Effect of increased patient-physician contact time and health education in achieving diabetes mellitus management objectives in a resource-poor environment

Abstract

Introduction: Diabetes mellitus remains a significant universal health problem. Globally, the prevalence of diabetes mellitus is projected to grow from 135 million in 1995 to 300 million in 2025. Due to inadequate healthcare facilities and providers, poverty, and illiteracy coupled with increasing prevalence of diabetes mellitus, there is limited patient-physician contact time. As a result, patients with diabetes mellitus develop complications and die early in life due to poor management. This has grave economic implications as diabetes mellitus principally affects people in their most productive years of life. A cross-sectional and longitudinal study on patients with type 2 diabetes mellitus was carried out to demonstrate how diabetic management objectives can be achieved in a resource-poor environment by increasing patient-physician contact time and with health education.

Methods: One group of 105 consecutive patients with type 2 diabetes mellitus were recruited and managed in the metabolic research unit (MRU), where health education was emphasised for five years, served as the intensively-treated cohort (ITC). Another group of 115 patients with type 2 diabetes mellitus were also recruited and managed over the same five-year period in the medical outpatient department (MOPD) of the same hospital, where there was patient congestion at the clinic, served as the control cohort (CC). The CC also reported to the MRU during their follow-up for measurement of their blood pressure and urinalysis. Other measurements for the CC were obtained from the MOPD on the same day of their visit to the MRU. Morbidities were recorded on recruitment, at each visit, and at the end of the study in each cohort.

Results: There was a marked reduction of morbidity at the end of the study in the ITC (222 versus 106, p-value is 0.0013), compared to the CC (138 versus 130, p-value is greater than 0.05). There was also a significant reduction in the number of patients with individual morbidities in the ITC, while significant reduction was only noticed in hypertension, eye problems, neuropathies, infections/boils, and ulcer/blisters in the CC. In 85 percent of the ITC, plasma glucose clustered around the target of the study as compared to only 58 percent of the CC.

Conclusion: Diabetes mellitus management objectives can be achieved by increasing both patient-physician contact time and health education in addition to other conventional forms of treatment, especially in a resource-poor environment.