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 appropriately, complications can arise including: Skin infections Glaucoma Cataracts Diabetic foot Diabetic 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 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 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 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.

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 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.

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