• Print ISSN: 2395 - 1400, Online ISSN: 2455 - 8923
Clinical and disability profile of diabetic patients admitted in a tertiary care hospital: A cross-sectional study
*Corresponding Author

Dr Nagaraj K
Professor and Head, Department of community medicine,
Kamineni Institute of Medical Sciences, Narketpally, Nalgonda district, Telangana state, India – 508 254,

Email Id: sanjurajrekha@yahoo.co.in

1Professor and Head, 2Intern, Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana state, India.

Abstract

Background: Diabetes mellitus has gained importance in public health due to increasing number of cases and disease related complications. Along with the disease and its complications, there is also an adverse impact on the quality of life of the patients.

Materials and Methods: A total of 80 diabetic patients with diabetes mellitus with or without complications admitted in the tertiary care hospital were the study subjects. A pre-structured questionnaire with socio-demographic and clinical details and relevant disability subscales from WHO Disability Assessment Schedule 2.0 was used.

Results: Mean duration of diabetes among study subjects was 8.18 years and 76.3% of the patients had diabetes related complications. Out of the 80 study subjects, 57(71.3%) had family history of diabetes and among those, 6(7.5%) had family history of diabetic complications. When disability subscales were administered, 6.3% of the patients were unable to perform their daily activities on their own. 16.3% were extremely unable to participate in community activities and 12.5% found it impossible to emotionally cope up with their diabetic status. 31(38.8%) participants lost their jobs due to the severity of diabetes and related complications.

Conclusions: The mean duration of diabetes explains chronicity of the illness and risk of development of complications. The presence of a family history of diabetes indicates the need for implementing primordial and primary prevention strategies to prevent diabetes among risk groups. Disability profile shows deterioration in quality of life and the need for addressing this problem.

Key words: Diabetes, diabetic complications, disability

Introduction

Diabetes mellitus is gaining importance in public health due to increasing number of cases and related complications.

As per the data available in 2013, 382 million people across the globe had diabetes and the number is expected to rise to 592 million by 2035.1 It is expected that, by 2030, diabetes mellitus may afflict up to 79.4 million individuals in India.2 Along with the disease and complications, there is also an adverse impact on daily routine and quality of life of those afflicted with diabetes. Reduced productivity and increased mortality has been reported among diabetics in addition to deterioration in quality of life.3 Population in India is heterogeneous, i.e., a mix of rural and urban population. So far, studies in India have been conducted either only in urban areas,4 or as a comparison between urban and rural diabetic population.

Moreover, the disparity between rural and urban areas with respect to facilities available, awareness and other factors related to health care makes the results of these studies inadequate in reporting the actual magnitude of the problem. This study aims at observing the socio-demographic, clinical and disability profile of the study subjects in relation to diabetes in a tertiary hospital of a rural area in Telangana state.

Materials and Methods

The study was a cross-sectional study carried out at Kamineni Institute of Medical Sciences (KIMS) Hospital, a tertiary care hospital in Narketpally, a rural area in Nalgonda district of Telangana state. The study population consisted of a sample size of 80 diabetic patients admitted in KIMS hospital during the study period of two months (June-July2014). Inclusion criteria were all diabetic patients with or without complications and co-morbidities admitted to the hospital. Out patients, patients with gestational diabetes and in the pediatric age group, mentally unstable and comatose patients were excluded from the study.

A structured questionnaire with socio-demographic and clinical questions and relevant sub-scales from WHO Disability Assessment Schedule 2.0 modified according to scenario were used as study instruments. Data analysis was done using SPSS version 19 with data presented as percentages in respective categories.

Approval was obtained from the Institutional Ethics Committee before commencement of Research. A written-informed consent was obtained in the vernacular language from all participants. Confidentiality of the data was maintained.

Results

The data has been collected from 80 diabetic subjects admitted in the hospital in various departments both for regular diabetic care as well as due to complications. The results have been presented below.

Table I: Age-wise distribution of the study

Age group (in years) Frequency Percentage (%)
<20 1 1.2
20-40 14 17.5
40-60 43 53.8
>60 22 27.5
Total 80 100.0

Majority of study subjects (53.8%) belong to the age group of 40-60 years followed by the age groups of > 60 years (27.5%), 20-40 years (17.5%) and < 20 years (1.2%) respectively (Table I). Among a total of 80 study subjects interviewed, 61(76.2%) were male and 19(23.8%) were female as mentioned in table II.

The educational status of the group studied is as follows, 47.5% of the total subjects were illiterate, 27.5% went to primary school, 21.2 % received secondary school education and only 3.8% were graduated.

Table II: Distribution of the study subjects according to gender

Gender Frequency Percentage (%)
Male 61 76.2
Female 19 23.8
Total 80 100.0

As depicted in table III, it is clearly evident that most of them are illiterates.

Table III: Distribution of the study subjects according to Education status

Education status Frequency Percentage (%)
Illiterate 38 47.5
Primary school 22 27.5
Secondary school 17 21.2
Graduate 3 3.8
Total 80 100

The socio-economic status of the subjects has been classified based on modified B G Prasad classification for rural areas. According to this, 37.5% of the study subjects belong to lower class and 32.5% belong to upper middle class, 8.7% were poor, 16.3% belong to upper class and 5% belongs to higher class (Table IV).

Table IV: Distribution of the study subjects according to Socio-economic status

Class Frequency Percentage (%)
I (higher) 4 5
II (upper) 13 16.3
III (upper middle) 26 32.5
IV (lower middle) 30 37.5
V (poor) 7 8.7
Total 80 100

Mean duration of diabetes among the study subjects was found to 8.18±5.02 and median 7 years. Among the total 80 subjects, 61(76.3%) had diabetes related complications whereas 19 (23.7%) did not have (Table V).

Table V: Distribution of the study subjects according to presence or absence of Diabetes related complications

Complications Frequency Percentage (%)
Absent 19 23.7
Present 61 76.3
Total 80 100

Among those with complications, 42.6% had foot complications,18% had renal complications,14.8% had ocular complications and the remaining 24.6% had other complications such as recurrent fevers, infections etc. (Table VI).

Table VI: Distribution of the study subjects according to types of complications (n=61)

Complications Frequency Percentage  (%)
Foot 26 42.6
Renal 11 18
Ocular 9 14.8
Others 15 24.6
Total 61 100

Vegetarians constituted 46.2% of the subjects studied and the remaining (53.8%) had mixed diet (Table VII).

Table VII: Distribution of the study subjects according to food habits

Food habits Frequency Percentage (%)
Vegetarian 37 46.2
Mixed 43 53.8
Total 80 100

Among the study subjects 23.8% of the subjects were smokers, 26.2% were taking alcohol occasionally, 6.2% had other addictions and 43.8% had no addictions (table VIII).

Table VIII: Distribution of the study subjects according to Habits and addictions

Habits Frequency Percentage (%)
Smoking 19 23.8
Alcohol 21 26.2
Others 5 6.2
None 35 43.8
Total 80 100

Among the 80 study subjects, 23(28.8%) had a family history of diabetes (Table IX) and out of those, 26.1% had family members with diabetic complications (Table X).

Table IX: Distribution of the study subjects according to presence or absence of Family history of diabetes

Family history Frequency Percentage (%)
No 57 71.2
Yes 23 28.8
Total 80 100.0

Table X: Distribution of the study subjects according to family history of diabetic complications

Family History of Diabetic Complications Frequency Percentage  (%) 
No 17 73.9
Yes 6 26.1
Total 23 100.0

As depicted in table XI, 11.3% of the total subjects were under weight, 75% had a normal BMI and 13.8 % were overweight.

Table XI: Distribution of the study subjects according to Body mass index

BMI

Frequency

Percentage (%)

Under weight

9

11.2

Normal

60

75.0

Over-weight and obese

11

13.8

Total

80

100


Of the 80 study subjects, 51.3% were on oral hypoglycemic drugs, 28.8% on insulin, 18.8% were prescribed both and 1.3%(only one subject) were not taking any medication (Fig.1).

Disability was assessed using a study setting based modification of WHODAS 2.0 with modifying the questions into 4 groups. 37.5% of the total study subjects had no difficulty in performing daily activities after diagnosis of diabetes whereas 18.7% had mild, 21.3% had moderate, and 16.3% had severe difficulty in doing their activities. However, 6.2% of the study subjects were disabled to an extent of not being able to do their daily activities (Table XII).

Table XII: Distribution of the study subjects according to disability sub scale –daily activities

Degree of difficulty-daily activities Frequency Percentage (%)
None 30 37.5
Mild 15 18.7
Moderate 17 21.3
Severe 13 16.3
Extreme or cannot do 5 6.2
Total 80 100.0

Community participation was without any difficulty among 17.5%, with mild and moderate difficulty among 12.5 % each and 41.2% had severe difficulty in participating in community activities post diagnosis of diabetes (Table XIII).

Table XIII: Disability sub scale –distribution of degrees of ability to be active in community

Degree of difficulty - activities in community Frequency Percentage (%)
None 14 17.5
Mild 10 12.5
Moderate 10 12.5
Severe 33 41.2
Extreme or cannot do 13 16.3
Total 80 100.0

Out of the total study subjects, 45% were severely emotionally disturbed due to the illness whereas 12.5% of them were not able to cope up with the emotional factor associated with diabetes (Table XIV).

Table XIV: Disability sub-scale: degree of emotional disturbances due to diabetes

Degree of difficulty – emotional disturbances Frequency Percentage (%)
None 5 6.2
Mild 11 13.8
Moderate 18 22.5
Severe 36 45.0
Extreme / cannot do 10 12.5
Total 80 100.0

Among the study subjects, 11.2% had no difficulty in attending day to day work, 2.5% had mild difficulty, 16.3% had moderate difficulty, 31.2% had severe difficulty whereas 38.8% opted out of work due to diabetes and associated illness (Table XV).

Table XV: Disability subscale: distribution of ability to attend occupation or educational institution (students)

Degree of difficulty –occupation / education

Frequency

Percentage (%)

None

9

11.2

Mild

2

2.5

Moderate

13

16.3

Severe

25

31.2

Extreme/ cannot do

31

38.8

Total

80

100.0


Mean Fasting blood sugar in the sample is 167.90 mg/dl, and mean post lunch blood sugar was 252.91 mg/dl.

Discussion

Mean duration of diabetes among the study subjects was found to 8.18±5.02 years. The mean duration of diabetes among rural participants was 7.5±5.5 years,13.6±8.6 years and 8 years based on the studies done in India by Grover S et al,5 Anil kapur’s et al6 and Adler NE et al7 respectively.

Among the total 80 subjects, 61 (76.3%) had diabetes related complications whereas 19(23.8%) didn’t. The mean duration of diabetes among the study sample shows that it is quite chronic, thus evolving into complications. Among those with complications, 42.8% had foot complications,18% had renal complications,14.8% had ocular complications and the remaining 24.6% had other complications such as recurrent fevers, infections etc. This large proportion of the sample having complications coincides well with the other studies conducted in South India.7,8 Few studies however did not take into consideration presence or absence of complications.5,9

Out of the 80 subjects, 23(28.8%) had a family history of diabetes and out of those, 6 had family members with diabetic complications. This was as told by the patients and the study subjects aged over 60 years didn’t know if there was a family history of diabetes or related complications. Out of the total subjects, 11.3% were under weight, 75% had a normal BMI and 13.8% were overweight.

This high percentage of people with normal BMI can be justified because the study setting is rural, most of the participants being agriculturists do manual labor and thus physical activity to some extent contributes to normal BMI.

Disability was assessed using a study setting based modification of WHODAS 2.0 with modifying the questions into 4 groups. 37.5% of the total study subjects had no difficulty in performing daily activities after diagnosis of diabetes whereas 18% had mild, 21.3% had moderate, 16.3% had severe difficulty in doing their activities. However, 6.3% were disabled to an extent of not being able to attempt to do the activities. Community participation was without any difficulty among 17.5%, with mild and moderate difficulty among 12.5% each and 41.3% had severe difficulty in participating in community activities post diagnosis of diabetes. Of the total study subjects, 45% were severely emotionally disturbed due to the illness whereas 12.5% of them were not able to cope up with the emotional factor associated with diabetes.

Among the study subjects, 11.3% had no difficulty in attending day to day work, 2.5% had mild difficulty, 16.3% had moderate difficulty, and 31.3% had severe difficulty whereas 38.8% opted out of work due to diabetes and associated illness. All the above presented data indicates that diabetes did affect the quality of life of the study participants in the form of social, physical, emotional and occupational disturbances.

Mean Fasting blood sugar in the sample is 167.90 mg/dl, and mean post lunch blood sugar us 252.91 mg/dl. This shows that most of the study participants were admitted in hospital due to hyperglycemia.

Conclusions

Most of the study subjects hail from the most economically productive group in a given population i.e., 40-60 years. The mean duration of diabetes is long and this explains the chronicity of the illness and scope for development of complications, which would in turn increase physical, social, psychological and economic burden of the disease. The disability profile clearly shows a decreased quality of life being lead by the patients and thus the strategies to address this problem.

References

  1. Guariguata L, Whiting DR,  Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014 Feb;103(2):137-49.
  2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of Diabetes estimates for the year 2000, projections for 2030. Diabetes Care. 2004 May;27(5):1047-53.
  3. Lucioni C, GaranciniMP, Massi-Benedetti M, Mazzi S, Serra G; CODE-2 Italian Advisory Board. The costs of Type-2 Diabetes mellitus in Italy: a CODE-2 sub-study. Treat Endocrinol. 2003;2(2):121-33.
  4. Akari S, Mateti UV, Kunduru BR. Health-care cost of diabetes in South India: A cost of illness study. J Res Pharm Pract 2013;2:114-7
  5. Grover S, Avasthi A, Bhansali A, Chakrabarti S, Kulhara P. Cost of ambulatory care of diabetes mellitus: a study from North India. Postgrad Med J 2005;81:391-5.
  6. Anil Kapur. Influence of socio-economic factors on diabetes care. International journal of Diabetes in developing countries (2001).Vol 21: 77-85.
  7. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. HealthAff (Millwood) 2002;21:60-76.
  8. Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India. Diabetes Care. 2007 Feb;30(2):252-6.
  9. Kumpatla S, Kothandan H, Tharkar S, Viswanathan V.The Costs of Treating Long Term Diabetic Complications in a Developing Country: A Study from India. J Assoc Physicians India. 2013 Feb;61(2):102-9.