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             \author[1]{Gobezie Temesgen  Tegegne}

             \author[2]{Belayneh Kefale  Gelaw}

             \author[3]{Amsalu Degu  Defersha}

             \affil[1]{  Ambo University, college of medicine and health science, department of parmacy}

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\date{\small \em Received: 10 December 2013 Accepted: 3 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


Background: The main goal in diabetes care is to improve the patient's quality of life, to maintain satisfactory metabolic control and to retain minimal complications caused by diabetes mellitus (DM). To accomplish these goals, self-care has a great role. However, most patients don't control their blood sugar label. The objective of this study was to investigate status of glycemic control and self-care practice among Ambulatory diabetes patients in Ambo General Hospital.Method: Cross-sectional study was conducted from 01 February to 30 May 30/ 2014. Sample population includes all diabetes patients who will come for checkup during data collection period. The data was collected with structured questionnaires and check list by trained data collectors. Data was cleaned and analyzed using SPSS version 20.

\end{abstract}


\keywords{diabetes, self-care, fasting blood sugar, glycemic control, ambo general hospital}

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\let\tabcellsep& 	 	 		 \par
type 1 diabetes and the remaining 41.5\% were type2 DM. Mean FBS of three consecutive month was183.28 mg/dL. Only23.4\%, 34.2\% and 28.8\% of the respondents were able to control their Fasting Blood Sugar (FBS) to level below 126 mg/dL during their last first, second and third visit to the hospital. 20(18.01\%) of the respondents do exercise daily and attend their follow up program as scheduled respectively. 
\section[{Conclusion:}]{Conclusion:}\par
The present study illustrates that the level of knowledge about diabetes and self care practices amongst diabetic patients was low. In addition, it showed that respondents' level of physical activity, their educational status and time of insulin injection was low. Type 1 DM is the most prevalent type identified during the study period. In general, self-care practice was inadequate, especially in terms of physical self-care activity and a deficit in terms of knowledge related to diabetes; this could be explained by factors such as limited education and low levels of economic status Recommendation: Health care providers should educate and promote health to address the lack of information on a healthy diet, benefits of exercise and how exercise should be undertaken for ambulatory DM patients when they come for regular follow up regularly at the hospital. Primary care physician must interpret (preferably in patient's language), for each diabetic patient, the short and long-term benefits of adhering to diet and exercise recommendations, insulin storage site in the hospital as well as at home must be given special emphasis.\par
Introduction a) Background iabetes mellitus is not a single disease entity but rather a group of metabolic disorders sharing the common underlying feature of hyperglycemia. Hyperglycemia in diabetes results from defects in insulin secretion, insulin action, or, most commonly, both. The chronic hyperglycemia and attendant metabolic dysregulation of diabetes mellitus may be associated with secondary damage in multiple organ systems, especially the kidneys, eyes, nerves, and blood vessels. It also greatly increases the risk of developing coronary artery disease and cerebrovascular disease. In concert with great technologic advances, there have been pronounced changes in human behavior, with increasingly sedentary life styles and poor eating habits. This has contributed to the simultaneous escalation of diabetes and obesity worldwide, which some have termed the "diabesity" epidemic. \hyperref[b6]{(6)} Prevalence of both type 1 and type 2 DM is increasing worldwide, type 2 DM is rising much more rapidly, presumably because of increasing obesity, reduced activity levels as countries become more industrialized, and the aging of the population \hyperref[b0]{[1]}.\par
According to IDF diabetes Atlas, 5th edition 2012 report, currently, more than 80\% of people with diabetes live in low and middle income countries. The African region is expected to experience the highest increase in coming years withestimated increase in prevalence rates of 98\% for sub-Saharan Africa, and 94\% for North Africa and the Middle East  {\ref (10,} {\ref 11,} {\ref 12,} {\ref 13)}.It also said regional prevalence of 3.8\%. This would rise to 4.3\% 2030.Based on the IDF Atlas 5th edition, 2012 report, number of cases of diabetes in Ethiopia to be estimated about 1.4 million in 2011 \hyperref[b7]{(7,}\hyperref[b8]{8)}.\par
The diagnosis involves evaluation of blood glucose levels which are normally maintained in a very narrow range; usually 70 to 120 mg/dl that is established by elevation of blood glucose by any one of the following three criteria \hyperref[b0]{(1,}\hyperref[b2]{3)} A random blood glucose concentration of 200 mg/dL or higher, with classical signs and symptoms; A fasting glucose concentration of 126 mg/dL or higher on more than one occasion, or; An abnormal oral glucose tolerance test (OGTT), in which the glucose concentration is 200 mg/dL or higher 2 hours after a standard carbohydrate load (75 gm of glucose). (  {\ref 2}) b) Statement Of The Problem DM is a life-long challenge that requires behavioral change and adequate self-care practices for better glycemic control. In the absence of appropriate self-care practice, the desired therapy targets are difficult, or even impossible, to achieve.\par
Thus, the aim of the present study was to assess self-care practices and glycemic control among diabetes patients in Ambo general hospital.\par
Non-communicable diseases including diabetes account for 60\% of all deaths worldwide andmore than 80\% of diabetes deaths occur in low-and middle-income countries. According to IDF Atlas 5th edition2012 report, Diabetes caused 4.6 million deaths in 2011 globally. World Health Organization projects that diabetesdeaths will double between 2005 and 2030. Statistics for medical complications from diabetes are also concerning. Proportions of patients with diabetic complications in sub Saharan region ranged from 7-63\% for retinopathy, 27-66\%for neuropathy and 10-83\% for nephropathy. Diabetes is likely to increase the risk of several important infections inthe region, including tuberculosis, pneumonia and sepsis (14).Diabetes being a chronic illness requires continuous selfmanagement practices bysufferers so that they can contribute meaningfully in the management of their lives. A situation where diabetes patients visit clinics regularly and their blood glucose levels still remain high despite the treatment they receive is problem that calls for attention. This is a very common observation in many diabetes patients. Severe complications, like gangrene that may lead to amputation and possible premature death, this might be because of lack of appropriate selfmanagement practices \hyperref[b3]{(4)}.\par
Despite the benefits of engaging in a recommended self-management practice, research remains limited on determining recommended self-care practices level and its associated factors among diabetes patients. Researchers have suggested that self-care activities vary extensively according to the nature of the activity itself, with taking of medication often occurring as recommended and exercise frequently falling below recommended levels. For example, results from one study showed that 97\% of respondents' with diabetes always or usually took their medication, whereas only 41\% always or usually exercised, as cited by NancyE. Schoenberg (14). Furthermore, we currently lack an in-depth understanding of level and associated factors of type2 diabetes patients to ward diabetes self-care practices.\par
Although all forms of diabetes mellitus share hyperglycemia as a common feature, the underlying causes of hyperglycemia vary widely. The vast majority of cases of diabetes fall into one of two broad classes: \hyperref[b0]{(1)} Type1diabetes is characterized by an absolute deficiency of insulin secretion caused by pancreatic ?cell destruction, usually resulting from an autoimmune attack. It accounts for approximately 10\% of all cases \hyperref[b5]{(5)}. 
\section[{c) Significance Of The Study}]{c) Significance Of The Study}\par
The major problematic condition about diabetes self-care practices is that there is limited research findings on diabetic patients in our country, even there is no enough published material and little research is done on this areas. To address these deficits, this research explores for diabetes self-management practices. So the findings of this research can help diabetic patients to know how to control their sugar level and improve their self-care practice. Based on the findings of the research, patients of DM at Ambo hospital will be advised to strengthen those positive practices and will also be advised to practice appropriately by discouraging improper practices. The study can also serve as starting material for those who want to undertake further research on this area. ? To assess dietary self-care practices among diabetic patients at Ambo General Hospital. ? To assess the physical activity and foot care practices among diabetic patients at Ambo ? General hospital. ? To assess blood glucose monitoring practice among the diabetic patients within three months. 
\section[{II.}]{II.} 
\section[{Objectives of The Study}]{Objectives of The Study}\par
III. 
\section[{Methods and Participants a) Study area and period}]{Methods and Participants a) Study area and period}\par
This study was conducted in Ambo General Hospital, which is found in Ambo town, west showa, Ethiopia. Ambo has a total population of 260, 193 of whom 131, 922 are men. It is located in the west Showa zone of the Oromia region, 114 km West of Addis Ababa, the town has a latitude and longitude of 8.983O N 37.850O E and an elevation of 2101m. The town has an annual rain fall of 1012 mm with 18 CO average temperatures. The Hospital is found in 01 kebele of Ambo town near West Shewa zone prison House. The hospital give serves for about 10,000 People  
\section[{c) Source population}]{c) Source population}\par
Source population includes all diabetes patients that attend their follow up schedule in Ambo general hospital. 
\section[{d) Study population}]{d) Study population}\par
Study population includes all diabetes patients that follow their diseases status in Ambo general Hospital for the last three months. 
\section[{e) Sampling size Determination}]{e) Sampling size Determination}\par
All DM patients who came to Ambo general hospital for follow up during data collection period were considered to be included in the sample. Accordingly 111 patients fulfilled the inclusion criteria and were included in the study. Six of the patients that didn't fulfilled the inclusion criteria were excluded from the study. f) Inclusion and exclusion criteria i. 
\section[{Inclusion criteria}]{Inclusion criteria}\par
Patient that has been part of a follow-up program for at least three follow at Ambo General Hospital was included in the study.\par
ii. 
\section[{Exclusion criteria}]{Exclusion criteria}\par
Patients with mental health problems, hearing impairments or any other serious health problems and those patients who were unable to provide the appropriate information were excluded. 
\section[{g) Study Variables}]{g) Study Variables}\par
i. 
\section[{Dependent variables}]{Dependent variables}\par
Self-care practice among diabetic patients, glycemic control ii. 
\section[{Independent variables}]{Independent variables}\par
Socio demographic characteristics of study population h) Data collection procedure and Instrument Patients were interviewed using structured questionnaires and check lists was used to gain information from their card. The data collection was conducted by the joint collaboration of the investigator, nurses and health care professionals that are involved in delivery of care to the specified patients in the hospital by orienting them on how to collect the data. Questionnaires were prepared in English and translated into Amharic and Afan Oromo (local languages) and translated back into English to check its consistency. To identify the patterns of glycemic control, patients' charts was reviewed, retrospectively; the last three successive FBS or RBS results was recorded from the patient's card. 
\section[{i) Data quality control}]{i) Data quality control}\par
Pretest was done in 10 patients at Ambo Hospital to assure validity of the check list and questionnaire. Language experts who were qualified with second degree with linguistic and are Ambo University stuff members were used to translate the questionnaires from English to Amharic and Afan Oromo version. The questionnaires were revised for its completeness and consistency. 
\section[{j) Data analysis}]{j) Data analysis}\par
The data was cleaned, coded, entered and analyzed using SPSS version 20. Categorical variables were described by frequencies and percentages, and continuous variables were described by means and standard deviations. Figures and tables were used to summarize the results. 
\section[{k) Ethical consideration}]{k) Ethical consideration}\par
Formal letter was obtained from Research Ethics Committee of Ambo University and submitted to Ambo General Hospital, so the letter was given to the hospitals and they allowed us to do the research. Verbal consent was taken from the patient. 
\section[{l) Operational definition}]{l) Operational definition}\par
The level of glycemic control was indicated as 'adequate glycemic control' when FBS results were less than 126 mg/dL (7 mm/L) (i.e. an average of three visits), or when RBS results were less than 200/dL; 'inadequate glycemic control' takes place when a parameter is beyond the criteria of adequate glycemic.\par
Knowledge of patients' relating to diabetes and self-care practice was assessed by making use of 'yes/no' questions. A correct answer will be coded as  {\ref '1'} and an incorrect answer as '0'; the score is then computed. Respondents are labeled as having knowledge of diabetes and self-care practices if he or she scored ? the mean value, and having poor knowledge if he or she scored less than the mean.\par
The levels of physical activity of the patients were classified into three levels based on their physical activities as light, moderate and heavy. of exercise or different types of medication you may need to make. 
\section[{m) Limitations of the study}]{m) Limitations of the study}\par
The findings from this situational analysis may not be generalized to the total population because of the lower sample size than the expected.\par
IV. 
\section[{Results}]{Results}\par
a) Socio-demographic characteristics of the participants A total of 111diabetic patients were participated in the study giving a response rate of 100\%. From total respondents 63 (56.75\%) were male, regarding the age of participants, 33 (29.7\%) of them were younger than 30 years of age and the remaining 78 respondents (70.27\%) were above age of 30. Most of them completed grade 7-12 and 29 patients had monthly income of 500-800 birr. Of the patients who were using insulin, only 23 (20.7\%) took meals 30 minutes after each insulin injection, and the remaining patients were used to eat before injection while 70.2\% took meals after one hour of taking an injection. The majority of the respondents (104, 93.7\%) follow their medication strictly to avoid Volume XIV Issue VII Version IYear 2014 ( B )\par
raise in blood sugar level. From the total respondents, 96 of them (86.5\%) attend their follow up program as per the schedule.10.8\% patients have habit of alcohol or smoking and the remaining 99 respondents (89.2\%) do not have any habit.\par
Means of communication was assessed to know how diabetic patients can obtain information or education from Medias and from newspapers as well as to know whether they have phone in case they face emergency conditions(hypoglycemia or hyperglycemia) to obtain health services. The results shows the majority of the patients have access to radio, TV and phone services and 91 respondents (82\%) do not have the chance to get newspapers. c) Knowledge about diabetes\par
Participants were asked whether DM is a chronic disease or a curable disease and whether it is possible to control it by interventions, such as a healthy diet, exercise, and administering insulin and hypoglycemic drugs. Accordingly, 72 respondents (64.86\%) responded that it is chronic disease 39 respondents (35.14\%) said that DM is curable and 96respondents (86.48\%) reported that it is possible to control diabetes. Furthermore, the majority (83.78\%) of the respondents knows the sign and symptoms of DM and the remaining (16.22\%) do not know the signs and symptoms of DM. d) Selfcare practice i. Dietary self -care practice Concerning to food items that they consume to control their sugar level, the majority of the respondents answered that injera (i.e. a stable food diet in Ethiopia made of Teff cereal), barely and kocho (i.e. a traditional staple food made of a false banana plant called enset or Ensete Scitamineae) have a low glycemic index and could be eaten freely by diabetic patients; Only 74 respondents (66.7\%) stated that fibrous food (e.g.whole grain cereals) has a high glycemic index and similarly 29 respondents (26.1\%) do not know the sign and symptoms of hypoglycemia.From those who know the sign and symptoms of hypoglycemia, 50\% uses candy to control their sugar, 46\% uses table sugar and the remaining uses soft drinks. 59.5\% have regular time for meal whereas the remaining 41.5\% do not have regular meal time. The majority of the respondents (103, 92.8\%) eat three times per day. iii. Self-Blood glucose monitoring, medication selfcare, and Foot care practice There were 102 patients practicing blood glucose monitoring at home. 79.27\% of the respondents do not forget to use their medication, whereas 98(88.28\%) do not miss their medication intentionally. Most patients (106, 95.49\%) do not interrupt their medication due to side effect or when feeling free of the disease but the rest 4.51 \% (5 patients) interrupt their medication due to side effect or when feeling free of the disease. 99 of the respondents (89.19\%) do not forget their medication while travelling but the rest 12(10.81\%) do. With regard to the presence of health problem other than DM, 82 respondents (73.87\%) say no and the rest 29 patients (26.13\%) say yes. 78 patients(70.27\%) say no family member with DM and the rest 33(29.73\%) say there is a family member with DM. 
\section[{Volume XIV Issue VII Version I}]{Volume XIV Issue VII Version I} 
\section[{Volume XIV Issue VII Version I}]{Volume XIV Issue VII Version I}\par
Year 2014 
\section[{( B )}]{( B )}\par
When we look their respective drug use, 35 patients which contribute 31.53\% use glabinclamide, 22 patients which contribute about19.81\% use metformin, 6 patients which contribute 5.1\% use both insulin \&metformin, and 63 patients which contribute about 56.76\% use insulin. Out of the 69 insulin users, 10 patients (14.49\%) use refrigerator, 53 patients (76.81\%) use home prepared cool sites and 6 patients (8.70\%) use other methods for storage of the drug at appropriate temperature.     
\section[{B}]{B}\par
To know the sugar level of the patients each patient's card was revised to obtain their FBS level during their last three visits to Ambo Hospital and the result obtained was presented in the chart below\par
The chart below shows that the mean FBS of the respondents during the last visit to the hospital was 183.28. Out of the total 111 patients who visited Ambo Hospital during the third month 62 of them (55.8\%) were tested to have FBS level of above 126, 13 (11.7\%) have IFG level,32(28.8\%) of them maintained their normal blood sugar level and 4 patients fall in hypoglycemia. During their second visit 38 patients (34.2\%) maintained the FBS level within the normal range and 54 of them (48.6\%) were in hyperglycemia. Similarly the FBS of the patients during their first visit shows 74 of them (66.65\%) were tested to have FBS of above 126, 9 of them (8.1\%) impaired sugar level,26 of them(23.4\%) maintained their normal FBS.  
\section[{Discussion}]{Discussion}\par
The present study attempted to assess diabetes mellitus Patients' knowledge and self-care practices in terms of living with the disease. According to the findings of the study, most of the respondents know that DM is chronic disease. But 35.14\% of the respondents think DM is curable and 16.22\% of the respondents even do not know the sign and symptoms of DM. This is in agreement with the study conducted in Jima University \hyperref[b9]{[9]} in which 34.21\% of the patients responded DM is curable. The majority of the respondents consume teff, barely and kocho which they think have low glycemic index and could be eaten freely by diabetic patients. Diabetes self-management behaviors such as diet and exercise involve and depend on guidance from a health care provider, meal preparation in a family context and exercising with a partner \hyperref[b0]{[1]}.\par
The study also shows physical activity level of the patients were sub optimal and 41(36.42\%) respondents never do any physical activity. This is in line with the study conducted at JimmaUniversity \hyperref[b8]{[8]} in which most of the respondents has sub optimal physical exercise which could be because of having inadequate knowledge in terms of the benefits of regular physical exercise and a fear of hypoglycemia. Exercise has multiple positive benefits including cardiovascular risk reduction, reduced blood pressure, maintenance of muscle mass, reduction in body fat, and weight loss. For individuals with type 1 or type 2 DM, exercise is also useful for lowering plasma glucose (during and following exercise) and increasing insulin sensitivity \hyperref[b0]{[1]}. In patients with diabetes, the ADA recommends 150 min/week (distributed over at least 3 days) of moderate aerobic physical activity. The exercise regimen should also include resistance training.\par
The study also showed that the majority of the respondents 95.49\% wear shoe and 99.09\% of the respondents wash their foot daily which is very important to decrease the complications associated with footwear or minor trauma, daily foot hygiene to keep the skin clean and moist, avoidance of self-treatment of foot abnormalities and high-risk behavior (e.g., walking barefoot), and prompt consultation with a health care provider if an abnormality arises \hyperref[b0]{(1)}.\par
Of the patients who were using insulin, only 23 (20.7\%) took meals 30 minutes after each insulin injection, and the majority 70.2\% of the patients were used to eat before injection. Regular insulin is given 30-45 min prior to a meal \hyperref[b0]{[1]}. 6.3\% of the respondents miss their medication and 13.5\% do not attend their follow up as scheduled for them. More than half of the respondents 65(58.5\%) were type 1 DM. Diabetes is managed via a regimen of control. Physicians advise adults living with type 2 diabetes to control blood sugar levels by controlling diet, maintaining regular exercise, and complying with medication. The extent to which individuals are able to adhere to such recommendations varies \hyperref[b5]{(5)}.\par
Regarding the FBS of the patients for the last three months the mean FBS of the last visit was found to be 183.28mg/dl which are far from the normal glucose homeostasis. Generally the results of their last three visit shows only, 32(28.8\%) of them during the third month, 38 patients (34.2\%) during the second month and 23.4\% of them during the first visit maintained their sugar level within the normal range. This is consistent with other studies [10] who reported adequate glycemic control in 43.8\% of type -2 diabetic patients. This indicates that most of the patients were not controlling their blood glucose level, despite most of them taking medication provided for them. Despite the increasing prevalence of diabetes, improved understanding of the disease, and a variety of new medications, glycemic control does not appear to be improving. Self-monitoring of blood glucose (SMBG) is one strategy for improving glycemic control; however, patient's adherence is suboptimal and a proper education and follow-up are crucial. SMBG should include post-prandial monitoring to identify glycemic excursions after meals, to indicate the need for lifestyle adjustments, and to provide patients' feedback on dietary choices (12).\par
Discussing the adequacy of glycemic control will be a handicap without mentioning glycosylated hemoglobin (HbAlc) determination; the ADA recommends that a patient should have glycosylated hemoglobin determination at least twice yearly. In addition, a study conducted in the United States of America (USA) showed that at least 77\% of diabetic patients had at least one glycosylated hemoglobin determination in the two years preceding the study. However, none of the patients had glycosylated hemoglobin. Our findings, therefore, suggest that monitoring of glycemic control among DM patients at Ambo Hospital west Shoa Ethiopia may be less than optimal and this may be a probable contributory factor to late detection of patients at risk of complications and death from poorly controlled diabetes.\par
To know and follow self care practices anthropometric measurements are also important parameters for diabetic patents. But none of them have anthropometric measurement data.\par
Self-care activity in diabetic management includes medication self-care, dietary self-care, physical activity self-care and self-monitoring of blood glucose levels. 
\section[{VI. Conclusion and Recommendation a) Conclusion}]{VI. Conclusion and Recommendation a) Conclusion}\par
In general, self-care practice was inadequate, especially in terms of physical self-care activity and a deficit in terms of knowledge related to diabetes. In some cases the patients do not attend their follow up strictly and sometimes miss taking their medications. Almost all the patients have good foot care hygiene. Regarding insulin injection time with respect to meal, majority of them take their medication after eating. The mean fasting blood sugar of the patients during the last visit was not controlled. 
\section[{b) Reccomandations}]{b) Reccomandations}\par
The following recommendations are forwarded.\par
Health care providers: should educate and promote health to address the lack of information on a healthy diet, benefits of exercise and how exercise should be undertaken for ambulatory DM patients when they come for regular follow up regularly at the hospital Primary care physician must interpret (preferably in patient's language), for each diabetic patient, the short and long-term benefits of adhering to diet and exercise recommendations, Insulin storage site in the hospital as well as at home must be given special emphasis. Patients should learn to follow their medication strictly including the site of injection care for their diet with regular meal time and understand the benefit of physical exercise.\par
The hospital follow up schedule must not be longer than one month and patients must adapt to frequently visit the hospital for regular checkup. Patients can learn to control their blood sugar level at home by using glucometer.\par
Generally self -care practice including blood glucose monitoring is the back bone to control DM, hence further investigation by researchers is needed to strengthen diabetic self-care practice and promote health. \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}?}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-3.png}
\caption{\label{fig_1}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-4.png}
\caption{\label{fig_2}1 .}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-5.png}
\caption{\label{fig_3}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-6.png}
\caption{\label{fig_4}Figuer 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2}\includegraphics[]{image-7.png}
\caption{\label{fig_6}Figuer 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-8.png}
\caption{\label{fig_7}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-9.png}
\caption{\label{fig_8}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.39625454545454547\textwidth}P{0.1428\textwidth}P{0.16010909090909092\textwidth}P{0.15083636363636363\textwidth}}
Characteristic type\tabcellsep Characteristic\tabcellsep \tabcellsep Frequency (\%)\\
\tabcellsep Male\tabcellsep \tabcellsep 63( 56.75)\\
Sex\tabcellsep Female\tabcellsep \tabcellsep 48(43.25)\\
\tabcellsep 1-29\tabcellsep \tabcellsep 33(29.7)\\
Age\tabcellsep 30-44\tabcellsep \tabcellsep 31(27.9)\\
\tabcellsep 45-64\tabcellsep \tabcellsep 37(33.3)\\
\tabcellsep Above 65\tabcellsep \tabcellsep 10(9)\\
\tabcellsep Single\tabcellsep \tabcellsep 42(37.8)\\
Marital status\tabcellsep Married\tabcellsep \tabcellsep 65(58.5)\\
\tabcellsep Widowed\tabcellsep \tabcellsep 4(3.3)\\
\tabcellsep Orthodox\tabcellsep \tabcellsep 64(57.6)\\
Religion\tabcellsep Muslim\tabcellsep \tabcellsep 8(7.2)\\
\tabcellsep Protestant\tabcellsep \tabcellsep 37(33.3)\\
\tabcellsep Others\tabcellsep \tabcellsep 2(1.8)\\
\tabcellsep Oromo\tabcellsep \tabcellsep 96(86.7)\\
Ethnicity\tabcellsep Amhara\tabcellsep \tabcellsep 14(12.6)\\
\tabcellsep Tigre\tabcellsep \tabcellsep 1(0.9)\\
\tabcellsep Farmer\tabcellsep \tabcellsep 38(34.2)\\
Occupation\tabcellsep Merchant\tabcellsep \tabcellsep 20(18)\\
\tabcellsep Civil servant\tabcellsep \tabcellsep 28(25.2)\\
\tabcellsep Others\tabcellsep \tabcellsep 25(22.5\textunderscore )\\
\tabcellsep \multicolumn{2}{l}{Illiterate \& non formal edu.}\tabcellsep 18(16.2)\\
\tabcellsep Grade 1-6\tabcellsep \tabcellsep 26(23.4)\\
Education level\tabcellsep Grade 7-12\tabcellsep \tabcellsep 44(39.6)\\
\tabcellsep Above grade 12\tabcellsep \tabcellsep 23(20.7)\\
\tabcellsep <500\tabcellsep \tabcellsep 51(45.9)\\
Income\tabcellsep 500-800\tabcellsep \tabcellsep 29(26.1)\\
\tabcellsep 801-1500\tabcellsep \tabcellsep 16(14.4)\\
\tabcellsep >1500\tabcellsep \tabcellsep 15(13.5)\\
\multicolumn{2}{l}{b) Clinical characteristics of the patients}\tabcellsep \multicolumn{2}{l}{about19.81\% use metformin, 6 patients which contribute}\\
\multicolumn{2}{l}{Regarding the clinical characteristics of the}\tabcellsep \multicolumn{2}{l}{5.1\% use both insulin \& metformin, and 65 patients}\\
\multicolumn{2}{l}{patients, from the total of 111 patients 65 of them were}\tabcellsep \multicolumn{2}{l}{which contribute about 58.55\% use insulin. Out of the 65}\\
\multicolumn{2}{l}{diagnosed for type 1 DM (58.5\%) and the remaining 46}\tabcellsep \multicolumn{2}{l}{insulin users, 10 patients (15.38\%) use refrigerator,}\\
\multicolumn{2}{l}{of them (41.5\%) were type 2 DM.70.27\% say no family}\tabcellsep \multicolumn{2}{l}{55(84.61\%) use home prepared cool sites.}\\
\multicolumn{2}{l}{member with DM and the rest 29.73\% say there is a}\tabcellsep \\
\multicolumn{2}{l}{family member with DM. Concerning the presence of}\tabcellsep \\
\multicolumn{2}{l}{other co morbidities 17. 11\% have hypertension and}\tabcellsep \\
\multicolumn{2}{l}{6.3\% of the patients have CKD. When we look their}\tabcellsep \\
\multicolumn{2}{l}{respective drug use, 35 patients which contribute}\tabcellsep \\
\multicolumn{2}{l}{31.53\% use glabinclamide, 22 patients which contribute}\tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.45878003696857667\textwidth}P{0.10369685767097966\textwidth}P{0.2875231053604436\textwidth}}
\tabcellsep \multicolumn{2}{l}{clinical characteristics of the patients}\\
\tabcellsep VariablesFrequency (\%)\tabcellsep \\
Type of DM\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{Type1 DM}\tabcellsep 65(58.55)\\
\multicolumn{2}{l}{Type 2 DM}\tabcellsep 46(41.44)\\
\multicolumn{2}{l}{Time since DM d}\tabcellsep \\
\multicolumn{2}{l}{<2000}\tabcellsep 6(5.4)\\
\multicolumn{2}{l}{2000-2002}\tabcellsep 33(29.7)]\\
\multicolumn{2}{l}{2003-2006}\tabcellsep 72(64.89)\\
\multicolumn{2}{l}{Hx of DM in the family}\tabcellsep \\
Yes\tabcellsep \tabcellsep 33(29.73)\\
No\tabcellsep \tabcellsep 78(70.27)\\
\multicolumn{2}{l}{Co morbidities}\tabcellsep \\
CKD\tabcellsep \tabcellsep 7(6.3)\\
HTN\tabcellsep \tabcellsep 19(17.11)\\
CHF\tabcellsep \tabcellsep 1(0.9)\\
\multicolumn{2}{l}{Stroke}\tabcellsep 0(0)\\
\multicolumn{2}{l}{Others}\tabcellsep 13(11.71)\\
\multicolumn{2}{l}{Pattern of drugs for DM}\tabcellsep \\
\multicolumn{2}{l}{Insulin}\tabcellsep 65(58.55)\\
\multicolumn{2}{l}{Oral hypoglycemic agents}\tabcellsep \\
\multicolumn{2}{l}{Metformin}\tabcellsep 22(19.81)\\
\multicolumn{2}{l}{Glabineclamide}\tabcellsep 35(31.53)\\
\multicolumn{2}{l}{Insulin \&metformin}\tabcellsep 6(5.4)\\
\multicolumn{2}{l}{Source of information for DM}\tabcellsep \\
\multicolumn{2}{l}{Radio Yes}\tabcellsep 83(74.8)\\
No\tabcellsep \tabcellsep 28(25.2)\\
TV\tabcellsep Yes\tabcellsep 60(54)\\
No\tabcellsep \tabcellsep 51(46)\\
\multicolumn{2}{l}{Phone Yes}\tabcellsep 58(52.2)\\
No\tabcellsep \tabcellsep 53(47.8)\\
\multicolumn{2}{l}{Newspaper yes}\tabcellsep 20(18)\\
No\tabcellsep \tabcellsep 91(82)\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.85\textwidth}}
Year 2014\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.85\textwidth}}
2004\end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{5} \par 
\begin{longtable}{P{0.551255230125523\textwidth}P{0.06757322175732218\textwidth}P{0.2311715481171548\textwidth}}
Question\tabcellsep Response\tabcellsep Number of respondents(\%)\\
1-Blood glucose monitoring practice at home\tabcellsep Yes\tabcellsep 9(8.11)\\
\tabcellsep No\tabcellsep 102(91.89)\\
2-Forgetting medication use\tabcellsep Yes\tabcellsep 23(20.73)\\
\tabcellsep No\tabcellsep 88(79.27)\\
4-Medication missing for a reason other\tabcellsep Yes\tabcellsep 13(11.72)\\
than\tabcellsep No\tabcellsep 98(88.28)\\
forgetting\tabcellsep \tabcellsep \\
6-Medication interruption due to side effect\tabcellsep Yes\tabcellsep 5(4.51)\\
\tabcellsep No\tabcellsep 106(95.49)\\
7-Forgetting medicine while traveling\tabcellsep Yes\tabcellsep 12(10.81)\\
\tabcellsep No\tabcellsep 99(89.19)\\
8-Interruption of medication when feeling free\tabcellsep Yes\tabcellsep 5(4.51)\\
\tabcellsep No\tabcellsep 106(95.49)\\
of the disease\tabcellsep \tabcellsep \\
iv. Glycemic control among respondents\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_4}Table 5 :}\end{figure}
 			\footnote{© 2014 Global Journals Inc. (US)} 		 		\backmatter   			 
\subsection[{VIII. Acknowledgements}]{VIII. Acknowledgements}\par
We are very grateful to our college staff members for unreserved guidance and constructive suggestions and comments from the stage of proposal development to this end. We would like to thank Ambo University for supporting the budget which required for this research. Finally our deepest gratitude goes to Ambo General Hospital staff workers who help and allow us in conducting this research. 			  			 
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\end{document}