Effects of diabetes self-management, related distress and non-acceptance on glycemic control among diabetics in selected hospitals in Ashanti Region

There is limited information on how well or otherwise diabetics in Ghana manage their condition and the impact of that on their glycemic control. Using a retrospective design, this study sought to measure the prevalence of poor glycemic control among diabetes patients in Ghana and also to ascertain how diabetes self-management in the past, diabetes-related distress and diabetes non-acceptance affected glycemic control (glycated hemoglobin levels). Study participants were known diabetics attending two diabetes clinics in Ashanti region of Ghana. We calculated a sample size of 103 and collected data between September and December, 2015. Structured questionnaire was used to collect socio-demographic information and validated Diabetes Self-Management Questionnaire (DSMQ), Diabetes-related Distress Scale (DDS) and Acceptance and Action Diabetes Scale (AAD) were used to collect data on each participant. Anthropometric data (weight and height) were collected using weighing scale and Stadiometer and recorded to the nearest 0.1kg and 0.1cm respectively. The Fast Ion-Exchange Resin Separation Method was used to determine glycated hemoglobin levels of participants. Patients’ folders were also reviewed to retrieve their clinical information. A glycated hemoglobin (HbA1c) level >6.4% was considered as poor glycemic control according to IDF guidelines. 115 participants completed the study. Greater than half (56.5%) of the participants had HbA1c levels above normal (mean of 7.2%), indicative of poor glycemic control. Mean BMI was higher in females than males (28.2 versus 24.6 kg/m2. Females diabetics had slightly lower HbA1c than their male counterparts (p=0.080); younger participants and those with normal BMI had better glycemic control compared to older and overweight/obese participants. Overall score for Diabetes Self-Management was 80.2, implying that majority of the patients had good diabetes management. However comparing the four subscales within DSMS, glucose management had the highest mean score (87.4%) whilst dietary control recorded the lowest (74.2%), with no significant gender or age variations. About 1 in 20 participants (5.2%) had severe diabetes-related distress using a cut-off point of ≥3 and patients with good glycemic control had less distress than poorly-glycemic controlled participants (p=0.006). Mean score for diabetes acceptances was 2.5 and although no age, gender, BMI nor duration of DM differences were observed, participants with low diabetes acceptance were more likely to have poor glycemic control (77% of poor acceptance compared with 48.9% of good acceptance participants had poor glycemic control). When controlled for socio-demographic characteristics, DSMS was significantly negatively correlated with HbA1c. Regression analysis with diabetes distress, diabetes acceptance and diabetes self-management in the model showed DSMS as the only significant predictor of HbA1c levels (exponent=-.563, 95% CI -0.09-0.015). In conclusion, the diabetics involved in this study had general high self-management, low distress and good acceptance of their condition and scores of these influenced glycemic control.

Source: KNUST