AWARENESS OF DIABETES RISK FACTOR & COMPLICATIONS AMONG DIABETIC POPULATION AT A TERTIARY CARE TEACHING HOSPITAL

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1 WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Shahnooshi et al. SJIF Impact Factor Volume 3, Issue 8, Research Article ISSN AWARENESS OF DIABETES RISK FACTOR & COMPLICATIONS AMONG DIABETIC POPULATION AT A TERTIARY CARE TEACHING HOSPITAL Shahnooshi Javad F* 1, Dr. Shashidhar. G 2, Anita Dadollahi Sarab 3, Dr. Syed Imam Rabbani 4 1 Doctor of Pharmacy (Indian Pharmaceutical Association Member), Department of Pharmacy Practice, Krupandhi College of Pharmacy, Chikkabellandur Village, Varthur Hobli, Bangalore , India. 2 Asst.Professor, General medicine, MVJ Medical College & Research Center, Bangalore Doctor of Pharmacy, Department of Pharmacy Practice, Krupandhi College of Pharmacy, Chikkabellandur Village, Varthur Hobli, Bangalore , India. 4 Department of Pharmacy Practice, Krupandhi College of Pharmacy, Chikkabellandur Village, Varthur Hobli, Bangalore , India. Article Received on 24 May 2014, Revised on 15 June 2014, Accepted on 03 July 2014 *Correspondence for Author Shahnooshi Javad F Doctor of Pharmacy (Indian Pharmaceutical Association Member), Department of Pharmacy Practice, Krupandhi College of Pharmacy, Chikkabellandur Village, Varthur Hobli, Bangalore , India ABSTRACT Multiple studies from various parts of India have revealed a rising trend in the prevalence of type II diabetes in the urban areas. An increase of 12.1% in the prevalence of diabetes was noted in National Urban Survey of year In addition, socio-economic transition in rural areas has led to a rise from 2.4% to 6.4% in the incidence of diabetes. This cross-sectional community-based study was conducted in MVJ hospital, Bangalore. The study samples were collected from each ward. A total of 115 diabetic patients were interviewed through a predesigned questionnaire. Subjects age > 15 years, either have been diagnosed as diabetes or using any hypoglycaemic medication were selected for the study. The questions were designed to elicit details of age, gender, educational status, socioeconomically status, family history of diabetes, general knowledge, knowledge of risk factors and awareness of complications for each participant. The mean (±SD) diabetes risk factor awareness score of all participants was ± out of a total score of 7. The mean (±SD) diabetes complication awareness score of all participants was ± out of a total score of 6. As we considered that, three and more, correct Vol 3, Issue 8,

2 answer to risk factor and complication was positive answer, 70% and 52.72% of participants had positive answer for diabetes risk factor and complication respectively. Keywords: Awareness, Diabetics population, Risk factors, Complications INTRODUCTION The World Health Organization has predicted a rise of 170% in the incidence of diabetes mellitus in the developing world, with an estimated 228 million sufferers in developing countries accounting for as much as 75% of the world s diabetic population by ,2,3 Among the top 10 countries/territories with the largest number of diabetic adults, five are in Asia. 4 China tops the list with 90.0 million followed by India which has 61.3 million persons affected by diabetes. The numbers are estimated to rise to million and million, respectively by These estimates are likely to be underestimations as the prevalence data are mostly available for urban areas and reports from rural areas are scanty. 5 There is a global increase in the prevalence of diabetes and the major impact is seen in the South East Asian countries. 6, 7 India has the largest number of the persons with diabetes. 6, 8 India is a country with varied social, economic, cultural and educational patterns and has a vast rural population. 6,9 Several regions in the country are still under developed and the people have several myths and beliefs regarding diseases. WHO estimates that diabetes, heart disease and stroke together will cost about $ billion over the next 10 years in India alone. 10 Multiple studies from various parts of India have revealed a rising trend in the prevalence of type II diabetes in the urban areas. An increase of 12.1% in the prevalence of diabetes was noted in National Urban Survey of year In addition, socio-economic transition in rural areas has led to a rise from 2.4% to 6.4% in the incidence of diabetes 12. Although this trend is well accepted among medical personnel, awareness in general population was found to be only 25 per cent. The fact that diabetes is a metabolic disorder and may be preventable is not well known in the general population. In fact a study demonstrated that only 22 per cent of the population thought that diabetes could be prevented 13. Though the awareness levels increased with education, only 42.6 per cent of postgraduates and professionals including doctors knew that diabetes was preventable. The knowledge of risk factors was even lower. Only 11.9 per cent of the study subjects reported obesity and physical inactivity as risk factors. Even amongst the known diabetics, only 40.6 per cent were aware that diabetes could lead to some organ damage and complications. Many people (46 %) with diabetes felt that it was a temporary phenomenon 14. Objectives of this study are level of Vol 3, Issue 8,

3 awareness on diabetes risk factors and complications, Identify factors that influence the awareness of diabetes risk factors, Identify factors that influence the awareness of diabetes complications. METHODOLOGY This cross-sectional community-based study was conducted in MVJ hospital, Bangalore. The study samples were collected from each ward. A total of 115 diabetic patients were interviewed through a predesigned questionnaire. Subjects age > 15 years, either have been diagnosed as diabetes or using any hypoglycaemic medication were selected for the study. The questionnaires were pre-tested in fifteen subjects with diabetes. Based on the responses, the questionnaires were modified and the coding for the responses were finalized. Participation was voluntary and written consent was acquired from each participant before administering the questionnaire, confidentiality of all participants was maintained. If the participants could not understand the questions due to language problems, interview was carried out in the language of the patient (Telugu, Kannada and Hindi). The questions were designed to elicit details of age, gender, educational status, socioeconomically status, family history of diabetes, general knowledge, knowledge of risk factors, awareness of complications for each participant. Step one: calculation of mean knowledge score of diabetes (risk factors, complications); fifteen options for risk factors and same number of options for complications listed in which seven for risk factors and six for complications related to diabetes. The correct answer was given one point, while incorrect and unsure answers were given zero. The mean score for each section (risk factors, and complications) was calculated based on the total possible score in each; then it was expressed as mean ± standard deviation (SD). The calculation of the mean diabetes knowledge score was based on the total marks of the three mentioned sections. Step two: Factors associated with knowledge and awareness of diabetes risk factors and complications analysed. Chi-square test was employed to look for association of two key aspects of awareness (diabetes risk factors and complications) of diabetic patients with gender, education, medication, family history, occupation and age. In this step If he can select any three of following risk factors; obesity, sedentary lifestyle and smoking, high fat intake, family history, high blood pressure, high lipids, from fifteen factors listed, it will consider a positive answer. For awareness of complications again selection of any three of the following was considered a positive response (kidney disease, heart disease, eye problems, numbness of Vol 3, Issue 8,

4 feet, impotence, foot problems). Data was analyzed using Statistical Package for Social Sciences 16 (SPSS, Inc., Chicago, IL, USA). RESULT Fig 1: Distribution of participant s education level Fig 2: Distribution of participant s socioeconomic status Fig 3: History of diabetes Vol 3, Issue 8,

5 Table 1: The mean diabetes knowledge score and the mean scores for risk factors and complications of DM in MVJ hospital (n = 2007), (values expressed as Mean ± SD and as percentage). Risk factors Complications Overall Total possible score Mean ±SD percentage 44.82% 41.36% 43.09% Table 2: Factors Associated with Knowledge of Diabetes Risk Factors Gender Age Socioeconomic status Education History of diabetes Family history Variables Knowledge of Risk Factors Odds ratio P value Yes (%) No (%) Male 48 (68) 22 (32) 1 < Female 10 (25) 30 (75) yrs 6 (30) 14 (70) yrs 41 (55) 33 (45) >60 yrs 11 (68) 5 (32) <10, (70) 9 (30) thou 47 (73) 17 (27) thou 7 (77) 2 (23) >40,000 3 (42) 4 (58) Uneducated 15 (32) 31 (68) 1 High school and less 28 (62) 17 (38) Bachelors and more 15 (78) 4 (22) Newly diagnosed 40 (76) 12 (24) 1 Less than 1 year 21 (61) 13 (39) years 13 (72) 5 (28) More than 3 years With family history Without Family history 4 (66) 2 (34) (65) 8 (35) 1 63 (72) 24 (28) With a response rate of 100%, all 110 patients which included 70 (63.63%) males and 40(36.36%) females, participated in the study. Maximum number 74 (67.27%) of participants were in the age group years % of patients were >40 years of age % of Vol 3, Issue 8,

6 participants were illiterate (Fig 1). Around 1/3 of participant had family history of diabetes and socioeconomic status of participants showed that 58.18% of participants had thousand Rupees income per month (Fig 2). 52 patients were newly diagnosed as diabetes patient (Fig 3). The mean (±SD) diabetes risk factor awareness score of all participants was ± out of a total score of 7. The mean (±SD) diabetes complication awareness score of all participants was ± out of a total score of 6. (Table 1) As we considered that, three and more, correct answer to risk factor and complication was positive answer, 70% and 52.72% of participants had positive answer for diabetes risk factor and complication respectively. 68% percent of males had knowledge of diabetes risk factors as compared to 25% of females. 57% percent of males had knowledge of diabetes risk factors as compared to 45% of females. Other factors significantly influencing knowledge of diabetes risk factors and complication included age, participants, years old had lesser awareness about diabetes risk factor as compare to other groups while diabetics patients with 60 years above had better awareness about diabetes complications (odds ratio:5.133). When it comes to socioeconomic status, participants with monthly income between to Rupees and to were more aware about diabetes risk factor and complication. In addition, Education was much more significant as highly educated diabetics who had knowledge of diabetes risk factors were almost six times (Odds ratio 6.13) more as compared to illiterate diabetics (p<0.0027) and the same case can be seen for diabetes complications, i.e. highly educated participants had better awareness (odds ratio:7.7500) as compare other groups. (Table 2) Participants without family history of diabetes had better awareness about diabetes risk factor and complication (odds ratio and respectively). With regard to medical history, participants with diabetes history had better awareness about diabetes complications (odds ratio: 6.30) whereas diabetes history of participants did not significantly change their awareness about diabetes risk factors. (Table 3) Vol 3, Issue 8,

7 Table 3: Factors Associated with Knowledge of Diabetes Complication Variables Knowledge of Complication Odds ratio P value Yes (%) No (%) Gender Male 40 (57) 30 (43) Female 18 (45) 22 (55) yrs 15 (75) 5 (25) 1 Age yrs 51 (68) 23 (32) >60 yrs 12 (75) 4 (25) 1 1 <10, (54) 14 (46) 1 Socioeconomic status thou 33 (51) 31 (49) thou 6 (66) 3 (34) >40,000 3 (42) 4 (58) Uneducated 12 (26) 34 (74) 1 Education History of diabetes Family history High school and less Bachelors and more Newly diagnosed Less than 1 year 31 (68) 14 (32) (68) 6 (32) (44) 29 (56) 1 20 (58) 14 (42) years 10 (55) 8 (45) More than 3 years With family history Without Family history 5 (83) 1 (17) (43.47) 13 (56) 1 48 (55) 39 (45) Vol 3, Issue 8,

8 DISCUSSION Patient education programme exists only in a few tertiary care centres. Studies from India had shown that repeated exposures to education on healthy lifestyle were necessary for achieving compliance with treatment recommendations in persons with diabetes. 15, 16, 17 Facilities for such integrated patient education modalities lack in countries like India and Pakistan 18 where prevalence of diabetes is escalating. The need for a proactive approach by health care professionals is brought out in a study on public awareness of diabetes in Singapore`9, city in Southern India 20, Al-Qassim region, Saudi Arabia 21 and rural Tamakar,Kolar. The study design and the outcome were almost similar to the present study. Creating awareness about the disease, its causes, treatment and complications is the first step in the crusade against this disease. Several countries like India which have a large burden of diabetes 22 lack a structured national programme for creating awareness about the disease. This should be considered as a national health care priority. Successfully managing diabetes requires a lifelong commitment to self-care. As patients are the most important decision-makers, they should receive enough instruction to make informed decisions about their treatment. However, there is surprisingly little data on knowledge levels of patients who have had diabetes for a number of years. This is a study for evaluating the knowledge of diabetic patients about the risk factors of diabetes and its complications. The current literature evaluating the relationship between sex and knowledge of diabetes yielded mixed findings, most of them reporting that sex was a determinant of knowledge of diabetes. 23, 24 In our study, sex was associated with knowledge of diabetes risk factors and complication, male participants had more awareness as compare to female participants. Respondents who were aged years had lesser awareness of diabetes complications than younger and older respondents. This was in agreement with several studies that found a relation between age and knowledge of diabetes. 25, 26 However a number of studies revealed no association between age and knowledge of diabetes. 27, 28 In our study a significant positive association was seen between high socioeconomic status of participants and awareness of diabetes risk factors and complications. This association was supported by one study 29 but one study found no such association 30.Our study showed that, educated patients are more aware about diabetes risk factors and complications this is supporting most of the study. 31,32 One study showed significant association of family history with diabetes awareness 33,34 our study found no such association. When it comes to correlation of awareness of diabetes complication and history of patients, participants with three years and more of diabetes history have higher odds ratio as compare to other groups. Vol 3, Issue 8,

9 CONCLUSION This is the report to show the knowledge of diabetes risk factors and complications among diabetic population in MWJ hospital, overall 110 patients participated in our study, numbers of male participants were more than female participants, most of participants are newly diagnosed diabetes followed by patients with less than one year diabetes history, our data shows that, diabetic population in MVJ hospital has enough knowledge of the general knowledge of diabetes regarding risk factors, However, they are not very well aware of the diabetes associated secondary complications.education was much more significant as highly educated participants were more aware about diabetes risk factor and complications. Awareness of the risk factors and complications of diabetes is important so as to heighten the need for disease prevention and early diagnosis among the general public and for disease control among individuals with diabetes. Most of the participants were not aware that sedentary life style, physical inactivity and diet are risk factors of diabetes. REFERENCES 1. King, H., Aubert, R. E. and Herman, W. H. Global burden of diabetes : prevalence, numerical estimates, and projections. Diabetes Care Sep;21(9): Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for Diabetes Care 2004; 27: Farooq Mohyud Din Chaudhary, Sadia Mohyud Din Chaudhary, awareness about diabetes risk factors & complications in diabetic patients: a cross-sectional study, Nishtar Medical Journal Vol 2, No 3 July - September Unwin N, Whiting D, Guariguata L, Ghyoot G, Gan D (Eds). The IDF Diabetes Atlas, 5th edition. Brussels, Belgium: International Diabetes Federation; 2011.pp Ambady Ramachandran, Ananth Samith Shetty, Arun Nanditha, Chamukuttan Snehalatha, Type 2 Diabetes in India: Challenges and Possible Solutions, N. Murugesan, C. Snehalatha, R. Shobhana, G. Roglic, A. Ramachandran, Awareness about diabetes and its complications in the general and diabetic population in a city in southern India, Diabetes Research and Clinical Practice 77 (2007) S. Wild, G. Roglic, A. Green, R. Sicree, H. King, WHO global prevention of diabetes: estimates for the year 2000 and projections for 2030, Diabetes Care 27 (2004) Vol 3, Issue 8,

10 8. A. Ramachandran, Epidemiology of diabetes in India threedecades of research, J. Assn. Phys. India 53 (2005) R. Shobana, R. Begum, C. Snehalatha, V. Vijay, A. Ramachandran, Patients adherence to diabetes treatment, J. Assn. Phys. India 47 (1999) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia : report of a WHO/IDF consultation. World Health Organization p. 21.ISBN Rajiv Gupta, Diabetes in India: Current Status(August 2008), express health care ( 12. Prevalence of diabetes mellitus and impaired glucose tolerance in adults: WHO Ad Hoc Diabetes Reporting Group. Diabetes Care 16: , Borchers AT, Uibo R, Gershwin ME. The geoepidemiology of type 1 diabetes. Autoimmun Rev. Mar 2010; 9(5):A Barchetta I, Riccieri V, Vasile M, et al. High prevalence of capillary abnormalities in patients with diabetes and association with retinopathy. Diabet Med. Sep 2011;28(9): A. Ramachandran, C. Snehalatha, A. Kapur, V. Vijay, V. Mohan,A.K. Das, et al., For the Diabetes Epidemiology Study Group in India (DESI). High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey, Diabetologia 44 (2001) R. Shobana, R. Begum, C. Snehalatha, V. Vijay, A. Ramachandran,, Patients adherence to diabetes treatment, J. Assn. Phys. India 47 (1999) R. Shobhana, A. Christina, V. Vijay, A. Ramachandran, Improving, psycho-social care: the Indian experience, Diabetes Voice 50, (2005) M.M. Shahpurwala, N. Sani, S. Shah, F. Shuja, K. Shahid, H. Tariq, et al., General medical practitioners in Pakistan fail to educate patients adequately about complications of diabetes: a major cause of concern for developing country, Practical Diab. Int. 23 (2006) H.L. Wee, H.K. Ho, S.C. Li, Public awareness of diabetes in Singapore, Singapore Med. J. 43 (2002) N. Murugesan, C. Snehalatha, R. Shobhana, G. Roglic, A. Ramachandran, Awareness about diabetes and its complications in the general and diabetic population in a city in southern India, Diabetes Research and Clinical Practice 77 (2007) Vol 3, Issue 8,

11 21. Abdelmarouf Hassan Mohieldein, Mohammad A. Alzohairy and Marghoob Hasan, Awareness of diabetes mellitus among Saudi nondiabetic population in Al-Qassim region, Saudi Arabia, Journal of Diabetes and Endocrinology Vol. 2(2), pp , April R. Sicree, J. Shaw, P. Zimmet, Diabetes and impaired glucose tolerance (Chapter 1). Part 1.1. Prevalence and projections, in: Diabetes Atlas, 3rd edn., International Diabetes Federation, Brussels, Belgium, 2006, pp 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): Epub 2007 Feb Caliskan D, Ozdemir O, Ocaktan E, Idil A. Evaluation of awareness of diabetes mellitus and associated factors in four health center areas. Patient Educ Couns 2006 Jul;62(1): Epub 2005 Sep Caliskan D, Ozdemir O, Ocaktan E, Idil A. Evaluation of awareness of diabetes mellitus and associated factors in four health center areas. Patient Educ Couns 2006 Jul;62(1): Epub 2005 Sep He X, Wharrad HJ. Diabetes knowledge and glycemic control among Chinese people with type 2 diabetes. Int Nurs Rev 2007 Sep; 54(3): 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): Epub 2007 Feb Yun LS, Hassan Y, Aziz NA, Awaisu A, Ghazali R. A comparison of knowledge of diabetes mellitus between patients with diabetes and healthy adults: a survey from north Malaysia. Patient Educ Couns 2007 Dec;69(1-3): Epub 2007 Aug Murata GH, Shah JH, Adam KD, Wendel CS, Bokhari SU, Solvas PA, et al. Factors affecting diabetes knowledge in Type 2 diabetic veterans Aug; 46(8): Epub 2003 Jul Ulvi OS, Chaudhary RY, Ali T, Alvi RA, Khan MF, Khan M, et al. Investigating the awareness level about diabetes mellitus and associated factors in Tarlai (rural Islamabad). J Pak Med Assoc Nov; 59(11): Farooq Mohyud Din Chaudhary, Sadia Mohyud Din Chaudhary, awareness about diabetes risk factors & complications in diabetic patients: a cross-sectional study, Vol 2, No 3 July - September Kesha Baptiste-Roberts, Tiffany L. Gary, Gloria L.A. Beckles, Edward W. Gregg, Michelle Owens, Deborah Porterfield, and Michael M. Engelgau, Family History of Vol 3, Issue 8,

12 Diabetes, Awareness of Risk Factors, and Health Behaviors Among African Americans, 2007 May; 97(5): Kanji JN, Anglin RE, Hunt DL, Panju A (April 2010). "Does this patient with diabetes have large-fiber peripheral neuropathy," JAMA 303 (15): doi: /jama PMID Armstrong DG. Loss of protective sensation: a practical evidence-based definition. J Foot Ankle Surg.1999; 38: Armstrong DG. The 10-g monofilament: the diagnostic divining rod for the diabetic foot? [editorial] [In Process Citation] Diabetes Care. 2000; 23: Abbott CA, Carrington AL, et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med.2002; 19: Vol 3, Issue 8,