Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review

Figures & data

Figure 1 PRISMA flow diagram showing the selection process of the included studies in the literature review.

Table 1 The English, local and scientific names of herbs that were used by patients with diabetes in Jordan.^70,71

English name	Local name	Scientific name
Cinnamon	Kerfah	Cinnamon zeylaniucm blume
Fenugreek	Helba	Trigonella foenum-graecum
Garlic	Thoom	Allium sativum
Germander	Geádah	Teucrium polium
Ginger	Zanjabeel	Zingiber officinale Rosc.
Okra	Bamia	Abelmoschus esculentus
Olive leaves	Waraq Zaytoon	Olea europaea
White lupine	Termos	Lupinus albus L

Table S1 Summary of the studies that were reviewed in this literature

Author/s and date	Sample size and characteristics	Research design and methods of data collection	Main findings
El-Qudah, 2016.^Citation8 Different hospitals in Amman, Jordan.	Convenience sampling, 180 females with diabetes	Cross-sectional study. Dietary knowledge was assessed by a self-reported questionnaire.	More than half of patients (56.1%) provided wrong answers for meals recommended for diabetes/day and that should be used with hypoglycemia, food rich in protein, number of snacks (50.6%) and their role (43.1%), drinks permitted with unlimited amounts (61.4%) and suitable time to drink juice (78.1%).
Khattab et al, 2010.^Citation10 The National Diabetes Centre, Jordan.	Systematic random sample, 917 patients with T2DM.	Cross-sectional study. Sociodemographic data and diabetes self-management behaviours were collected by questionnaire. All blood glucose levels and lipid profiles were taken from patients’ files.	65.1% had HbA1c ≥7% and negative attitude towards diabetes.
Al-Khawaldeh et al, 2012.^Citation11 The National Diabetes Centre, Jordan.	Convenience sample, 223 patients with T2DM.	Cross-sectional survey. Data were collected by diabetes management self-efficacy scale, and a diabetes self-management behaviours scale	Diet self-efficacy and diet self-management behaviours predicted better glycemic control, whereas insulin use was a predictor for poor glycemic control.
Khatib et al, 2006.^Citation14 The National Diabetes Centre, Jordan.	Convenience sampling, 988 patients with diabetes.	Cross-sectional survey. The prevalence rate of erectile dysfunction was measured by structured interviews.	The overall prevalence of erectile dysfunction was 62% and 30.3% had severe erectile dysfunction.
Al-Bdour et al, 2008.^Citation15 Jordan University Hospital.	Convenience sampling, 1961 patients with diabetes.	Cross-sectional survey. Full eye examination, biochemical measurements and medical assessment were used to collect data about risk factors for diabetic retinopathy.	64.1% (n=1257) were found to have one type of diabetic retinopathy, and there was association between diabetic retinopathy with poorly controlled diabetes and longer duration of disease.
Rabiu et al, 2015. ^Citation16 North Jordan, Jordan.	Random selection, 104 patients with diabetes.	Cross-sectional study. Data were collected by standardized examination protocol, which included ophthalmic examination, random blood sugar test using digital glucometers and dilated fundus examination.	Untreated cataract and diabetic retinopathy were the major causes of blindness, accounting for 46.7% and 33.2% of total blindness cases, respectively. The prevalence of any retinopathy was 48.4%.
Bakkar et al, 2017.^Citation17 General population; Amman, Zarqa, and Irbid.	Random selection, 237 patients with T2DM.	Cross-sectional study. Awareness and knowledge of diabetes and diabetic Retinopathy were assessed by a questionnaire.	88.2% were aware that diabetes can affect the eyes and 81% reported that diabetic retinopathy can lead to blindness.
Ajlouni et al, 2008.^Citation18 Comprehensive health centre, Jordan.	Random selection, 1121 participants (general population).	Cross-sectional survey. Data were collected by sociodemographic questionnaire, anthropometric and biochemical measurements.	The study findings identified 195 participants who had T2DM, of whom 79 (54%) were poorly controlled cases.
Albikawi and Abuadas, 2015.^Citation19 Diabetes Specialized Centre, Jordan.	Convenience sampling, 49 patients with T2DM.	Cross-sectional study. Data about diabetes management behaviours were collected by a self-report questionnaire.	The most frequently performed self-care management behaviours was medication taking followed by foot care, dietary adherence, exercise, and the least performed behaviour was blood glucose testing.
Khawaja et al, 2018.^Citation21 The National Diabetes Centre, Jordan.	Convenience, 1003 patients with T2DM.	Cross-sectional study. Data were collected from participants during a face-to-face structured interview.	The overall prevalence of diabetic neuropathy was 39.5%, The most frequently reported symptoms were numbness (32.3%) and pain with walking (29.7%), while the least reported symptoms were the history of amputation (1.3%), loss of sensation in legs/feet while walking (3.8%), and 57.9% of the patients (n=581) had an HbA1c more than 7%.
Ali et al, 2008.^Citation25 The National Diabetes Centre, Jordan.	Random selection, 613 female patients with diabetes and 524 women without diabetes	Cross-sectional study. sexual dysfunction was measured by The Female Sexual Function Index questionnaire	Prevalence of sexual dysfunction in diabetic women was 59.6% vs 45.6% in nondiabetic women.
Yasein and Masa’d, 2011.^Citation26 Jordan University hospital, Jordan.	Random selection, 730 Patients with chronic conditions including T2DM.	Cross-sectional study. Data were collected by sociodemographic questionnaire, anthropometric (weight, height, hip, BP and waist circumferences) and biochemical (fasting blood glucose and lipid profile) measurements.	The prevalence of metabolic syndrome was 37.4% (31.7% in men; 41.0% in women). The prevalence increased with age in the total sample and in both sexes. High waist circumference showed the highest prevalence in the total sample (61.6%). Among females it ranked as the first criterion (73.5%). High serum triglyceride level showed the highest prevalence in males (50.2%).
Al-Amer et al, 2008.^Citation29 The national diabetes centre, Jordan.	Random selection, 1000 patients with T2DM	Cross-sectional study. Prevalence and risk factors of diabetic retinopathy were assessed by eye examination.	The prevalence of diabetic retinopathy in patients was 34.1%. Duration of DM and hyperglycemia were associated with diabetic retinopathy.
Al-Amer et al, 2011.^Citation31 Jordan University Hospital, Jordan.	Systematic random sampling, 649 patients with diabetes.	Cross sectional study. Prevalence of undiagnosed depression and the relationship between depression and blood sugar control were collected by a structured questionnaire.	128 (19.7) have depression, females are more likely to develop depression than males. 64.7% of participants did not follow the diabetic diet and 70.9% of the participants were poorly controlled
Al Omari et al, 2009.^Citation33 A primary care centre, Jordan.	Convenience sampling, 337 patients with T2DM.	Cross sectional study. The data were collected by reviewing the patients’ medical records	56.1% had HbA1c <7%. The mean HbA1c was 7.1%. Half of the patients achieved the target levels of total cholesterol, triglycerides and HDL.
Bawadi et al., 2013.^Citation34 King Abdulla University Hospital, Jordan.	Convenience sampling, 750 patients with T2DM	Cross-sectional survey. Dietary profile of participants was assessed by a semi-quantitative food frequency questionnaire (FFQ).	Patients reported high intakes of fruits and grains, enough intakes of vegetables and low intakes of milk, meat and beans. Daily caloric consumption was 65% from carbohydrates, 13% protein, and 29% fat (distributed as 8% from saturated fat, 14% from monounsaturated fat, and 3.5% from polyunsaturated fat).
Al-Sarihin et al, 2012.^Citation35 Hospital, Jordan.	Convenience sample, 100 patients with diabetes.	Cross-sectional study. Data were collected by using Fitzgerald’s (1998) questionnaire to assess general diabetes knowledge and insulin knowledge.	The overall scores of the total sample were low; Total knowledge was (49.8±13.4); General Diabetes Knowledge was (54±14) and Insulin Knowledge was (43±19.6). Men scored higher than women in the total Knowledge (52.9 vs 46.7); General Diabetes Knowledge (56.8 vs 51.1); and Insulin Knowledge (46.9 vs 39.8). Moreover, there were no differences found between patients with type 1 and type 2 Diabetes in study group.
Barghouti et al, 2015.^Citation41 Jordan.	Random selection, 3196 (General population).	Cross-sectional study. Knowledge and practice of leisure-time physical activity were assessed by a questionnaire.	12.5% were physically active, and 55.9% of the participants recognised the recommended physical activity guidelines in Jordan.
Darawad et al, 2016.^Citation42 Four hospitals in Jordan, Jordan.	Convenience, 115 patients with diabetes.	Cross-sectional survey. Exercise behaviours were measured by patients’ self-reported questionnaires.	An average number of 3.2 physical activities per week (average of 2.9 hrs), with walking being the most common activity. Lack of desire, time, having diabetes were reasons for not exercising.
Al Jamal and Ibrahim, 2011.^Citation43 Al Mafraq Governmental Hospital in Jordan.	Random selection, 45 patients with T2DM and 15 healthy participants.	Pre/post randomised trial. Data about the changes produced in the lipid profile after consumption olive oil were collected by asking participants to consume 30 ml of olive oil per day	Four weeks of consumption of olive oil lowered the levels of fasting blood glucose, triglycerides, total cholesterol, and low density lipoproteins in both groups. Reduction was more profound in diabetics than in healthy controls.
Jammal et al, 2013.^Citation44 The National Diabetes Centre and diabetes clinic, Jordan.	Random selection, 127 patients with T2DM.	Cross-sectional study. Data were collected by complete ocular examinations	Prevalence of diabetic retinopathy of 7.9%.
Abdel-Aal et al, 2008.^Citation45 The National Diabetes Centre, Jordan.	Convenience sampling, 702 patients with T2DM.	Cross-sectional study. Data were collected by reviewing medical records.	90% of a sample of 702 patients with T2DM had one or more types of dyslipidaemia in Jordan.
Jarab et al, 2018.^Citation48 The Royal Medical Services Hospital, Jordan.	Purposive sampling, 36 patients with T2DM.	Qualitative study. Focus group method was used to collect data about patients’ perspective and experiences regarding T2DM.	Medication regimen characteristics including rout of administration, number of prescribed medications and dosage frequency in addition to perceived side effects represented the major barriers to medication adherence.
Awwad et al, 2015.^Citation50 The University of Jordan Hospital and Jordan Hospital.	Convenience sampling, 902 patients with chronic conditions including T2DM.	Cross-sectional survey. Adherence to medicines using Morisky Medication Adherence Scale (MMAS-8).	Most of the participants had low adherence. High income and higher education were associated with higher adherence scores.
Basheti et al, 2016.^Citation51 Jordan.	Random selection, 167 patients with chronic conditions.	Cross-sectional survey. Adherence to medications was assessed Morisky Medication Adherence Scale (MMAS-8).	46.1% of participants were non adherent. Patient adherence was positively affected by older age, higher educational level, and higher number of physician visits per month, while it was negatively affected by reporting difficulties with getting prescription refills on time.
Al-Keilani et al, 2017.^Citation53 18 hospitals and health care centres in Jordan.	Convenience sampling, 1079 patients with diabetes.	Cross-sectional survey. Self-monitoring of blood glucose (SMBG) adherence was measured by questionnaire.	59% of participants were SMBG adherent. Patients who were taking oral hypoglycemic agents or insulin therapy tested more frequently as compared to others.
Salayta and Aleyadeh, 2010.^Citation54 King Hussein Medical Centre, Jordan.	Convenience sampling, 60 patients with diabetes.	Longitudinal cohort, prospective. Following up 60 patients with a diabetic foot infection to identify the progression of diabetic foot infection	Ten patients out of 60 (17%) had below knee amputation after failure of local foot debridement.
Bakri et al, 2012.^Citation55 The National Diabetes Centre, Jordan.	Random selection, 1000 patients with diabetes.	Cross-sectional survey. Data about the prevalence of diabetic foot ulcers were collected by reviewing the medical records, interviewing, and examining the patients.	Diabetic foot ulcer prevalence was 4.6%, sensory neuropathy 14.9%, lower limb ischemia 7.5%, and amputation 1.7%.
Al-Sahouri et al, 2019.^Citation56 Comprehensive health care centre, Jordan.	Purposeful sampling, 38 patients with T2DM.	Qualitative study. Attitudes, perceptions and knowledge of patients were explored by a focus group method.	Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes.
Abu-Qamar and Wilson, 2011.^Citation57 Six hospitals throughout Jordan	Purposeful sampling, 7 patients with diabetes.	Qualitative. Patient’s views of diabetic foot care within the Jordanian healthcare system were collected by unstructured interviews.	Participants were not practising preventive foot care behaviours. Participants believed that the presence of diabetes does not necessitate the need for regular foot examination when there are no active ulcers on their feet.
Wazaify et al, 2013.^Citation70 Jordan University Hospital, Jordan.	Random selection, 700 patients with chronic conditions including T2DM.	Cross sectional study. The prevalence of herbal medicine use was explored by a semi-structured questionnaire.	7.6% of a sample reported using herbs. Most of complementary and alternative medicine users were older than 50 years of age and predominantly female.
Wazaify et al, 2011.^Citation71 National Diabetes Centre, Jordan.	Random selection, 1000 patients with diabetes.	Cross sectional study. Data about prevalence, type, frequency, purpose and pattern of herbal preparation were collected by a semi-structured questionnaire.	16.6% (n=166)of a sample of 1000 patients with diabetes, were users of herbal remedies in Jordan and green tea was the most popular herb used by participants.

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