Assessment of Elderly Type 2 Diabetic Patients who Self-adjust Their Insulin Regimen in Al-Qassim Region
DOI:
https://doi.org/10.3889/oamjms.2023.11606Keywords:
elderly, Diabetes, Self-adjust, Insulin, Al-Qassim RegionAbstract
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a multifactorial chronic disease. To avoid long-term and short-term complications, good glycemic control must be achieved. The majority of T2DM patients who require insulin therapy have their doses modified by their physicians; this procedure takes time and may not result in the optimal glycemic control.
AIM: This study aims to ascertain whether elderly T2DM patients in Al-Qassim region modify their own insulin regimen and its effect on their glycemic control.
METHODS: This cross-sectional study was conducted in Al-Qassim University Medical City and Diabetic Centers in Buraydah, Saudi Arabia. Data were collected using a questionnaire.
RESULTS: A total of 384 participants were enrolled with a mean age of 70.2 ± 6.0 (61–94) years, majority (53.6%) of whom were females. About half (50.8%) were not educated and two-third (66.1%) giving insulin injections by themselves. Less than half (40.6%) of the participants changed their insulin dose, out of which 8.3% changed the dose by themselves. The mean hemoglobin A1C (HbA1c) level was 8.8 ± 1.9 with a range of 5.2–17. About 30.5% had recent hypoglycemic attacks, majority (47.9%) of whom had only one episode. Diabetic complications were seen among 127 participants with retinopathy as the most common (43.3%) complication. Hypoglycemic attacks and insulin dose adjusting were not found to be significantly associated (p = 0.476). The last HbA1c level was found to be significantly associated with adjusting insulin dose.
CONCLUSION: Self-adjusting insulin dose was found to be rare. Moreover, HbA1c in patients who self-adjust their insulin dose was found to be significantly lower.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577-89. https://doi.org/10.1056/nejmoa0806470 DOI: https://doi.org/10.1056/NEJMoa0806470
PMid: 18784090
Khunti K, Davies MJ, Kalra S. Self-titration of insulin in the management of people with type 2 diabetes: a practical solution to improve management in primary care. Diabetes Obes Metab. 2013;15(8):690-700. https://doi.org/10.1111/dom.12053 DOI: https://doi.org/10.1111/dom.12053
PMid: 23253563.
Beluchin E, Bäz L, Müller N, Lehmann T, Kloos C, Wolf G, et al. Frequency of self-adjustment of insulin dose and metabolic control in Type 2 diabetes -is there an association? Diabet Med. 2013;30(3):e91-4. https://doi.org/10.1111/dme.12071 DOI: https://doi.org/10.1111/dme.12071
PMid: 23167905.
Kramer G, Kuniss N, Kloos C, Lehmann T, Müller N, Sanow B, et al. Principles of self-adjustment of insulin dose in people with diabetes type 2 and flexible insulin therapy. Diabetes Res Clin Pract. 2016;116:165-70. https://doi.org/10.1016/j.diabres.2016.04.017 DOI: https://doi.org/10.1016/j.diabres.2016.04.017
PMid: 27321332.
Kramer G, Kuniss N, Kloos C, Lehmann T, Müller N, Wolf G, et al. Principles and frequency of self-adjustment of insulin dose in people with diabetes mellitus type 1 and correlation with markers of metabolic control. Diabetes Res Clin Pract. 2016;116:299-305. https://doi.org/10.1016/j.diabres.2016.04.025 DOI: https://doi.org/10.1016/j.diabres.2016.04.025
PMid: 27321348.
Munshi MN, Slyne C, Segal AR, Saul N, Lyons C, Weinger K. Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia. JAMA Intern Med. 2016 Jul 1;176(7):1023-5. https://doi.org/10.1001/jamainternmed.2016.2288 DOI: https://doi.org/10.1001/jamainternmed.2016.2288
PMid: 27273335.
Reach G, Zerrouki A, Leclercq D, d'Ivernois JF. Adjusting insulin doses: from knowledge to decision. Patient Educ Couns. 2005;56(1):98-103. https://doi.org/10.1016/j.pec.2004.01.001 DOI: https://doi.org/10.1016/j.pec.2004.01.001
PMid: 15590229.
Netere AK, Ashete E, Gebreyohannes EA, Belachew SA. Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals. BMC Public Health. 2020;20(1):1537. https://doi.org/10.1186/s12889-020-09622-4 DOI: https://doi.org/10.1186/s12889-020-09622-4
PMid: 33046046
Janež A, Guja C, Mitrakou A, Lalic N, Tankova T, Czupryniak L, et al. Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. Diabetes Ther. 2020;11(2):387-409. https://doi.org/10.1007/s13300-019-00743-7 DOI: https://doi.org/10.1007/s13300-019-00743-7
PMid: 31902063
Akın S, Bölük C. Prevalence of comorbidities in patients with type-2 diabetes mellitus. Prim Care Diabetes. 2020;14(5):431-4. https://doi.org/10.1016/j.pcd.2019.12.006 DOI: https://doi.org/10.1016/j.pcd.2019.12.006
PMid: 31902582.
Alshwikh HE, Hander F. Overview of glycemic control among admitted patients with diabetes in Tripoli University Hospital. J Cardiol Cardiovasc Med. 2022;7:13-6. https://doi.org/10.29328/journal.jccm.1001125 DOI: https://doi.org/10.29328/journal.jccm.1001125
Diabetes Research in Children Network (DirecNet) Study Group; Tsalikian E, Kollman C, Tamborlane WB, Beck RW, Fiallo-Scharer R, Fox L, et al. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care. 2006;29(10):2200-4. https://doi.org/10.2337/dc06-0495 DOI: https://doi.org/10.2337/dc06-0495
PMid: 17003293
Papatheodorou K, Banach M, Edmonds M, Papanas N, Papazoglou D. Complications of Diabetes. J Diabetes Res. 2015;2015:189525. https://doi.org/10.1155/2015/189525 DOI: https://doi.org/10.1155/2015/189525
PMid: 26247036
Silva DD, Bosco AA. An educational program for insulin self-adjustment associated with structured self-monitoring of blood glucose significantly improves glycemic control in patients with type 2 diabetes mellitus after 12 weeks: a randomized, controlled pilot study. Diabetol Metab Syndr. 2015;7:2. https://doi.org/10.1186/1758-5996-7-2 DOI: https://doi.org/10.1186/1758-5996-7-2
PMid: 25904987
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Mariam S. Alharbi, Turki Alrashidi, Moath Saleh Al-Harbi, Essa Al Zahrani, Mohammed H. Alkahlot, Mohammed S Aljaberi (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0