Self-perceived health and metabolic control in Tanzanian diabetic patients

Objectives: To analyse self-perceived health and metabolic control over a two-year period in a group of urban adult diabetic patients in Dar es Salaam, Tanzania.Design: A longitudinal study with cross-sectional measurements of metabolic control and self-perceived health.Setting: The study was carried out at the diabetes out-patient clinic of Muhimbili Medical Centre and at three district hospitals in the Dar es Salaam area in Tanzania.Subjects: In 1995, one hundred and fifty consecutive diabetic patients (M/F:78/72) were seen. A re-organisation of the diabetes care was done in 1996. Due to difficulties in tracing the patients after the re-organisation, 50.4% of them were re-assessed in 1997.Main outcome measures: The Swahili version of SF-36 health questionnaire was used to assess health. HbA1c and fasting blood-glucose were used to evaluate metabolic control.Results: In patients assessed both in 1995 and 1997 significant improvements were found in the socialand emotional functioning health domains. The mean HbA1c valuewas significantly improved after the two years (9.3±3.2% in 1995 versus 7.5±2.8%). Significant negativecorrelations were found between metabolic control and the health domains bodily pain, general health and vitality.Conclusions: The study has highlighted the difficulties in performing follow up studies and it is most important to put lot of effort in informing patients prior to re-organisation of the care. Furthermore, our findings have shown that Tanzanian diabetic patients had improved their self-perceived health in social and emotional functioning and they had an improved metabolic control over the two-year period indicating an improved diabetes care

Self-rated health and factors influencing responses among young Egyptian type 1 diabetes patients

<p>Abstract</p> <p>Background</p> <p>Patients diagnosed with type 1 diabetes mellitus (T1DM) face major daily challenges. Self-rated health (SRH) is a global measure of an individual's health related quality of life (HRQoL) and is based on the question, "In general, how would you rate your health?" Subjects rate their health as excellent, very good, good, poor or very poor. Our objective was to determine the HRQoL using the SRH measure and determine factors influencing responses. We hypothesized that better SRH responses were associated with shorter diabetes duration, better compliance and better glycemic control.</p> <p>Methods</p> <p>The standardized SRH measure was the instrument used for health related quality of life assessment. Logistic regression analysis was used to examine the association between SRH responses and selected variables.</p> <p>Results</p> <p>124 subjects, 64 females (51.6%) and 60 males (48.4%) were included. Average age was 13.08 (±3.19) and average diabetes duration was 5.82 (±1.60), while the mean HbA₁C was 8.02 (±1.60). The majority rated their health as good (31%), 29% rated it as excellent, 11% as very good, 14% as poor and 15% as very poor. Regression analysis showed that regular exercise was the only predictor that was independently and significantly associated with a "better" self-health rating, with an OR of 12.84, CI of 1.425-115.727 and a <it>p </it>value of 0.023.</p> <p>Conclusion</p> <p>Regular exercise among Egyptian children with T1DM is strongly associated with a "better" overall health related quality of life and should be repeatedly encouraged.</p

Teenagers' perceptions of factors affecting decision-making competence in the management of type 1 diabetes

AIMS: Decision-making is an important prerequisite for empowerment. The aim of this study was to explore teenagers' perceptions of factors affecting decision-making competence in diabetes management. BACKGROUND: A previous study that assessed an empowerment programme for teenagers with diabetes showed no effects on metabolic control or empowerment outcomes, which is not in accordance with results from studies on adult diabetes patients. The definition of empowerment highlights the patient's own responsibility for decision-making. Earlier studies have shown that many teenagers' may not be mature in decision-making competence until late adolescence. To explore the significance of decision-making competence on the effectiveness of empowerment education we wanted to explore teenagers' own view on factors affecting this competence. DESIGN: An explorative, qualitative interview study was conducted with 31 teenagers with type 1 diabetes, aged 12-17 years. METHODS: The teenagers were interviewed two weeks after completing an empowerment education programme. The interviews were analysed using qualitative content analysis. RESULTS: Five categories stood out as important for decision-making competence: cognitive maturity, personal qualities, experience, social network and parent involvement. Based on the content in the interviews and the five categories, we made an interpretation and formulated an overall theme: 'Teenagers deserve respect and support for their short-comings during the maturity process'. CONCLUSION: Our conclusion is that teenagers deserve respect for their immature decision-making competence. Decision-making competence was described as cognitive abilities, personal qualifications and experience. To compensate for the deficiencies the teenagers deserve constructive support from their social network and the essential support is expected to come from their parents. RELEVANCE TO CLINICAL PRACTICE: These findings can be useful for diabetes team members in supporting teenagers with diabetes and their parents both in individual meetings and when planning and delivering group education