Self-care practices and barriers to compliance among patients with diabetes in a community in rural Bangladesh

Diabetes is an emerging health threat in Bangladesh. The study objectives were to evaluate self-management practices among a population with diabetes in rural Bangladesh and to identify barriers to complying with prescriptions for diet, physical activity and drug use. In this cross-sectional study, 220 patients with diabetes were recruited from logs of diabetes clinics in Mirzapur, Bangladesh. Participants were asked about self-care practices and health complications and comorbidities associated with diabetes. Participants were also asked about treatments costs, barriers to diabetes treatment and socio-demographic characteristics. Almost half of the participants (49 %) were taking oral hypoglycemic agents (OHA), and 47 % were taking a combination of OHA and insulin; however, 30 % of those using insulin were not confident in their ability to self-administer the medication. The majority of participants (86 %) had complications that they attributed to diabetes, including vision impairments, poor wound healing and dizziness. The median monthly cost of diabetes maintenance was 725 taka (~US$9), approximately 8 % of the median monthly income. Common barriers to treatment included the high cost of medication, access and proximity to services, and feeling unwell as a result of prescribed treatments. Although the vast majority of participants managed their diabetes using OHA and insulin, there were common barriers that prevented patients with diabetes from complying with doctor’s recommendations for diabetes management. Given the high incidence of self-reported diabetic complications among this population, addressing these barriers may improve self-care practices and overall quality of life among those with diabetes in rural areas in Bangladesh.