Original Article

Clinical and disability profile of diabetic patients admitted in a tertiary care hospital: A cross-sectional study

• *Nagaraj K¹, Anupama VV²

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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)

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.

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