English: In 2013, 382 million people suffered from diabetes, with 80% of cases occurring in low-and-middle income countries. Diabetes and diabetes-related complications is the fourth most treated disease in Lesotho hospitals, incurring high medical costs which are largely subsidized by the Government. This study aimed to evaluate the socio-economic factors, nutritional status, medical history, glycemic control, and barriers to treatment compliance among Basotho out-patients with T2DM. A quantitative descriptive study was conducted among 124 consenting patients with T2DM who attended Domiciliary and LDF Clinics in urban Maseru between October 2012 and March 2013. Information were recorded via questionnaires administered by structured one-on-one interviews with the participants; information from patient files and by anthropometrical measurements. Activity was assessed with the validated International Physical Activity Questionnaire. Most participants were married (72.6%); employed (42.7%) or self-employed (26.6%); but 52.4% earned only M0.300 – M1500 per month; and most had only a primary (29.8%) or a high school (49.2%) education. Most were 40 - 60 years old, with almost 50% of the males being ≤50 years. Most participants were female, and females also had the lowest income and education levels. Most (53.2%) had been diagnosed with T2DM for ≤5 years, and 67.7% were on oral glucose-lowering therapy, which 99.2% believed to be effective, and 98.4% reported strictly adhering to. All visit the clinics only every third month (61.3% for free and the rest for ≤ M15.00 per visit), while 40% reported that they sometimes failed to attend due to lack of money (75.8% travelled to the clinic by taxi). Most (82.9%) believed that overweight causes diabetes, yet based on BMI, 89.2% were overweight/obese; and based on WC, WHtR, and BAI, 98.3%, 96.8% and 64.5% were at risk for diabetes-related complications. Almost all were knowledgeable about prudent dietary and lifestyle guidelines and the importance thereof for the management of T2DM, and reported that they had received information on these subjects at the clinics, albeit for 92% never as written, individualized instructions from a dietician/nutritionist. Most participants also did not meet the daily recommendations for intakes of milk and dairy products (92.7%), fruits (65.3%) and vegetables (78.2%); and mostly relied on maize porridge (91.9%) and brown bread (71%) as daily staples. Most cited financial constraints (65.3%) and poor self-control (90.3%) as reasons for non-compliance to dietary guidelines. Most (98%) were moderately active; 78.2% reported abstaining from alcohol, but 52% of the males reported taking 4-6 units of alcohol, mostly commercial beer, per session; and approximately 10% were current tobacco users. None of the participants performed self-monitoring of blood glucose and 90.3% were ignorant about normal reference values. HbA1c measurements done by the researcher indicated suboptimal glucose control in 36.3%. Most (94.4%) suffered from hypertension, which remained uncontrolled despite receiving anti-hypertension drugs from the clinics. Participants were not screened for retinopathy, neuropathy, nephropathy or dyslipidemia at the clinics, and few had HbA1c measurements recorded in their files. Despite the services falling short of international recommendations for the management of patients with T2DM, 98.4% of participants were satisfied with the services rendered and 82.0% were happy with the communication between patient and health care professional at the clinics. Most (75.8%) however felt that the services took too long, and 17.7% reported that the clinic did not always have all their medications available. None of the participants believed that diabetes was due to witchcraft or punishment from God, or reported preferring to consult traditional healers. Few used traditional medicines (mostly “Haelale”); “home remedies” including cinnamon, garlic, ginger and green tea; or nutritional supplements; mostly in addition to (85.7%) rather than instead of, their prescribed medications. In summary, this study identified shortcomings in the health services rendered to patients with T2DM at government-supported clinics in Maseru, as well as various barriers to compliance to dietary and lifestyle recommendations, which need to be addressed: in recognition of patients’ right to quality treatment, and to prevent diabetes-related complications which imparts a heavy financial burden on the health care system of a developing country like Lesotho.
Afrikaans: In 2013, het 382 miljoen mense wêreldwyd aan diabetes gely, en 80% van gevalle het in lae- en middelinkomste-lande voorgekom. Diabetes is die vierde mees behandelde siekte in Lesotho-hospitale (twa verwante komplikasies), en lei tot hoë mediese kostes wat grootliks deur die staat gesubsidieer word. Hierdie studie het gepoog om die sosio-ekonomiese faktore, voedingstatus, mediese geskiedenis, glukemiese beheer en hindernisse tot die nakoming van behandeling onder Basotho buite-pasiënte met T2DM, te evalueer. 'n Kwantitatiewe beskrywende studie is uitgevoer onder 124 pasiënte met T2DM wat Domiciliary en LDF Klinieke in stedelike Maseru tussen Oktober 2012 en Maart 2013 besoek het, en ingeligte toestemming gegee het. Inligting is ingesamel mbv vraelyste tydens gestruktureerde een-tot-een onderhoude met die deelnemers; uit pasiëntlêers, en deur antropometriese metings. Aktiwiteit is beoordeel met die geldige “International Physical Activity Questionnaire”. Die meeste deelnemers was getroud (72.6%); indiensgeneem (42.7%) of self-indiensgeneem (26.6%); maar 52.4% het net M0.300 - M1500 per maand verdien; en die meeste het net primêre- (29.8%), of hoërskool (49.2%) opleiding gehad. Die meeste was 40 - 60 jaar ouds; met byna 50% van die mans ≤50 jaar. Die meeste deelnemers was vroulik, en vrouens het ook die laagste inkomste- en opvoedingsvlakke gehad. Die meeste (53.2%) was ≤5 jaar met T2DM gediagnoseer, en 67.7% was op orale glukose-verlagende terapie; wat 99.2% geglo het doeltreffend was; en 98.4% aangedui het dat hulle streng volg. Almal het die klinieke slegs elke derde maand besoek (61.3% gratis, en die res teen ≤M15.00 per besoek), terwyl 40% gerapporteer het dat hulle soms besoeke oorslaan twa 'n gebrek aan geld (75.8% het per taxi na die kliniek gereis). Hoewel die meeste (82.9%) geglo het dat diabetes deur oormassa veroorsaak kan word was 89.2% oormassa/vetsugtig volgens liggaamsmassa-indeks (LMI). Gebaseer op middelomtrek, middelomtrek: lengte-verhouding (WHtR), en liggaamsvetindeks (BAI), het 98.3%, 96.8% en 64.5% verhoodge risiko’s vir diabeteskomplikasies gehad. Byna almal was goed ingelig oor aanbevole dieet- en lewenstylriglyne, en die belangrikheid daarvan vir die beheer van T2DM; en het gerapporteer dat hulle inligting oor hierdie onderwerpe by die klinieke ontvang het; hoewel 92% van deelnemers aangedui het dat hulle nooit ‘n geskrewe, geïndividualiseerde program van ‘n dieetkundige/voedingskundige ontvang het nie. Die meeste deelnemers het nie aan die daaglikse aanbevelings vir inname van melk en suiwelprodukte (92.7%), vrugte (65.3%) en groente (78.2%) voldoen nie; en het meestal staatgemaak op mieliepap (91.9%) en bruinbrood (71%) as stapelvoedsels. Die meeste het finansiële beperkinge (65.3%) en swak selfbeheersing (90.3%) as redes aangevoer vir die nie-nakoming van die dieetriglyne. Die meeste (98%) was matig aktief; en 78.2% het geen alkoholinname gerapporteer nie, maar 52% van die mans het aangedui dat hulle 4-6 eenhede alkohol, meestal kommersiële bier, per sessie inneem. Ongeveer 10% was huidige tabakgebruikers. Geen deelnemers het aangedui dat hulle self-monitering van bloedglukose doen nie en 90.3% was onbewus van normale verwysingwaardes. HbA1c-metings deur die navorser, het suboptimale glukosebeheer in 36.3% aangedui. Die meeste (94.4%) het aan hipertensie gely, wat ongekontroleerd gebly het tsv van hipertensiemedikasie wat deur die klinieke aan hulle verskaf is. Geen deelnemers is vir retinopatie, neuropatie, nefropatie of dislipidemie gesif nie, en vir slegs 'n paar was HbA1c metings in hul lêers aangeteken. Ten spyte daarvan dat die dienste nie aan internasionale aanbevelings vir die hantering van pasiënte met T2DM voldoen het nie, was 98.4% van die deelnemers daarmee tevrede, en 82.0% was tevrede met die kommunikasie tussen die pasiënt en die gesondheidsorgspan by die klinieke. Die meeste (75.8%) was egter van mening dat die dienste te lank neem, en 17.7% het gerapporteer dat die kliniek nie altyd al hul medisyne beskikbaar het nie. Geen deelnemers het geglo dat diabetes aan heksery of straf van God toegeskryf moet word nie, of aangedui dat hulle 'n tradisionele geneser verkies nie. Min het tradisionele medisyne (meestal "Haelale"); "tuispreparate", insluitend kaneel, knoffel, gemmer en groen tee; of voedingsaanvullings gebruik; meestal saam met (85.7%), eerder as in plaas van, hul voorgeskrewe medikasies. Ter opsomming, het hierdie studie tekortkominge in die gesondheidsdienste wat aan pasiënte met T2DM by die regeringsondersteunde klinieke in Maseru gelewer word, asook verskeie hindernisse tot nakoming van dieet- en lewenstylaanbevelings, geïdentifiseer, wat aangespreek moet word: ter erkenning van die pasiënte se reg tot gehalte-behandeling, en om diabetes-verwante komplikasies te voorkom wat 'n swaar finansiële las op die gesondheidsorgstelsel van 'n ontwikkelende land soos Lesotho plaas.