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Home > Effect of Diabetes Self-Management Education on Glycemic Control, Compared to Usual Care in Type 2 Diabetic Patients at the Family Medicine Clinic, Aga Khan University Hospital Nairobi

Effect of Diabetes Self-Management Education on Glycemic Control, Compared to Usual Care in Type 2 Diabetic Patients at the Family Medicine Clinic, Aga Khan University Hospital Nairobi

Thesis Info

Author

Gathu, Catherine Wanjiku

Department

Family Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2015

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728047012

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Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored. Objective: To compare the effect of a structured Diabetes Self-Management Education programme to usual care, in type 2 diabetic patients managed at the family medicine clinic, Aga Khan University Hospital, Nairobi (AKUHN). Methods: This was an open label randomized clinical trial carried out at the outpatient family medicine clinic of the Aga Khan University Hospital, Nairobi. One hundred and forty type 2 diabetic patients were recruited, 70 patients randomly allocated to either group using a computer generated sequence. DSME was applied in the intervention arm by Certified Diabetic Educators (CDE) while the control group received usual care from the family medicine doctor. The primary outcome, glycated hemoglobin (HBA1c) was used to determine the mean difference in blood glucose control after 6 months of follow up. Secondary biomedical outcomes included blood pressure, body weight, height and BMI. Data was analyzed using the per protocol analysis. STATA version 12 software was used. Difference in means of the outcome variables was compared using the student t-test. Results: A total of 96 patients (69%) completed the study, 55 in the DSME group and 41 in the usual care group. The mean (± SD) age of all the patients at baseline was 48.8 (± 9.8) years with a mean (± SD) HBA1c of 9.9% (± 1.76). After 6 months of follow up, no significant difference was noted in the primary outcome (HBA1c) between both groups, with a mean difference of 0.37 (95% CI - 0.45 to 1.19; P = 0.37). DSME also made no remarkable change in any of the secondary outcome measures. Conclusion: Overall, DSME did not show significant improvements in the primary or secondary biomedical outcomes. This may suggest that a well-trained family physician offering diabetes education may be just as good as a DSME trained educator. Further studies are however required to support this finding, particularly
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خان بہادر مولوی محمد شفیع

خان بہادر مولوی محمد شفیع
مولوی محمد شفیع ہندوستان میں پہلے شخص تھے جنھوں نے مشرقی علوم و فنون پر خالص مستشرقین کے انداز میں خودبھی مخطوطات کی تحقیق وترتیب اور مختلف تاریخی و ادبی موضوعات پرمحققانہ مقالات لکھنے کاکام کیااور اپنے فیض تربیت سے ایک ایسی نسل بھی پیدا کردی جو برصغیر ہندوپاک کے مختلف گوشوں میں اُسی نہج پرکام کررہی ہے۔ مرحوم کی مسلسل مخلصانہ کوششوں کا نتیجہ یہ ہوا کہ ایک عرصہ تک پنجاب یونیورسٹی کاشعبۂ عربی وفارسی ہندوستان کی یونیورسٹوں میں سب سے زیادہ باوقار شعبہ سمجھاجاتا تھا۔ ذاتی طور پر وہ خود بے حد محنتی اوراوقات کے بڑے پابند تھے، پھرخوش قسمتی سے اُن کوپروفیسر محمد اقبال اور حافظ محمود شیرانی ایسے رفیق اور ڈاکٹر سیدعبداﷲ اورشیخ عنایت اﷲ ایسے تلمیذ مل گئے، جنھوں نے اُردو زبان کے علمی سرمایہ میں کمیت اور کیفیت کے لحاظ سے بڑا قابلِ قدر اضافہ کیا اور اُس کامعیار اونچا کردیا ہے۔
مرحوم بُرہان اور ندوۃ المصنفین کے بڑے قدر داں تھے اور وقتاً فوقتاً اڈیٹر بُرہان کے نام خطوط میں حوصلہ افزائی فرماتے رہتے تھے۔ چند برس ہوئے مرحوم کی علمی وتحقیقی خدمات کے اعتراف میں ’’ارمغانِ علمی‘‘ کے نام سے پنجاب یونیورسٹی نے ایک ضخیم کتاب شائع کی تھی جومشرق ومغرب کے نامور فضلائے علوم مشرقیہ کے بلند پایہ مقالات کابڑا قابلِ قدر مجموعہ ہے۔اس کتاب سے مرحوم کے سوانح حیات اوراُن کے علمی کارناموں کامفصل علم ہوسکتا ہے۔ [جون ۱۹۶۳ء]

Development of Kabul under Mughals 1504-1738 AD

Kabul was a bridge between Indian Mughal Empire and Central Asia, the ancestral homeland of the founder of the Mughal Empire. Kabul, the capital of Afghanistan, carries about 3,500 years old historical records mentioning Kabul with different names like, Kubha, Gandahara, Kabura, Ortospana, Kapul, Zavul, and Zabul etc. Many great warriors and conquerors from Central Asia used Kabul as their route to India. It was also known as a gateway to India and Central Asia. Kabul became the foundation stone for the Mughal Empire in India. During the Mughal era Kabul entered into a new phase and with the invasion of Babur the area got the position of the capital of the Mughals. The early Mughal rulers paid much attention to the affairs of Kabul, because their existence to a greater extent was dependent on their strong hold over Kabul. The research work is focused on development of Kabul under Mughal kings particularly Babur, Humayun, Akbar, Shah Jahan and Aurangzeb.  The later Mughal kings after Aurangzeb were not able to end political disturbances in Kabul which not only displeased the people of Kabul but also encouraged the neighbouring powers to invade the valley. Historical and analytical methods are used in this research and Pashtu, Dari, Urdu and English sources have been utilized to gauge development of Kabul during that point in time. No research work has been carried out on this aspect of Kabul so far. The analysis of the development of Kabul under Mughals brings to limelight the geostrategic and politico-economic worth of Kabul as an important Caravanserai on the trade route between Central and South Asia.

Automated Detection of Glaucoma from Fundus and Optical Coherence Tomography Images

Medical image analysis can play a substantial role in diagnosis of different medical problems. Glaucoma is an asymptomatic neurological disease. Oculists mostly use fundoscopy or OpticalCoherence-Tomography (O-C-T) to diagnose glaucoma.Fundoscopy can be used to analyse the external stratum of posterior part of the eye whereas, O-C-T imaging technology has the ability to analyse the internal stratums of posterior part of the eye.In this thesis, a Hybrid Computer Aided Diagnosis (H-CAD) system has been proposed that integrates both fundus and O-C-T imaging technologies for reliable diagnosis. Fundus module has a novel combination of hybrid structural and textural features. The system improves the decision making process after analysing a variety of glaucoma conditions. It further consists of two sub modules Hybrid Structural Feature-set (HSF) and Hybrid Texture Feature-set (HTF). HSF module calculates structural changes i.e. Cupto-Disc-Ratio (C-D-R) and classifies a sample using Support-Vector-Machine (S-V-M). HTF module analyses the textural properties of optic nerve head and again using S-V-M, makes a decision. In O-C-T module, C-D-R has been calculated on the base of the inner stratums of the retina. In the Cup Diameter Extraction (C-D-E) method, cup boundary has been marked on the base of Inner-Limiting-Membrane (I-L-M) stratum. The O-C-T module presents a new method to increase the accuracy of I-L-M stratum segmentation. It also introduces a new method to interpolate missing points on the extracted Upper-Surface of I-L-M stratum (?????). In addition, a novel technique to remove outliers from ????? has been applied. In Disc-Diameter-Extraction (D-D-E) process, Retinal-Pigment-Epithelium (R-P-E) stratum termination points have been used to locate disc margin. Earlier to R-P-E stratum segmentation, I-L-M stratum elimination has been done by a new approach to trace and eliminate I-L-M stratum. Finally, precise R-P-E stratum segmentation has been achieved on the base of new Thickness Value approximation technique. Furthermore, a novel standard for cup boundaries identification, on the base of mean value of R-P-E stratum terminations points is offered. A local-dataset of SD-O-C-T and fundus images annotated by four oculists has been used for evaluation of proposed H-CAD system. Each module ofH_CAD system classifies data independently. The final result of H-CAD system is determined based on decision of three diverse modules. The evaluations and results have shown that the final result of H_CAD system is more trustable than its contemporary automated models.