Knowledge of and Adherence to Health Advice among Adults with Diabetes in Libya

Background: Non-adherence to medical and health care advice is a common problem, though reasons for non-adherence can differ across different groups and societies as well as between individuals. Objective: to examine diabetes knowledge among people with both type1 and type2 diabetes in Libya and explore any other factors that enhance adherence to treatment and management of the condition. Methods: A cross-sectional survey design was used to collect data from adults with type1 or type2 diabetes who have been diagnosed for 12 months or more, in Benghazi Diabetes Centre, which is one of the oldest and largest diabetes registries in Libya. A total of 855 participants were asked to fill in two questionnaires; the Michigan Diabetes Knowledge Test to investigate the level of diabetes knowledge and the Confidence in diabetes Self-care Scale to assess self-efficacy. For the purpose of the study descriptive statistics and inferential statistical tests were conducted. Results: Diabetes knowledge is very poor especially among females and those classed as illiterate within the sample. The Mean HbA1c of 9.39 was higher than the recommended levels. Four variables namely knowledge about diabetes, duration of illness, family history and self-efficacy significantly predicted levels of HBA1c. Conclusion: Based on the above findings two different programmes of diabetes education would be recommended. The first programme of education would focus primarily on those with inadequate levels of knowledge about diabetes, particularly female and people with long duration diabetes. The second programme would be for both healthcare professionals and people with type 1 and type2 diabetes, which would consider the psychological factors that are involved in the process of diabetes management

Lack of confidence among trainee doctors in the management of diabetes: the Trainees Own Perception of Delivery of Care (TOPDOC) Diabetes Study

Background: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care

Training tomorrow's doctors in diabetes: self-reported confidence levels, practice and perceived training needs of post-graduate trainee doctors in the UK. A multi-centre survey

<p>Abstract</p> <p>Objective</p> <p>To assess the confidence, practices and perceived training needs in diabetes care of post-graduate trainee doctors in the UK.</p> <p>Methods</p> <p>An anonymised postal questionnaire using a validated 'Confidence Rating' (CR) scale was applied to aspects of diabetes care and administered to junior doctors from three UK hospitals. The frequency of aspects of day-to-day practice was assessed using a five-point scale with narrative description in combination with numeric values. Respondents had a choice of 'always' (100%), 'almost always' (80–99%), 'often' (50–79%), 'not very often' (20–49%) and 'rarely' (less than 20%). Yes/No questions were used to assess perception of further training requirements. Additional 'free-text' comments were also sought.</p> <p>Results</p> <p>82 doctors completed the survey. The mean number of years since medical qualification was 3 years and 4 months, (range: 4 months to 14 years and 1 month). Only 11 of the respondents had undergone specific diabetes training since qualification.</p> <p>4(5%) reported 'not confident' (CR1), 30 (37%) 'satisfactory but lacked confidence' (CR2), 25 (30%) felt 'confident in some cases' (CR3) and 23 (28%) doctors felt fully confident (CR4) in diagnosing diabetes. 12 (15%) doctors would always, 24 (29%) almost always, 20 (24%) often, 22 (27%) not very often and 4 (5%) rarely take the initiative to optimise gcaemic control. 5 (6%) reported training in diagnosis of diabetes was adequate while 59 (72%) would welcome more training. Reported confidence was better in managing diabetes emergencies, with 4 (5%) not confident in managing hypoglycaemia, 10 (12%) lacking confidence, 22 (27%) confident in some cases and 45 (55%) fully confident in almost all cases. Managing diabetic ketoacidosis, 5 (6%) doctors did not feel confident, 16 (20%) lacked confidence, 20 (24%) confident in some cases, and 40 (50%) felt fully confident in almost all cases.</p> <p>Conclusion</p> <p>There is a lack of confidence in managing aspects of diabetes care, including the management of diabetes emergencies, amongst postgraduate trainee doctors with a perceived need for more training. This may have considerable significance and further research is required to identify the causes of deficiencies identified in this study.</p

The outcome of brittle type 1 diabetes--a 20 year study

Aims: To determine the long-term (20 years from presentation) outcome of brittle type 1 diabetes characterized by recurrent episodes of ketoacidosis (DKA). Methods: The cohort studied was a group of brittle diabetic patients from various parts of UK originally identified between 1979 and 1985. Patients were traced, where possible, via their diabetic clinics and/or general practitioners. Data on survival or otherwise were obtained from hospital case notes and information from diabetes care team members. For survivors, clinical and demographic information obtained included complication status and whether they still had brittle characteristics. They were also compared with a matched case–control group of type 1 patients with no history of brittle behaviour. Results: The original cohort comprised 33 patients—all female and mean�SD, aged 18�5 years and diabetes duration 8�4 years. Thirteen were not traceable and 10 of the remaining 20 (50%) had died during the mean 22 years of follow-up. Deaths occurred evenly throughout the period, and causes were chronic renal failure (3), DKA (3), hypoglycaemia (2), subarachnoid haemorrhage (1) and uncertain (1). Age at death ranged from 27 to 45 years. Of the 10 survivors, none remained brittle, but they had a substantial burden of complications. Compared with the non-brittle control group, there was a significant excess of nephropathy and autonomic neuropathy. Conclusions: We conclude that brittle diabetes characterized by recurrent DKA has high long-term outcome mortality. These deaths were premature and almost all diabetes related. Those who survived had resolution of brittleness, but suffered a significant complication burden