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Year : 2013 | Volume : 1 | Issue : 2 | Page : 44 - 47  


Original Articles
A cross-sectional study on knowledge, attitude and practices among diabetic patients about diabetes and its complications in Central Delhi.

Ravinder Pal Singh1, Megha Khobragade2, Anil. Kumar3, L.S.Chauhan4

1MPH scholar, 2Deputy Director, 3HOD Epidemiology, 4Director, National Center for Disease Control (NCDC), New Delhi, India

Abstract:

Background: Diabetes mellitus (DM) is now one of the most common non-communicable diseases globally. It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many economically developing and newly industrialized nations. The mortality due to diabetes is mostly due to its complication and the most effective way to prevent complications is to impart knowledge to patient so that they can practice for prevention of complication of diabetes.

Objective: To assess the knowledge, attitude and practices of diabetic patients for diabetes and its complications.

Methods: Data was collected using a pre-tested, validated questionnaire from a total of 170 patients attending diabetes clinic in Ram Monohar Lohia Hospital New Delhi.

Results: Out of 170 patients, 91 (53.5 %) were female and 79(46.5 %) were male patients. In the study population 146 (85.9%) participants had the basic knowledge regarding what type of disorder diabetes is, and about 149 (87.6 %) participants in study population said that the know what to eat. The maximum knowledge was seen about eye problems 48.82 % and kidney problems 40%.

Conclusion: There is still need for increase in IEC and BCC activity in term of campaigns on diabetic complication, awareness regarding foot care, regular exercise, and regular routine checkups.

Key words: Attitude, Diabetes Mellitus, Knowledge, Practices

Corresponding Author: Dr. Megha Khobragade, Deputy Director, National Center for Disease Control (NCDC), New Delhi, India. Email: drmegha1603@gmail.com

Introduction

The term diabetes mellitus describes a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long-term damage, dysfunction and failure of various organs. Diabetes mellitus may present with characteristic symptoms such as thirst, polyuria, blurring of vision, and weight loss. In its most severe forms, ketoacidosis or a non-ketotic hyper osmolar state may develop and lead to stupor, coma and, in absence of effective treatment, death. [1]

Diabetes mellitus (DM) is now one of the most common non-communicable diseases globally. It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many economically developing and newly industrialized nations. Complications from diabetes, such as coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure and blindness are resulting in increasing disability, reduced life expectancy and enormous health costs for virtually every society. Diabetes is undoubtedly one of the most challenging health problems in the 21st century. [2]

According to Diabetes Atlas published by the International Diabetes Federation (IDF), there were an estimated 50.8 million persons with diabetes in India in 2010 and this number is predicted to rise to almost 87 million people by 2030. The countries with the largest number of diabetic people will be India, China and USA by 2030. It is estimated that every fifth person with diabetes will be an Indian. Due to these sheer numbers, the economic burden due to diabetes in India is amongst the highest in the world. [3]

There are several studies from various parts of India which reveal a rising trend in the prevalence of type II diabetes in the urban areas. A National Urban Survey in 2000 observed that the prevalence of diabetes in urban India in adults was 12.1 per cent. Recent data has illustrated the impact of socio-economic transition occurring in rural India. The transition has occurred in the last 15 years and the prevalence has risen from 2.4 per cent to 6.4 per cent. [4]

There are a limited number of KAP studies on complication of diabetes in diabetics worldwide which is even significantly low in north Indian settings. The real burden of the disease is however due to its associated complications which lead to increased morbidity and mortality. WHO estimates that mortality from diabetes, heart disease and stroke costs about $210 billion in India in the year 2005. Much of the heart disease and stroke in these estimates was linked to diabetes. WHO estimates that diabetes, heart disease and stroke together will cost about $ 333.6 billion over the next 10 years in India alone. [5]

The mortality due to diabetes is mostly due to its complication and the most effective way to prevent complications is to impart knowledge to patient so that they can practice for prevention of complication of diabetes. With this background, the present study was undertaken to assess the knowledge, attitude and practices among diabetes patients.

Material and Methods

Study area: The study was carried out in Ram Monohar Lohia government hospital of central Delhi among patients attending diabetes clinic in that hospital.

Study design: Cross-sectional study.

Study population: Patients of diabetes of 21years and above who visit the selected diabetic clinic during the study period.

Inclusion criteria:

  • All subjects of age 21 and above who has diabetes and attending the diabetic clinic.

Exclusion criteria:

  • Non-willing patients.
  • Patients 20 year and less than 20 years of age.

Sampling method:

Purposive sampling was done from total number of outpatient in that clinic for that day. A total of 170 patients were enrolled in the study during the study period. Before the study was conducted the pilot testing was done on 20 patients and all necessary changes were made where ever applicable.

Patients were enrolled from the diabetic clinic of the Ram Manohar Lohia hospital in central Delhi. The diabetic clinic in hospital was visited individually on respected days of diabetic clinic during (OPD) timing of 9 am to 1 pm and 2pm to 4pm between 21st of March 2011 to 1st of April 2011; all the self-reported diagnosed patients at that particular day will be enrolled. Only one patient was interviewed at a time and only after completing the interview next patient was enrolled. Any patient missed in between was considered excluded. Data was collected from personal interview with proper verbal consent.

Operational definitions:

A case of age 21years and above of both the sexes having fasting glucose level >126mg/dl and postprandial level >200mg/dl in considered as diabetic according to latest WHO GUIDELINES. [6]

Data collection:

Data was collected using a pre-tested, validated questionnaire from a total of 170 patients attending diabetes clinic in Ram Monohar Lohia Hospital New Delhi.

Questionnaire was pre-tested on a similar population before conducting the study and analyzed and its results have not been included in the final report.

Questionnaire was divided into 4 parts, 1st part contains information on socio-demographic profile followed by questions on knowledge about diabetes and its complications and then questions regarding attitude for diabetes and its complications. Last part of the questionnaire contains questions regarding practices in diabetes.

Data analysis:

Data was entered and then analyzed with the help of Epi-info software version 5 by the investigator during the study.

Results:

Out of 170 patients, 91 (53.5 %) were female and 79(46.5 %) were male patients. Among both the sexes the maximum numbers of male patients were between the age group of 51 years to 60 years and maximum number of female patient between age group of 41 years to 50 years.

In the study population 146 (85.9%) participants had the basic knowledge regarding what type of disorder diabetes is, and about 149 (87.6 %) participants in study population said that the know what to eat, while only 20 (11.8%) participants knows about normal blood pressure and 48 (28.2%) participants had knowledge about normal blood sugar levels, also only 42 (24.7%) participants had idea about ideal body weight. (Table 1)

The maximum knowledge was seen about eye problems 48.82 % and kidney problems 40% while very little knowledge was noted for complication like stroke and diabetic coma which was included in others category. (Figure 1)

The average response of attitude is about 72.65% with maximum positive attitude for ill-effect of missing medicine on health around 88.2% while attitude for regular exercise was least around 62.4%. (Table 2)

Table 3 shows practices among the study population regarding diabetes and its complications. The practice of taking regular medicine without missing dose is seen in 88.6% of patients followed by 81.8 % patient practicing a planned and controlled diet while only 17.2 % of the patients have done their routine investigation in last 1 year and only 31.2% of patient do regular exercise.

Discussion

Diabetes mellitus, which is a common problem worldwide and whose prevalence is increasing with time; is a great risk for economic resources of all communities especially for the developing country like India. To increase the community wellbeing and decrease economic burden of Diabetes, it is essential to educate the population in general and diabetics especially, make early diagnosis, proper monitoring and management of this disease

In a KAP study conducted by us on diabetes and its complications among the 170 diabetic patient’s attending the diabetic clinic in a central government hospital in central Delhi. There were about 91 female participants (53.5%) and 79 males participants (46.5%). The maximum participants were in the age group of 51years to 60 years of age group and the mean age was 55.9+9.5 years while in a similar study done by CK Priyanka Raj et al [7] in Bijapur, Karnataka in 2006 had a mean age of 56.64+11.38 years which correlates to our study population, but the percentage of male patients were 67% which was more than that of our study population.

The literacy status of our study population showed that males have a higher literacy status of 84.81% as compared to 61.54% in females which is similar to a study done by Murgesan N et al [8] where educational status was low in female population.

The knowledge about diabetes and its complication was low in our study population; the maximum knowledge was regarding ‘what to eat in food items’ 87.6% while the least knowledge was 11.8% regarding normal blood pressure level. Similar study done in Nepal by Upadhyay DK et al [9] in 2007 showed a mean score of 4.9+3.4 for knowledge which was lower than that in our study. Another study conducted in Malaysia by Ding CH et al [10] in 2004 showed an overall knowledge score of patients with diabetes was 81.8% which was higher than that in our study.

In our study 85.9% of the study population knows what diabetes is while in a similar study conducted by Mumtaz Ali Chhutto et al [11] in 2008 in Larkana, Pakistan showed only 26.2% patients know about diabetes which is much lower than that in our study. In our study population 47.6% had knowledge about complications of diabetes while in a similar done by Deepa Mohan et al 12 in Chennai in 2005 show 40.6% of the self reported diabetic patients were aware about the complications of diabetes which is similar to our study results.

In our study population the most known complications were eye problem 48.82%, kidney problem 40%, foot problems 29.4%, and heart disease 27.06% while in a similar study done by Deepa Mohan et al [12] in Chennai in 2005 showed that 23% knew about foot problems and 17.4% knew about kidney problems which was less than that in our study.

The positive attitude score in our study is from 62-88%. In another similar study done by C K Priyanka Raj et al [7] In 2005 in Bijapur, Karnataka had a positive attitude score of 60-90% which was similar to our study.

In our study population only 31.2% of the study population was doing a regular exercise while in a similar study done by C K Priyanka Raj et al [7] in 2009 in Bijapur, Karnataka showed that only 40.7% were practising regular exercises which was similar to our study results.

In our study only 28.2% of the participants had knowledge about normal blood sugar levels while in a similar study regarding the awareness of diabetes conducted by Mumtaz Ali Chhutto et al [11] in 2008 in Larkana, Pakistan showed that 36.8% of the participants had knowledge about normal blood sugsr levels which are somewhat similar to our results.

Conclusion

  • The knowledge about diabetes as a disease of high blood sugar levels was known to 85.9 % of the patients and the knowledge regarding what they should eat was 87.6 but most of them only gave response that they should take decreased sugar intake in food items and other things about diet management were not known.
  • Knowledge about normal blood pressure level and normal blood sugar level was very less
  • The patients have got good positive attitude but this is not reflecting in their practices.
  • The practices of taking medicine without missing out dose and having planned and controlled diet are good, but practices like daily exercise and getting their routine investigation done once a year for early diagnosis of complications is least done.

Recommendations

  • There is still need for increase in IEC and BCC activity in term of campaigns on diabetic complication, awareness regarding foot care, regular exercise, and regular routine checkups.
  • Diabetic patients should be recommended for attending diabetes counseling centre and dietician for diet control by the attending physician.
  • The patient should get hassle free services for regular checking of blood sugar level and blood pressure

Limitations

  • Since study is conducted in hospitals, results of the study can’t be referred to general population at large.
  • The study population had mostly patients who are central government employees and hence were mostly educated this might have lead to good results.
  • The study is based on patient interview-it was not been possible to verify and confirm information provided.
  • Since there was a time and man power constrain the study was conducted in only one hospital and the study population was limited.

References:

  1. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complication. Available from: http://www.who.int/diabetes/currentpublications/en/ cited on 27 of March 2011
  2. http://atlas.idf-bxl.org/book/export/html/37 cited on 27 of March 2011
  3. diabetesatlas.org to view prevalence data from the Diabetes Atlas, Fourth Edition (2009). Cited on 27 0f March 2011.
  4. National urban diabetes survey 2000.
  5. http://www.expresshealthcare.in/200808/diabetes02.shtml.cited on 27-3-2011
  6. emro.who.int/dsaf/dsa664.pdf cited on 27-4-2011
  7. Priyanka Raj CK, Angadi MM. Hospital-based KAP Study on Diabetes in Bijapur, Karnataka. Indian Journal of Medical Specialities 2010;1(2):80-3
  8. Murugesan N, Snehalatha C, Shobhana R, Roglic G, Ramachandran A. Awareness about diabetes and its complications in the general and diabetic population in a city in southern India. Diabetes Res Clin Pract. 2007 Sep;77(3):433-7
  9. Upadhyay DK, Subish P, Ravi Shankar P, Mishra P. Knowledge, Attitude and Practice about Diabetes among Diabetes Patients in Western Nepal. Rawal Med J Jan - Jun 2008;33(1):8-11.
  10. Ding CH, Teng CL, Koh CN. Knowledge of Diabetes Mellitus Among Diabetic and Non-Diabetic Patients in Klinik Kesihatan Seremban. Med J Malaysia. 2006 Oct;61(4):399-404.
  11. Mumtaz Ali Chhutto, Habib-UR-Rahman Qadr, Hakim Ali Abro, Majid Ahmed Shaikh, Bashir Ahmed Shaikh, Naheed Shaikh et al. Awareness of diabetes mellitus and its complications in diabetic patients. Medical Channel 2009;15(4):153-6
  12. Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A et al. Awareness and Knowledge of Diabetes in Chennai - The Chennai Urban Rural Epidemiology Study. J Assoc Physicians India. 2005 Apr;53:283-7.

Tables and Figures:

Table 1: Participant’s knowledge of diabetes and its complications (N= 170)

Question

Participants giving positive response

Percentage of patients having knowledge

knows about diabetes

146

85.9

knows what is the cause of his diabetes

47

27.4

knows about the complications of diabetes

80

47.6

knows about normal blood sugar level

48

28.2

knows about normal blood pressure

20

11.8

knows what to eat in food items

149

87.6

knows about ideal body weight

42

24.7

knows about that daily exercise of 20 - 40 min’s helps

99

58.2

aware that habit of smoking increases risk of complication

92

54.1

knows that diabetic patient should take extra foot care

86

50.06

knows that diabetic patient should get his eyes checked at least once a year

104

61.2

 

Table 2: Attitude of study population regarding diabetes and its complications

Questions

Participants giving positive response

Percentage of patients having positive attitude

should a patient with diabetes exercise regularly

106

62.4

should a patient with diabetes follow controlled diet

110

64.7

do you think that missing medicine has bad effects on health

150

88.2

do you think that you should get yourself examined for complications

128

75.3

 

Table 3: Practices among study population regarding diabetes and its complication.

Questions

No. of patients having Good practices

Percentage of patients having Good practices

do you regularly check your blood sugar

127

74.7

do you regularly check your blood pressure

81

47.6

have you got your eyes checked in last 1 year

105

61.8

do you regularly visit your physician

126

74.1

do you take a planned and controlled diet

139

81.8

done routine investigation in last 1 yr

29

17.1

do you take medicine without missing dose

150

88.6

do you regularly exercise

53

31.2

 

Figure 1: Participants knowledge about different complications of diabetes (N=170)

 

Source of Support: Nil. Conflict of Interest: None.





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