Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study

BACKGROUND: Preventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients' attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events. METHODOLOGY: A cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0-4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities. RESULTS: A total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients' problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients' problem-solving ability (p < 0.05). CONCLUSIONS: Healthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management

Early diastolic filling dynamics in diastolic dysfunction

BACKGROUND: The aim of the study was to determine the relationship between the rate of peak early mitral inflow velocity and the peak early diastolic mitral annular tissue velocities in normal controls and to compare them with subjects with diastolic dysfunction. METHODS: The relationship between early passive diastolic transmitral flow and peak early mitral annular velocity in the normal and in diastolic dysfunction was studied. Two groups comprising 22 normal controls and 25 patients with diastolic dysfunction were studied. RESULTS: Compared with the normal group, those with diastolic dysfunction had a lower E/A ratio (0.7 ± 0.2 vs. 1.9 ± 0.5, p < 0.001), a higher time-velocity integral of the atrial component (11.7 ± 3.2 cm vs. 5.5 ± 2.1 cm, p < 0.0001), a longer isovolumic relaxation time 73 ± 12 ms vs. 94 ± 6 ms, p < 0.01 and a lower rate of acceleration of blood across the mitral valve (549.2 ± 151.9 cm/sec(2 )vs. 871 ± 128.1 cm/sec(2), p < 0.001). They also had a lower mitral annular relaxation velocity (Ea) (6.08 ± 1.6 cm/sec vs 12.8 ± 0.67 cm/sec, p < 0.001), which was positively correlated to the acceleration of early diastolic filling (R = 0.66), p < 0.05. CONCLUSIONS: This investigation provides information on the acceleration of early diastolic filling and its relationship to mitral annular peak tissue velocity (Ea) recorded by Doppler tissue imaging. It supports not only the premise that recoil is an important mechanism for rapid early diastolic filling but also the existence of an early diastolic mechanism in normal

Adherence to cardiovascular medications among Arabic women living in Kuwait

BACKGROUND: Little is known about Arab women’s (AW) perceptions of medication use in Kuwait. Women with cardiovascular disease (CVD) manage their condition in the context of their lives and responsibilities, so a culturally adapted intervention may have a greater impact on individual behaviour. This study aims to assess adherence to CVD medications among Arab women with cardiovascular disease (AW-CVD), to explore barriers to adherence from the perspectives of both patients and healthcare providers (HCP), to examine possible service developments and to make recommendations to optimise treatment outcomes. METHOD: A mixed methods approach was used, including a cross-sectional survey (N=270) followed by 29 face-to-face and telephone semi-structured interviews with AW-CVD and 17 face-to-face interviews with HCP. Settings: Multiple health centres across Kuwait (N=10). Survey instruments: Patients’ demographics, clinical variables, the 8-item Modified Morisky Adherence Scale (MMAS-8), the Brief Illness Perception Questionnaire, the Beliefs about Medication Questionnaire (Necessity and Concern Scale), social support from family and friends section of the Chronic Illness Resources Survey, measurement of healthcare provisions, beliefs about herbal remedies, and measurement of CVD self-care behaviours. All interviews investigated perceived barriers to medication adherence. The HCP interviews further explored HCPs’ current practice, their suggestions on how to improve current practice and a discussion on the difficulties and opportunities of applying these suggestions. Alongside a review of existing worldwide models of chronic disease management, the collected data helped inform the development of culturally sensitive chronic care services and behaviour change intervention. RESULTS: Ninety-three per cent of AW-CVDs were sub-optimally adherent to medications based on MMAS-8. Several barriers to medication adherence were identified from both AW-CVD and HCP perspectives: patient-related factors, HCP-related factors, disease-related factors, therapy-related factors and social factors. The HCPs tried to support medication adherence by educating the patients, simplifying the treatment regimen and ensuring the availability of medications. However, a number of limitations in their work structure restrict such progress, including time constraints, shortage of work force, lack of training and resources, lack of performance evaluations and poor cooperation among HCPs. The development of a chronic disease management model was proposed to overcome this gap. Such a model would suggest integrated services in which the HCP is provided with the necessary skills and resources to educate patients to become proactive and make informed decisions with the support of their communities. CONCLUSION: This research extends our knowledge of barriers to CVD medication adherence. The findings of the thesis suggest that there is a definite need for reorganization of the current chronic care system in Kuwait. This information was used to develop a chronic disease management model. The challenge now for future studies is to understand the feasibility of the proposed model