Knowledge, attitude and practice of Sudanese individuals with type 2 diabetes about medication used in treatment of diabetes, hypertension and dyslipidaemia: a matter of debate or matter of concern?

Shaima Salah Eldin Khogali, Walaa Ahmad Ali, Sara Yousif Mohamed, Hisham Elhag Abdelrahim, Ashwag Abdulrahim Mirghani, Rabah Hassan Ali, Mashaeir Jailani, Banan Mustafa Omer, Nada Abdrahman Ibrahim, Mohamed H. Ahmed


Background: Diabetes is a chronic disease requires lifelong integrated treatment that includes lifestyle modifications and use of diabetes medication. The aim of this study was to establish knowledge, attitude and practice of Sudanese individuals with type 2 diabetes toward their medication.
Methods: This was a cross-sectional study that recruited 383 individuals with type 2 diabetes attend Jabir Abu Eliz Diabetes Canter. They aged between 18–65 years old. Individuals with type 2 diabetes are selected randomly and invited to complete the questionnaire, while Individuals with type1 diabetes, gestational diabetes and those aged less than 18 years old were excluded from this study.
Results: 76.5% of the interviewed patients had a valid health insurance, especially with 44% have diabetes for more than 10 years. Hypertension was one of the commonest co-morbidities (58%). Importantly 73% of the patients didn’t purchase all their prescribed medications (medicine not available, no medical insurance and expensive medication). The common medication used in treatment of diabetes is metformin (46%). Glibenclamide accounted for (16%), glimepiride for (10%), glipizide for (0.3%) and pioglitazone for (1.3%).The most common antihypertensive medication used are angiotensin converting enzyme inhibitor (27%), angiotensin receptor blocker (24%) and calcium channel blocker (24%). 17% of the study population were receiving statins and 84% in low dose aspirin. Almost one third (31.7%) of interviewed patients were on insulin. Approximately 72% of these patients were using mixed insulin, 21% using soluble insulin and 3% used more than one type of insulin at the same time. Two-third of this population usually takes the insulin dose by themselves and (34%) of this group rotated injection site routinely in comparison with (66%) who stick to one site. In Sudan room temperature rarely drops to under 30 °C which necessitated refrigeration of insulin. Majority of the patients (81%) confirmed the storage of insulin vials in the refrigerator.
Conclusions: More than two third of Sudanese individuals did not bought all medications used in treatment of diabetes and co-morbidities. Metformin and sulfonylureas were widely used in treatment of diabetes. Hypertension is well treated but lipid lowering medication was used by almost less than one fifth of the individual with type 2 diabetes. Intensive education is needed to increase knowledge of individuals about diabetes in order to enhance attitude and practice. This education can be achieved in part by both community and clinical pharmacists.