Knowledge, practice on nutrition and compliance for use of medication in type 2 diabetes outpatients at the Hospital of Agriculture in 2016

Nội dung text: Knowledge, practice on nutrition and compliance for use of medication in type 2 diabetes outpatients at the Hospital of Agriculture in 2016

1. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 KNOWLEDGE, PRACTICE ON NUTRITION AND COMPLIANCE FOR USE OF MEDICATION IN TYPE 2 DIABETES OUTPATIENTS AT THE HOSPITAL OF AGRICULTURE IN 2016 Tong Le Van1,2, Hoang Hai1 SUMMARY Objectives: To describe the reality of knowledge, practice on food consumption, and adherence to medication in patients with type 2 diabetes (T2D) among outpatients at Agriculture General Hospital in 2016. Subjects and methods: A cross-sectional descriptive study was conducted through an interview on 602 patients using pre-designed questionnaires. Results: The rate of understanding about food choices suitable for people with diabetes: 5 food groups should be consumed (69.3%), 7 food groups should be limited (66.9%) and 4 food groups should not eat/drink (83.1%). Regular daily foods: Rice (100%), green vegetables (99.5%), the meat of all kinds (81.4%), ripe fruits (72.1%). The rate of eating foods daily is reasonable for people with diabetes: 1 bowl of rice or 1 full bowl of rice (36.9% and 21.9%); boiled/steamed or braised meat (32.6% and 38.0%); eating green vegetables reached ≥ 5 standard units/1 day (25.0%); eating ripe fruit after 2 hours postprandial of the main meal (41.2%). Adherence to medication in the treatment of diabetes: 84.6%, non-compliance: 15.4%. Conclusion: Knowledge about choosing the right food for people with diabetes is limited. The proper rate of daily food intake of people with diabetes is low. The rate of adherence to medication in the treatment of diabetes is not high. * Keywords: Knowledge; Practice; Nutrition; Drug use; Diabetes; Agricultural Hospital. INTRODUCTION have increased to 629 million people by 2045 [11]. In Vietnam, the prevalence of Type 2 diabetes mellitus is a chronic diabetes and impaired glucose tolerance non-communicable metabolic disorder, with among the 30 - 69 years old nationwide a social nature related to nutrition and increased faster than the forecast, lifestyle, with a rapid development rate in approximately doubling within 10 years many countries around the world [8]. from 2002 to 2012. In 2012, the survey by According to the International Diabetes the National Hospital of Endocrinology on Federation (IDF), in 1994 there were 110 11,000 people aged 30 - 69 across the million people with diabetes worldwide, country showed that 5.42% had diabetes this number increased to 246 million in [1]. It is forecasted that each year there 2010 and 425 million in 2017, and it will will be about 88,000 new cases of diabetes, 1Vietnam Military Medical University 2Hospital of Agriculture Corresponding author: Tong Le Van (vanbvnn@yahoo.com) Date received: 11/6/2021 Date accepted: 30/6/2021 162
2. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 bringing the number of diabetic patients to SUBJECTS AND METHODS 3.42 million by 2030 [2]. Treatment of 1. Subjects, location, time diabetes is an ongoing process that lasts throughout the life of the patient. During Patients with T2D had been confirmed the course of treatment, if the patient with T2D for 6 months or more prior to the adheres well to treatment processes such survey date; currently undergoing outpatient as proper nutrition, daily physical exercise, treatment at Agricultural General Hospital, strict adherence to the medication treatment registered to join the hospital diabetes regimen, periodical examination, and good education club and agreed to participate glucose control, blood sugar will maintain in the study. a stable optimal blood sugar level, slow * Research period: From September down complications, improve quality of life, 2016 to October 2016. reduce the burden of disease, disability, 2. Method and death for patients, families, and society. However, in daily medical examination * Sample size and sample selection of and treatment at outpatient clinics, outpatient T2D patients doctors often pay little attention to + Apply the formula in descriptive counseling, education knowledge, nutrition, research: and daily physical exercise for patients, n = Z2 but often focus on medication (1-α/2) prescriptions and treatment outcomes Of which: after each follow-up visit instead. A survey + n: Minimum sample size of research of 330 patients with T2D outpatients at subjects. the National Hospital of Geriatrics in 2012 + α: Statistically significant level: choose showed that the rate of having correct α = 0.05. knowledge about foods with high sugar content only reached 17.6% and 21.5% [3]. + z: (Confidence coefficient) = 1.96 The proportion of patients with T2D treated (α = 0.05 95% confidence level) as outpatients at My Tho City General Hospital + p: choose p = 0.781 (The percentage (Tien Giang) in 2016, having correct of patients with T2D who adhere to knowledge about diabetic diets was 77.9% medication in outpatient treatment at [4]. It is only necessary for diabetic patients Hospital 198 was 78.1%, according to the to have knowledge and practice about research results of Le Thi Huong Giang unreasonable daily diet and nutrition, which et al. in 2013) [5]. also becomes one of the main causes of Substitute the values into the formula reducing the effectiveness of treatment to get n = 526. Prophylaxis 10% of the and increasing the diabetic complications study sample size, calculated n = 579. and treatment costs. Objectives of the study: Actually investigated 602 patients. To describe the current status of knowledge, practice on food selection, use and Apply a convenient sampling method. adherence to medication use of patients In 2 months (September, October, 2016), with T2DM, outpatient at Agriculture 602 patients who met the criteria were General Hospital in 2016. selected to participate in the study. 163
3. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 * Methods: regime (tablets, injections) and missed Cross-sectional descriptive study, directly medication within the last 6 months. interviewing outpatients using a pre-designed * Data processing and analysis: questionnaire. Data processing using Epidata 3.1 * Research content and indicators: and Stata 14.0 software and performing - General characteristics of research descriptive analysis of percentages (%). subjects: Gender, age, education level, RESULTS occupation, marital status, family economy, family history of diabetes, duration of 1. General characteristics of the diabetes. study subjects - Knowledge of nutrition: The subject's Total survey subjects: 602 people; understanding of the selection of foods male (50%), female (50%); average age: to eat, to limit and not to eat/drink; how 67.5 ± 8.9 years; group ≥ 65 years old to eat fruit everyday not to increase accounted for the highest rate (63.3%); blood sugar 53.7% of subjects had lower and upper - Nutritional practice: The subject's secondary education; retirees accounted food habits in the past 6 months include: for the highest percentage (60.0%); 98.8% The food group used daily and the food group used 3 - 4 times/week; portion of of subjects were married; the household rice for each meal of the day; habit of economy was at an average level or eating green vegetables, ripe fruits, and higher (97.2%); no family member with meat everyday. diabetes was present in 97.5%; The - Compliance with medication use in majority of the subjects had one year or the treatment of diabetes: Medication use more of diabetes (90.5%). 2. Knowledge and practice of nutrition * Knowledge of food selection: Table 1: Subjects' understanding of appropriate food choices for people with diabetes (n = 602). Food/Drink Frequency Rate (%) Foods to eat Vegetables/fruits 597 99.2 Legumes (soybeans, chickpeas, white beans, red beans) 523 86.9 Fruits with a low glycemic index (apple, pear, guava, orange, grapefruit, 381 63.0 peach) Fish, seafood 345 57.3 Skinless poultry meat 238 39.5 Others and do not know do not answer 0 0.0 Total 417 69.3 164
4. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Food/Drink Frequency Rate (%) Foods to limit Fried, stir-fried, roasted dishes 410 68.1 Rice 578 96.0 Clear noodle 344 57.1 Potatoes of all kinds 373 62.0 White bread 210 34.9 Fruits with a medium glycemic index (banana, papaya) 512 85.0 Dried fruit, canned fruit 397 65.9 Fat, butter 402 66.8 Others and do not know do not answer 0 0.0 Total 403 66.9 Foods you should not eat/drink: Cakes, candies, sweets, sugary drinks 586 97.3 Organs, brains of animals 487 80.9 Processed meats (bacon, ham, sausage, beef/buffalo, canned meat) 403 66.9 Fruits with a high glycemic index (pineapple, lychee, longan, mango, custard 526 87.4 apple, durian, jackfruit) Others and do not know do not answer 0 0.0 Total 501 83.1 The average rate of the 5 food groups that should be eaten was 69.3% (the highest was green vegetables/fruits: 99.2%; the lowest was skinless poultry: 39.5%). The average rate of the 7 food groups that should be limited was 66.9% (the highest was rice: 96.0%; the lowest was white bread: 34.9%). The average rate of the 4 food groups that should not be eaten/dried was 83.1% (the highest was cakes, candies, sweets, sugary drinks: 97.3%; the lowest was processed meats: variable: 66.9%). Table 2: Proportion of subjects who knew how to eat fruit properly (n = 602). How to eat Frequency Rate (%) Eat the whole fruit or cut it into pieces 458 76.1 Do not eat/drink juice or smoothies 431 71.6 Eat only 2 - 3 times a day 163 27.1 Do not eat fruit immediately after a meal 252 41.9 Eat fruit away from main meals 185 30.7 Do not repeat the same fruit over and over again 132 21.9 Do not eat many fruits with a high glycemic index at the same time 386 64.1 Others and do not know do not answer 0 0.0 Total 287 47.8 165
5. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 The average rate of the 7 ways of eating fruits to avoid high blood sugar was 47.8%; the highest was eating the whole fruit or cutting into pieces (76.1%); the lowest was not eating repeatedly a certain fruit (21.9%). 2. Practice using food Table 3: Distribution of food-eating habits of subjects in the last 6 months (n = 602). Food group Food name Frequency Rate (%) Regular daily use Green vegetables Vegetables, tubers of all kinds 599 99.5 High glucose food Rice 602 100.0 High-protein foods Meat of all kinds 490 81.4 Fruit Ripe fruits of all kinds 434 72.1 High-fat foods Vegetable oil 367 61.0 Milk Milk of all kinds 281 46.7 Frequency of use 3 - 4 times/week: Fish and seafood 512 85.0 Egg 431 71.6 High-protein foods Tofu 426 70.8 Beans of all kinds 211 35.0 Peanut, sesame 258 42.9 High-fat foods Vegetable oil 207 34.4 Instant noodles 275 45.7 Clear noodle 198 32.9 Foods high in glucose Sweet potato 174 28.9 Bread, dumplings 162 26.9 Fruit Ripe fruits of all kinds 131 21.8 The food used daily: The highest was rice (100%), green vegetables (99.5%), the meat of all kinds (81.4%), ripe fruit (72.1%), vegetable oil (61.0%), and milk (46.7%). Foods used 3 - 4 times/week: Protein-rich foods such as fish and seafood (85.0%), eggs (71.6%), tofu (70.8%), beans/beans types (35.0%); food groups rich in lipids such as peanuts, sesame (42.9%), vegetable oil (34.4%). Foods are rich in glucose such as instant noodles (45.7%), vermicelli (32.9%), sweet potatoes (28.9%), bread, dumplings (26.9%, ripe fruit (21.8%). 166
6. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Table 4: The subject's daily portion of rice for each meal ni the last 6 months (n = 602). The portion of rice for each meal Frequency Rate (%) About 1/2 bowl 154 25.6 A bowl 222 36.9 A bowl full 132 21.9 Two bowls 59 9.8 Two bowls full 35 5.8 Don't remember/don't answer 0 0.0 The rate of eating rice per meal, the highest was eating one bowl (36.9%), followed by eating 1/2 bowl (25.6%), eating a full bowl (21.9%), eating two bowls (9.8%), and eat two full bowls (5.8%). Table 5: Distribution of subjects' daily habits of eating green vegetables/fruits in the last 6 months (n = 599). Group of variables Frequency Rate (%) Cook soup 566 94.5 Boiled 512 85.5 Raw food 329 54.9 Food processing form Stir-fry 228 38.1 Salad, mix 143 23.9 Pickles/coffee salt 183 30.6 1 - 2 units 167 27.9 Number of standard units per day 3 - 4 units 282 47.1 ≥ 5 units 150 25.0 Of the 599 people who eat vegetables and fruit every day, the number of people eating boiled vegetables and soup was the highest (94.5% and 85.5%), raw food (54.9%), fried (38.1%), rinsed salt (30.6%), salad/mix (23.9%). The number of people who eat ≥ 5 units of green vegetables/day was 25.0%. 167
7. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Table 6: Distribution of subjects' daily habits of eating ripe fruits in the last 6 months (n = 434). Group of variables Frequency Rate (%) Ripe fruits: Guava 182 41.9 Apple 152 35.0 Ripe fruits have a low Orange, grapefruit 142 32.7 glycemic index Pear 63 14.5 Papaya 55 12.8 Grapes 112 25.8 Total 118 27.1 Banana 73 16.8 Fruits with medium Mango 48 11.2 glycemic index and high glycemic index Fabric, label 29 6.7 Pineapple 26 6.0 Total 43 9.9 Habit of eating ripe fruit: 1 fruit/each time 150 34.6 2 fruits/each time 198 45.6 ≥ 3 fruits/each time 86 19.8 How to eat Eat the whole fruit 21 4.8 Eat cut pieces 361 83.2 Blend/squeeze smoothies 52 12.0 Before the main meal 22 5.1 Time of eating Right after the main meal 86 19.8 related to the main Less than 2 hours postprandial main meal 95 21.9 meal 2 hours or more postprandial main meal 179 41.2 Any time of the day 52 12.0 The average rate that subjects used 6 types of fruits with a low glycemic index was 27.1% (the highest was guava: 41.9%; the lowest was papaya 12.8%). The average rate that subjects used 5 fruits with medium glycemic index and high glycemic index was 9.9% (the highest was banana (16.8%); the lowest was pineapple: 6.0%) Eat 1 or 2 fruits/each time (34.6% and 45.6%), ≥ 3 kinds of fruit/each time (19.8%). Eat whole fruit and slice/piece (4.8% and 83.2%), blend/juice (12.0%). Eat ripe fruit ≥ 2 hours after main meal (41.2%), eat less than 2 hours after main meal (41.7%), and any time of day (12.0%). 168
8. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Table 7: Distribution of subjects' daily meat-eating habits in the last 6 months (n = 490). Group of variables Frequency Rate (%) Pork 358 73.1 Type of meat Poultry 100 20.4 Beef 32 6.5 Boiled/Steamed 160 32.6 Braised 186 38.0 Processing Fry 87 17.8 form Dried shrimp paste 32 6.5 Cold meat (smoked, sausage, ham, spring rolls, ...) 25 5.1 Daily meat-eating habits are mainly pork (73.1%), poultry (20.4%), beef (6.5%), braised and boiled/steamed meat (38.0% and 32.8%), fried (17.8%), dried shrimp (6.5%), and processed cold cuts (5.1%). 3. Status of adherence to diabetes medication Table 8: Study subjects' diabetes medication regimen (n = 602). How to take medicine Frequency Rate (%) Only pills 275 45.7 Medicines for treatment Only injectables 192 31.9 Pills + injections 135 22.4 Once a day 117 28.5 Pills (n = 410) Twice a day 268 65.4 Three times a day 25 6.1 Once a day 66 20.2 Twice a day 225 68.7 insulin injections (n = 327) Three times a day 31 9.6 Other 5 1.5 Yes, often 509 84.6 Strictly take or inject drugs on Sometimes late 5 0.8 time as prescribed by the doctor (in the last 6 months) Sometimes forgot medicine 86 14.3 Do not take medicine sometimes 2 0.3 The proportion of subjects treated with only pills accounted for 45.7%, only injections: 31.9%, and both drugs: 22.4%. People who used tablets or the drug twice and once a day constituted 65.4% and 28.5%, respectively. The incidence of people who use insulin injections, the drug once and twice a day was found in 68.7% and 20.2%, respectively. The majority of subjects used the drug exactly as prescribed by the doctor (84.6%). 169
9. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Table 9: Status of forgetting to take medicine of study subjects within the last 6 months (n = 86). Situation of forgetting medicine Frequency Rate (%) Pills 49 57.0 Type of medicine Injections 37 43.0 Less than 3 times 19 38.8 Number of missed pills/month 3 times or more 30 61.2 Busy 9 18.4 Forgot to bring medicine when away 6 12.2 Reasons for forgetting pills No one reminded 4 8.2 Forget 30 61.2 Drink to make up for the next drink 13 26.5 What to do when forgetting to take your Throw away the medicine 27 55.1 pills Ask a doctor 9 18.4 Less than 3 times 9 24.3 Number of missed injections/1 month 3 times or more 28 75.7 Busy 6 16.2 Forgot to bring medicine when away 4 10.8 Reasons for forgetting injections No one reminded 2 5.4 Forget 25 67.6 Make up for the next injection 6 16.2 What to do when forgetting to take your Throw away the medicine 23 62.1 injections Ask a doctor 8 21.7 Among 86 subjects who forgot to take medicine: 57.0% forgot pill, 43.0% forgot injection. Missing pills and injections ≥ 3 times/month accounted for 61.2% and 75.7%). The main reason for forgetting pills and injections is not remembering (61.2% and 67.6%. The most common way to manage when forgetting pills and injections is to skip them and don't make up for them next time (55.1% and 62.1%), seek medical advice (18.4% and 21.7%). 170
10. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 DISCUSSIONS cons of eating the above foods are higher 1. Reality of knowledge and practice than the research results of Bui Nam of nutrition for T2D Trung et al. at the Central Geriatric Hospital in 2012 showed that 21.5% of Diabetes treatment is not only a long T2D outpatient had correct knowledge and persistent process, but also a about foods to avoid [3]. The results of combination of many measures, including table 2 show that in 7 ways to eat fruit to drug treatment, nutrition, proper physical not raise blood sugar, the average rate of activity, blood sugar control in a good, subjects knew only 47.8%. It shows the timely manner, in which compliance with a great demand for strengthening reasonable diet plays an important role. communication - health education about According to a report by the American nutrition knowledge for diabetics and Diabetes Association, more than 3.2 million people in the community to know how to people with diabetes are hospitalized for choose and use food appropriately to not inpatient treatment due to non-compliance raise blood glucose postprandial. with the treatment regimen leading to + Regarding the practice of using food: cardiovascular complications (40% of Commonly used foods daily for the past 6 hospital admissions), respiratory diseases, months showed: 100% of subjects used and infections (30%) [10]. rice, green vegetables (99.5%), meat of + Knowledge of food choices: The results all kinds (81.4%), ripe fruit (72.1%), of table 1 show that the percentage of vegetable oil (61.0%) and milk (46.7%). subjects with correct knowledge about Rice (high in glucose) and meat (high in choosing foods to eat is quite high (99.2% protein) are the two most common and 86.9% choose to eat vegetables and essential foods mainly used to provide a legumes) to increase fiber and help reduce high percentage of energy and protein to glucose absorption. Meanwhile, the correct meet the people’s daily needs. Asian in knowledge about other foods that should general and Vietnamese people, in particular, be eaten is not as high as the knowledge use them as regular foods and in large of fruits with low glycemic index (apple, quantity, stable and long-lasting food and pear, guava, orange, grapefruit, peach) these foods themselves constitute an (63.0%); fish, seafood (57.3%); skinless indispensable component of the diet and poultry meat (39.5%), or correct are the main dishes in every family's daily knowledge of foods to avoid (should not meal. However, the proportion of subjects be eaten/drunk) such as offal, animal who ate a reasonable portion of rice in a brain; processed meats (bacon, ham, meal of diabetics (1 small bowl or 1 full bowl) sausage, beef/buffalo, canned meat); was only 36.9% and 21.9%, respectively. fruits with a high glycemic index (pineapple, Meanwhile, the proportion of eating rice is lychee, longan, mango, custard apple, not reasonable for these people: 25.6% durian, jackfruit) only reached 80.9%; consumed 1/2 bowl of rice/meal (slightly 66.9% and 87.4%. The results of our less), 9.8% and 5.8% consumed two study on the proportion of subjects with small bowls or two full bowls (slightly too correct knowledge about the pros and much). Among subjects who eat meat 171