Theses (MSc. Public Health)

Introduction The number of people globally with Type 2 Diabetes Mellitus is projected to rise to 439 million by 2030, which represents 7.7% of the total adult population of the world. Complications due to poorly controlled Diabetes Mellitus results in poor health and quality of life .Diabetes Self -Care Activities is a key element in managing Type 2 Diabetes Mellitus, a chronic non-communicable disease. Objectives The objectives of this study were to determine the practice of Diabetes Self-Care Activities and the factors associated with the practice of DSCA among Type 2 Diabetes Mellitus patients attending the primary care Health Clinic. The study also examined the level of glycaemic control and medication compliance among the patients. Finally, the study explored the factors affecting DSCA. Methodology A facility based cross-sectional study was conducted among the sample of 450 T2DM patients in an urban public primary care Health Clinic in Kuala Lumpur. Toobert’s Summary of Diabetes Self- Care Activities (SDSCA) survey tool was adopted with modifications to explore the factors affecting non-performance of DSCA. and medication non-compliance. Descriptive and inferential statistics were used in the data analysis. Results The study population n=450 comprised of 37.6 % ethnic Indians, 32.4% % Chinese and 30% Malays. The mean age was 61.6 (+ 9.2). The mean HbA1c was 8.23 % (+ 6.51) and the mean duration of T2DM was 11.07 years (+ 6.32). Performance of home blood glucose monitoring was the most deficient, with only 2.0 % performing it on all 7 days. The mean score of diet was 5.21 ( + 1.9), exercise was 4.12 ( + 2.07),HBGM 1.28 ( + 1.9),foot care 4.16 ( + 3.08) and medication was 6.74 ( + 0.828) Performance of Home Blood Glucose Monitoring was found to be associated with gender (p=0.02,CI=.234,703,OR.405).The regression results showed male gender were more compliant (r=.022,p=0.001,CI=0.886,1.082). There was significant association between sociodemographic factors and HbA1c level [ ethnicity p= <0.001,R.352,CI=0.253-0.398]. Conclusion The study finds that practice of DSCA was poor among the T2DM patients except for medication compliance. To encourage the patients to participate in DSCA more training should be conducted with frequent feedback. The Study also showed that patients who were more compliant to DSCA had better blood glucose control which proves that DSCA can help to improve the glycaemic control. Policies to facilitate financial support are required to facilitate patients to do home blood glucose monitoring as most of the patients cited costs and unaffordability of test strips. Social support networks to encourage patients to do daily exercise with adequate intensity is also advocated to motivate and sustain patients in lifestyle modification.