A study to assess the Knowledge regarding glycemic
control and self- management among diabetic patients in Amala Institute of
Medical Sciences, Thrissur
Don Jose K1*, Femi Sebastian2,
Fiby Franklin3, Divya Davis4, Iriene B. Padanilath5,
Jeena Johnson6
1Assistant
Professor, Amala College of Nursing, Thrissur, Kerala, India.
2,3,4,5,6
Third Year B.Sc Nursing, Amala College of Nursing, Thrissur, Kerala, India.
ABSTRACT:
A
study was conducted in order to assess the knowledge regarding glycemic control
and self-management among diabetic patients in Amala Institute of Medical
Science, Thrissur. A Nonexperimental descriptive survey design is used for the
study. The sample consists of 30 subjects. Samples were selected by convenient
sampling technique and according to inclusion and exclusion criteria. The tools
used were Structured Knowledge Questionnaire and Demographic variables.
Structured knowledge questionnaires were administered after giving necessary
instructions. The collected data were analyzed by using descriptive and
inferential statistics. Findings of the study showed that the majority of subjects
have good knowledge (56.6%) on glycemic control and self- management of diabetes mellitus. Area wise Analysis of
knowledge obtained based on diabetes mellitus are in general (66.6%),
definition, etiology, and risk factors (76.6%), diagnostic measures and insulin
administration immediate (63%), self-care and dietary management (63.3%)
respectively. The results also shows
that there is a significant association between knowledge regarding glycemic
control and self-management among diabetic patients with age group, religion,
educational status, occupation, residence, dietary pattern, duration of illness
and previous knowledge.
KEYWORDS: Diabetes mellitus, Glycemic
control, self-management, nonexperimental descriptive survey.
INTRODUCTION:
Our
life is changing from time to time. We know industrialization is the period of
social and economic changes that transform a human group from a generation
society into an industrial one, involving the re- organization of an economy
for manufacturing. As industrial workers, income rises, markets for consumer
goods, and reviews of all kinds tend to expand and provide a further stimulus
to industrial investment and economic growth.1
Along
with this industrialization, our eating habit is also changing. We may have
certain eating habits. For so long that we do not realize it as unhealthy. A
lot of diseases arise due to their unhealthy eating habits. Among these
diseases, the commonest and dangerous disease condition is Diabetes mellitus2.
Diabetes is a metabolic disorder, arising either due to relative or absolute
deficiency of a digestive hormone called insulin or inability or resistance of
body cells to use the available insulin. People affected by it need to modify their lifestyles and accept the
possibility of acute and chronic
complications.3 The scenario is changing rapidly due to
socio-economic transition occurring in rural areas, environmental and lifestyle
changes.4
Diabetes
can affect nearly every organ in the body. Diabetes-related complications are
coronary artery disease, peripheral vascular disease, stroke, neuropathy,
dental ailments, amputations, retinopathy, nephropathy, skin diseases, etc.
People with diabetes are 25 times more
likely to develop blindness, 17 times
more likely to develop kidney disease, 30-40 times more likely to undergo
amputation, 2-4 times more likely to develop myocardial infarction, and twice
more likely to suffer a stroke than non-diabetics. Women with diabetes are at
greater risk and those over 55 years are 7 times more likely to have heart disease.5
Diabetes
occurs worldwide, and the incidence of type 1 and type 2 is rising by 2030.
Globally there were approximately 135 million adults with diabetes in 2006. By
the year 2025, the figure is expected to rise to 300 million which increases by
approximately 120%.6 India has a high prevalence of diabetes mellitus and the
number of members is increasing at an alarming rate, increase from 40.6 million
in 2006 to 79.4 million by 2030. Several studies from different parts of Kerala
support the high prevalence of diabetes. One study from Central Kerala reported
a prevalence of diabetes at 20% and prediabetes at 11%.7
Another
study from Southern Kerala showed a wide urban-rural gradient in
age-standardized [30-64 years] prevalence of diabetes mellitus indicating an
important role of lifestyle factors. The prevalence was 17% in urban, 10% in
midland, 7% in highland, and 4% in the coastal region.8 For a
diabetic patient, it is difficult to visit the doctor very often. Therefore,
the patients must learn how to manage their disease themselves as much as
possible. They must learn about the disease, its nature, approach in the
treatment of diabetes mellitus, selection of diet, the role of exercise, and
early recognition of complications of the disease.9
From
the above contexts, the investigator came to an understanding that diabetic
patients lack proper knowledge on glycemic control and self-care. Thorough
knowledge regarding self-care management is very essential among diabetic
patients. Therefore, the investigator felt the need to conduct the study to
assess the knowledge of diabetic patients regarding glycemic control and
self-care, to tackle their problems using an information leaflet.
OBJECTIVES:
1.
To assess the knowledge regarding
glycemic control and self-management among diabetic patients in Amala Institute
of Medical Sciences, Thrissur.
2.
To find out the association among
the level of knowledge among the diabetic patients and selected socio
demographic variables.
3.
To prepare an information leaflet
on diabetic mellitus.
ASSUMPTIONS:
·
Diabetic patients may have some
knowledge regarding glycemic control and self-care.
·
Imparting knowledge to the
diabetic patients may improve the skill in diabetic control and self-care.
HYPOTHESIS:
The
hypothesis will be tested at 0.05 level of significance.
H1:
There will be significant association between the mean knowledge scores of
diabetic patients on self-care and the selected demographic variables (age,
sex, educational status, and duration of illness)
MATERIALS
AND METHODS:
A
Nonexperimental descriptive survey design was used for the study. The sample
consists of 30 subjects. Samples were selected by convenient sampling
technique and according to inclusion and exclusion criteria. A formal written
permission was obtained from the authorities of the selected institute for
conducting the research study by the investigator before the collection of the
data. The confidentiality of their identity and responses was assured in order
to ensure their co- operation and prompt responses. An informed consent was
taken from the subjects. The tools used were Structured Knowledge Questionnaire
and Demographic variables. The content validity of same was done by giving the
tools to seven experts in the field of nursing and tools were in Malayalam
language. Structured knowledge questionnaires were administered after giving
necessary instructions. The average time taken was 30 minutes. The respondents
cooperated well with the investigators and were happy with the provision of
information leaflets. The collected data were analyzed by using descriptive and
inferential statistics. The investigator did not face any problems during the
data collection procedure.
INCLUSION
CRITERIA:
Patients
who are:
·
diagnosed as diabetic
(outpatient/inpatient) and consulting in Amala Institute of Medical Sciences,
Thrissur.
·
able to read and write.
·
willing to participate in the
study.
EXCLUSION
CRITERIA:
Patients
who are:
·
unconscious and actively ill
·
having sensory impairment
[hearing, visual]
·
not able to read and write.
RESULTS
AND DISCUSSION:
Data
collected were analyzed and presented under the following headings.
SECTION
1- Description of demographic variables of patients with diabetic mellitus
Table 1: Distribution of subjects selected according to
age group. N=30
|
SL.
NO.
|
AGE GROUP
(In years)
|
FREQUENCY
|
PERCENTAGE
|
|
1.
|
30-40 years
|
2
|
6.6%
|
|
2.
|
41-50 years
|
1
|
3.3%
|
|
3.
|
51-60 years
|
9
|
30%
|
|
4.
|
61 and above
|
18
|
60%
|
Table
1 shows that the majority [60%] of the samples selected for the study were of
age group of 61 years and above.
|
SL. NO
|
GENDER
|
NUMBER OF SAMPLES
|
PERCENTAGE (%)
|
|
1.
|
Male
|
14
|
46.6%
|
|
2.
|
Female
|
16
|
53.3%
|
|
|
Table 2 -Distribution of subjects
selected according to gender. N=30
The
table 2 shows that the samples contain 46.6% of males and 53.3% of female.
Table 3. Distribution of subjects selected according to
religion. N=30
|
SL.
NO.
|
RELIGION
|
NUMBER OF SAMPLES
|
PERCENTAGE
%
|
|
1.
|
Hindu
|
15
|
50%
|
|
2.
|
Christian
|
12
|
40%
|
|
3.
|
Muslim
|
3
|
10%
|
|
4.
|
Others
|
0
|
0%
|
The
table shows that the majority (50%) of samples selected were Hindu followed by
Christians 40% and Muslims 10%.
Table 4. Distribution of subjects selected according to
educational status. N=30
|
SL. NO
|
EDUCATIONAL STATUS
|
NUMBER OF SAMPLES
|
PERCENTAGE (%)
|
|
1.
|
Illiterate
|
0
|
0%
|
|
2.
|
Primary education
|
16
|
53.3%
|
|
3.
|
Secondary education
|
6
|
20%
|
|
4.
|
Others
|
8
|
26.6%
|
The
table shows that the majority of samples have primary educational status up to
53.3%.
Table 5. - Distribution of subjects selected according
to occupation. N=30
|
SL.
NO.
|
OCCUPATION
|
NUMBER OF SAMPLES
|
PERCENTAGE (%)
|
|
1.
|
Unemployment
|
19
|
63.3%
|
|
2.
|
Government employee
|
2
|
6.6%
|
|
3.
|
Private employee
|
4
|
13.3%
|
|
4.
|
Others
|
5
|
16.6%
|
The
table shows that the Majority of samples are unemployed (63.3%), followed by
private employee (13.3%), government employee (6.6%), and others (5%).
Table 6. Distribution of subjects selected according to
dietary pattern. N=30
|
Sl.
No.
|
Dietary Pattern
|
Number of Samples
|
Percentage (%)
|
|
1.
|
Vegetarian
|
10
|
33.3%
|
|
2.
|
Nonvegetarian
|
20
|
66.6%
|
The
table shows that Majority of samples belong to non- vegetarian dietary pattern
(66.6%).
Table 7. Distribution of subjects selected according to
their duration of illness. N=30
|
SL. NO
|
Duration of Illness
|
Number of Samples
|
Percentage (%)
|
|
1.
|
Below 3 years
|
2
|
6.6%
|
|
2.
|
4-6 years
|
2
|
6.6%
|
|
3.
|
7-9 years
|
1
|
3.3%
|
|
4.
|
Above 10 years
|
25
|
83.3%
|
The
table and shows that Majority of samples belongs to age group above 10 years
(83.3%).
Table 8. Distribution of subjects selected according to
their previous knowledge. N=30
|
SL.
NO.
|
Previous
Knowledge
|
Number of Samples
|
Percentage
(%)
|
|
1.
|
From family members
|
3
|
10%
|
|
2.
|
Health workers
|
15
|
50%
|
|
3.
|
Social medias
|
3
|
10%
|
|
4.
|
Others
|
9
|
30%
|
The
table shows that Majority of samples have previous knowledge from health
workers.
Section
2 - Assessing the Knowledge of Diabetic Patients Regarding Glycemic Control and
self Management of Diabetes Mellitus
Table 9 Assessing the knowledge of diabetic patients
regarding glycaemic control and self-management of diabetes mellitus
|
SL. NO
|
Knowledge Level (%)
|
Frequency
|
Percentage (%)
|
|
1
|
Good knowledge (16-
20)
|
11
|
36.6%
|
|
2
|
Adequate knowledge (11-15)
|
17
|
56.6%
|
|
3
|
Poor knowledge (below 11)
|
2
|
6.6%
|
Figure 1. Bar diagram showing knowledge of diabetic
patients regarding glycemic control and self-management of diabetes mellitus
The
table and figure shows that 56.6% of the selected samples have good knowledge,
36.6% have adequate knowledge. Only 6.6% have poor knowledge.
Section
3-Description of Knowledge in general, Definition, etiology and risk factors,
diagnostic measures and insulin Administration and Immediate, self care and
dietary Management.
Table 10 description of knowledge in general,
definition, etiology and risk factors, diagnostic measures and insulin
administration and immediate, self-care and dietary management
|
Sl. No
|
Question
|
Score
|
Percentage (%)
|
|
1
|
Diabetes mellitus is a
communicable disease
|
1
|
3.3%
|
|
2
|
Diabetes mellitus is a
hereditary disease
|
20
|
66.6%
|
|
3
|
Diabetes mellitus is a non-
communicable disease
|
4
|
13.3%
|
|
4
|
None
|
5
|
16.6%
|
Table
shows, the Selected subjects have an average score of 66.6% out of 20 questions
in assessing knowledge of diabetes in general.
Table 11 Analysis of knowledge of patients about
definition, etiology and risk factors of diabetes mellitus.
|
Sl. No
|
Question
|
Score
|
Percentage (%)
|
|
1
|
Diabetes mellitus is due to
increased blood glucose level.
|
28
|
93.3%
|
|
2
|
Pancreatic dysfunction is one
of the causes of diabetes
mellitus.
|
23
|
76.6%
|
Table
shows, out of 2 questions related to definition and risk factors, an average
score of 93.3%for definition, 76.6% for etiology and risk factors of diabetes
mellitus.
|
Sl. No
|
Question
|
Score
|
Percentage (%)
|
|
1
|
70-120 mg/dl is the normal range of
fasting blood glucose level
|
19
|
63.3%
|
|
2
|
Middle forearm is the site not used
for insulin administration
|
20
|
66.6%
|
|
3
|
Insulin bottles are being stored in
refrigerator
|
30
|
100%
|
|
4
|
One bottle of insulin can be used
for less than one month
|
7
|
29.3%
|
|
5
|
Rotating the injection site is the technique
adopted to avoid necrosis
at the injection site
|
22
|
73.3%
|
|
|
Table 12 Analysis of knowledge of
patients on diagnostic measures and insulin administration.
90%
were obtained for prevention of lowering of blood glucose level.
Table 13 Analysis of knowledge on immediate, self-care
and dietary management of diabetes mellitus
|
Sl. No
|
Questions
|
Score
|
Percentage (%)
|
|
1
|
Eating sugar or candy can be
adopted when blood glucose falls
suddenly
|
28
|
93.3%
|
|
2
|
By wearing well-fitting
chapels is the way by which the diabetic patients should take care of their
feet
|
10
|
33.3%
|
|
3
|
Diabetic patients must massage
their foot every day in order
to increase blood circulation
|
20
|
66.6%
|
|
4
|
Diabetes patients should avoid
sugar rich food item
|
29
|
96.6%
|
|
5
|
Diabetic patients should not
skip
their meals as it lowers the
blood glucose level
|
27
|
90%
|
Out
of 5 questions regarding immediate, self-care and dietary management, an
average score of 93.3%were obtained for immediate management, 63.3% were
obtained for foot care, 66.6% were obtained for foot massaging to increase the
blood circulation, 86.6% were obtained for avoidable foods for diabetic patient
and
Section 4- Description of association between knowledge and selected demographic variables.
Table 14 Association between knowledge of diabetic
patients with age.
|
Sl.
No.
|
Age group (in years)
|
Poor
|
Average
|
Good
|
Chi square
|
P
value
|
|
1.
|
30-40 years
|
0
|
2
|
0
|
11.5
|
0.075
|
|
2.
|
41-50 years
|
0
|
1
|
0
|
|
3.
|
51-60 years
|
0
|
10
|
0
|
|
4.
|
61 and above
|
2
|
7
|
8
|
The
majority of the samples selected for the study were of age group of 61 years
and above [60%] and P value
reveals
that there is a significant association between knowledge regarding glycemic
control and self- management among diabetic patients and age group.
Table 15 Association between knowledge of diabetic
patients with religion.
|
Sl. No
|
Religion
|
Poor
|
Average
|
Good
|
Chi square
|
P value
|
|
1.
|
Hindu
|
1
|
7
|
7
|
6.71
|
0.152
|
|
2.
|
Christian
|
1
|
10
|
1
|
|
3.
|
Muslim
|
0
|
3
|
0
|
|
4.
|
Others
|
0
|
0
|
0
|
Out
of 5 questions related to diagnostic measures and insulin administration for
diabetes mellitus, an average score of 63.6% were obtained for diagnostic
measures, about 66.6% score were obtained for insulin administration sites,
100% were obtained regarding the storage of insulin, 56.6% were obtained as a
score for the usage of an insulin bottle and 73.3% were obtained for the
technique adopted to avoid necrosis.
The
majority of samples selected were Hindu 50% followed by Christians 40% and
Muslims 10%. There is an association between knowledge regarding glycemic
control and self-management among diabetic patients and religion.
Table 16 Association of knowledge of diabetic patients
with educational status.
|
Sl.
No.
|
Educational status
|
Poor
|
Average
|
Good
|
Chi square
|
P value
|
|
1.
|
Illiterate
|
0
|
0
|
0
|
3.38
|
0.497
|
|
2.
|
Primary
education
|
1
|
12
|
3
|
|
3.
|
Secondary education
|
1
|
3
|
3
|
|
4.
|
Others
|
0
|
4
|
3
|
There
is a significant association between knowledge regarding glycemic control and
self-management among diabetic patients and education status.
Table 17 Association between knowledge of diabetic
mellitus with occupation
|
Sl.
No.
|
Occupation
|
Poor
|
Average
|
Good
|
Chi square
|
P value
|
|
1.
|
Unemployment
|
2
|
12
|
5
|
1.95
|
0.925
|
|
2.
|
Government employee
|
0
|
1
|
1
|
|
3.
|
Private employee
|
0
|
3
|
1
|
|
4.
|
Others
|
0
|
4
|
1
|
There
is a significant association between knowledge regarding glycemic control and
self-management among diabetic patients and occupation.
Table 18 Association between knowledge of diabetic
patients with residence
|
Sl.No.
|
Residence
|
Poor
|
Average
|
Good
|
Chi square
|
P value
|
|
1.
|
City
|
0
|
7
|
4
|
1.79
|
0.408
|
|
2.
|
Village
|
2
|
13
|
4
|
There
is a significant association between knowledge regarding glycemic control and
self-management among diabetic patients and residence.
Table 19 Association between knowledge of diabetic
patients with dietary pattern
|
Sl.
No.
|
Dietary pattern
|
Poor
|
Average
|
Good
|
Chi square
|
P value
|
|
1.
|
Vegetarian
|
0
|
8
|
2
|
1.65
|
0.438
|
|
2.
|
Nonvegetarian
|
2
|
12
|
6
|
There
is a significant association between knowledge regarding glycemic control and
self-management among diabetic patients and dietary pattern.
Table 20 Association between knowledge of diabetic
patients with duration of illness
|
Sl.No.
|
Duration of illness
|
Poor
|
Average
|
Good
|
Chi square
|
P value
|
|
1.
|
Below 3 years
|
0
|
2
|
0
|
3
|
0.809
|
|
2.
|
4-6 years
|
0
|
2
|
0
|
|
3.
|
7-9 years
|
0
|
1
|
0
|
|
4.
|
Above 10 years
|
2
|
15
|
8
|
There
is a significant association between knowledge regarding glycemic control and
self-management among diabetic patients and duration of illness.
Table 21 Association between knowledge of diabetic
patients with previous knowledge
|
Sl.
No.
|
previous knowledge
|
Poor
|
Adequate
|
Good
|
Chi
squ are
|
P
value
|
|
1.
|
From family
|
0
|
3
|
0
|
14.
|
0.067
|
|
|
members
|
|
|
|
9
|
|
|
2.
|
Health
|
0
|
12
|
3
|
|
|
|
|
workers
|
|
|
|
|
|
|
3.
|
Social
|
0
|
0
|
3
|
|
|
|
|
medias
|
|
|
|
|
|
|
4.
|
Others
|
2
|
5
|
2
|
|
|
There
is a significant association between knowledge regarding glycemic control and
self-management among diabetic patients and previous knowledge.
RECOMMENDATIONS:
On
the basis of studies, following recommendations are stated:
·
Similar study can be conducted in
the community setting.
·
Similar study can be conducted
with large samples in different hospitals.
CONCLUSION:
This
study was conducted in order to assess the knowledge regarding glycemic control
and self- management among diabetic patients in Amala Institute of Medical
Science, Thrissur. Majority of samples selected for the study were of age group
61 years and above (60%) and 53.3% were females. Findings of the study showed
that the majority of subjects have good knowledge (56.6%) on glycemic control
and self- management of diabetes mellitus. Area wise Analysis of knowledge
obtained based on diabetes mellitus are in general (66.6%), definition,
etiology, and risk factors (76.6%), diagnostic measures and insulin administration
immediate (63%), self-care and dietary management (63.3%) respectively. The
results also show that there is a significant association between knowledge
regarding glycemic control and self-management among diabetic patients with age
group, religion, educational status, occupation, residence, dietary pattern,
duration of illness and previous knowledge.
CONFLICT
OF INTEREST:
The
authors have no conflicts of interest regarding this investigation.
ACKNOWLEDGMENTS:
The
authors would like to thank Amala College of Nursing, Thrissur and Amala
Institute of Medical Sciences, Thrissur for their kind support during the study
period.
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Received on 29.05.2021 Modified
on 21.06.2021
Accepted on 08.07.2021 ©A&V Publications All right reserved
Asian J. Nursing
Education and Research. 2021; 11(4):571-576.
DOI:
10.52711/2349-2996.2021.00133