- : Ms Word, Ms Word Format
- : 100 Pages
- : ₦5000
- : 1-5 Chapters
- Click to DOWNLOAD Materials
THE EFFECT OF FAMILY FUNCTIONING ON GLYCEMIC CONTROL AMONG TYPE 2 DIABETES PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINICS OF UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN
SUMMARY
Optimal diabetic care depends mainly on adequate glycemic control among type 2 diabetes patients. Adequate glycemic control has been found to delay or reduce diabetes related complications both acute and chronic. There is high prevalence of inadequate glycemic control among type 2 DM patients especially in the primary care setting. This requires all hands on deck to reduce this high prevalence more so that there are many factors affecting it.
This study was done at the GOPD of UITH, Ilorin, to: determine the prevalence of adequate glycemic control among the type 2 DM patients attending here; to determine the family functioning of these patients; to determine any associations between family functioning and glycemic control and to assess the influence of the various socio-demographic and clinical factors on glycemic control of respondents.
Data was collected from 340 type 2 DM patients over four months with the use of structured questionnaires including the family APGAR, together with their anthropometric measurements and physical examinations. Laboratory assessments were done to determine their fasting blood glucose and glycosylated hemoglobin.
The result of the study revealed that the overall prevalence of adequate glycemic control among type 2 DM patients was 50.4% using HbA1c <7% as target control. The family functioning of respondents was high, with 96.2% of them living in functional families. However there was no statistically significant association between their level of glycemic control and family functioning. Nevertheless, there were significant associations between glycemic control and BMI, Duration of DM, frequency of visit to the doctor, help in transportation to and from hospital, frequency of discussion about DM with the family and Perception of acceptability of DM status by the family. There were also significant relationship between family functioning and the following: help in transport, frequency of received help, frequency of discussion about DM with family and the household type. This buttresses the fact that family support enhances family functioning.
In conclusion the study showed that family support enhances adequate glycemic control through the effect on family functioning. Therefore physician treating type 2 DM should always explore family support issues in their interaction with patients. There will be need for further research on the appropriate tool to assess family functioning in our environment as the APGAR score might not be measuring the desired family functioning especially in our setting.
TABLE OF CONTENT
Title page i
Preface and Acknowledgement ii
Dedication iii
Declaration iv
Certification v
List of Abbreviations vi-vii
Table of content viii
List of Tables ix
List of Figures x
List of Appendices xi
Summary 1
Chapter One: Introduction 3
Chapter Two: Literature Review 8
Chapter Three: Materials and Method 27
Chapter Four: Results 39
Chapter Five: Discussion 75
Limitation of Study 88
Conclusion and Recommendation 89
References 92
Appendix 106
CHAPTER ONE INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Diabetes mellitus is a clinical syndrome that is characterized by hyperglycemia due to absolute or relative insulin deficiency.1 There are two types, type 1 and type 2; and type 2 constitute about 95% of cases of diabetes mellitus.1 It is a chronic disease which is associated with a lot of metabolic dysregulation caused by some secondary pathopysiologic changes in multiple organs of the body; leading to a lot of burdens on the patient, the family and the healthcare system of any nation.1
The chronic nature of this disease and the attendant complication arising from it makes it a major cause of morbidity and mortality. Physically, patients can develop complications affecting the eyes, the heart, the kidneys, the brain, the blood vessels and the feet. The effect of these complications on the socioeconomic and psychological wellbeing of the patient cannot be overemphasized. The Nigerian national prevalence rate of type 2 diabetes mellitus is put at 2.2%, globally it is estimated to be 6.4%.2–4 The number of deaths in adults with diabetes mellitus worldwide is estimated to be 3.96 million per year, putting the global mortality rate in all ages is about 6.8%.5 In Nigeria, a hospital based mortality study in Ilorin suggested a rate of 32.5%.6
The goals of therapy for type 2 diabetes mellitus are to eliminate symptoms, reduce microvascular and macrovascular long term complications and allow patients to achieve as normal lifestyle as possible.7 Adequate glycemic control is important in achieving these goals.
Adequate glycemic control is central to optimal diabetic care as it reduces or delays diabetic related complications.4,6,7 Many clinical trials have supported the fact that the maintenance of glycosylated hemoglobin less than 7% is beneficial and can prevent or delay diabetic related
complications.8, 9, 10
The family is a social intimate nurturing group of individuals that are connected biologically, legally or by choice and from whom one can expect a measure of support in the form of food, shelter, finance, and emotional nurturing.11 There is interpersonal and inter dependent relationship within the family system which has capacity to influence the physical, psychological, and social functioning of the individual within that family.11 This pattern of interaction within the family allows it to have great influence on the management of chronic illnesses like diabetes mellitus. It is a well recognized fact that type 2 diabetes requires tedious management procedure that can force major changes in the family lifestyle.11 Thus the psychosocial consequences of negative family interactional pattern can impact negatively on the patients ’physiologic system which in turn affects glycemic control and long term outcome of diabetes mellitus.
The biopsychosocial model of medicine in which patients are treated in the context of their families has a potential for ameliorating some complex situations in chronic diseases like diabetes mellitus.11, 12 This paradigm shift from disease-focused patient care to patient-centered care enable physicians caring for patient especially at the primary care setting to intervene successfully in family factors militating against the control of such chronic illnesses.
Socioeconomic and demographic factors are known to influence adherence to medication in many chronic illnesses including DM. For example, factors such as age, gender, employment status and educational level could affect medication adherence and by extension level of
glycemic control. 13
1.2 STATEMENT OF THE RESEARCH PROBLEM.
1.2:1 GLYCEMIC CONTROL IN FAMILY PRACTICE.
The prevalence of adequate glycemic control varies widely according to geographical setting and on methodology used in the studies. For instance a study in Britain reported a rate of 34% while another in the USA reported 28.4%.9. The target cut off of adequate control in these studies was glycated hemoglobin (HbA1C) less than 7%. A study done at the University of Ilorin Teaching Hospital by Adebisi et al (2009) reported a prevalence of 36%14 which is consistent with the above trend.
Many studies in primary care setting in developed countries suggest that inadequate glycemic control is common.9, 15-18 For instance Fox KM et al (2006) found 76% prevalence of inadequate glycemic control in the UK general practice, 9 while Assuoncao MCF et al (2005) reported a rate of 50.5%.18 But local studies in Nigeria, particularly in the North central zone, the setting of this study are still scarce.
Despite the availability of effective treatment, many patients with diabetes do not achieve optimal glycemic control19 especially at the primary care setting. Various reasons have been adduced to this , and include patient related factors like younger age, high body mass index, poor knowledge about diabetes, smoking habits, and depression.19 Furthermore, other factors like diabetic complications, medication types, poor adherence to glucose monitoring and family
functioning,19,20 have been implicated.
The relationship between highly functional family and adequate glycemic control has been explored in developed countries,13, 20, 21 and has been found to be positive. However, local studies on the effect of family dynamics on glycemic control are few and need to be promoted especially in the primary care setting.
In this study, the gap in the research finding in terms of current knowledge of degree and level of glycemic control among diabetes patients attending the primary care is explored. In addition, the relationship between family functioning and glycemic control previously unresearched in our setting is also explored. So is the influence of socio-demographic and economic factors; all in an effort to improve glycemic control in this setting specifically and diabetes care in general.
1.3 RATIONALE/JUSTIFICATION FOR THE STUDY.
The reduction of adverse effect both acute and long term due to poor glycemic control especially in the primary care setting is a necessary step to improve the quality of life of type 2 diabetics. Hence the importance of this study which will help us to determine how common is inadequate glycemic control in the GOPC and the possible effect of dysfunctional family on this control; thereby giving the family physician more insight into the complex factors affecting glycemic control in our practice.
Family physicians that are reported to see about 85% of cases in our hospital setting according to the medical record department require special knowledge, attitude and skill to deal with inadequate glycemic control and the influence of family factors in order to improve the care of our patients. This study is likely to contribute to the body of knowledge that will assist us in this regard.
Furthermore, the information derived from this study will also help reduce the gap in knowledge about glycemic control in the primary care setting especially pertaining to family factors that affect glycemic control. It may also provide a data base for further research on this subject in primary care.
1.4. AIM AND OBJECTIVES.
1.4:1.The aim of this study was to assess the effect of family functioning on the pattern of glycemic control among type 2 diabetic patients attending the general outpatient clinics of University of Ilorin teaching hospital. This was with a view to gaining knowledge and understanding that will assist in improving family involvement and counseling in the management of type 2 diabetes.
1.4:2. The specific objectives were:
- To determine the level of glycemic control among type 2 diabetes patients seen at the GOPD, UITH Ilorin.
- To determine the level of family functioning among type 2 diabetes patients seen at the GOPC, UITH Ilorin.
- To determine the association between the family function and glycemic control among type 2 diabetes patients seen at the GOPC, UITH Ilorin.
- To determine the influence of the various socio-demographic characteristics of patients on the level of glycemic control among type 2 diabetes mellitus patients seen at the GOPD, UITH Ilorin.
THE EFFECT OF FAMILY FUNCTIONING ON GLYCEMIC CONTROL AMONG TYPE 2 DIABETES PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINICS OF UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN
