See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/266502628

Evaluation of knowledge and self care practices in diabetic patients and their
role in disease management

Article  in  The National medical journal of India · January 2012

CITATIONS READS

45 1,008

5 authors, including:

Trupti N Bodhare Sameer Valsangkar

Prathima Institute of Medical Sciences Prathima Institute of Medical Sciences
11 PUBLICATIONS   238 CITATIONS    17 PUBLICATIONS   255 CITATIONS   

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Sameer Valsangkar on 08 June 2015.

The user has requested enhancement of the downloaded file.

 pISSN: 0976 3325 eISSN: 2229 6816  
ORIGINAL ARTICLE.

EVALUATION OF KNOWLEDGE AND SELF CARE

PRACTICES IN DIABETIC PATIENTS AND THEIR ROLE
IN DISEASE MANAGEMENT
Karam Padma1, Samir D Bele2, Trupti N Bodhare2, Sameer Valsangkar3

1Post graduate student, 2Assistant Professor, 3Lecturer Department of Community Medicine,

Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh

Correspondance:
Dr. Karam Padma,
Department of Community Medicine,
Prathima Institute of Medical Sciences,
Karimnagar, Andhra Pradesh - 505417
Email: [email protected] Mobile: 9393014307

ABSTRACT

Background: Poor awareness and practices among diabetic patients are some of the important
variables influencing the progression of diabetes and its complications, which are largely preventable
through education and involvement of the patient.
Methods: A hospital based cross sectional study was conducted among type 2 diabetics attending
diabetes clinic in tertiary care hospital. Knowledge and self care practices were evaluated using a
semi structured questionnaire. Statistical methods used included frequencies, proportions and chi
square test.
Results: A total of 117 diabetic patients consented and participated in the study of whom 63 (53.85%)
were male and 54 (46. 15%) female. Majority of the respondents (45.30%) between the age of 41-50
years,75 (64.10 %) belonged to lower class, and 60 (51.28 %) had a duration of disease between 1 to 5
years. 71 (61.68%) were aware of importance of exercise for the control of disease while 88 (75.21%)
said that modification in diet is essential for the control of the disease. 75 (64%) of the respondents
had achieved glycemic control. Among self care practices, following a controlled diet (p = 0.04),
regular exercise (p = 0.04) and compliance with drugs (p = 0.03) were significantly associated with the
achieving glycemic control.
Conclusion: As evidenced by the study, patients who were regularly involved in self care practices
have achieved better glycemic control.

Key words: knowledge, self care practices, type 2 diabetes, glycemic control

INTRODUCTION prevalence in India is attributed to the lifestyle

transition coupled with urbanization,
The prevalence of the diabetes is increasing at an
industrialization and lifestyle changes.3
alarming rate particularly in developing
countries. Estimate of global diabetes prevalence Poor awareness and practices among diabetic
predict 6.4%, affecting 285 million adults in patients are some of the important variables
2010, and will increase to 7.7% and 439 million influencing the progression of diabetes and its
adults by 2030.1 India harbors the largest complications, which are largely preventable.
number of diabetic patients in the world. The Compared with the general population
International Diabetes Federation (IDF) reported incidence of Coronary heart diseases and stroke
that the total number of diabetic subjects in are more among patients of diabetes. Quality of
India is 41 million in 2006 and that this would life further impacted by complications like
rise to 70 million by the year 2025.2 Increased diabetic renal disease and diabetic retinopathy
National Journal of Community Medicine Vol 3 Issue 1 Jan-March 2012 Page 3
 pISSN: 0976 3325 eISSN: 2229 6816  
and neuropathy which are frequently occurring consented and participated in the study. A semi
among the patients having poor glycemic structured questionnaire was administered
control. Developing countries which are already which consisted of the following parts A).Socio-
overburdened have to muddle through with the demographic information, B) Diabetes specific
additional challenges posed by the chronic non information C)Knowledge regarding diabetes
communicable disease. Sub-optimal treatment, among patients D)Self care practices followed by
inadequate health education and follow up the patients. Socio-demographic information
leads to the poor glycemic control and increase including patients age, gender, and educational
the toll of unnecessary disabilities among the status. Socioeconomic status of the patient was
people4. It is therefore essential to provide calculated by using Kuppuswammy
comprehensive services including health classification including total family monthly
education regarding the self management of the income, occupational and educational status of
disease in order to prevent the debilitating the respondents9. Diabetes specific information
complications which in long term reduces the including the duration of the disease, glycemic
enormous financial burden on the health care levels, mode of treatment and medical care
system. Helping patients to achieve their best personnel. Knowledge of the respondents was
possible level of glycemic control will require assessed by questions related to the nature of
the utilization of appropriate therapy, the disease, method of detection of diabetes,
appropriate monitoring, and comprehensive importance of diet, exercise and drug
instruction in diabetes self-management. Self- compliance in controlling the disease etc. Self
care in the form of adherence to diet and drugs, care practices were assessed by patients’
blood glucose monitoring, foot care, exercise, behavior regarding testing blood sugar,
recognition of symptoms is crucial elements in following healthy eating plan, exercise,
secondary prevention. Interventions to promote compliance to the drugs and checking feet
better self-management have reported regularly etc.
improvements in blood glucose control and
Patients were classified into those who had
Improved glycemic control is highly
achieved glycemic control and those who did
advantageous in preventing the long term
not, based on the fasting blood sugar levels <
complications of type 1 and type 2 diabetes as
than 110 mg/dl based on Consensus Statement
demonstrated by various studies 5,6,7,8. Diabetes
on Guidelines for Glycemic Control provided by
self-management education is teaching people
American College of Endocrinology10. Self care
to manage their diabetes has become an
practices were compared across the two groups
important part of the clinical management of
and significant associations evaluated. Statistical
diabetes however the process is often complex,
methods used included frequencies, proportions
demanding and not given much emphasis at
and chi square test.
professional level because of the time constraint
of clinicians. Assessment of patient’s knowledge
and practices about diabetes is imperative in RESULTS
developing various intervention strategies and
educational material. Baseline characteristics of the respondents are
depicted in table 1. A total of 117 diabetic
The study aimed to evaluate the role of disease patients consented and participated in the study
knowledge and self care practices and their role of whom 63 (53.85%) were male and 54 (46. 15%)
in achieving glycemic control and disease female. Age ranged from 34 years to 66 years in
management. the sample with majority of the respondents
(45.30%) between the age of 41-50 years.
Socioeconomic status was assessed by
MATERIAL AND METHODS
categorizing the patient into lower, middle and
A cross sectional study was conducted among upper class, 75 (64.10 %) belonged to lower
patients with type 2 diabetes mellitus attending class, 30 (26. 64%) to the middle class and 12
the diabetes clinic in a teaching hospital during (10.26 %) to upper by Kuppuswamy
September, 2010 were included in the study. The classification. Most of the respondents, 60 (51.28
purpose of the study was explained and %) had a duration of disease between 1 to 5
informed consent was obtained from the years whereas 9 (7.6%) of the people were
respondents. Privacy and confidentiality was having duration less than one year. On the
ensured during the process. 117 patients were knowledge regarding diabetes questionnaire, 78

National Journal of Community Medicine Vol 3 Issue 1 Jan-March 2012 Page 4

 pISSN: 0976 3325 eISSN: 2229 6816  
(66.67%) correctly answered regarding the evaluation of knowledge among diabetes patient
hereditary nature of the disease, 105 (89.74%) and their self care practices and its relation with
correctly answered regarding non infectious glycemic control. Majority of the respondents
nature of the disease. Regarding mode of (45.30%) belonged to the age group of 41-50
investigation of the disease, 109 (93.16%) years as the disease usually comes in light after
answered that diabetes can be diagnosed by middle years of life however the age group of
blood sugar examination. 71 (61.68%) were the patient is little younger compared to the
aware of importance of exercise for the control findings of the studies conducted by priyanka et
of disease while 88 (75.21%) said that al and shah et al11, 12. This variation may be
modification in diet is essential for the control of because of selection bias as we recruited the
the disease. 73 (62.39%) said that quitting cases from the tertiary care hospital. 51.28% of
smoking or alcohol is beneficial for control. the patients suffering from diabetes from
Drugs should be continued even after control of
blood sugar was the response from the 88
(75.21%) while diabetes cannot be cured was the Table 2: Respondent’s correct knowledge
response from 74 (63.25%) of the respondents. regarding diabetes mellitus
Variables Numbers (%)
Tables 1: Baseline characteristics of sample Is diabetes Hereditary? 78 (66.67)
respondents Is diabetes Infectious? 105 (89.74)
How can diabetes be detected? 109 (93.16)
Variables Numbers (n=117) (%)
Is exercise beneficial for 71 (61.68)
Age
control?
< 40 years 17 (14.53)
Is dietary modification 88 (75.21)
41-50 years 53 (45.3)
beneficial for control?
51-60 years 35 (29.91)
Stop smoking / alcohol is 73 (62.39)
> 60 years 12 (10.26)
beneficial?
Gender
Once controlled drugs should 88 (75.21)
Male 63 (53.85)
be stopped?
Female 54 (46.15)
Diabetes can be cured? 74 (63.25)
Socioeconomic status
Upper class 12 (10.26)
1-5 years and 64.10% belong to lower
Middle class 30 (26.64)
socioeconomic strata. One of the promising
Lower class 75 (64.10)
findings of our study is good number of
Duration of onset of
respondents had positive knowledge regarding
Diabetes mellitus
diabetes. Change in the knowledge brings
< 1 year 9 (7.60)
change in the practice to bring desirable changes
1-5 years 60 (51.28)
for controlling the disease. Highest scores were
5-10 years 33 (28.21)
obtained on mode of detection of diabetes (93.16
> 10 years 5 (4.2)
%). Almost two third respondents were aware of
importance of exercise, diet control and drug
75 (64%) of the respondents had achieved
compliance. These findings are consistent with
glycemic control based on their fasting blood
the finding observed by shah et al and priyanka
sugar levels less than 110 mg while 42 (36%) had
et al 11, 12. Significant numbers of the
not. Among self care practices, following a
respondents, 75 (64%) achieved glycemic control
controlled diet (p = 0.04), regular exercise (p =
in the present study. As evidenced by the study,
0.04) and compliance with drugs (p = 0.03) were
there is a significant association between the
significantly associated with the achieving
patient following a healthy diet, involved in
glycemic control.
regular exercise and compliant to the drug
therapy with their glycemic control and these
findings are in consistent with the studies
DISCUSSION
conducted by Wyun Nyunt S et al and Jones H
The present study is a hospital based cross et al 5,6.
sectional study conducted among subjects
having type 2 diabetes attending diabetes clinic
in tertiary care hospital and mainly focus on

National Journal of Community Medicine Vol 3 Issue 1 Jan-March 2012 Page 5

 pISSN: 0976 3325 eISSN: 2229 6816  
Table 3: Self care activities and its association with glycemic control
Variables Glycemic control Glycemic control Total P value
achieved (75) not achieved (42) (n=117)
Test blood sugar regularly 68 38 106 0.76
Follow healthful eating plan 62 27 89 0.04
Participate in exercise 35 11 46 0.04
Good Drug compliance 57 23 80 0.03
Check feet 13 2 15 0.09
Carry quick acting sugar 35 15 50 0.34

CONCLUSION: 4. K Park. Park’s Textbook of Preventive and Social

Medicine, 21st ed. Jabalpur: Bhanot Publishers; 2011. p
As evidenced by the study, patients who were 341-45.
more self aware about the disease, having 5. Jones H, Edwards L, Vallis TM, Ruggiero L, Rossi SR,
knowledge and regularly involved in self care Rossi JS, et al. Changes in diabetes self-care behaviors
practices achieve better glycemic control and make a difference in glycemic control: the Diabetes
Stages of Change (DiSC) study. Diabetes Care 2003
better management of the disease. Regular
Mar;26:732-7.
inculcation of health education, making the
patient aware regarding the disease and 6. Wynn Nyunt S, Howteerakul N, Suwannapong N,
Rajatanun T. Self-efficacy, self-care behaviors and
encouraging self care management during glycemic control among type-2 diabetes patients
treatment will reduce health care burden and attending two private clinics in Yangon, Myanmar.
help achieve optimal control of the disease with Southeast Asian J Trop Med Public Health 2010;41:943-
minimal long term complications. 51.
7. Ciechanowski P, Russo J, Katon W, Von Korff M,
Ludman E, Lin E, Simon G,et al. Influence of patient
LIMITATION: attachment style on self-care and outcomes in diabetes.
Psychosom Med 2004 ; 66:720-8.
Glycemic control was evaluated based on 8. Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE,
Fasting blood sugar. Data regarding self care Engelgau MM, Jack L,et al. Increasing diabetes self-
practices was mainly on verbal responses. management education in community settings. A
systematic review. Am J Prev Med 2002 ;22:39-66

9. Kumar N, Shekhar C, Kumar P, Kundu AS.

REFERENCES: Kuppuswamy's socioeconomic status scale-updating
for 2007. Indian J Pediatr. 2007;74:1131-2.
1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the
prevalence of diabetes for 2010 and 2030. Diabetes Res 10. American College of Endocrinology: Consensus
Clin Pract 2010 ;87:4-14. statement on guidelines for glycemic control. Endocrine
Pract 8 (Suppl. 1):5–11, 2002
2. Sicree R, Shaw J, Zimmet P. Diabetes and impaired
glucose tolerance. In: Gan D, editor. Diabetes Atlas. 11. Shah VN, Kamdar PK, Shah N. Assessing the
International Diabetes Federation. 3rd ed.Belgium: knowledge, attitudes and practice of type 2 diabetes
International Diabetes Federation; 2006 p. 15-103. among patients of Saurashtra region, Gujarat. Int J
Diabetes Dev Ctries2009;29: 118-22.
3. Ramachandran A, Snehalatha C, Baskar AD, Mary S,
Kumar CK, Selvam S, et al. 3. Temporal changes in 12. Priyanka CK, Angadi MM. Hospital-based KAP study
prevalence of diabetes and impaired glucose tolerance on Diabetes in Bijapur, Karnataka. Indian Journal of
associated with lifestyle transition occurring in the Medical Specialties 2010;1:80-83.
rural population in India. Diabetologia 2004; 47:860-5.

National Journal of Community Medicine Vol 3 Issue 1 Jan-March 2012 Page 6

V i e w p u b l i c a t i o n s t a t s