People with diabetes adherence to drug, dietary, and lifestyle changes in Erbil city, Iraq

Knowledge, Attitudes, and Practices (KAP) of Postgraduate Medical Trainees Regarding Patient Care in Diabetes and Hypertension

BACKGROUND

Diabetes and hypertension are common chronic illnesses that need to be effectively managed. To improve patient outcomes, healthcare workers' knowledge, attitudes, and practices (KAP) are essential.

OBJECTIVE

This study aimed to evaluate the KAP of postgraduate medical trainees regarding the management of diabetes and hypertension.

METHODOLOGY

A cross-sectional study was conducted over one year from January 2023 to December 2023. The study participants were 384 postgraduate medical trainees who fulfilled the predetermined inclusion and exclusion criteria. A validated questionnaire that evaluated attitudes toward patient-centered care, knowledge of clinical guidelines, and illness management methods was used to gather data. SPSS version 26 (IBM Corp., Armonk, NY) was used for statistical analysis to investigate correlations between KAP levels and demographic characteristics.

RESULTS

Of the 384 trainees, 320 (83.33%) correctly identified clinical guidelines for diabetes management and 290 (75.75%) for hypertension management. The majority (350 (91.67%)) supported patient-centered care, with 320 (83.33%) believing that patients should be actively involved in treatment decisions. In terms of practices, 300 (78.13%) regularly monitored blood glucose levels, and 320 (83.33%) routinely checked blood pressure in hypertensive patients. Adherence to national treatment guidelines was reported by 280 (72.92%) for diabetes and 270 (70.31%) for hypertension. Younger trainees and those with 6-12 months of clinical experience exhibited higher KAP scores. Significant associations were found between age, clinical experience, and training program and KAP levels.

CONCLUSION

Although postgraduate trainees show strong knowledge of and favorable attitudes toward managing diabetes and hypertension, there is room for improvement in their practical application, particularly with regard to medication adherence and following guidelines, in order to provide high-quality patient care.

The Psychological Impact of Diabetes as a Risk Factor for Erectile Dysfunction at the Layla Qasim Center in Erbil City, Iraq

Background Diabetes mellitus is a chronic metabolic disorder that can lead to various complications, including erectile dysfunction (ED). Therefore, this study aimed to investigate the relationship between ED and psychological factors (anxiety, stress, and depression) in Erbil City, Iraq. Methodology Using a purposive sampling method, this cross-sectional study was conducted from June 15th to November 27th, 2023, at the Layla Qasim Center in Erbil City. The questionnaire included demographic information, the Depression, Anxiety and Stress Scale - 21 Items for assessing depression, anxiety, and stress, and the International Index of Erectile Dysfunction Questionnaire. Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX, USA). Significance levels were considered at p-values <0.05. Results A total of 403 participants were included in the study. The mean score for depression was 9.95 ± 4.99, indicating moderate levels of depression. Anxiety levels were more severe, with a mean score of 9.25 ± 4.25, while stress levels were moderate with a mean score of 11.63 ± 3.91. ED scores indicated mild-to-moderate ED, with a mean score of 13.46 ± 4.30. There was a significant negative correlation between ED and depression (r = -0.11, p < 0.001), anxiety (r = -0.16, p < 0.001), and stress (r = -0.13, p < 0.001). Conclusions The study demonstrated a significant negative correlation between ED, depression, anxiety, and stress among diabetic patients. Policymakers and healthcare providers should develop targeted interventions to address psychological factors and support ED in diabetic patients.

Measuring Diabetic Medication Adherence and Factors That Lead to Non-adherence Among Patients in Erbil

Introduction T2D is a chronic and progressive disorder characterized by persistent hyperglycemia resulting from inadequate insulin secretion or utilization. The global prevalence of T2D is increasing rapidly, posing a significant health burden in many regions. In the Kurdistan region of Iraq, T2D presents a significant health burden, exacerbated by socioeconomic changes, dietary shifts, and rising obesity rates. Poor adherence to antidiabetic medications is a major factor contributing to poor glycemic control, accelerating disease progression, and increasing complications. This study aims to assess medication adherence rates among adult T2D patients in Erbil using the Kurdish version of the Morisky Medication Adherence Scale-8 (MMAS-8) and identify factors associated with non-adherence. Methods We conducted a cross-sectional study at public and private clinics in Erbil City, Kurdistan, Iraq, between May 1 and September 30, 2023. A convenience sample of 300 adult Kurdish T2D patients, aged ≥ 25 years and on antidiabetic medications for three months or more, was recruited. Data were collected using a structured questionnaire comprising sociodemographic characteristics, clinical and anthropometric measures, and medication adherence assessed by the Kurdish version of the MMAS-8. Statistical analysis included analysis of variance, Kruskal-Wallis, chi-square, and logistic regression models to identify factors associated with medication adherence. Results Of the 300 participants, 81 (27%) demonstrated high adherence, 98 (32.6%) moderate adherence, and 121 (40.3%) low adherence based on the MMAS-8. Low adherence was significantly associated with lower education (56/121, 46.3% vs. 13/81, 16.0%, p < 0.001), unemployment (73/121, 60.3% vs. 29/81, 35.8%, p = 0.008), rural residence (41/121, 33.9% vs. 10/81, 12.3%, p < 0.001), and lower income (62/121, 51.2% vs. 12/81, 14.8%, p < 0.001). High adherence was linked to better diabetes knowledge, home glucose monitoring, and exercise. High adherence was also associated with better glycemic control, with 76/81 (93.8%) of highly adherent patients achieving glycated hemoglobin (HbA1c) <7%, compared to 15/121 (12.4%) in the low adherence group (p < 0.001). Multivariate analysis identified HbA1c, dyslipidemia, and home blood glucose monitoring as independent factors associated with high adherence. Conclusions This study highlights the substantial impact of socioeconomic, behavioral, and clinical factors on medication adherence among T2D patients in Erbil. Low adherence is associated with lower education, income, and awareness of diabetes management, while high adherence is linked to improved glycemic control and reduced complications. Targeted interventions addressing these factors are essential to enhance adherence and optimize T2D management in this population.

Knowledge about type 2 diabetes: its impact for future management

Diabetes can cause several long-term complications. Knowledge about this disease can play an important role in reducing diabetes-related complications. In addition, the lack of awareness leads to misconceptions, which joined with inadequate knowledge, are relevant barriers to proper diabetes management. In this study, we aimed to assess the diabetes knowledge of a type 2 diabetes (T2D) population and identify major knowledge gaps, in order to prevent complications and to increase quality of life. In a cross-sectional, observational study in a convenience sample, we identified individuals diagnosed with T2D attending ambulatory visits from five health settings, older than 18 years, with a time diagnosis of at least 1 year, and attending multidisciplinary visits for at least 3 months. To assess the knowledge of T2D individuals, we applied the Portuguese version of the Diabetes Knowledge Test. The sample included a total of 1,200 persons, of whom almost half were female. The age range of the participants varied from 24 to 94 years old, and the mean age was 65.6 ± 11.4 years. Most of the sample had a level of education under secondary and lived with someone. In our sample, 479 (39.9%) were insulin-treated. The percentage of correct answers was 51.8% for non-insulin vs. 58.7% for insulin treated (p < 0.05). There were three items with a percentage of correct answers lower than 15%; the item with the lower value of correct answers was the one related to the identification of signs of ketoacidosis with only 4.4% of correct answers, the errors presented a random pattern; the item related to the identification of which food should not be used to treat low blood glucose with 11.9%, where 56.9% of the sample's participants considered that one cup of skim milk would be the correct answer (53.1% in non-insulin patients and 62.6% in insulin treated patients; p < 0.001). The item regarding the knowledge of free food presented a 13.3% of correct answers (10.8% non-insulin group vs. 17.1% insulin group; p < 0.01). Two of the three items with lower value of correct answers were related to glycemic control and health status monitoring, the other was related to diet and food.

Co-occurrence of Modifiable Risk Factors for Cardiovascular Disease amongst Diabetic Patients in Lagos State, Nigeria

BACKGROUND

Diabetes significantly increases the likelihood of developing cardiovascular disease (CVD). This risk can be reduced by addressing modifiable risk factors. The objectives of this study were to assess the modifiable risks for CVD amongst persons with diabetes and identify the factors associated with multiple risk factors.

METHODS

This cross-sectional study was conducted amongst 357 diabetic patients attending a large tertiary hospital in Southwest Nigeria. Eligible patients were recruited consecutively on clinic days till the minimum sample size was reached. An interviewer-administered survey tool adapted from the World Health Organization STEPS was used to obtain information from study participants. The following risk factors were assessed: tobacco use, obesity, high blood pressure, physical activity, sedentary time and hours of sleep. Data were analysed using the STATA version 15.0 (Stata Corp.) statistical programme.

RESULTS

The mean age of the participants was 61.7 ± 12.6 years, and they were mostly females (63.9%). Of the risk factors assessed, the most prevalent modifiable risk factors amongst the respondents were inadequate sleep - <8 h on average (91.6%), abdominal obesity (82.6%) and high blood pressure (72%). Others were inadequate physical activity (56%) and lifetime tobacco use (21%). Up to 40.3% of the diabetic persons had three or more co-existing CVD risk factors. Age, gender, work and marital status (P ≤ 0.01) were statistically associated with multiple CVD risk factors. Being male, unmarried and increasing age were predictors of multiple CVD risk factors amongst the diabetic patients.

CONCLUSION

A significant proportion of the diabetic patients have multiple co-existing modifiable CVD risks. Abdominal obesity and poor sleep were the most prevalent. Older men who are unmarried were more likely to have multiple risks. Primary and secondary preventive measures to address CVD risks amongst diabetic patients are warranted and should target older unmarried men.