1. Patient Uncompliance in Diabetes Prof. Morsi Arab

2. Definition: comply= agree/ yield Consequences : 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