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Knowledge attitude and practice of type 2 diabetic patients in a tertiary care teaching hospital in India

Ravi Kant

All India Institute of Medical Sciences, Department of Medicine, Rishikesh, Uttrakhand, India

Vinita Thapliyal

All India Institute of Medical Sciences, Department of Medicine, Rishikesh, Uttrakhand, India

E-mail : Vinita.thapliyal22@gmail.com

DOI: 10.15761/IFNM.1000115

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Abstract

Objective

To assess the Knowledge, Attitude and Practice of type 2 diabetic patients at AIIMS Rishikesh.

Materials and methods: A cross-sectional study was done at the All India Institute of Medical Sciences (AIIMS) Rishikesh through a structured interview of 200 diabetes mellitus (Type 2) patients attending outdoor facility at the Institute. The questionnaire did not contain any questions that reveal the identity of the patients.

Results

A total of 200 outdoor patients were analyzed. Only 30% of the patients had BMI up to or below 23kg/m2. Out of 200 patients 64% were male 36% were female patients. 18% of the population did not know any complication regarding the diabetes. 78% of the population was literate. Only 50 % of the population knew what diabetes is? 88% of the population still believes that bitter substances can control diabetes. 80% of the population thinks that insulin should be avoided as it is habit forming. Misconceptions were quite common among the population regarding diet, insulin and diabetes. This highlights the urgent need for better health information to the patient through large scale awareness programmes so as to change the attitude of our public regarding diabetes as India being the world capital.

Conclusions

This study showed that there was poor knowledge, attitude and practice about the diabetes which calls for immediate action and education by skilled health care providers.

Key words

diabetes mellitus, knowledge, attitude, practice, patients

Introduction

Diabetes mellitus is a metabolic disorder of multiple etiological factors characterized by chronic hyperglycemia with disturbance of carbohydrate metabolism which resulted from either insufficient insulin secretion, resistance to the action of Insulin or both [1,2]. International diabetes federation's report described that 382 million had diabetes in the year 2013 and it was estimated to reach 592 million in the year 2035. Diabetes mellitus is classified in to type I(IDDM), type 2 (NIDDM) and Gestational Diabetes Mellitus(GDM) type I being characterized by insulin deficiency which needs daily administration of insulin. Type 2 diabetes mellitus results from the body's ineffective use of insulin while gestational diabetes is hyperglycemia with onset or first recognition during pregnancy [3,4] Participation of patients is very crucial in the management of diabetes mellitus as medications alone aren't enough to manage the disease without different non-pharmacological measures taken [5,6]. Prevalence of diabetes mellitus is increasing globally, [7] more so in developing countries like India due to rapid urbanization [8,9].

Materials and methods

Subjects and sampling

200 Type 2 diabetic patients seen sequentially at the medicine OPD of AIIMS Rishikesh to assess the knowledge, attitude and practice of diabetes mellitus patients towards the disease.

Data collection

Data was collected through a structured interview with patients attending the outpatient door of the institute during the study period from the November 2014 to January 2015.These included the newly diagnosed Type 2 diabetes mellitus patients and medicine OPD or referred from within and outside institute for treatment of diabetes mellitus. The exclusion criteria precluded patients who were not physically or mentally able to conduct the interview. In the present study 200 patients who fulfilled the inclusion criteria and were willing to participate in the study were interviewed. Furthermore the data collected through the interviews was kept confidential and used strictly for the purpose of the study.

Characteristics

Body mass index

As per WHO patients those have a BMI between 18.5 -23 kg/m2 considered normal, those having BMI between 24-27 kg/m2 were considered overweight and above 27.5 kg/m2 obese.

Assessment of knowledge

A questionnaire was prepared to assess the knowledge of the patients regarding the diabetes having content about Diet, Insulin and Diabetes and its complications.

Diet and Exercise practice

Diet was assessed by asking about the major food groups taken by the patient. Exercisepractice was assessed by enquiring about the nature of exercise done.

Results

Characteristics of the subjects

The 64% of the patients were male and 36% of the patients were female. The mean age was 50 years and the mean duration of the disease is 9.7 years. The 62% of the patients had family income >50,000 in a year. The 78% of the population was illiterate. The source of information for the entire population was doctor hence there by meaning lack of awareness by other health care provider (Table 1).

Table 1. Characteristics of population (N=200)

Variables

Percentage( n=200) p>0.05

Age(years) Mean ± SD

50 ± 9.32

Mean duration of the disease (years)

9.7

Gender Distribution

 

Male

64

Female

36

Work

 

Own Occupation

16

Student

3

House wife

23

Service

42

Labor

16

Annual Income

 

<20,000

18

20,000- 50,000

20

>50,000

62

Source of Information

 

Doctor

100

Dietician

-

Media

-

Internet

-

Some other source

-

Education

 

Illiterate

22

Primary

18

Secondary/ Middle

24

Graduate

26

Postgraduate

10

Weight status

It is worrisome that only 30 % of the populations were having BMI between 18-23 which is considered to be normal for Asian population because of having thrifty phenotype. 53% of the populations were overweight having BMI between 24-30 and 17% of the populations were having BMI > 30 (Table 2).

Table 2. Body mass index of population (N=200)

BMI

Percentage

18 – 23

30

24 -30

53

>30

17

Table 3. Knowledge regarding complications of diabetes (N=200)

Complications

Percentage

Heart

4

Renal

20

Retinopathy

8

Stroke

20

Neuropathy

30

Don’t Know

18

Table 4. Assessment regarding diabetes and its features (N=200)

Questions to assess knowledge

Correct answer percentage

What is diabetes?

50

What causes diabetes?

54

Can diabetes be cured?

12

How can diabetes be detected? Features of diabetes

26

Polyuria

30

Polyphagia

8

Weight Loss

6

Numbness in feets

18

Can be asymptomatic

10

Excessive Thirst

16

Don’t know

30

Is diabetes  hereditary?

44

Is diabetes  infectious?

100

Table 5. Knowledge of exercise and diet (N=200)

Knowledge of exercise and diet

Percentage

What shoud be done to control DM?

 

Exercise

32

Diet Modification

18

Both

50

Exercise should be done only by obese?

16

Bitter substances can cure diabetes?

88

Table 6. Knowledge regarding OHA, insulin, hebal drugs (N=200)

Knowledge of drug therapy

Percentage

Once DM is control drug should be stop?

66

Drug is more important than diet control?

 36

Herbal drugs are better?

18

Insulin Should be avoided?

80

Insulin is habit forming?

90

Table 7. Attitude and practice towards diabetic care, eating practices and health care (N=200)

Respondent attitude and practice

Percentage

Who is responsible for your diabetic care?

    Yourself

     Doctor

     Family

Do you include fruits?

Do you include GLV’s in your diet?

Do you have glucometer?

Do you check your sugar regularly?

Do you check your foot regularly?

Do you take herbal drugs?

48

26

6

72

90

32

36

44

70

Knowledge regarding the complications of diabetes

The population has poor knowledge regarding the complications of diabetes. 18% of the population didn’t know any kind of complications regarding the diabetes. Only 4% of the population knows that diabetes can affect proper functioning of heart.

Assessment of knowledge

The overall assessment regarding the knowledge of diabetes was satisfactory 50% of the population knows what diabetes is and what causes diabetes? But the population had poor knowledge regarding the features of diabetes.

Knowledge of exercise and diet

Misconception about the diet is prevailing 88% of the population still believes in the fact that bitter substances can cure diabetes. Half the population believes that both exercise and diet modification should be to control the diabetes.-

Knowledge of drug therapy

The population had very poor knowledge about the drug therapy 80% of the population believes that insulin should be avoided and 90% believe that it is habit forming. Hence majority of the population refuse Insulin in spite of uncontrolled sugar level showing lack of knowledge and awareness regarding the disease.

Attitude and practice towards diabetes

The overall attitude and practice towards diabetes was below satisfaction. Only 26% of the population still believes that doctor is responsible for their diabetic care. Only 36% of the populations were checking their sugar regularly and 32% of the population had glucometer at their home. 70% of the populations were taking herbal medicine for one or the other purpose.

Discussion

Most studied regarding epidemiology and prevalence of diabetes were conducted from south India [10-13] and very few studies from north India [14]. There is no studies regarding KAP available for Uttrakhand and western Uttar Pradesh hence, this study is an attempt to gather the data regarding the same.

The management of DM not only requires the prescription of the appropriate nutritional and pharmacological regimen by the physician but also intensive education and counselling of the patient [15]. This finding emphasizes that the average knowledge levels are low despite of 78% literacy rate in communities with higher diabetes prevalence [16]

References

  1. Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15: 539-553. [Crossref]
  2. Sicree R, Shaw J, Zimmet P. The Global Burden: Diabetes and Impaired Glucose Tolerance. IDF Diabetes Atlas. 4th edn.
  3. International Diabetes Federation, IDF Diabetes Atlas 2013; 6th edn.
  4. World Health Organization. Diabetes Fact sheet 2013; No. 312.
  5. Siminerio L, Kulkarni K, Pearson T, Rodbard H, Meece J, et al. (2011) Strategies for Insulin Injection Therapy in Diabetes Self-Management: American Association of Diabetes Educators.
  6. Clifford RM, Davis WA, Batty KT, Davis TM (2005) Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 28: 771-776. [Crossref]
  7. Kuller LH (1997) Dietary fat and chronic diseases: epidemiologic overview. J Am Diet Assoc 97: S9-S15. [Crossref]
  8. Grol ME, Halabi YT, Gerstenbluth I, Alberts JF, O'Niel J (1997) Lifestyle in Curaçao. Smoking, alcohol consumption, eating habits and exercise. West Indian Med J 46: 8-14. [Crossref]
  9. Ramachandran A, Snehalatha C, Baskar AD, Mary S, Kumar CK, et al. (2004) Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia 47: 860-865. [Crossref]
  10. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, et al. (2001) High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 44: 1094-1101. [Crossref]
  11. Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K (2000) Type 2 diabetes in southern Kerala: variation in prevalence among geographic divisions within a region. Natl Med J India 13: 287-292. [Crossref]
  12. Ramachandran A, Jali MV, Mohan V, Snehalatha C,  Viswanathan M (1988) High prevalence of diabetes in an urban population in south India. BMJ 297: 587-590. [Crossref]
  13. Ramachandran A, Snehalatha C, Latha E, Vijay V, Viswanathan M (1997) Rising prevalence of NIDDM in an urban population in India. Diabetologia 40: 232-237. [Crossref]
  14. Nuttall FQ (1993) Carbohydrate and dietary management of individuals with insulin-requiring diabetes. Diabetes Care16: 1039-1042. [Crossref]
  15. Viral N Shah, Kamdar PK, Nishit Shah (2009) Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. Int J Diabetes Dev Ctries 29: 118-122. [Crossref]
  16. Tham KY, Ong JJ, Tan DK, How KY (2004) How much do diabetic patients know about diabetes mellitus and its complications? Ann Acad Med Singapore 33: 503-509. [Crossref]

Editorial Information

Editor-in-Chief

Masayoshi Yamaguchi
Emory University School of Medicine

Article Type

Research Article

Publication history

Received date: December 03, 2014
Accepted date: January 16, 2015
Published date: January 20, 2015

Copyright

©2015 Kant R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Kant R, Thapliyal V (2015) Knowledge attitude and practice of type 2 diabetic patients in a tertiary care teaching hospital in India. Integr Food Nutr Metab 2: DOI: 10.15761/IFNM.1000115

Corresponding author

Vinita Thapliyal

All India Institute of Medical Sciences, Department of Medicine, Rishikesh, Uttrakhand, India.

E-mail : Vinita.thapliyal22@gmail.com

Table 1. Characteristics of population (N=200)

Variables

Percentage( n=200) p>0.05

Age(years) Mean ± SD

50 ± 9.32

Mean duration of the disease (years)

9.7

Gender Distribution

 

Male

64

Female

36

Work

 

Own Occupation

16

Student

3

House wife

23

Service

42

Labor

16

Annual Income

 

<20,000

18

20,000- 50,000

20

>50,000

62

Source of Information

 

Doctor

100

Dietician

-

Media

-

Internet

-

Some other source

-

Education

 

Illiterate

22

Primary

18

Secondary/ Middle

24

Graduate

26

Postgraduate

10

Table 2. Body mass index of population (N=200)

BMI

Percentage

18 – 23

30

24 -30

53

>30

17

Table 3. Knowledge regarding complications of diabetes (N=200)

Complications

Percentage

Heart

4

Renal

20

Retinopathy

8

Stroke

20

Neuropathy

30

Don’t Know

18

Table 4. Assessment regarding diabetes and its features (N=200)

Questions to assess knowledge

Correct answer percentage

What is diabetes?

50

What causes diabetes?

54

Can diabetes be cured?

12

How can diabetes be detected? Features of diabetes

26

Polyuria

30

Polyphagia

8

Weight Loss

6

Numbness in feets

18

Can be asymptomatic

10

Excessive Thirst

16

Don’t know

30

Is diabetes  hereditary?

44

Is diabetes  infectious?

100

Table 5. Knowledge of exercise and diet (N=200)

Knowledge of exercise and diet

Percentage

What shoud be done to control DM?

 

Exercise

32

Diet Modification

18

Both

50

Exercise should be done only by obese?

16

Bitter substances can cure diabetes?

88

Table 6. Knowledge regarding OHA, insulin, hebal drugs (N=200)

Knowledge of drug therapy

Percentage

Once DM is control drug should be stop?

66

Drug is more important than diet control?

 36

Herbal drugs are better?

18

Insulin Should be avoided?

80

Insulin is habit forming?

90

Table 7. Attitude and practice towards diabetic care, eating practices and health care (N=200)

Respondent attitude and practice

Percentage

Who is responsible for your diabetic care?

    Yourself

     Doctor

     Family

Do you include fruits?

Do you include GLV’s in your diet?

Do you have glucometer?

Do you check your sugar regularly?

Do you check your foot regularly?

Do you take herbal drugs?

48

26

6

72

90

32

36

44

70