دراسة تقيمية لبرنامج رعاية مرضى السكري في مركز السكري التابع لمستشفى المطلع في الفترة ما بين 2005 – 2009
سماح موسى أحمد الخطيب
SAMAH MUSA AHMAD ALKHATIB
Background: Nutritional intervention program is an integral and essential component of diabetes management and care. It aims to optimize diabetes control and to prevent complications. People with diabetes are advised to implement healthy diet; dietary changes including modifications in food habits and meal patterns for life long. However, a significant amount of patients remain with limited control. Study aim and objectives: The aim of the study was to evaluate the effectiveness of the Diabetes Care Program in controlling diabetes among type 2 diabetic patients registered at the diabetes care center at Augusta Victoria Hospital. The objectives were to examine the effect of nutrition counseling on HbA1c level and the effect of the program on patients’ physical health, body mass index throughout the follow up period and to identify patients socio-demographic characteristics in determining her/his response to the program. Methodology: This evaluative file based study was conducted on 746 patients’ with type 2 diabetes who were followed at the Diabetes Care Center of Augusta Victoria Hospital between years 2005 to 2009. Four visits were taken for every patient including the first and final results, but the period between these visits were not regular and similar for all patients. Personal, medical and family history, physical examination and laboratory evaluation data were extracted from the patients’ files. Results: Analysis of patients' data showed that the mean age of the patients was 57 years ± 9.34(mean ± S.D). Of the study population, 84% were married and 53% were females. 74% did not work, 15% were illiterate, the mean duration of having diabetes was 10.08 years and 57.2% had MOH insurance.41% of the patients were given a diet of 1000 Calories during the study period .82% of the patients were classified as with light physical activity in the 1st visit and 76% were in the 4th visit. The mean HbA1c in the 1st visit was9.08±2.1 and in the 4th visit 8.46 ±1.7. The mean BMI in the 1st visit was 31.2±5.3 and in the 4th visit 31.9 ±5.3. The study identified factors associated with good glycemic control, as measured by HbA1c levels. The percentage of patients with optimal control (HbA1c <7%) increased from 19.2% at the first visit to22.1% at the 4th visit. 60.7% of the patients had good change in HbA1c between the 1st and 4th visit. The multivariate logistic regression model for the study population (n=746) showed that between the first and last IV recorded visit, being registered in the center was associated with the good change in HbA1c but was inversely associated with good change in MAU. Age, residency, type of insurance, smoking, BMI, physical activity, cholesterol level and caloric intake did not show any significant associations with good change in HbA1c in this period of study. Conclusion: This is the first study done in the Diabetes Care Center which identified the determinants of the change in HbA1c and evaluate the program which shows that there was an irregular follow up period between the visits of the patients, which was shown in the results as an important factor in determining the change in HbA1c level. Results recommends the need for modification of the dietary program through involving the patients in this modification to increase their adherence to the program , system of appointment for follow up and evaluation of the compliance of patients with the diet, physical activity and as well as the medication.
الإدارة الصحية , Health Management