Effectiveness of Educational Intervention on Body Mass Index (BMI) of Patients with Type 2 Diabetes Mellitus in South Indian Population

 

Sindhu L¹, Jaya Kumar B²

¹Assistant Professor, Government College of Nursing, Medical College, Thiruvananthapuram.

²Former Professor and Head, Dept. of Medicine, Medical College Hospital, Thiruvananthapuram.

 

ABSTRACT:

Introduction: Type 2 diabetes mellitus is a complex metabolic disease that is associated with serious complications resulting in increased morbidity and mortality. The objective of the present study was to evaluate the effect of educational intervention on BMI of patients with type 2 diabetes mellitus. Methodology: Quasi-experimental pretest posttest control group design was adopted for the present study. The study was conducted among 140 patients with type 2 diabetes mellitus- 70 in the experimental group and 70 in the control group- who attended the diabetic clinic, Medical College Hospital, Thiruvananthapuram. Samples were selected consecutively. Researcher collected data from the patients using a semi structured interview schedule and BMI was calculated by dividing the body weight in kilogram by the square of height in meter. The educational intervention was given to the patients in the experimental group at the diabetic clinic in small groups/ individually and the patients in the control group received only the standard treatment. The effect of intervention was evaluated in the 3 ^rd month and 6^th month. Results: The study showed that in the experimental group there was a reduction in the mean BMI from 24.60±3.14 kg/m² to 24.22±3.16kg/m² from base line to 6 months follow up, whereas there was an increase in mean BMI from 24.89±3.81kg/m² to 25.41±3.82 kg/m² in the control group. The effect of educational intervention on BMI in the experimental group with respect to control group was assessed by repeated measures ANOVA and found that it was statistically significant (p<0.0001). This study showed that educational intervention would significantly decrease the BMI among patients with type 2 diabetes mellitus. Conclusion: We conclude that educational intervention was effective in decreasing the BMI in patients with type 2 diabetes mellitus.

 

 

 

 

INTRODUCTION:

Diabetes mellitus is one of the most expensive chronic diseases of the world. The dramatic rise in the incidence and prevalence of diabetes is a great challenge for all nations. The people with diabetes have high prevalence of obesity which increases the risk of cardiovascular disease. There is strong evidence to suggest that obesity management is beneficial in the management of type 2 diabetes mellitus and sustained weight loss will improve glycemic control and decrease the need for glucose lowering agents. Reduction in BMI also decreases the risk of cardiovascular diseases.¹ Structured weight reduction programme should be incorporated in the lifestyle intervention among patients with type 2 diabetes mellitus. Since diabetes is a chronic disease, it requires continuous medical care and patient self-managementeducation.² Diabetes management education is an important aspect of care in order to improve patient outcome.^{3, 4.}

 

There is a strong association between obesity and diabetes mellitus.^5,6,7 Obese and overweight patients tend to have increased risk of cardiovascular diseases.⁸ Therefore structured weight reduction be an important lifestyle intervention in diabetes care. The challenges for diabetes care in India include lack of knowledge and training of patients to manage their disease because of inadequate manpower facility for patient education.⁹ The effect of self-management education on body weight and BMI of the patients with type 2 diabetes mellitus has been shown.^10,11,12

 

Nurses have an important role to play in educating patients with diabetes mellitus to make life style modification. Therefore, the investigators intended to replicate the effectiveness of educational intervention on BMI of patients with type 2 diabetes mellitus.

 

MATERIALS AND METHODS:

Study was started after obtaining clearance from Institutional Ethics Committee. A quasi-experimental pre-test post-test control group design was adopted for the study. 140 patients after 6 months of diagnosis and between the age group of 25–65 years for the study – 70 in the control group and 70 in the experimental group. Apart from socio demographic data clinical profile of the patient anthropometric measurements like height, weight, weight circumference and hip circumference were measured and recorded. Weight was measured using validated standard weighing machine. Height was measured in centimetres while standing barefoot in flat surface. BMI was calculated as a ratio of weight in kilogram to square of height in meters.

 

On the first day, pre-test was conducted on the experimental group and control group. Patients in the experimental group were given educational intervention which consists of one teaching session of 60–90 minutes limited to 2- 3 patients/group or individually. It includes session on information on diabetes mellitus, risk factors, clinical manifestation, diagnosis, complications and management of diabetes mellitus and pamphlets was distributed to them. They were regularly followed up on monthly basis. Reinforcement was given on repeated monthly visit to the experimental group. The patients in the control group received only the standard treatment available in the diabetic clinic. The posttest was conducted at follow up visits after 3 and 6 months from both the experimental group and control group.

 

Data were analysed using both descriptive and inferential statistical tests. The demographic and clinical data were tabulated and percentages were calculated. For analysing the effect of educational intervention on BMI, ANOVA for repeated measures was used.

 

RESULTS:

Out of the 140 patients studied, mean age of the patient was 56±11.6 years. 50% each of the patients was males and females. With respect to religion, 65% of patients were Hindus, 22.1% were Christians and 12.9% were Muslims. 93.6% patients were married. Regarding the level of education, 10.7% of patients had only primary education, 48.6% had intermediate education. 45% of patients were unemployed. 65.7% of patients belonged to nuclear family. 73.6% patients were from rural area. 57.1% of patients had family history of diabetes mellitus.

 

The mean duration of diabetes was 10.86±8.49 years and 10.85±8.10 years in the experimental group and control group respectively. Majority of patients in the experimental group (97.14%) and control group (98.5%) were on modern medicine as treatment. Majority of patients in the experimental group (97.1%) and control group (95.71%) were on mixed diet. 31.43% of patients in the experimental group and 27.14% of patients in the control group were on regular exercise. The co- morbid condition present in the experimental group were hypertension (51.43%) and dyslipidemia (42.89%) and in the control group 52.86% were hypertensive and 48.6% were having dyslipidemia. 82.85% of patients in the experimental group and 80% of patients in the control group had good compliance to treatment.

 

Table 1: Socio demographic and anthropometric data of study patients

Characteristics	Experimental group(n = 70)	Control group (n= 70)
Age in years	56.81 ± 10.80	55.89 ±10.62
Duration of diabetes mellitus(years)	10.86±8.49	10.85 ±8.10
Duration of treatment (years)	10.65 ±8.6	10.38 ±7.58
Body weight (Kg)	64.20 ±9.86	63.99 ±11.28
BMI(Kg/m2)	24.60 ±3.14	24.89 ±3.81
Waist circumference (cm)	93.17 ±9.45	91.46 ±18.05
Hip circumference	96.54 ±8.65	94.83 ±15.76
HbA1c (%)	8.23 ±1.60	8.30 ±1.43

 

 

Table 2: Within group comparison of BMI in the experimental and control group

*Significant (p < 0.05)

Table 2 revealed that there was a mean reduction in  BMI from 24.60 ± 3.14 to 24.22 ± 3.16 (from baseline to 6months) in the experimental group, which was statistically significant (F = 5.46 , p = 0.005). Within the control group there was a mean increase of BMI from 24.89 ± 3.81 to 25.41 ± 3.82 (from baseline to 6 months).This was also found to be statistically significant (F = 50.20, p = 0.001).

 

Table 3: Comparison of BMI between experimental group and control group – Repeated measure ANOVA table

Source variation	Mean Square	F	p
Between group	20.15	22.89	0.001*
Within group	0.05	0.56	0.813

*Significant (p < 0.05)

 

Data depicted in Table 3 shows that there is significant difference between the post test scores of BMI of the experimental group and control group, which was found to be statistically significant (p< 0.05)

 

DISCUSSION:

The aim of the present study was to see the effect of educational intervention on BMI in patients with type 2 diabetes mellitus. The study has shown a reduction in BMI. The findings of the present study was similar to the observation in other studies where educational intervention is used as an intervention.^{13, 14, 15}

 

The reduction in BMI may be postulated due to self-efficiency .Education may increase sense of mastery over the consequences of diabetes and they might have changed their dietary pattern and exercise behaviour.

 

LIMITATION:

The limitation of the present study was that study included non-random samples and the period of intervention was short (6 months). The study didn’t examine if the effect of educational intervention is persisting after 6 months.

 

CONCLUSION AND RECOMMENDATIONS:

The study findings give evidence that educational intervention would significantly decrease the BMI in patients with type 2 diabetes mellitus and suggest the need for patient empowerment in the self-management. The study recommends training nurses in diabetes education so that they can actively be involved in educating the patients with diabetes mellitus.

 

ACKNOWLEDGEMENT:

Authors are thankful to the study participants for their co - operation.

 

SOURCES OF FUNDING

Nil.

 

CONFLICT OF INTEREST

None to declare.

 

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Received on 03.02.2018          Modified on 28.03.2018

Accepted on 22.04.2018      ©A&V Publications All right reserved