
 Cataracts
 Diabetic foot
 Diabetic ketoacidosis
•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 OBJECTIVES
 Overall objective
To evaluate the management of diabetic patients at the out- patient
diabetic clinic in Kenyatta national hospital
 Specific objectives
 To assess diabetic patients compliance to their anti-diabetic
medications.
 To determine the factors that lead to non compliance to antidiabetic 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
Age of diabetic patients
40.00%
35.00%
30.00%
25.00%
20.00%
Number of patients
15.00%
10.00%
5.00%
0.00%
20-30
31-40
41-50
51-60
61-70
71-80
81-90
91-100
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.
BMI of patients
Overweight
Obese
Underweight
Normal
RESULTS AND DISCUSSION…
 Some type two obese patients reported
not attending regular counseling sessions
and experienced problems such as:
 Visual disturbances
 Numbness/ burning sensation on the
foot
 High cholesterol
 Kidney problems
 Amputation of the toe
RESULTS AND DISCUSSION…
 Type one diabetics reported challenges in:
 Measuring insulin dose
 Cost of the insulin
 Forgetting 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.
Regularity of exercise
Sometimes
Often
4.80%
0.97%
10.70%
Occasionally
Series1
Every 3 days
1.90%
77.70%
Daily
Three time a week
2.90%
0.00% 10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%
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).
Types of medication
Combination
(tablets+Insuli
n)
30%
Oral
hypoglycemics
36%
Insulin
34%
RESULTS AND DISCUSSION…
Low compliance observed 10 % of the participants
due to:
 Cost of the medications
 Lack of drug information
 Ignorance
 Forgetfulness in the old aged
 Irregularities in attending diabetic clinics
 Pill burden
 Side effects of medicines
 Difficulty in measuring the dose of insulin
 Difficulty in adhering to time due to work constraints
RESULTS AND DISCUSSION…
 41% percent of patients had been sent for HbA1C
 BP, weight and blood glucose were checked at every
visit
 Patients 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 clinic
 Patients 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.
RECOMMENDATIONS
Role 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