International Research Journal of Biological Sciences ___________________________________ ISSN 2278-3202Vol. 4(9), 69-73, September (2015) Int. Res. J. Biological Sci. International Science Congress Association 69 Evaluation of SMBG, Diet and Physical Activity in DM II Patients, A Case Study at Tertiary Care Hospital of Larkana, Sindh, Pakistan Waseem Abbas1,2*, Muhammad Ali Ghoto, Abdullah Dayo, Mudassar Iqbal Arain, Rabia Parveen and Ali QureshiDepartment of Pharmacy, SMBBMU, Larkana, PAKISTAN Department of Pharmaceutics, Faculty of Pharmacy, University of Sindh, Jamshoro, PAKISTAN Available online at: www.isca.in, www.isca.me Received th 2015, revised th 2015, accepted th 2015 Abstract Self monitoring of blood glucose level helps to evaluate the result of dietary requirements, medical treatment, stress and physical activity on glucose levels within blood.Out of 400 patients 9% were involved in SMBG once daily, (14%) were involved in SMBG two times in a week, 7% were involved in SMBG three times in a week and 70% were involved in SMBG once in a 15 days or month(s). The frequency of SMBG and adjustment in dose of drug was as 28 (78%) once daily, 34 (60%) two times in a week, 19 (67%) three times in week and none of the patients who were involved in SMBG once in a 15 days or month(s) adjust their dose. The frequency of SMBG and adjustment in diet was as 34 (94%) once daily, 42 (75%) two times in a week, 21 (75%) three times in week, 4 (50%) once in a 15 days and 122 (44%) who were involved in SMBG once in a month(s) involved in adjustment of their diet. The frequency of SMBG and adjustment in physical activity was as 16 (44%) once daily, 19 (33%) two times in week, 7 (25%) three times in a week and 74 (27%) who were involved in SMBG once in a month(s) involved in adjustment of their physical activity.It was also concluded that the patients who were involved in SMBG as per recommendation got the benefit by adjusting their dose, diet and physical activity. Keywords:Diabetes mellitus, Larkana, SMBG, tertiary care. Introduction Diabetes is a chronic metabolic disorder in which body either does not produce or use the insulin effectively. Diabetes burden will persist to rise all over world without effective prevention and management program. 85%-95% cases of diabetes are of type 2 diabetes in high income countries where as more than 95 % in middle and low income countries. Type 1 diabetes cases are less common compare type 2 diabetes. The patients with gestational diabetes are increasing throughout the world . Globally, with regard to its prevalence, complications, and costs diabetes is emerging as a disease of epidemic magnitude. As one cannot change the therapy in diabetic patients based on glycated hemoglobin A1C test that’s why SMBG is necessary for adjustment of the dose of anti diabetic medication, diet physical activities. SMBG plays a key role in effective glycaemic control for both type 1 diabetic and insulin-dependent type 2 diabetic patients demonstrated through clinical trials by providing help for adjusting the insulin dose through proper monitoring and helps to prevent hypoglycemia and pre-prandial as well post-prandial hyperglycemia. Routine SMBG in type 2 diabetic patient has been recommended by the American Diabetes Association. The progression risk of both macro as well microvascular complications can reduce by optimal management of glycaemia and other cardiovascular risk factors have demonstrated by numerous studies4-8. Using SMBG has potential to improve glycaemic control suggested by current evidence particularly by incorporating into comprehensive and ongoing education program that promotes management adjustments according to the ensuring blood glucose values9-11. SMBG is responsible for decreasing the HbA1c as compare to control group12. SMBG is expensive practice particularly for type 2 diabetic patients, therefore there is a substantial controversy about this but it is extensively recommended as a major part for diabetes control. However in proposed study it was observed that type 2 diabetic patients were able to get the advantage from SMBG by adjusting their dose of anti-diabetic medication, diet and physical activity based on their blood glucose level by identifying their glycemic control. Methodology For the collection of the data a well structured questionnaire was used which consist of some important parameters. The proposed study was done through descriptive research design means describing the peoples who were involved in the study design. Descriptive research design project can be done through three ways those are observational, case study and survey based. In proposed study the descriptive study was done through survey based method. The results are given on percentage basis by arranging the information in simple frequency tables. The percentage distribution was used for presenting research finding by making different graphs representing each parameter separately. Results are shown in graphs on percentage basis with the help of computer program. Sample Size: The sample size was 400 patients. Research Journal of Biological Sciences ___________________________________________________________ ISSN 2278-3202 Vol. 4(9), 69-73, September (2015) Int. Res. J. Biological Sci. International Science Congress Association 70 Sample: Tertiary Care Hospital Larkana Outpatient Department is the area from where all the samples were taken by purposive sampling method one of the procedure that can be followed for the selection of items for statistical samples. Data Collection Method: In biological science, there are different methods of data collections; I have collected the data with the help of structured questionnaire at tertiary care outpatient department which is also used in some related study 13,14. The basic parameters of the questionnaire that is used include: Name of the patient, Age, Gender, Address, Diabetic and any other chronic disease history, Pregnancy lactation status, Alcohol intake history, Self blood glucose monitoring history, Diabetic associated complication, Medication history, Life Style Changes based on SMBG results, Adjustment in dose of Anti-Diabetic Medication based on SMBG result Inclsion criteria: The inclusion criteria for current study were all diabetic patients having age between 30 years to 80 years. Exclusion criteria: All the diabetic patients with any persistent kidney disorder, persistent liver disorder, alcohol abuse, pregnancy, lactating mother are exclusion criteria.Results and Discussion Total 400 diabetic patients were evaluated at tertiary care outpatient department with the help of structured questionnaire. Out of 400 patients 36 (9%) patients were involved in SMBG level in once daily, 56 (14%) patients were involved in SMBG level two times weekly, 28 (7%) patients were involved in SMBG level three times weekly, 8 (2%) patients were involved in checking their blood glucose level once in a 15 days while rest of 272 (68%) patients were involved in SMBG once after a month or few months (table-1 and figure-1). From the total 400 diabetic patients who were involved in the study 28 (78%) of the patients out of 36 who were involved in SMBG once daily adjust the dose of anti diabetic medication, 34 (60%) of the patients out of 56 who were involved in SMBG two times in a week adjust the dose of anti diabetic medication, 19 (67%) of the patients out of 28 who were involved in SMBG level three times in a week adjust the dose of anti diabetic medication and 280 (100%) out of 280 who were involved in SMBG level once in a 15 days or month(s) did not adjust the dose of anti diabetic medication themselves (table-2 and figure-2). Out of total 400 diabetic patients who were involved in the study 34 (94%) of the patients out of 36 who are involved in SMBG once daily adjust their diet, 42 (75%) of the patients out of 56 who were involved in SMBG two times in a week adjust their diet, 21 (75%) of the patients out of 28 who were involved in SMBG three times in a week adjust their diet, 4 (50%) of the patients out of 8 who are involved in SMBG once in a 15 days and 122 (44%) out of 272 who were involved in SMBG once in month(s) adjust their diet themselves compare to related study in which from the total patients who were involved in study and make the adjustment in their diet, 24.1% of the patients were involved in checking their blood glucose level occasionally or less than once a month while 25.1% of the patients were involved in checking their blood glucose level daily or two times in a day13 which indicate that greater percentage of patients who were involved in SMBG adjust their diet in current study. (table-3). From the total 400 diabetic patients who were involved in the study 16 (44%) of the patients out of 36 who are involved in SMBG once daily adjust their physical activity, 19 (33%) of the patients out of 56 who were involved in SMBG two times in a week adjust their physical activity, 7 (25%) of the patients out of 28 who were involved in SMBG three times in a week adjust their physical activity, not a single patient out of 8 who are involved in SMBG once in a 15 days adjust their physical activity and 74 (27%) out of 272 who were involved in SMBG once in a month(s) adjust their physical activity themselves compare to related study in which from the total patients who were involved in study and make the adjustment in their physical activity, 24.6% of the patients were involved in checking their blood glucose level occasionally while 36.2% of the patients were involved in checking their blood glucose level three or more times in a day13 which showed that the patients who were involved in SMBG on daily basis adjust their physical activity in current study (table-4 and figure-3). Conclusion It was concluded through this study that the SMBG is an essential tool for diabetic population. It was observed the greater percentage of the patients were got the benefit of adjusting their dose of anti-diabetic medication, diet and physical activity check their blood glucose level on daily basis. It was also seen that the patients who were involved in self monitoring of blood glucose level as per recommendations were convinced that SMBG is an important parameter for adjusting their routine life style modification and dose of anti-diabetic medication based on their blood glucose level. Table-1 Self Blood Glucose Level (SMBG) FrequencySMBG No: of Patients Percentage Once Daily 36 9% Two Times in a Week 56 14% Three Times in a Week 28 7% Once in 15 Days 8 2% Once after a Month(s) 272 68% Total 400 100% Research Journal of Biological Sciences ___________________________________________________________ ISSN 2278-3202 Vol. 4(9), 69-73, September (2015) Int. Res. J. Biological Sci. International Science Congress Association 71 Figure-1 Self Blood Glucose Level (SMBG) Frequency Table-2 SMBG Frequency and adjustment in Anti-Diabetes Medication DoseSMBG No: Of Patients Adjustment in Anti-Diabetes medication dose Percentage of Patients involved in Adjustment in Anti-Diabetes medication dose Once Daily 36 28 78% Two Times in a Week 56 34 60% Three Times in a Week 28 19 67% Once in 15 Days 8 0 0% Once after a Month(s) 272 0 0% Table-3 SMBG Frequency and adjustment in DietSMBG No: Of Patients Adjustment in Diet Percentage of Patients involved in Diet Once Daily 36 34 94% Two Times in a Week 56 42 75% Three Times in a Week 28 21 75% Once in 15 Days 8 4 50% Once after a Month(s) 272 122 44% 36562827250100150200250300Once in a DayTwo times in aWeekThree Times in a WeekOnce in a 15 DaysOnce in a Month(s)No: of Patients No: of Patients Research Journal of Biological Sciences ___________________________________________________________ ISSN 2278-3202 Vol. 4(9), 69-73, September (2015) Int. Res. J. Biological Sci. International Science Congress Association 72 Figure-2 SMBG Frequency and adjustment in dose of Anti-Diabetic Medication Figure-3 Frequency and adjustment in Physical activity 3656282722834190050100150200250300Once in a DayTwo times in aWeekThree Times in a WeekOnce in a 15 DaysOnce in a Month(s) No: of Patients Adjustment in a dose of Anti-Diabetic medication 36562827216197450100150200250300Once in a DayTwo times in aWeekThree Times in a WeekOnce in a 15 DaysOnce in a Month(s) No: of Patients Adjustment in Physical Activity Research Journal of Biological Sciences ___________________________________________________________ ISSN 2278-3202 Vol. 4(9), 69-73, September (2015) Int. Res. J. Biological Sci. International Science Congress Association 73 Table-4 SMBG Frequency and adjustment in Physical activitySMBG No: Of Patients Adjustment in Physical Activity Percentage of Patients involved in Adjustment in Physical Activity Once Daily 36 16 44% Two Times in a Week 56 19 33% Three Times in a Week 28 7 25% Once in 15 Days 8 0 0% Once after a Month(s) 272 74 27% References 1.Harris M and Zimmet P, Classifiation of diabetes mellitus and other categories of glucose intolerance. International Textbook of Diabetes Mellitus, Second edition. chichester: John Wiley and Sons Ltd; P9-231997)2.Hunt Kj Schullerkl, The increasing prevalence of diabetes in pregnancy, Obstet Gynecolclin north Am, 34 (2), 173-199 (2007) 3.Al-Nuaim Ar, Mirdad S, Al-Rubeaan K, Al-Mazrouy, Al-Attas O and Al-Daghari N., Pattern and factors associated with glycemic control of Saudi diabetic patients, Ann Saudi Med., 18, 109-12 (1998)4.Diabetes Control and Complications Trial (DCCT) Research Group, The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus, N Engl J Med, 329, 977-986 (1993)5.Uk Prospective Diabetes Study (Ukpds) Group, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), Lancet, 352, 837-853 (1998)6.Coutinho M, Gerstein Hc, Wang Y and Yusuf S., The relationship between glucose and incident cardiovascular events: A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years, Diabetes Care, 22, 233–240 (1999)7.Stratton Im, Adler Ai, Neil Ha, Matthews Dr, Manley Se, Cull Ca, Hadden D, Turner Rc and Holman Rr, Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35), prospective observational study. BMJ, 321, 405-412 (2000)8.Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven Pd and ZieveFj et.al, Glucose control and vascular complications in veterans with type 2 diabetes, N Engl J Med;360, 129-139 (2009)9.Schwedes U, Siebolds M and Mertes G., Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients, Diabetes Care, 25, 1928-1932 (2002)10.Jansen Jp, Self-monitoring of glucose in type 2 diabetes mellitus: A Bayesian meta-analysis of direct and indirect comparisons, Curr Med Res Opin, 22, 671-681 (2006)11.SarolJn Jr, Nicodemus Na Jr, Tan Km and Grava Mb, Self-monitoring of blood glucose as part of a multicomponent therapy among non-insulin requiring type 2 diabetes patients: a meta-analysis (1966–2004), Curr Med Res Opin., 21, 173–84 (2005)12.Welschen Lm1, Bloemendal E, Nijpels G, Dekker Jm, Heine Rj, StalmanWa and Bouter Lm, Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: A systematic review, Diabetes Care, 28, 1510–17 (2005)13.Katharine D, Barnard Amanda, J Young and Norman R Waugh, Self-Monitoring of Blood Glucose: A Survey of Diabetes UK Members with Type 2 Diabetes Who Use SMBG, BMC Research Notes, , 318, (2010)14.Maureen Harris Mi., Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes, Diabetes Care, 24, 979-82 (2001)