Self-care practices among diabetics attending rural health centre in Nalgonda District of Telangana
1Assistant Professor, 2Professor and Head, 3Professor, 4Associate Professor, Department of Community Medicine, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana State, 5Assistant Professor, Department of Community Medicine, Kamineni Academy of Medical Sciences and Research center, Hyderabad, Telangana.
Diabetes mellitus (DM) is a chronic progressive endocrine disorder characterized by hyperglycemia, either due to absolute insulin deficiency (type 1 DM), or relative deficiency or insulin resistance or both (type 2 DM).
Globally, the prevalence of DM is rising and projected to reach 366 million in 2030.1 DM virtually affects every system of the body mainly due to metabolic disturbances, especially if diabetes control is suboptimal.2 Diabetes is associated with micro- and macro-vascular complications leading to cardiovascular diseases, nephropathy, retinopathy and neuropathy, which cause disabilities, and may lead to premature mortality. 3
One of the challenges for healthcare providers today is addressing the continued needs of patients with chronic illnesses including diabetes. Regular follow-up of diabetic patients is of great significance in preventing, delaying and early diagnosing complications associated with the disease. Studies have reported that optimal glycemic control prevent and delay the progression of diabetes associated complications. The management of DM is not only limited to adequate glycemic control, but also involves education and counseling of the patients, as well as proactive actions to prevent complications, limit disability and facilitate rehabilitation.
Self-care is integral to secondary prevention in diabetics, and dictates that diabetics shoulder responsibility for their own care through learnt-behaviour that is supported and empowered by health care providers.4 Essential self-care in diabetes includes healthy eating, being physically active, monitoring of blood sugar, regular medications, good-problem solving skills, healthy coping skills and risk-reduction behavior.5 Studies in India and abroad have revealed that these practices are associated with better glycemic control, decrease prevalence of acute and chronic complications and improved quality of life. 6-10 Considerable significance of self-care in diabetes management demands that this aspect is studied in different socio-demographic groups. The present study was conducted to assess the self-care practices among diabetics residing in rural Nalgonda.
Materials and methods
Study design and period: A cross-sectional study was conducted during April-June 2015
Study Setting: All diabetic patients attending Rural Health And Training Centre (RHTC) of department of Community medicine, Kamineni Institute of Medical Sciences, Narketpally.
Inclusion Criteria: Type 2 diabetic patients, who had been taking anti-diabetic medications for at least one month prior, and were willing to participate.
Exclusion Criteria: Patients who were too ill to participate, pregnant, newly diagnosed (less than 1 month), or yet to be placed on medications were excluded.
Study Instruments: A pre-designed and pretested structured questionnaire in local language (Telugu) was used for data collection. The questionnaire consisted of the following sections a) Socio demographic information, b) Diabetes specific information c) Knowledge regarding diabetes d) Self care practices followed by the patients. Socio-demographic information included patient’s age, gender, and educational status and socioeconomic status. Diabetes specific information captured the duration of the disease, glycemic control, type and source of treatment. Knowledge of the respondents was evaluated by questions related to the nature of the disease, method of detection of diabetes, importance of diet, exercise and drug compliance in controlling the disease etc. Self-care practices were assessed by patient’s behavior regarding testing blood sugar, adopting healthy diet, exercise, compliance to the drugs and regular self-inspection of feet.
Ethical Considerations. Approval of Institutional Ethics Committee and informed consent from individual participants were obtained.
Data Analysis: Data validation was done and formats were physically verified to eliminate errors during data entry. Data were coded into Microsoft Excel, and analyzed using Statistical Package for the Social Sciences version 19.0. Statistics like mean and proportion were calculated to summarize self-care practices among the study participants.
A total of 70 diabetics were included in the study. The mean age of study population was 59.6 years, with a male: female ratio of 1:1.92. Majority (95.7%) of the subjects were Hindus, 23 (32.9%) were literate, 33 (47.1%) were gainfully employed and 48.6% belonged to middle socio-economic class. (Table 1)
Table 1: Socio Demographic Profile of Study Population (N=70)
|Age (in Years)||40-50||15||21.4|
The average duration of diabetes was 9.4 years with almost one-forth (27.1%) diagnosed during previous one year (Table 2). The source of treatment as shown in fig.1, highlights that 72.8% of the patients were receiving health care from government or medical college facilities including RHTC, while only 4.3% were being managed by Registered Medical Practitioners (RMP).
Table 2: Distribution of Study Subjects according to Duration of Diabetes (N=70)
|Duration (in Years)||Number||%|
|Less than 1||19||27.1|
|1 - 2||14||20.0|
|2 - 3||09||12.9|
|4 - 5||12||17.1|
|More than 5||16||22.9|
Fig. 1: Source of Treatment of the study Population (N=70)
Table 3 highlights the self-care practices and relevant life-style modifications being observed by the study subjects. The study showed that 57 out of 70 (81.4%) were on regular treatment, and 78.5% were getting their blood sugar tested at least once in three months. The study revealed that 40% study participants were using tobacco, and self-care practices regarding regular exercise, dietary control, foot-care and self-care precaution for acute emergencies of DM were unsatisfactory.
This cross sectional study carried out in a primary health care setting focused on self-care practices by diabetics. The study finding that 81.4% of the population was on regular treatment and 78.5% were getting their blood sugar estimation done at least once in a quarter indicates positive trends in management of DM in rural Nalgonda.
These findings of the study are in agreement with the studies done by Raithatha et al11 in Anand district of Gujarat, Gopichandran et al12 in Vellore and Suguna et al13 in rural Bangalore.
Table 3: Self Care Practice regarding Diabetes among the study population (N=70)
|Regularity of treatment||Regular||57||81.4|
|Periodicity of blood sugar estimation||Once a month||26||37.1|
|1 – 3 months||29||41.4|
|3 – 6 months||09||12.9|
|> 6 months||06||08.6|
|Dietary practices||Regular frequent meals||55||78.6|
|Avoidance of high glycemic index food-items||30||42.9|
|Increase consumption of fruits and vegetables||15||21.4|
|Foot care practices||Improved foot-hygiene||55||78.6|
|Self-examination of feet, at least once a week||45||64.3|
|Use of special footwear||15||21.4|
|Exercise||Moderate exercises at least 150 minutes per week||12||17.14|
|Non-consumption of tobacco||Non smoker and non-consumption of smokeless tobacco||42||60|
|Precautions for acute complications||Carry ID Card||08||11.4|
|Aware of symptoms of Hypoglycemia||38||54.3|
|Carrying sugar-items for self-management of hypoglycemia||5||7.14|
Dietary management of diabetes is challenging, especially in lower social strata due to ignorance and economic reasons. This study also showed that less than half (42.9%) diabetics were avoiding food items that have high glycemic index, and only 21.4% had increased their consumption of vegetable and fruits, post-diagnosis. A study by Rajasekharan et al14 in a tertiary care settings in Mangalore (Karnataka) reported that 45.9% diabetics had a healthy eating plan, whereas only 26.2% consumed fruits and vegetables on all days in a week; findings similar to our study.
Diabetic foot is one of the most common complications of the disease, more so among rural populace who is often exposed to injuries, and uses footwear that are less protective. The study finding of sub-optimal self-care practices in foot care reflects ineffectiveness of healthcare providers to bring healthy behavior modifications among our clients. The study also observed that there was lack of self-care practices in the areas of regular exercise, non-use of tobacco, and preparedness for any acute complications of DM.
The study found that prevalence of good self care practices related to diabetes was satisfactory in respect to regular treatment and blood sugar monitoring. However, there is considerable scope for improvement in other areas i.e. diet management, exercise, foot-care, avoidance of tobacco products in all forms, and preparedness for acute emergencies of diabetes. The adoption of self-care practices by diabetics is a reflection of comprehensiveness.
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