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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:drileshkotecha@gmail.com

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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