|Year : 2021 | Volume
| Issue : 3 | Page : 326-330
A community-based cross-sectional study on self-care and its role in the management of diabetes among patients with type 2 diabetes mellitus
Dinesh Peraje Vasu1, Annarao Gunderao Kulkarni2, Namratha Kurunji Gangadhar3
1 Department of Community Medicine, KVG Medical College, Sullia (DK), Karnataka 574327, India
2 East Point Medical College, Bidrahalli, Bangalore 560049, India
3 Department of Microbiology, KVG Medical College, Sullia (DK), Karnataka 574327, India
|Date of Submission||29-Jan-2021|
|Date of Acceptance||07-May-2021|
|Date of Web Publication||30-Sep-2021|
Dr. Dinesh Peraje Vasu
Department of Community Medicine, KVG Medical College, Sullia (DK), Karnataka.
Source of Support: None, Conflict of Interest: None
Introduction: Type 2 diabetes mellitus is one of the most common non-communicable diseases in India. Self-care practices in diabetes are essential for the control of the disease and improvement of quality of life. The objective of this study was to assess the proportion of study subjects practicing self-care practices and to study their influence on glycemic control. Materials and Methods: This is a community-based cross-sectional study on 400 diabetic patients selected by probability proportionate to sample size to assess the self-care practices with the help of a semistructured questionnaire after obtaining institutional ethical clearance. Results: Majority of the study population were males (62.75%) and belonged to the age group of 40–60 years (60.25%). About 51% of the respondents were diabetic for less than 6 years; 24% and 16% followed a healthful eating plan and exercised regularly, respectively. About 46% were regular in taking medications and 71% checked their blood sugars regularly. Only 0.5% checked their foot and inside of their foot wear regularly. Conclusion: Self-care practices were found to be unsatisfactory in most of the domains that were studied. As these practices are essential for the prevention of complications and to provide a better quality of life, more efforts are needed to educate the people about self-care practices.
Keywords: Glycemic control, self-care practices, type 2 diabetes mellitus
|How to cite this article:|
Vasu DP, Kulkarni AG, Gangadhar NK. A community-based cross-sectional study on self-care and its role in the management of diabetes among patients with type 2 diabetes mellitus. J Diabetol 2021;12:326-30
|How to cite this URL:|
Vasu DP, Kulkarni AG, Gangadhar NK. A community-based cross-sectional study on self-care and its role in the management of diabetes among patients with type 2 diabetes mellitus. J Diabetol [serial online] 2021 [cited 2021 Dec 2];12:326-30. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/3/326/327300
| Introduction|| |
Diabetes is a chronic metabolic disease characterized by elevated levels of blood glucose which leads to a serious damage to heart, blood vessels, eyes, kidneys, and nerves over a period of time. Globally, an estimated 422 million adults were living with diabetes in 2014. This killer disease has taken a toll of approximately 1.6 million in 2015. Higher than optimal blood glucose has caused an additional 2.2 million deaths, by increasing the risks of cardiovascular and other diseases.
A multipronged approach is required in diabetes care. In the control of this disease, patients themselves have a very important role to play. It is often said that if a patient has to attain a desired level of blood glucose, he/she is expected to follow certain self-care practices of which regular physical activity, appropriate dietary practice, foot care practice, regular medications, and managing complications like hypoglycemia are very important. All diabetic patients must be taught regarding these activities when they are diagnosed, and the same should be reinforced at regular intervals during their visits to the health facility.
The objective of this study was to assess the proportion of study subjects practicing self-care practices and to study their influence on glycemic control and also the prevention of complications.
| Materials and Methods|| |
A community-based cross-sectional study was done among patients diagnosed with type 2 diabetes mellitus in the rural part of Sullia taluk, Karnataka, India to assess the proportion of patients practicing self-care practices and also to assess whether the self-care practices had any role in the control of their blood sugars.
Assuming that 50% of the patients followed self-care practices as advised to them by their healthcare providers and considering a precision of 5%, the sample size was calculated using the formula 4pq/d2. Thus the study was conducted among 400 patients who were already diagnosed by a physician as having type 2 diabetes mellitus. Patients of age 20 years and above and those who were diagnosed and living with the disease for more than a year and residing in the locality for more than a year were included in the study. The patients were selected from 40 villages of Sullia by probability proportionate to sample size and then by a random sampling technique.
A pretested semistructured questionnaire containing information about the participants’ sociodemographic status, disease-specific information, and self-care practices followed by them was prepared and used for the study. Information regarding their last blood sugars was collected from the laboratory report available with them. Ethical clearance was obtained from the Institutional Ethical Committee before the actual start of the study.
Details regarding self-care activities were collected using the Summary Diabetes Self-care activities questionnaire after making minor changes to it to suit the local study population. The variables that were checked include smoking habits, foot care and checking of foot wear, examining blood sugars regularly and as advised by his/her healthcare provider, regular drug intake, exercise for at least 5 days a week, and adherence to a healthy eating plan.
Since self-care practices cannot be scored collectively and given a single value, it was partitioned into different habits and then scored accordingly. No smoking was considered as a good behavior. Checking the foot and inside of the shoes or foot wear at least on 70% of the recommended duration was considered a good behavior, i.e., at least 5 days a week. Monitoring of blood sugars at least once in 3 months and taking all recommended drugs or insulin were defined as good behavior. Exercising for at least 20 min a day for 5 days in a week and doing non-work-related exercises were considered as a good behavior. Adherence to a healthful eating plan as advised by the participant’s healthcare provider and taking at least five or more servings of fruits and vegetables per week were considered good behaviors. Thus participants were either found to have followed good or poor self-care practices.
The data were entered in Microsoft Excel Office 2007, and SPSS statistic version 20 was used for analysis. The data were expressed in terms of frequencies and percentages. χ2 test was done to find whether there was any statistical significance between the variables. P-value less than 0.05 was considered as significant. Binary logistic regression was done to predict the relationship between the dependent and the independent variables, in which the dependent variable was binary.
| Results|| |
The baseline characteristics of the study population are shown in [Table 1]. It can be seen that the majority of them were males (62.75%) and belonged to the age group of 40–60 years (60.25%). The mean age of the study population was 54.48 ± 12.24 years. Most (70.25%) of them were Hindus and were married (95.25%). Majority of them were educated till upper primary (22%) and were agriculturists and self-employed (28.25%). About 41.25% of the study population belonged to upper middle class.
[Figure 1] shows the duration of diabetes in the study population. Many (51%) of the respondents were diabetic for less than 6 years, whereas 34% were diabetic for 6–10 years. Only 4% were suffering from the disease for more than 20 years. The mean duration of diabetes in the study population was 6.8 ± 5.2 years. The mean body mass index of the study population was 26.64 ± 2.27 kg/m2.
[Table 2] gives information on the self-care practices. It can be noted that checking the foot daily or inspecting the inside of the shoes/foot wear daily was not done by 99.5% of the respondents. Only 15.75% of the respondents exercised for at least 5 days a week; 71% and 64% of the study participants checked their blood sugars at least once in 3 months and as advised by doctor, respectively. The mean HbA1c of the study population was 6.8 ± 0.85%. Less than 50% of the participants took their drugs every day and regularly. A χ2 test was done to see whether there was a relationship between adherence to self-care practices and achievement of target blood sugars. Achievement of glycemic control was better in those diabetic patients who did not smoke, checked blood sugars regularly and as advised by their healthcare provider, follow a healthful eating plan, take drugs regularly and as advised, and exercise for at least 5 days a week for 20–30 min.
|Table 2: Relationship of self-care practices with achievement of glycemic control in diabetic population (original)|
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A χ2 test was done to see whether there was any relationship between the sociodemographic variables and achievement of target blood sugars. None of the studied variables was found related to the achievement of target blood sugars as seen in [Table 3].
|Table 3: Achievement of target blood sugars in various sociodemographic groups (original)|
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Logistic regression of each of the self-care behaviors with blood sugars was done, and it was noted that following good dietary behavior was the most important factor influencing the achievement of target blood sugars among the participants with odds ratio of 1.755 with a confidence interval at 95% of 1.499–2.055 and P-value less than 0.0001.
| Discussion|| |
The present study was done to assess the proportion of patients with type 2 diabetes mellitus following self-care practices and also to assess the influence of these practices on control of blood sugars. The idea of self-care practices was introduced to empower the patient with the knowledge about their disease and its management. The patients can set targets for themselves and choose what suits their lifestyle to manage diabetes effectively.
It is reported that expenditures associated with diabetes are abnormally high. For every 10 s, diabetes causes one death and one amputation every 30 s. It is furthermore related with blindness, cardiovascular disease (CVD), and renal malfunction. So self-care practices play an important role in preventing all these complications and also to reduce the burden of expenditure related to diabetes.
Since self-care practices cannot be scored collectively and given a single value, it was partitioned into different habits and then scored accordingly in the present study. It is a generally held view that healthful eating plan is linked to adequate weight management and blood sugar control. Intake of at least 400–500 g/day of fruits and vegetables not only helps in maintenance of blood sugar levels but also can help in preventing complications such as CVDs, stroke, gastrointestinal tumors, etc. Only 24.25% of the participants followed a healthful eating plan in the present study. This is in contrast to studies done by Veerakumar et al. and Padma et al., in which healthful eating plan was followed in more than 70% of the diabetic patients.
Regular exercises are recommended for diabetics as they help in better blood sugar control, reduction in insulin resistance, better control of blood pressure, and cardiovascular protection. Only 15.75% of the participants were involved in regular physical activity in the present study. The proportion of diabetics involved in regular physical activity varied widely and it was seen that 65% of them followed regular physical activity in a study done by Veerakumar et al., whereas it was 45% and 39% in studies conducted by Suguna et al.[l3] and Padma et al., respectively. The difference in physical activity and eating plan may be due to differences in sociodemographic pattern.
Regular monitoring of blood sugars helps in assessing the effectiveness of the treatment received by the diabetic patient. In the present study, only 64% of the participants checked their blood sugars at least once in 3 months. This is quite lower when compared with studies done by Karthik et al., in which 75.2% of the participants checked their blood sugars regularly. In studies done by Veerakumar et al. and Padma et al., 90% and more of the participants checked their blood sugars regularly. Most of the participants interviewed were of the belief that they could sense the change in blood sugars in them by some manifestations like increased urination at night, giddiness, or generalized weakness and that there is no need to check their blood sugar levels unless they come across any of these manifestations.
Adherence to the drugs was seen only in 46.25% of the study participants. This was in contrast to studies done by Rajasekharan et al. and Gopichandran et al., in which the adherence rates were 60.5% and 79%, respectively. The difference in adherence rate may be because the participants in the above-mentioned studies were under the Community Health Department of a medical college and were thus closely monitored, whereas the present study was a survey done in whole of Sullia taluk irrespective of whether they were under the Community Health Department. This reflects the importance of health education in the management of diabetes.
The important aspects of foot care like checking the foot daily and inspection of inside of shoes and footwear daily were only found in 0.5% of the study population. A study conducted by Dedefo et al. in Ethiopia reported that 82.9% of the study participants followed proper foot care practices. Studies done in India showed that diabetic patients gave less importance to foot care as suggested by Garg et al. where only 37.4% practiced satisfactory foot care and Goyal and Gupta report that only 14.2% inspected the footwear on most of the days. Foot care practices are important because subsequent development of foot ulcers and gangrenous lesions could be prevented.
It was also noted that none of the sociodemographic determinants studied was associated with achievement of target blood sugars in the study population. Good dietary behavior was the most important factor influencing the achievement of target blood sugars among the participants of the present study. Whereas the study conducted by Wynn Nyunt et al. reported that following a healthy diet, exercising for at least 5 days a week and compliance to drug therapy were all associated statistically with achievement of glycemic control.
Self-care practices were self-reported. The questions on diet and exercise were simplified, and a detailed study on these aspects would have provided much information.
| Conclusion|| |
The practice of self-care practices was found to be unsatisfactory among the study population. Good dietary behavior was the most important factor influencing the achievement of target blood sugars among the participants. As these practices are essential to prevent future complications to provide patients with a better quality of life, efforts must be put to educate the patients regarding its importance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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