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Year : 2014 | Volume : 2 | Issue : 1 | Page : 11 - 14  


Original Articles
An Assessment of Knowledge and Self Care Practices Among Diabetics in an Urban Area

RL Lakshman1, Shravya Nuthi2, Sameer Valsangkar3

1Associate professor, 2Student, 3Senior resident, Department of Community Medicine, Gandhi Medical College, Hyderabad

Abstract:

Background– One in three people in India suffer from diabetes and this number is rising due to an epidemiological transition. An understanding of the impact of knowledge and self care practices is crucial to assuage the outcome of the condition.

Objectives: To evaluate socio-demographic, clinical characteristics and knowledge among diabetic patients and To assess the self care practices pertaining to diabetes among them

Materials and Methods: A cross sectional, hospital based study was conducted among patients attending the outpatient department in a tertiary teaching hospital through systemic random sampling. Informed consent was obtained and responses were obtained through a face to face interview regarding socio-demographic, clinical characteristics, knowledge regarding diabetes and self care practices. Statistical measures obtained included means, standard deviation, percentages and proportions.

Results: A total of 150 patients consented and participated in the current study. 80 (53.3%) were male and 70 (46.7%) were female. Most of the respondents were aged between 40 – 50 years, with 72 (48%) of the respondents belonging to that particular age group. The mean duration of time since diagnosis of diabetes was 8.05 ± 5.84 years. Knowledge regarding diabetes was lacking with less than a third of the sample being able to identify the type of diabetes and the type they were suffering from. Self care practices were relatively more satisfactory than domains of knowledge.

Conclusions: A lack of knowledge accompanied by satisfactory self care practices may indicate a lack of sustainability and warrants further study and evaluation. Adequate knowledge and an informed patient is the key to managing this accelerating prevalence of diabetes.

Keywords: Diabetes, self care practices, knowledge

Corresponding Author: Dr. R L Lakshman Rao, Department of Community Medicine, Gandhi Medical College, Hyderabad, Email: rllakshmanrao@gmail.com

Introduction:

India is the world capital of diabetes with an estimated one in three people suffering from this lifelong, chronic condition. [1] Current estimates of the prevalence of the burden of the disease and mortality are 347 million people suffering from the condition worldwide with one percent (3.4 million) among them dying of complications of high blood glucose. [2] In India, there are an estimated 41 million diabetics with the number being projected to rise to 68 million by the year 2025. [1]

India suffers from a triple burden of disease, infectious, non communicable and injuries, albeit due to the epidemiological transition, the burden of mortality and morbidity is contributed to a large extent by non communicable diseases (NCD) which cause 53% of all deaths occurring in India. [3] The condition, once associated with affluence has been postulated to affect even middle class and lower socio-economic strata which may surpass the upper classes in prevalence. [4] Four out of every five people with diabetes now live in developing countries, with most affected men and women being of working age. [5]

Diabetes is a causal and component factor for cardio-vascular disease, cerebro-vascular accidents and accelerates the occurrence of atherosclerosis. In addition, diabetes also leads to a decrease in quality of life through numerous complications affecting end organs such as the retina, kidney, microvasculature and the nervous system. [6] The burden of NCDs can be assuaged by primordial measures, health education, and early detection and in whom the disease has already occurred by emphasizing on regular monitoring and self care. [7]

Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context. [8] There are seven essential self-care behaviors in people with diabetes which predict good outcomes including healthy eating, being physically active, monitoring of blood sugar, being compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors. [9]

The involvement of the patient in his own care provides manifold benefits with reduction in healthcare and provider costs, ownership and responsibility of the patient to work towards better   health, an increasing awareness and ability to monitor and recognize worsening of the conditions and complications and better patient satisfaction due to involvement of the patient in the treatment process. Better knowledge of the disease enables the patient to halt and even reverse the complications of the condition through lifestyle modifications and maintaining optimal glycemic control.

The current cross sectional study was devised to measure the knowledge regarding the condition among diabetic patients, to evaluate the self care practices they indulge in to understand the role and impact of knowledge and self care practices on the outcome of the condition.

Methodology:

A cross sectional study was conducted among known diabetics attending the outpatient department in Gandhi Medical College over a period of one month. Every tenth patient attending the OPD was selected for the study through systemic random sampling during the month of December 2013. Subjects with duration of diagnosed diabetes for a period of at least one year were included in the study. The purpose of the study was explained and informed consent was obtained from the respondents. Privacy and confidentiality was ensured during the process. A total of 163 patients consented to and participated in the study. Thirteen patients were excluded from the final data analysis due to missing responses in the questionnaire and therefore the sample size was 150.

A semi structured questionnaire was administered through a face to face interview consisting of the following parts, namely 1) Socio-demographic information 2) Clinical characteristics of diabetes 3) Knowledge regarding diabetes 4) Self care practices employed by the patients.

Socio-demographic information obtained included the age, gender and socioeconomic status. Habits such as smoking, consumption of alcohol were obtained and if the respondent consumed tobacco or alcohol, their duration and frequency of consumption were obtained. Clinical characteristics of diabetes obtained included duration of diabetes, presence of other associated co-morbidities such as hypertension, familial history of diabetes and if present, whether on the maternal or paternal side. Knowledge regarding the condition among the respondents was evaluated and they were assessed on whether they were aware about the types of diabetes, the type they suffered from, the impact of uncontrolled blood glucose and its duration on complications, the organ systems affected by complications, importance of foot care and alleviation of hypoglycemia. Self care practices that the respondents followed were evaluated, pertaining to regular monitoring of blood glucose, periodic health examinations, diet practices, physical activity, compliance with medication, and indulgence in physical activity and foot care practices.

Statistical analysis was conducted using Statistical Products and Service Solutions (SPSS) version 20. Categorical data was appropriately coded and entered and numerical data was entered as such. Statistical measures obtained included descriptives including means, standard deviation, proportions and percentages.

Results:

A total of 150 patients consented and participated in the current study and were included in the final analysis after excluding missing responses.

Among the 150, 80 (53.3%) were male and 70 (46.7%) were female. Most of the respondents were aged between 40 – 50 years, with 72 (48%) of the respondents belonging to that particular age group. There were four (2.7%) people aged above 70 years and the remaining were aged between 50 – 70 years. Profession was obtained as per Kuppuswamy classification, 74 (49.33%) were unemployed, followed by 62 (41.33%) who were professionals. A very small proportion of the sample were semi-professionals, farmers, skilled and unskilled workers. Habits such as consumption of alcohol and tobacco were evaluated. Among the sample, 39 (26%) consumed alcohol and 25 (16.7%) were smokers. The socio-demographic characteristics are represented in table one.

Clinical characteristics relating to diabetes were obtained. The mean duration of time since diagnosis of diabetes was 8.05 ± 5.84 years. Most diabetics in the sample had been diagnosed between one to five years ago with 64 (42.7%) of the sample belonging to that group. There were only two (1.3%) of the diabetics diagnosed over 25 years ago. Co-morbid condition such as concurrent hypertension was evaluation. A majority of the sample also suffered from hypertension with 77 (51.3%) of the respondent also being known hypertensives. Familial history of diabetes was obtained and 82 (54.7%) of the respondents had a positive family history of diabetes on the paternal or maternal side. These results are depicted in table two.

Knowledge regarding diabetes among the respondents was evaluated and presented in table three. Knowledge was evaluated over five areas concerned with basic knowledge regarding diabetes and knowledge related to self care practices. Among the respondents, 50 (33.3%) were able to answer that there were two types of diabetes and 46 (30.7%) were able to identify that they were suffering from type II diabetes. A same number of respondents were aware that duration of diabetes plays an important role in the occurrence of complications in the condition. Eight one (54%) of the respondents were aware that control of blood glucose is important in reducing complications. Some respondents were aware of the proper management of hypoglycemic symptoms with 52 (34.7%) answering that they would consume sugar and 23 (15.3%) answering that they would consume a food item in a hypoglycemic episode.

Table 4 represents the self care practices followed by the respondents. Compliance to hypoglycemic therapy was evaluated and 135 (90%) of the respondents had consumed their medication over the last month regularly missing less than three doses a month. An euglycemic diet with avoidance of boluses of simple carbohydrates was followed by only 47 (31.3%) of the respondents. One hundred and two (68%) respondents regularly monitored their blood glucose at least once in six months. Among the respondents, 119 (79.3%) underwent periodic checkups for evaluation of complications of diabetes and titration of anti-diabetic medication. Among the respondents, 114 (76%) followed practices of simple foot care including regular inspection and wearing of proper footwear. Physical activity, at least once in a week for a period of at least two hours apart from routine activities was present among 70 (46.7%) of the respondents.

Discussion:

The current cross sectional study was conducted among 150 respondents attending the outpatient department of a tertiary teaching hospital using systemic random sampling through a face to face interview to evaluate socio-demographic, clinical characteristics related to diabetes, knowledge regarding diabetes and self care practices followed.

The sample had an almost equal distribution with respect to gender with 80 males and 70 females, an age ranging from 40 years to 70 years and above. Most of the respondents in the sample were either unemployed or professionals providing for a variegated and representative sample in terms of age, gender and occupation to evaluate knowledge and self care practices among the diabetic population. There were relatively few consumers of tobacco and alcohol among the sample compared to national figures in large scale population surveys [10] which indicates a healthier perspective and avoidance of noxious habits in a subset of people already at risk for atherosclerotic disease possibly due to repetitive attempts at health education.

The mean duration of diabetes was 8.05 years with a dispersion of 5.84 years providing for a representative sample in terms of exposure to the number of years suffering from diabetes. Other studies exploring the knowledge and self care practices among the Indian population also observed a high proportion of diabetics with duration of disease ranging from one to five years and attending the outpatient department. [7] Co-morbid condition such as hypertension were quite common among the sample similar to international [2] and national [11] studies.

Knowledge regarding diabetes was lacking in the sample with less than a third of the sample being able to identify the type of diabetes and the type they were suffering from in particular. A similar number were unable to identify the importance of the duration of hyperglycemia in the occurrence of complications in diabetes. The low penetrance of knowledge with regards to the importance of proper euglycemic control and the management of hypoglycemic symptoms among the sample is burdensome. Though similar studies [7, 12] have been conducted in India evaluating knowledge, the levels are not comparable due to cross cultural differences and differences in the domains of knowledge evaluated.

Self care practices were relatively more satisfactory than domains of knowledge which is a reflection of patient health education through repeated contacts with healthcare professionals. Compliance was highly satisfactory with 90% of the respondents reporting compliance and also a high number reported regular visits with a health professional and monitoring of blood glucose. However, the number of patients following a prescribed diabetic diet and physical activity were lower. Foot care practices were satisfactory with over 76% following the same. Similar levels of awareness and practice of foot care have been reported in India [13] with 86% of respondents adopting diabetic foot care.

Conclusions:

The current study conducted in a representative cross section of patients attending an outpatient department showed poor levels of knowledge with two thirds of the patients being unaware of basic facts regarding diabetes. However there were satisfactory responses to self care practices implying reinforcement through healthcare professionals and frequent points of contact due to motivation from healthcare professionals. However, a lack of knowledge accompanied by satisfactory self care practices may indicate a lack of sustainability and warrants further study and evaluation. Adequate knowledge and an informed patient is the key to managing this accelerating prevalence of diabetes.

Limitations:

The study was a cross sectional study and its limitations are inherent as that of the study design. Responses were obtained solely on verbal response and may have been subject to bias.

References:

  1. Joshi SR. Management of Obese Indian Patient. Indian Journal of Obesity. 2005; 1(1):11-20.
  2. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet, 2011, 378(9785):31–40.
  3. World Health Organization. Deaths from NCDs. Available at: http://www.who.int/gho/ncd/mortality_morbidity/ncd_total/en/index.html. [Last assessed on 2014 March 05].
  4. Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P et al. UN high-level meeting on non-communicable diseases: addressing four questions. Lancet 2011;378:449–55.
  5. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation, 2013.
  6. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH: Diabetes, Depression, and Quality of Life: A population study.       Diabetes Care 2004, 27(5):1066-1070
  7. Padma K, Bele SD, Bodhare TN, Valsangkar S. Evaluation of Knowledge and Self Care Practices in Diabetic Patients and Their Role in Disease Management. National Journal of Community Medicine. 2012;3(1):3-6.
  8. Cooper H, Booth K, Gill G: Patients’ perspectives on diabetes health care education.Health Educ Res 2003, 18(2):191-206.
  9. American Association of Diabetes Educators: AADE7 Self-Care Behaviors. Diabetes Educ 2008, 34:445-449.
  10. Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 2003;12(4):e4.
  11. Mohan V, Seedat YK, Pradeepa R. The rising burden of diabetes and hypertension in Southeast Asian and African regions: Need for effective strategies for prevention and control in primary health care settings. Int J Hypertens 2013;409083.
  12. Shah VN, Kamdar PK, Shah N. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. Int J Diabetes Dev Ctries 2009;29(3):118-22.
  13. Chellan G, Srikumar S, Varma AK, Mangalanandan TS, Sundaram KR, Jayakumar RV, et al. Foot care practice-the key to prevent diabetic foot ulcers in India. Foot (Edinb) 2012;22(4):298-302.

Table 1

Socio-demographic characteristics

 

 

Count

Percentage

Gender

Female

70

46.7%

Male

80

53.3%

Age

40 - 50 years

72

48.0%

51 - 60 years

45

30.0%

61 - 70 years

29

19.3%

> 70 years

4

2.7%

Occupation

Professional

62

41.33%

Semi professional

2

1.33%

Clerical, shop owner, farmer

1

0.67%

Skilled

6

4%

Unskilled

5

3.33%

Unemployed

74

49.33%

Alcohol

No

111

74.0%

Yes

39

26.0%

Smoking

No

125

83.3%

Yes

25

16.7%

 

Table 2

Clinical characteristics

 

 

Count

Percentage

Duration of diabetes

1 – 5 years

64

42.7%

6 – 10 years

42

28.0%

11 – 15 years

29

19.3%

16 – 20 years

10

6.7%

21 – 25 years

3

2.0%

> 25 years

2

1.3%

Hypertension

No

73

48.7%

Yes

77

51.3%

Family history of diabetes

No

68

45.3%

Yes

82

54.7%

 

Table 3

Knowledge regarding diabetes

 

Count

Percentage

How many types of diabetes do you know of?

Two types

50

33.3%

Not Sure

100

66.7%

Which type of diabetes do you suffer from?

Not Sure

104

69.3%

Type 2

46

30.7%

Is the duration of diabetes important in development of complications?

Not Sure

104

69.3%

Yes

46

30.7%

Is control of blood sugar levels important in reducing complications?

No

1

0.7%

Not Sure

68

45.3%

Yes

81

54.0%

If you suffer from symptoms of hypoglycaemia, what should you partake?

Food

23

15.3%

Medicine

1

0.7%

Not Sure

71

47.3%

Sugar

52

34.7%

Water

3

2.0%

 

Table 4

Self care practices

 

 

Count

Percentage

Do you take you diabetes medication regularly?

No

15

10.0%

Yes

135

90.0%

Do you maintain proper diabetic diet?

No

103

68.7%

Yes

47

31.3%

Do you monitor your blood glucose levels regularly?

No

48

32.0%

Yes

102

68.0%

Do you undergo periodic health checkups?

No

31

20.7%

Yes

119

79.3%

Do you follow prescribed care of feet?

No

36

24.0%

Yes

114

76.0%

Do you indulge in regular physical activity at least once a week?

No

80

53.3%

Yes

70

46.7%

 Source of Support: Nil. Conflict of Interest: None





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