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Introduction:
Around 3 million diabetes people die in
worldwide every year & nearly 1 million diabetes
peopledieinIndiaeveryyear.Diabetesisassociated
withthehighestco-morbidities&complicationsand
a f fe c t s peop le f rom a l l soc io -economic [1]
backgrounds .Types-2diabetesplaysan important
causal role in hypertension, dyslipidemia, obesity,[1]coronaryarterydisease,blindness& renal failure
Worldwidetotalno.ofdiabetescasesisestimatedto[2]bearound422millionin2016 ,amongthem>90%
aretype2diabetes.In2016,anestimated1.6million[3]
peoplediedfromconsequencesofhighbloodsugar .
Indiahasbeenhailedas thediabetescapitalof the[4]
world .Epidemiologicalstudiesfromdifferentparts
of the country show that diabetes in adult urban
Indianpopulationvariesfrom5.4%inthenorthern
statestosouthIndia(ashigh12.3-15.5%inChennai,
5.6%inPondicherry),tocentralIndia(12.3-16.8%in
Jaipur),while3%ofruralpopulationabovetheageof
Abstract:
Introduction:Inthecontextofanalarmingincreaseinthemagnitudeoftype2diabetesmellitusin
Indianpopulation,theprevailingperceptions&practicesofdiabeticsassumeimmenseimportanceinthe
controlofdisease.Objectives:Todetermine levelofknowledge,attitudeandpracticesofpatientswith
regardtothedisease.Method:Acrosssectionalstudywasconductedamong70patients,agedmorethan30
years,diagnosedwithtypes2diabetesmorethanyearback&visitingG.G.Govt.Hospital,Jamnagarforfollow
upfromJulytoAugust2019.Pre-testedPre-designedquestionnaireusedtointerviewthepatientsregarding
theirsociodemographiccharacteristic,knowledge,attitude&practicesrelatedtodisease.Results:Study
revealedthatknowledgeregardingsymptoms&complicationsofthediseasewaspoorexceptforfrequent
urination (42.85%) & eye complication (61.42%); however, only 24.2% patients had gone for eye
examinationduringthelast1yearoftheirtreatment.Awarenessoncomplicationsofdiabeteslikeperiodic
eyeexamination,BPmonitoring,hypoglycemia,footcarewerefoundtobepoor.Attitudetowardregular
exercise&dietarymodificationwasfoundtobefavorableinthemajority;howeverwhilecomplianceto
dietarymodificationwasreportedtobehigh(82.85%)itwaslowwithregularexercise(30%)Conclusion:
Diabeticpatientsrelymostlyondrugs&dietarymodificationfordiseasecontrolwhileneglectingother
lifestylemodification.Promotionofhealthylifestylemodification&self-careshouldbeincorporatedaspart
ofdiabeteseducationinalltreatmentfacilities.
KeyWords:Perceptions,Practices,Type2DiabetesMellitus
[5-8]15yearshavediabetes .Moreover,thereisalarge
poolofsubjectswithimpairedglucosetolerancewho[9,10]
are at a high risk of conversion to diabetes.
However,despitesuchhighprevalence,awarenesson
diabetes and its treatment still remain major
challenges,particularlyinthecontextofdeveloping
countrieslikeIndia.Preventionisimportantbecause
the burden of the disease on healthcare and its[11]economic implications are enormous. Very few
studieshavebeencarriedoutinourcountrytofind
the prevailing level of awareness, attitudes and
practicesamongdiabeticpatients,whichcanhelpin
thedevelopmentoffuturehealtheducationprograms[12,13]or interventions targeting the disease. The
objectives of this study are: To describe the
distributionofpatientswithtype2diabetesmellitus
attendingdiabeticclinicofatertiarycarefacility,with
regard to certain socio - demographic factors. To
determine their level of knowledge, attitude and
practiceswithregardtothedisease.
ACrossSectionalStudyonPerception&PracticesofType2DiabeticsinG.G.GovernmentHospital,Jamnagar,Gujarat
1 2 3NileshPrajapati ,IleshKotecha ,DipeshV.Parmar1 2 3SecondyearResidentDoctor, AssociateProfessor, Professor&HeadofDepartment,Departmentof
CommunityMedicine,ShriM.P.ShahGovt.MedicalCollege&G.G.GovernmentHospital,Jamnagar,Gujarat,India
Correspondence:Dr.IleshKotecha,E-mailId:[email protected]
OriginalArticle HealthlineJournalVolume11Issue1(January-June2020)
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Method:
A hospital based cross sectional study was
conducted among 70 patients attending a diabetes
clinic in aG.G.Govt.Hospital, Jamnagarduring the
study period from July 2019 to August 2019. The
study population comprised all the patients aged
morethan30yearsdiagnosedwithtypes2diabetes
mellitusmorethan1yearback&visitingthehospital
forfollowup.Writteninformedconsentwasobtained
fromthem.Aquestionnairewasdevelopedandtested
on 10 patients and suitably modified after
consultation with experts. This pretested
predesignedquestionnairewasusedtointerviewthe
patients regarding their socio-demographic
characteristics, knowledge, attitude and practices
related to diabetes mellitus. Knowledge had 13
questionsregardinggeneralawarenessondiabetes
mellitus, its symptoms, complications, prevention
and control. 08 questions related to attitude
regarding the usefulness of influencing/modifying
life style factors and investigations in the
management of the disease. Practice had 08
questions regarding life style and dietary habits,
monitoring of blood glucose, drug compliance, eye
examinationandfootcare.Thedatawereobtained,
compiledandanalyzedusingsimpleproportions.
Results:
Themeanageofthepatientswas52±7.21years;
Inthisstudy,53(75.71%)patientsweremalesand17
(24.28%)were females.17 patients (24.28%)were
illiterate and the remaining 53 (75.71%) were
educated.11males(20.75%)wereunemployedand
16 females (94.11%) were housewives. Only 40
patients(57.14%)knewthatdiabetesisacondition
characterized by raised blood sugar, 17 patients
(24.28%) knew that it resulted from a defect in
insulin, 50 patients (71.42%) responded that the
diseaseaffectspeopleintheeconomicallyproductive
agegroup,53(75.71%)knewthatbothsexescouldbe
affectedandonly30persons(42.85%)regardeditas
a lifelongdisease.Only2.8%knewthatthedisease
could be asymptomatic. Frequent urination was
reportedasthemostcommonsymptomofdiabetes
by 30 patients (42.85%). Regarding complications
resulting fromdiabetes,awarenessoneyedisorder
wasfoundtobethehighestin43patients(61.42%)
followedbykidneydiseases41(58.57%)andheart
diseases24(34.28%).Healthydietwasbelievedtobe
themostcommonlifestylefactorthatcouldprevent
thedisease.Knowledgeonotherlifestylefactorswas
poor(Table1).
Drugs and dietary modification were the most
common management options reported by 56
patients (80%) and 50 patients (71.42%),
respectively. Awareness on hypoglycemia, need for
periodic eye examination, BP monitoring and foot
careindiabeticswasfoundtobeverylow(Table2).
Attitudetowarddietarymodificationandregular
exercise was favorable in 82.8% and 60.1% of
diabetics, respectively.But17.1%patientsbelieved
that oncediabetes is controlled, eating restrictions
arenotrequiredand38.5%feltthatinsulinwasthe
lasttreatmentoptionandshouldbeavoidedasfaras
possible (Figure 1). Regarding their self-reported
practicesduringtheprevious1month,itwasfound
thatonlycompliancetotakingdrugs(>5days/week)
Issues on awarenessCorrect
responsesN (%)
Symptom(s) of diabetes
Weight gain/loss 8 (11.4)
Frequent urination 30 (42.8)
Frequent hunger 25 (35.7)
Frequent thirst 4 (5.7)
2 (2.8)
Complication(s) of diabetes
Heart disease 24 (34.2)
Kidney disease 41 (58.5)
Eye disease 43 (61.4)
Stroke 4 (5.7)
Foot problem 4 (5.7)
Death 8 (11.4)
Others 13 (18.5)
Lifestyle factor(s) which can prevent diabetes
Healthy diet 53 (75.7)
Regular exercise 27 (38.5)
Weight control 5 (7.1)
Asymptomatic
Table1:Distributionofrespondentsaccordingtotheirawarenessonsymptoms,complicationsandpreventionofdiabetes(n=70)
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asperdoctor'sinstructionswaspresentinmajority
(94.2%)ofthepatientsand82.8%tookamodified
diet, mostly, as prescribed by the doctor and/or
dietician.Only17persons(24.2%)hadtheireyeand
footexaminationdoneinthelast1year.Thepractices
regarding regular exercise for 30 minutes (>5
days/week) and routine (once monthly) blood
glucosemonitoringwerefoundtobelow(Figure2).
Discussion:
Thispreliminary studywas conductedwith the
aim of assessing the socio-demographic profile of
patients attending a diabetes clinic in a G.G. Govt.
hospital, Jamnagar, Gujarat and their knowledge,
attitude and practices regarding the disease. The
findingsofourstudyrevealedthatnearly24.2%of
the patients were illiterate, one-fifth of the males
wereunemployedandmajorityofthefemaleswere
housewives. Overall, it was observed that diabetic
patientswereawareofonlyafewaspectsregarding
thesymptoms,complications,preventionandcontrol
oftheirdiseasecondition.Only34.2%patientsknew
that the disease could run in families. Regarding
symptomsofthedisease,knowledgewaspoorexcept
for that on frequent urination (42.8%).Regular
annual screening fordiabetescomplicationsallows[14]
treatablediseasestobeidentified. Patients'lackof
knowledge about diabetes care can hamper their
abilitytomanagetheirdiseaseoritscomplications.
Eyecomplicationwasstatedtobethemostcommon
complicationofdiabetesby61.4%patientsbutonly
24.2%patientshadgoneforeyeexaminationduring
the last 1 year of their treatment. Awareness on
measures to detect early complications of diabetes
like periodic eye examination, BP monitoring and
awarenessonhypoglycemiawerefoundtobepoor,
which highlights the need for these aspects to be
focused in diabetes education programs. For
management of diabetes, majority (94.2%)
responded that drugs were used for treatment.
Lifestyle interventions, namely nutrition and
exercise,arethecornerstonesofsuccessfuldiabetes
therapy. Cigarette smoking is associatedwith poor
Table2:Distributionofrespondentsaccordingtotheirawarenessoncareindiabetes(n=70)
Care in diabetes N (%)
Diabetes is treated with
Drugs
Insulin
Healthy diet
Regular exercise
Weight control
Quit smoking
Symptom(s) of hypoglycemia
Sweating
Dizziness
Weakness/fatigue
Control of hypoglycemia
Allied care
Blood sugar examination
Eye examination
Foot care for diabetics
BP monitoring
56 (80)
41 (58.5)
50 (71.4)
46 (65.7)
11 (15.7)
2 (2.8)
3 (4.2)
2 (2.8)
6 (8.5)
4 (5.7)
48 (68.5)
14 (20)
2 (2.8)
4 (5.7)
Figure1:Distributionofdiabetesaccordingtotheirattitudetowarddiabetescontrolmeasures
Figure2:DistributionofdiabetesaccordingtotheirSelf-reportedpractices
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control of blood glucose and also strongly causally
relatedtohypertensionandheartdiseasesinpeople[15]with diabetes. Our study found awareness on
lifestylemodification related toweight control and
quitting of smoking was low. Some authors have
shownthathighereducation(16.0versus12.0,P<
0.0001) and professional or executive jobs (17.0
versus15.0,P<0.0001)weresignificantlyassociated[16]
withabetterawareness. Otherauthorshaveshown
thatevenpatientswithlowerlevelsofeducationare
wellinformedonvarious aspects of diabetes in
presence of a well-equipped diabetic clinic with[11]facilitiesforpatienteducation. Thepoorawareness
inourstudypatientsmighthavebeenconfoundedby
thefactthatmajorityhadlowlevelofeducationand
occupationalstatusinadditiontolackoforganized
diabetes education facilitiesinourclinic.Attitude
towardregularexerciseanddietarymodificationin
diabeticswasfoundtobefavorableinthemajority;
however, while compliance to dietarymodification
wasreportedtobehigh(82.8%)itwasnotthecase
withregularexercise(30%)possiblyduetolackof
time. The study found that monitoring of blood
glucose at home was very low due to lack of
awareness and cost factors but prescription
compliancewasveryhigh(94.2%)..Physicianshave
animportantroletoplayinthelong-termcontrolof
the disease and prevention of complications.
However, physician barriers like suboptimal
knowledge of guidelines, constraints of time and
facilities, focus on acute management rather than
preventivecare,competingcaredemandsanddelay
in clinical response to poor control impede[17]
appropriatemanagementofthedisease. Forpeople
affected by diabetes, self-management education
trainingisimportantsincepeoplewithdiabetesand
their families provide 95% of their care[18,19]themselves. The need for regular patient
counselingorgroupeducationatfollow-upvisitsby
health care professionals in improving patients'
knowledgeandultimatelymodifyingtheirpractices
cannot be overemphasized. However, the ground
reality is that proper diabetes education programs
arelackinginmostgovernmenthospitalsevenatthe
tertiary care levels and the existing programs are
weak and fragmented. Inadequacies in primary
healthcaresystemswhicharenotdesignedtocope
with additional challenges posed by non-
communicablediseasesresultinpoordetection,sub-
optimaltreatmentleadingtounnecessarydisabilities[19]and complications. The CURES study concluded
that awareness and knowledge regarding diabetes
among general population and diabetics are still
grossly inadequate in India and massive diabetes
education programs are urgently needed both in[13]
urbanandruralIndia.
Conclusion:
The findings of this study reveal that diabetic
patients rely mostly on drugs and dietary
modification to control their disease condition.
Promotionofhealthylifestylemodificationsandself-
care should be incorporated as part of diabetes
education in all treatment facilities. For people
affected by diabetes, self-management education
trainingisimportantsincepeoplewithdiabetesand
theirfamiliesprovide95%oftheircarethemselves.It
ispossiblethatconsultationwithdoctorsregarding
drugs and dietician was directly responsible in
motivatingthemtoadoptsuchpractices.
Recommendation:
Patienteducationinself-managementofthedisease
istheneedofthehour.Specialemphasisshouldbe
laidoneducatingthepatientsaboutcomplicationsof
thediseaseandneedforlifestylemodificationalong
with drug compliance and periodic laboratory
investigations.Onelimitationofthisstudywasthat
thefindingsarerestrictedtopatientsattendingthe
diabeticclinicinG.G.Govthospital,Jamnagar,Gujarat
andhencemaynotbegeneralizabletopatientsfrom
differentsocioeconomicbackgroundsinotherparts
of the country. Additional investigation in a larger
samplesizeinotherstudypopulationsisneededto
replicateandextend these findings.However, since
thesociodemographicprofileofpatientsattendinga
diabeticclinicinG.G.Govthospital,Jamnagar,Gujarat
isnotexpectedtobeverydifferent,thispreliminary
study throws some light on the prevailing level of
knowledge,attitudeandpracticesofdiabeticsinthis
area.
Declaration:
Funding:Nil
ConflictofInterest:Nil
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