Browsing by Author "Efrem Paulos"

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    Assessment of Self-Reported Insulin Injection Techniques among Patients with Diabetes Mellitus on Follow-up at Adult Endocrine Clinic at Tikur Anbessa Specialized Hospital: Hospital-Based Cross-Sectional Study September 1 - October 31, 2020 G.C.
    (Addis Abeba University, 2020-12) Efrem Paulos; Tarekegn Getahun
    Background Assessment of injection device use and injection technique, are key components of a comprehensive diabetes medical evaluation and treatment plan. Proper insulin injection technique may lead to more effective use of this therapy and, as such, holds the potential for improved clinical outcomes. The lack of a clear number of patients with diabetes mellitus requiring insulin therapy, and few studies focused on either assessing injection techniques or associated complications separately have indicated suboptimal knowledge and skill with higher than the worldwide average on the presence of complications. Objective Major insulin injection parameters were assessed among patients with diabetes mellitus on followup at the adult diabetes referral clinic in TASH, Addis Ababa from September 1 to October 31, 2020. Methods A cross-sectional survey was conducted from September 1 to October 31, 2020, at the diabetes clinic in Tikur Anbessa Specialized Hospital. Data were collected by using a structured, interviewer-administered questionnaire. Then, entered and analyzed using SPSS version 20. To identify factors associated with injection techniques, bivariable and multivariable binary logistic regression analyses were done. Statistical significance was considered at a level of significance of 5%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association Results A total of 293 participants were included in this study. The most common type of diabetes reported was Type 2 diabetes mellitus. From the recommended injection sites, 256 (87.4%) inject at more than 1 site with the thigh (249/85%) being the most often used site. The median total daily insulin dose was 54IU. Insulin syringe reuse was practiced by practically all (98%) of the participants. Injection site rotation is practiced by 272 (92.8%) of the participants. The presence of any swellings or lumps over the injection sites was reported by 113 (38.6%) of the participants with the thigh being the most common site. Disposal of used syringes capped into the trash is the practice of 176 (60.1%) of the study participants. From the multivariate analysis, sex (AOR=2.33, 95% CI:1.13-4.83), total daily dose of insulin (AOR=0.99, 95% CI:0.98-0.99), last time injection instructions were reviewed (AOR=0.35, 95% CI:0.13-0.97) and hyperglycemia events (AOR=0.56, 95% CI:0.31-0.99) showed significant association with the presence of lipohypertrophy. Conclusion: This study revealed that there are alarmingly high rates of injection-related complications. The diabetes education given pertaining to injection parameters and evaluation of injection sites are neglected which will fuel the occurrence of complications. It highlights the need for the provision of patient-centered instruction and education about insulin injection techniques. Keywords: diabetes mellitus, insulin, insulin injection technique, lipohypertrophy, cross-sectional study
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    The Risk factors for Osteoporosis and Falls, their Association, and Knowledge in Patients with Type 1 Diabetes Mellitus
    (Addis Ababa University, 2023-12) Efrem Paulos; Feleke Yeweyenhareg
    Background: Patients with type 1 diabetes have a lower bone mineral density (BMD) and up to6-fold higher risk of fracture compared to healthy subjects, justifying the classification of the disease as a non-modifiable risk factor for osteoporosis. The literature describes a variety of risk factors for low BMD in patients with type 1 diabetes, with some conflicting evidence. Data on osteoporosis and related factors in patients with type 1 diabetes in Ethiopia, Africa, and other low-and middle-income countries is lacking. Objectives: To determine the risk factors for osteoporosis and falls, their association, and knowledge in patients with Type 1 Diabetes age 40 years and above. Methods: An institution-based cross-sectional study was conducted from June 1 to August 31,2023GC at the diabetes clinic in Tikur Anbessa Specialized Hospital, Addis Ababa. All patients with Type 1 diabetes age 40 years and above attending the diabetes clinic during 2023GC were enrolled. Data was collected through pretested structured interviewer-administered questionna ires and analyzed using SPSS version 26. The statistical association was tested using Pearson'scorrelation coefficient, chi-square test, bivariate and multivariable logistic regression. Statistica lsignificance was considered at a level of significance of 5%, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to present the estimates of the strength of the association. Finally, outcomes were presented with tables, figures, and statements. Results: This study involved a total of 106 participants of which 54.7% were males and 47.2% were between the ages of 40-44 years. Ninety-six percent of the study participants were living with Diabetes for more than 10 years and two-thirds had persistent proteinuria. Fifty-two percent had diabetic eye complications, 10.4% had an eGFR of <60ml/min/1.73m2 while 9.4% of the participants consumed more than three units of alcohol per day. Only two participants had a high FRAX fracture risk score but 13.2% had a history of previous fragility fracture. Age and duration of diabetes had a positive correlation and eGFR had a negative one with the 10-year probability of a major osteoporosis-related and hip fracture. The magnitude of osteoporosis was 15%. Fifteen percent of the study participants had frequent falls and 13.2% had a high concern of falling. Being female (AOR=1.6, 95% CI=1.42, 5.88), having previous fragility fractures (AOR=1.8, 95% CI=1.04, 9.27), and osteoporosis (AOR=4.1, 95% CI=1.15, 16.49) were associated with frequentfalls. Eighty-three percent had poor knowledge about osteoporosis with a higher level of education associated with a higher level of osteoporosis knowledge. The factors associated with osteoporosis10were female gender (AOR=1.8, 95% CI=1.41, 7.69), excess alcohol use (AOR=5.7, 95% CI=1.69,47.38), diabetic eye complications (AOR=4.7, 95% CI=1.91, 24.35), and frequent falls (AOR=5.6,95% CI=1.19, 26.15). Conclusion: Type 1 diabetes carries an increased risk of osteoporosis, falls, and fractures. Being female, having previous fragility fractures and osteoporosis had a positive association with frequent falls, whereas being female, excess alcohol use, diabetic eye complications, and frequent falls were independent determinants of osteoporosis. A significant osteoporosis knowledge deficit was also seen among the participants with a higher level of education being positively associated. A high concern of falling with difficulties maintaining balance were other concerning outcomes.