Diagnostic Parameters Knowledge, Guideline Use and Dietary Approaches in Type 2 Diabetes and Prediabetes Care among Healthcare Providers in Ainamoi Subcounty, Kenya

Abstract

Type 2 diabetes and prediabetes are metabolic diseases which are currently of great public health concern worldwide and which are associated with significant morbidity, mortality and even disability. Correct diagnosis, use of guidelines and optimum dietary care in diabetes care by the healthcare providers (HCPs) are attributed to better outcomes among the patients. This study utilized a cross-sectional design carried out at purposively sampled level 2 to level 5 health facilities of Ainamoi Subcounty, Kericho Kenya. One hundred and fifty participants were recruited by convenience sampling. Structured questionnaire was administered using Open Data Kit (ODK) app and collected by trained enumerators. The questionnaire elucidated data on knowledge of diagnostic parameters for diabetes, access and use of guidelines and dietary approaches prescribed by healthcare providers. Research was approved by University of Eastern Africa Baraton Institutional Ethics Committee and National Commission for Science, Technology Institute, License Number. NACOSTI/P/23/23262. Data was analyzed using statistical package for social sciences (SPSS) version 20 software. Descriptive analyses were conducted for all the variables. Categorical data was summarized as frequencies and percentages. The Chi-square test was used to compare various categorical variables in the study. The statistical significance level was set at p < 0.05. Less than a quarter (21%) of the respondents did not use diabetes guidelines suggestions. Up to 88.3% of HCPs prescribed low carbohydrate and only 8.3% prescribed a Mediterranean diet. Additionally, 82.7% of respondents could correctly identify Fasting Plasma Glucose parameter for Type 2 diabetes diagnosis while about two thirds could identify this parameter in Prediabetes diagnosis. Correct identification of glycated hemoglobin A1C (HBA1C) parameter for prediabetes (p=0.001) and for T2DM (p<0.001) and Fasting Plasma Glucose for Type 2 diabetes diagnoses (0.003) were significantly associated with years of experience. Similarly, statistical significance was noted between access and use of diabetes guideline with level of practice (p <0.001) and with years of experience (p= 0.002). The findings of this study showed limited usage of guidelines in clinical practice which may be linked to the observed limited awareness of diagnostic criteria used in diabetes care. Low carbohydrate diet was majorly prescribed with low emphasis on Mediterranean diet. Improved access to and utilization of standardized guidelines in dietary diabetes care and aggressive advocacy for the same at all levels of healthcare provisions is recommended to ensure timely and optimum care for better outcomes.