ABSTRACT
Background: Diabetes is a public health problem of colossal proportions. The National Family Health Survey 5 (2019–2020) has found high blood sugar levels among 13.5% of women and 15.6% of men in India. The high morbidity and mortality in diabetes mellitus are due to uncontrolled hyperglycemia resulting in micro- and macrovascular changes affecting multiple organs in the body. The objectives of this study were to estimate glycemic control and its determinants among type 2 diabetics in the Ernakulam district. Methods: A community-based cross?sectional study was conducted among 364 type 2 diabetics who had the disease for at least 5 years duration in the Ernakulam district of Kerala. Probability proportional to size cluster sampling technique was adopted. A semi-structured questionnaire was used to collect sociodemographic and behavioral profiles. Participants’ HbA1c levels were assessed to determine glycemic control. Results: The proportion of people with good glycemic control was 21.4%. Determinants such as female gender adjusted odds ratio (aOR = 2.36, P = 0.005), body mass index >23 kg/m² (aOR = 2.71, P = 0.002), combined drug treatment with Oral Hypoglycaemic agents (OHA) and insulin (aOR = 3.76, P = 0.004), and poor compliance with medications (aOR = 1.93, P = 0.030) were found to be significantly associated with poor glycemic control. Conclusions: Poor compliance with medications and unhealthy lifestyle choices has resulted in a high proportion of diabetics with poor glycemic control in the district. Women are particularly more vulnerable to uncontrolled hyperglycemia than males. Type 2 diabetes mellitus people should be encouraged to maintain strict glycemic control, which is an important measure for secondary prevention of complications.
ABSTRACT
Background: Persons with type 2 diabetes mellitus (T2DM) are at high?risk for COVID?19 infection and are a priority group for vaccination. Objectives: The objective of this study is to estimate the seroconversion and determine the side effects after COVID?19 vaccination among persons with T2DM in urban, rural, and tribal areas in Kerala. Methods: A cross-sectional study was conducted in urban, rural, and tribal field practice areas of a medical college in Central Kerala, among 396 persons with T2DM. The participants were selected by simple random sampling from the 200–250 diabetic patients visiting each health center. Qualitative and quantitative estimation of antibodies were done by WANTAI Ab enzyme?linked immunosorbent assay kit and Abbott SARS COV?2 IgG Quantitative assay, respectively. Results: The mean age of the respondents was 59.40 ± 12.25 years. A majority (65.5%) had received both doses of vaccine. About half (51.5%) experienced side effects after vaccination. Antibodies (IgG or IgM) were detected in 93.2% (95% confidence interval [CI] 90.2, 95.5) of participants. Those with a duration of diabetes ?5 years, with a single dose of vaccine, were five times (adjusted odds ratio [aOR] – 5.23,95% CI 1.86, 14.66) and four times (aOR – 4.11, 95% CI 1.66, 10.13) more likely, respectively, to be seronegative. Those who took medication for diabetes were protected against a no antibody (aOR – 0.05, 95% CI 0.02, 0.148) response. The median antibody titer in a subset (150) of participants was 365.2 (90–1587) AU/ml. Past COVID infection was an independent determinant of high IgG titers (aOR – 4.95, 95% CI 1.50, 16.36). Conclusion: Reinforcing the importance of vaccination particularly among those with longer duration of diabetes is imperative.
ABSTRACT
Background: High level of adherence to prescribed medication is very essential to obtain the desired outcomes in chronic kidney disease (CKD) patients. Non-adherence to medication has been associated with increased morbidity, mortality, and higher costs of care. Objectives: The objectives of this study were as follows: (1) To assess adherence to medications in CKD patients, (2) to know the patient’s knowledge regarding treatment, and (3) to study factors associated with nonadherence to medications in CKD patients. Materials and Methods: A cross-sectional study was conducted in the nephrology department of a tertiary care hospital. Patients (n = 206) aged >18 years, diagnosed with CKD and on treatment for >3 months were interviewed. Permission from ethical committee was taken and informed consent was obtained from the study subjects before start of the study. Morisky Medication Adherence Questionnaire (MMAQ) was used to assess overall adherence. A high score indicates poor adherence. Results: Of 206 patients, 1.46% (3) were Stage 1, 2.91% (6) were Stage 2, 11.17% (23) were Stage 3, 15.53% (32) were Stage 4, and 68.93% (142) were Stage 5 of CKD according to the National Kidney Foundation 2002 guidelines. Using the MMAQ, high, medium, and low adherence was reported in 23.30%, 42.23%, and 34.47% of patients, respectively. An average number of medicines taken in a day by each patient was 5.75 ± 0.707. Common causes of non-adherence were forgetfulness (71.51%), high cost of medicine (24.05%), and large pill burden (18.35%). Conclusions: Non-adherence remains a major obstacle in the effective management of CKD population. Periodic counseling about the importance of medication adherence to the patients and caregivers is essential to improve adherence.