Worldwide, more than 400 million people are living with diabetes, and disease prevalence is expected to rise to 1 in 10 adults by 2040. Furthermore, complications related to diabetes result in 1.5 million deaths worldwide each year. The prevalence of diabetes in Pakistan is 9.8%, with the disease affecting males and females nearly equally (10.0% and 9.7%, respectively). Pakistan, which has the seventh highest prevalence of diabetes worldwide, is expected to experience further rises in the disease with advancing urbanization and associated factors of unhealthy lifestyle, genetic predisposition, and maternal and fetal malnutrition. Recent increases in prevalence can also be attributed to reduced physical activity, obesity, and increased caloric intake. Rising smoking rates among Pakistani adults have also contributed to the increased prevalence of diabetes. Furthermore, environmental pollution and consumption of high-caloric and high-fat food likely contribute to the increasing incidence of diabetes in Pakistan.
Background & Objectives: Globally, Pakistan is among the top 10 countries in terms of the proportion of the population living with diabetes. Type 2 diabetes cannot be cured permanently, but complications and premature deaths can be prevented by adopting healthy lifestyles. Self-management is the key to controlling diabetes. Besides rational therapeutic approaches, patient counseling by physicians and pharmacists is crucial because self-management practices are generally influenced by the patient’s knowledge of their disease. The objectives of this study were to explore self-management practices among type 2 diabetes patients visiting physicians and pharmacists, and to assess the differences in the self-management practices of patients who visit physicians and those who visit pharmacists concerning type 2 diabetes in the past two years.
Methods: This exploratory study recruited 363 established type 2 diabetes patients using a simple random sampling technique. The patients had consulted either a physician or pharmacist (but not both) over the past two years in relation to their type 2 diabetes, and physically visited a branch of a private-chain retail pharmacy in Lahore, Pakistan. Face-to-face interviews and structured questionnaires with a few open-ended questions were adopted as methods of data collection, focusing on socio-demographic and clinical factors, and the standard self-management practices of patients.
Results: Data were analyzed using frequencies, percentages, means and standard deviations. The difference between categorical variables, i.e. self-management practices and visits to healthcare professionals, were determined using chi-square tests. The results showed that none of the standard diabetes self-management practices were fully adhered to by the patients.
Conclusions: The use of the HbA1C test to monitor diabetes was the least used test among diabetic patients visiting a physician (29.60%) or pharmacist (25.70%). Patients visiting pharmacists adhered to medication use (88.50%, p<0.001), eating a well-balanced diet (75.22%, p=0.050), blood glucose level check (88.50%, p<0.001) and regular blood pressure monitoring (81.42%, p<0.001), whereas patients visiting physicians adhered better to daily feet checking (69.20%, p<0.001) and regular exercise (74.80%, p<0.001). Our study indicates that there is a significant fluctuation in adherence to key self-management practices among type 2 diabetes patients who visit physicians and those who visit pharmacists. Increasing the numbers of pharmacists in the healthcare system who have a special focus on diabetes may improve self-management practices among diabetic patients.