Management of Diabetic and Hypertensive Patients Who Seek Care at Komfo Anokye Teaching Hospital

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Background Available evidence suggest a surge in the number of people suffering from type II diabetes and hypertension worldwide, particularly in developing countries. There is also some evidence that most of these patients have poor glyceamic and blood pressure control. The aim of this study was to assess the management of patients with diabetes and hypertension who seek care at KATH. The focus was on medication, knowledge about non-pharmacological approaches and how they are responding to the various interventions given at KATH for disease management. Method This was a cross sectional study. The design was retrospective and it involved 325 patients who sought care at diabetic/hypertension clinic of KATH from March to September 2015.Structured questionnaire was used to extract data from Patients’ folder. Patients were also interviewed on their medication to fill for missing data. Results About Eighty nine percent (n=289) of the patients were on metformin either as monotherapy or in combination with other agents at baseline. Ninety one percent of the participants (n=296) were also on metformin as monotherapy or in combination with other antidiabetic medications on their next review as current medication. Sulfonylurea accounted for 57.8% (n=188) of prescription at baseline and 48.9% (n= 159) on the next review. About 43% of the patients (n=140) had their fasting blood glucose (FBG) levels within target at baseline, and 36% (n=117) had their FBG within target on the next review (Target FBG is <7mmol/l-American diabetes Association (ADA) guidelines 2014, adapted for use at KATH) ACEIs and ARBs accounted for the majority of antihypertensive prescriptions with over 97% (n=315) receiving the medication at baseline and 99.9 %(n=324) on the next review of therapy. The ACEI’s or ARB’s were either given as monotherapy or in combination with other antihypertensive agents. Calcium Channel Blockers also accounted for 66.8% (n=217) of prescriptions for antihypertensive therapy at baseline and 70 %( n=226) on the next review of patient’s condition and medications. Seventy nine percent of all the females’ participants (n=173) were either overweight or obese. Seventy four percent of males (n=78) were also overweight and obese. Optimal control of BP (<140/80mmHg as defined by the American Diabetes Association guidelines 2014) was evident in 48% of patients (n=156) at baseline and 44% on the next review (n=143) of their condition and medications. All (100%) of the participants were knowledgeable about simple lifestyle and dietary approaches to improve the management of diabetes and hypertension. Forty three percent (n=140) of participants had prescription given for medication outside the hospital at all times whereas 57 %( n=185) said they were given prescriptions for medicines outside the hospital at least once a while. Conclusion Majority of the patients exhibited adequate knowledge about lifestyle modifications, medications and dietary approaches to improve Blood pressure and glucose control, therapeutic outcomes observed in the clients were not optimal, based on the targets recommended in the standard guidelines (i.e,ADA 2014/STG 2010 ). Majority of the patients involved in the study (both males and females) were either overweight or obese, in particular the female subjects Majority of the patients involved in the study were prescribed ACEI/ARBs (i.e. lisinopril/losartan) and a biguanide (Metformin) for the management of hypertension and diabetes respectively. Almost all the patients were given prescription for medicines outside the hospital at least once a while. Recommendations Further study should be carried out to assess and understand other reasons for the sub-optimal outcomes observed in the patients, despite the use of standard guidelines by the clinicians to manage the patients. vii Efficient weight management strategies with input from dieticians must be adopted by both patients and the health care team to aid optimal weight control in the patients. This may contribute to improvement in glycaemic and blood pressure control for the patients.
A Thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the degree of Master of Science in Clinical Pharmacy,