الفهرس 
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Abstract
Diabetes mellitus is a highly prevalent worldwide disorder and is a major cause of morbidity and mortality due to its complications. (121) Type 2 diabetes accounts for about 90-95% of all diabetes,(123) it frequently goes undiagnosed for many years; nevertheless such patients are at an increased risk of developing macrovascular and microvascular complications.(127) Of all chronic non communicable diseases, diabetes is associated with the highest co-morbidities and complications and affects people from all socioeconomic backgrounds.(142)
Diabetes care has shifted to an approach that is more patient centered and places the person with diabetes and his or her family at the center of the care model.(37) Health education is the cornerstone of diabetes care. It aims to change the attitude and behavior towards the disease for better control and reduction of complications.(26) Effective diabetic health education program needs the availability of all essential structures, community participation and integration of the government and private sectors.(28)
In Egypt diabetes is emerging as an important public health problem for many reasons, not only are the risk factors associated with diabetes mellitus ever increasing, but the individual with diabetes frequently makes his or her decisions concerning the disease outside the clinical setting, either at home, on the job or within his/her existing community.(33) Egypt currently lacks structured education program regarding diabetes both for people at risk of the disease and for people suffering from it in most health care services. We need a lot of studies to assess the current knowledge levels and behaviors of people with diabetes, to evaluate their educational needs.
The aim of this study was to assess the knowledge and behaviors of type 2 diabetic patients regarding their disease, to reveal the effect of health education on patients’ compliance and glycemic control, and to identify factors that may contribute to the non-compliance.
To achieve these aims a descriptive cross sectional study was selected. The study sample included 84 type 2 diabetic patients of both sexes working in Amreya Petroleum Refining Company subjected to a diabetic health education program in small groups each 12-patient from January to April 2015.
Data were collected using interview questionnaire filled by the patients themselves and a transfer sheet that includes available data from patients’ files such as examinations, investigations, and complications. Data collection were carried out then scored, coded, and analyzed using appropriate statistical methods.
The results showed that males constituted 82.1% of the sample. The mean age was 49.63 ± 6.61 years. The most encountered educational level was basic or secondary level (47.6%), illiterate patients account for 28.6%, while those graduated from university account for 23.8%. 73.8% worked in usual hours-work style, and 26.2% in shift-work style. Only 3.6% had normal BMI. 52.4% were smokers or ex-smokers. Family history for diabetes was positive in 69%. The mean duration of the disease was 7.93 ± 5.66 years; with 41.7% had diabetes for 5 years or less. The majority was treated with oral hypoglycemic drugs, especially metformin and sulphonylureas, and only 16.7% were treated with Insulin. Dyslipidemia, hypertension, diabetic neuropathy, diabetic retinopathy, and diabetic kidney disease were found in 72.6%, 71.4%, 69.7%, 53.6%, and 36.9% respectively, while 39.3% of the patients suffered from ischemic heart disease, and 11.9% from diabetic foot.
The level of knowledge was poor; only 33.3% achieved satisfactory level of total knowledge, 32.1% regarding general knowledge, 50% regarding predisposing factors, 73.8% regarding clinical picture, 76.2% regarding complications, 29.8% regarding self-care behaviors, and 13.1% regarding foot care. Also, most of patients showed non-compliance behaviors; 70.2% were non-compliant in general; 88.1% to foot care, 76.2% to exercise, 71.4% to diet, 42.9% to medical service utilization, and 14.3% to medications. And accordingly poor diabetic control was noticed 63.1% had uncontrolled FPG with a mean of 176.40 mg/dl ± 27.72, 65.5% had uncontrolled 2h-PG with a mean of 251.82 mg/dl ± 43.22, and 70.2% had uncontrolled HbA1C with a mean of 8.80% ± 1.19.
The health education program was successful; satisfactory level in total knowledge had increased from 33.3% to 78.6%, reaching 81% regarding general knowledge, 91.7% regarding predisposing factors, 91.7% regarding clinical picture, 94% regarding complications, 85.7% regarding self-care behaviors, and 75% regarding foot care. Also, compliant patients increased from 29.8% pre-course to 54.8% post-course; with 64.3% to foot care, 34.5%to exercise, 46.4% to diet, 64.3% to medical service utilization, and 96.4% to medications. FPG became controlled in 51.2% with a mean of 113.63 mg/dl ± 12.90, 2h-PG became controlled in 46.4% with a mean of 155.28 mg/dl ± 17.01, and HbA1C became controlled in 45.2% with a mean of 6.79 ± 0.17, with less incidence of hypoglycemia (from 14.3% to 2.4%), and with a decrease in the mean of BMI from 31.75 pre-course to 30.78 post-course.
The present study showed strong relationship between level of education and gaining knowledge, with less powerful effect on changing behaviors and weak relationship regarding improvement in diabetic control.
Difficulty in changing eating habits and lack of knowledge about what to eat in healthy diet were the most mentioned causes of dietary non-compliance. Side effects of the drugs and forgetting to take medications were the most mentioned causes of medication intake non-compliance. Having no time, no place to practice, and feeling tired were the most mentioned causes of non-compliance to exercise. Lack of knowledge and feeling well were the most mentioned causes of non-compliance to foot care. Long waiting time, feeling well, and poor doctor-patient relationship were the most mentioned causes of non-compliance to medical service utilization.