الفهرس 
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Abstract
Diabetes is a complex, chronic disease that needs ongoing medical treatment with multifactorial approaches to reduce risk beyond glycemic control. Type 1 diabetes mellitus is characterized by autoimmune pancreatic beta-cell destruction, resulting in absolute insulin deficiency and organ damage. Elevated blood sugar is a common effect of uncontrolled diabetes, and over time can damage the heart, blood vessels, eyes, kidneys, nerves and every system of the body. Diabetes and its complications impose significant economic consequences on individuals, families, health systems and countries.
Patients should follow and adhere to the prescribed therapeutic regimen for maintaining an optimal health and wellbeing that includes frequent self-monitoring of blood glucose (SMBG), dietary modifications, physical activity, education, medication administration, and foot care to maintain adequate glycemic control. Non-adherence to the therapeutic regimen leads to inadequate metabolic control, contributing to acute and long-term complications; non-adherence often brings huge costs, not only to patients but also to the health systems. Poor adherence can cause more rapid progression of disease.
The aim of this study:
Was to identify adherence of patients with insulin dependent diabetes to therapeutic regimen.
Setting:
The study was conducted in diabetic-outpatient clinic at Shark El madina hospital.
Subjects:
A convenience sampling of 150 adult patients who were admitted to the above mentioned setting and meeting the following criteria was included:
• Adult patients diagnosed with IDDM aged from 20 to 60 years.
• Adult patients diagnosed with IDDM for at least 6 months.
• Able to communicate verbally.
• Willing to participate in the study.
Tool of the study:
One tool was used for data collection.
”Adherence of patients with insulin dependent diabetes to therapeutic regimen Structured interview schedule”
The tool was developed by the researcher based on review of related literature. It was divided into two parts:
- Part I :-
-This part included bio- sociodemographic data related to:
a) Patients’ socio-demographic data; it included the patient’s personal data such as: patient’s age, sex, marital status, educational status, residence, occupation, and monthly income.
b) Clinical data; It was utilized to obtain information about the patient’s diagnosis, family history of DM, presence of other chronic diseases, duration of diabetes, clinic attendance, and number of daily injections, type of insulin, symptoms, duration of treatment and history of complications.
Part II: Assessment of Adherence of Patients with Insulin- dependent Diabetes to Therapeutic Regimen: This part was consisted of six domains namely: diet, medication, exercise, blood glucose testing, foot care, smoking; and adherence barriers:
Data collection:
A convenience sampling of 150 adult patients who met the inclusion criteria were selected from the mentioned above setting, then each patient was interviewed individually once for 30-45 minutes by the researcher to collect the necessary data related to adherence to therapeutic regimen at the reception of the diabetic Outpatient Clinic before examination and filled by the researcher.
Method of the study
The developed tool was tested for content validity by 5 experts in the field of medical surgical nursing for content validity, correction and clarifying of needed items was done .A pilot study was conducted before the actual study and was done on 15 patients with insulin dependent diabetes mellitus to test the clarity and applicability of tool as well as necessary modification was done.
Statistical analysis of the data:
After completion of data collection, statistical tests were carried out using the statistical Package of Social Sciences (SPSS, version 20.0) for both data presentation and statistical analysis of the results.
• The numbers and percentage were used for describing and summarizing qualitative data. Mean and standard deviation were used to present the quantitative data.
The main results of the study showed that:
• More than half (54%) of the studied patients were within the age group 50 -60 years.
• More than half (60.7%) of the studied patients were females.
• All studied patients lived in urban area.
• More than half (58.7%) of the studied patients were married.
• Read and write patients as well as secondary education formed 26.7% of the studied patients
• Housewives represented (40%) of studied patients.
• The majority of studied patients (92%) had not sufficient monthly income to fulfill the daily requirements from patient’s point of view.
• The majority of studied patients (85.3%) had insulin dependent diabetes mellitus greater than five years.
• More than one third (40%) of studied patients complained of nocturia.
• Less than half (39.3%) of patients had complains more than 10 years.
• Nearly more than half of them (60.7%) started insulin injection for more than five years.
• More than two thirds of patients (72 %) had associated diseases.
• More than one third (40.7%) of studied patients performed checkup monthly.
• About half (52%) of the studied patients had parent history of diabetes.
• More than three quarter of the studied patients (76%) weren’t smoke.
• More than two thirds (81.3%) of the studied patients were sometimes experience diabetic complications.
• The majority of studied patients (82%) seek medical advice.
• More than half of the studied patients (59.3%) sometimes adhere to diabetic diet regimen.
• More than half (52.7%) of studied patients mentioned that they sometimes eat prescribed amount of food daily.
• More than half (58.1%) of the studied patients sometimes avoid foods high in trans-fat.
• More than one third (41%) of the studied patients adhered 3-5 days per week, while 23.8% of them adhered every day to therapeutic diet.
• The majority (88%) of studied patients took insulin before meal.
• The largest number (86 %, 63.3%, 64.7% and 65.3%) of the studied patients always adhere to type of prescribed insulin, time of taking insulin, prescribed insulin dose exactly and taking insulin before meal respectively.
• Nearly half (47.3%) of the studied patients never perform physical activity.
• About two thirds (65.3%) of the studied patients never measuring blood sugar level daily before meals.
• More than half of the studied patients (58%) were fair adhered to diabetic diet.
• About three quarters (75.3%, 76%) of the studied patients were poor adhering to both exercise and blood sugar testing.
• The studied patients who were fair and good adhering to foot care had the same percentage (38.7%).
• The majority (95.3%) of studied patients sometimes find barriers in adherence to therapeutic regimen.
• More than half of the studied patients (61.3%) had moderate overall adherence barriers.
• There was a highly statistical significant relation between patient’s age, sex, level of education, monthly income and overall adherence to therapeutic regimen as p values were>0.05.
• The highest percentage of the studied patients who had good adherence to therapeutic regimen were aged (40>50) years, female patients, university educated and had enough income (63.9%, 52.7%, 62.1%, 75%) respectively.
• Overall adherence barriers were moderate in the patient’s age group of 50-60 ,male, manual occupation , divorced , secondary educated and who hadn’t have enough income( 65.4%,55.9%,71.5%,71.4% ,70% and 63%)respectively.
• The following were the main recommendations based on the findings of the present study, the following recommendations are suggested:
• Development and application of educational sessions for patients to improve their knowledge about therapeutic regimen (diet, medication, blood glucose monitoring, exercise and foot care).
• In-service education on the importance of patient’s adherence to therapeutic regimen must be given to nurses by efficient and skilled physicians as well as experienced nurses.
• Study the impact of health teaching program on adherence of insulin dependent diabetes mellitus patients to therapeutic regimen.