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Noncompliance in Diabetes - Consequences, Types, and Diagnostic Approach

This article explores the consequences, types, and diagnostic approach to noncompliance in diabetes. It discusses the immediate consequences of noncompliance, unachievement of control levels, and the development of complications. The different types of noncompliance in medication, dieting, exercise, and other behaviors are also examined. The article further looks at the grades of noncompliance and the patient factors contributing to it. Finally, it discusses the inadequate education and methods of managing noncompliance, including the absence of follow-up evaluation.

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Noncompliance in Diabetes - Consequences, Types, and Diagnostic Approach

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  1. Patient Uncompliance in DiabetesProf. Morsi Arab

  2. Definition: comply= agree/ yieldConsequences : 1- immediate conseq. can be serious ; eg. Ketoacidocis , hypoglycaemia ,etc. 2- Unachievement or loss of Control levels (glycaemic, BMI, lipids, B.P., etc) 3- Development or acceleration of complications.Epidemiology : *a current national study. *Prevalence - Types and grades -- Risk factors- Correlations with consequences

  3. Types and Fields of uncompliance : (simple or combinations)I- In Medication:(insulin,oral & complementary) - total stop ( of one or more medicines) - diminish or exceed dose (or number of injections). - change type (e.g. mixed insulin instead of NPH) - interrupted treatment.

  4. II- In Dieting - unrestricted (exceed total intake) - errors in caloric distribution , number of meals snacks, skip meals, irregular timing ,etc. - Type: Over- intake of Fat , Sugar, etc (salt)

  5. III- In Exercise: basal – working – sports . IV- In Other Behaviours: ( smoking--alcohol –drugs addictions-- contraindicated medications (eg. Steroids ).

  6. Grades of Uncompliance : - Minor and major - Continuous or interrupted - Single or multiple aspects

  7. Diagnostic Approach to Uncompliance A- Patient Factors : 1- Psychological state after recent discovery of diabetes ( at stages of denial , revolt , despair ….) 2- Having wrong concepts and belief ( health locus , cause of illness , distorted information about diabetes.) 3- Nonspecific totalitarian lovers of opposing stand. 4- Slaves of their habits ( e.g. smoking , diet, exercise ) 5- Transient depression from failing to achieve goals . 6- Transient stress : social , economic , inter-current illness.

  8. B- Inadequate Education at Management I- unclear objectives Knowledge :,unsuitable to type and stage of diabetes ,wrong priorities. Skills : psychomotor , communication and cognitive . Attitudes and Behaviors. II- Inadequate methods : (a) In providing knowledge : - Too much , or unsuitable content in a presentation. - Poor performance at the one-to-one education ( listen, motivate, encourage, etc. ). - In small group education: ( ignorance of group dynamics ) - In large group presentation: ( Inability to ensure active participation of audience.) - In mass media education: (inducing panic and confusion). - Inadequate use of AV- aids ,and education facilities .

  9. ( b) In teaching skills, inadequate description--demonstration and exercise . (c) Neglect of attitudes changes through model inspiration (good & bad) , contacts , discussions. etc. III- Absence of follow-up evaluation: - pre and post testing - follow up records of control parameters and compliance - check lists of performance of skills - rating scales for attitude changes

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