Volume 13, Issue 1 (1-2024)
JCHR 2024, 13(1): 50-55 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Jayabalan J, Gorantla M, Kiranmai B. Exploring the Determinants of Diabetes’ Self-Care Practices among the Diabetics Living in Urban Field Practice Area of Medical College in Hyderabad. JCHR 2024; 13 (1) :50-55
URL: http://jhr.ssu.ac.ir/article-1-1003-en.html
URL: http://jhr.ssu.ac.ir/article-1-1003-en.html
1- Department of community medicine, Osmania medical college, Hyderabad, India
2- Department of community medicine, Osmania medical college, Hyderabad, India ,misha.gorantla@gmail.com
2- Department of community medicine, Osmania medical college, Hyderabad, India ,
Full-Text [PDF 789 kb]
(218 Downloads)
| Abstract (HTML) (387 Views)
How to cite this paper:
Jayabalan J, Gorantla M, Kiranmai B. Exploring the Determinants of Diabetes’ Self-Care Practices among the Diabetics Living in Urban Field Practice Area of Medical College in Hyderabad. J Community Health Research 2024; 13(1): 50-55.
Introduction
.PNG)
.PNG)
Table 3. Association between RBS control and the study variables
References
Full-Text: (31 Views)
| Exploring the Determinants of Diabetes’ Self-Care Practices among the Diabetics Living in Urban Field Practice Area of Medical College in Hyderabad |
Jayasuriya Jayabalan 1 
, Misha Gorantla * 1 , B Kiranmai 1
, Misha Gorantla * 1 , B Kiranmai 1- Department of community medicine, Osmania medical college, Hyderabad, India
| ARTICLE INFO | ABSTRACT | |
| Original Article Received: 08 Dec 2023 Accepted: 12 Feb 2024 |
Background: Diabetes is a chronic disease, and among the adults, type II diabetes is more common. In 2021, approximately 537 million adults between 20 to79 suffered from diabetes. Diabetics who follow self-care practices can manage their blood glucose levels better, which in turn prevents the secondary complications.
Methods: This was a community-based and cross-sectional study performed in the urban field practice (UHC) area of a tertiary care medical college conducted on 110 type II diabetics. The ‘summary of diabetes self-care activities’ questionnaire was used for data collection. Results: Mean age was 53 +/- 7.6, 70% of whom were females and 45.4% were lower-middle Socio-Economic Status. 33% of the participants had uncontrolled diabetes. The majority of study subjects (68.2%) suffered from hypertension as a co-morbidity, followed by heart disease (10.9%), thyroid disease (10%), and hypercholestrolism (1.8%). 62.7% of the subjects showed treatment adherence for > 4 days/week. Diabetics who had the disease for more than 5 years and followed a proper diet and adhered to treatment (> 4 d/week), showed a better control of glucose levels.
Conclusion: The findings of this study can be used to strengthen NPCDCS program to bridge the knowledge gap regarding self-care among patients and caregivers. Keywords: Type II Diabetes, Self-Care Practices, Diabetic Foot Care |
|
 |
||
Corresponding Author: Maryam Baradaran-Binazir maryam_baradaran@hotmail.com |
Jayabalan J, Gorantla M, Kiranmai B. Exploring the Determinants of Diabetes’ Self-Care Practices among the Diabetics Living in Urban Field Practice Area of Medical College in Hyderabad. J Community Health Research 2024; 13(1): 50-55.
Introduction
Diabetes occurs when pancreas is unable to produce insulin or when body is unable to use the insulin produced. Type II diabetes constitutes 90% of all the cases of diabetes (1).
In 2021, approximately 537 million adults in the age group of 20-79 were living with diabetes. This number is estimated to increase to 643 million by 2030 and 783 million by 2045. 3 in 4 adults suffering from diabetes are predicted to belong to low- and middle-income countries (1).
In India, there are 77 million people who are above the age of 18 and suffer from type II diabetes, and nearly 25 million are prediabetics (2).
Diabetes treatment centers on a good control of blood sugar level. Apart from medication, life style factors such as diet, physical activity, and frequent checking of blood sugar levels act as behaviors that facilitate control of diabetes and help in prevention of complications (3).
Self-care practices involve all the activities that affect the patient’s well-being with regard to any chronic disease (4).
Self-care practices encompass, physical activity, sleep (5).
Appropriate dietary practices, adherence to medication, regular hospital visits, daily foot examination, and knowledge about complications of hypoglycemic episodes (6, 7, 8)
Diabetic foot care is an important part of self-care for limb preservation as diabetics are prone to foot ulcers due to various biochemical changes that form the pathology of diabetes (9).
Diabetics who follow self-care practices can manage their blood glucose levels better, which in turn prevents secondary complications (6). This study aims to evaluate various factors influencing blood sugar control.
Methods
The study included 110 subjects.
In 2021, approximately 537 million adults in the age group of 20-79 were living with diabetes. This number is estimated to increase to 643 million by 2030 and 783 million by 2045. 3 in 4 adults suffering from diabetes are predicted to belong to low- and middle-income countries (1).
In India, there are 77 million people who are above the age of 18 and suffer from type II diabetes, and nearly 25 million are prediabetics (2).
Diabetes treatment centers on a good control of blood sugar level. Apart from medication, life style factors such as diet, physical activity, and frequent checking of blood sugar levels act as behaviors that facilitate control of diabetes and help in prevention of complications (3).
Self-care practices involve all the activities that affect the patient’s well-being with regard to any chronic disease (4).
Self-care practices encompass, physical activity, sleep (5).
Appropriate dietary practices, adherence to medication, regular hospital visits, daily foot examination, and knowledge about complications of hypoglycemic episodes (6, 7, 8)
Diabetic foot care is an important part of self-care for limb preservation as diabetics are prone to foot ulcers due to various biochemical changes that form the pathology of diabetes (9).
Diabetics who follow self-care practices can manage their blood glucose levels better, which in turn prevents secondary complications (6). This study aims to evaluate various factors influencing blood sugar control.
Methods
The present study was a community-based and cross-sectional study performed among type II diabetics living in slums around the urban field practice area of a tertiary care medical college. The prevalence of diabetes’ self-care practices was taken to be 50% and using the formula 4pq/l2, a sample size of 110 was reached. The study subjects were selected using simple random sampling from among the three slums under the UHC (urban health center). The study tool used was the summary of diabetes self-care activities questionnaire (SDSCA) (10).
The above questionnaire contains details regarding diet regimen, life style practices such as exercise and addiction, and blood glucose testing. Ethical approval for the study was obtained from the institution. All the type II diabetics over the age of 18 were included in the study after obtaining their informed consent. Critically ill patients who were unwilling to participate in the study were excluded. The participants were approached at their preferred time of convenience with the help of the field staff from urban health center, and interviews were conducted. Data was collected during February and March of 2023. The data obtained was entered into MS excel and relevant statistical tests were performed.
ResultThe above questionnaire contains details regarding diet regimen, life style practices such as exercise and addiction, and blood glucose testing. Ethical approval for the study was obtained from the institution. All the type II diabetics over the age of 18 were included in the study after obtaining their informed consent. Critically ill patients who were unwilling to participate in the study were excluded. The participants were approached at their preferred time of convenience with the help of the field staff from urban health center, and interviews were conducted. Data was collected during February and March of 2023. The data obtained was entered into MS excel and relevant statistical tests were performed.
The study included 110 subjects.
Table 1. Distribution of study subjects based on sociodemographic characteristics (n = 110)
| Socio demographic characteristics | n = 110 |
|
53 +/- 7.6 |
Female |
30% (33) 70% (77) |
Muslim |
68.20% (75) 31.80% (35) |
Joint |
57.30% (63) 42.70% (47) |
Upper – middle Lower – middle Upper – lower Lower |
20.90% (23) 9.10% (10) 45.40% (50) 15.50% (17) 9.10% (10) |
The mean age of the study population was 53 +/- 7.6. 70% of them were females, 68.2% were Hindus, 57.3% had a nuclear family, and 45.4% belonged to the lower-middle socio-economic status, as presented in Table 1.
Among 110 study subjects, 67% had controlled blood glucose levels, and 33% had uncontrolled diabetes as shown in Figure 1.
Among 110 study subjects, 67% had controlled blood glucose levels, and 33% had uncontrolled diabetes as shown in Figure 1.
Figure 1. Distribution of study subjects based on random blood sugar levels (n = 110)
Figure 2. Distribution of study subjects based on co-morbidities (n = 110)
68.2%of the participants had hypertension which was found to be the most common co-morbidity. This was followed by heart disease (10.9%), thyroid disease (10%), and hypercholestrolism (1.8%). 9.1% of the study subjects had no co-morbidities as shown in Figure 2.
Table 2 shows that 54.5% of the study subjects had diabetes for 5-10 years, and 26.4% of them for more than 10 years. Positive spouse diabetes status was found in 30.9% of the study subjects.
Among the study subjects, 32.7% showed uncontrolled diabetes (RBS > 200). 44.5% were overweight according to BMI, and 17.3% were obese. 8.2% of the individuals were on both OHA and insulin.
68.2% of them were having both diabetes and hypertension, and 25.3% suffered from chronic hypertensives. 42.7% had hypertension for 5-10 years as shown in Table 2.
Table 2 shows that 54.5% of the study subjects had diabetes for 5-10 years, and 26.4% of them for more than 10 years. Positive spouse diabetes status was found in 30.9% of the study subjects.
Among the study subjects, 32.7% showed uncontrolled diabetes (RBS > 200). 44.5% were overweight according to BMI, and 17.3% were obese. 8.2% of the individuals were on both OHA and insulin.
68.2% of them were having both diabetes and hypertension, and 25.3% suffered from chronic hypertensives. 42.7% had hypertension for 5-10 years as shown in Table 2.
Table 2. Distribution of study subjects based on medical history of diabetes (n = 110)
| Parameters | n = 110 |
5 - 10 years > 10 years |
19.10% (21) 54.50% (60) 26.40% (29) |
No |
30.90% (34) 69.10% (76) |
<200 |
67.30% (74) 32.70% (36) |
Overweight Obese |
38.20% (42) 44.50% (49) 17.30% (19) |
Oral hypoglycemics + insulin |
91.80% (101) 8.20% (9) |
No |
68.20% (75) 31.80% (35) |
5 - 10 years > 10 years |
32% (24) 42.70% (32) 25.30% (19) |
Table 3. Association between RBS control and the study variables
| RBS control vs study variable | Odds ratio (95% CI) |
P-value |
| Health profile | ||
|
5.4 (1.2 – 25.5) | < 0.05 (0.017) |
|
1.5 (O.6 – 3.5) | > 0.05 (0.31) |
|
1.1 (0.4 – 3.4) | > 0.05 (0.82) |
| Others | ||
|
0.45 (0.2 – 1.0) | > 0.05 (0.06) |
| Self – care practices | ||
|
2.8 (1.0 – 7.3) | < 0.05 (0.02) |
|
2.2 (0.9 – 5.3) | > 0.05 (0.07) |
|
0.5 (0.2 – 1.2) | > 0.05 (0.11) |
|
1.4 (0.2 – 7.4) | > 0.05 (0.32) |
|
3.5 (1.3 – 8.9) | < 0.01(0.007) |
According to Table 3, controlled RBS demonstrated a significant relationship with duration of diabetes where patients with diabetes of more than 5 years had 5.4 times better glycemic control than those with less period of diabetes. Among self-care practices, RBS showed a significant relationship with general diet where patients following general dietary guidelines had 2.8 times better glycemic control than those who did not follow the same diet. Glycemic control had an extremely significant relationship with medication where patients on regular medication (remembering to take medication regularly on 4 or more days of the week) had 3.5 times better glycemic control than those who did not take medication regularly, as shown in Table 3.
Discussion
The authors would like to thank all the participants and the department of community medicine and the field staff of urban health center who helped the researchers in identifying the patients and building rapport.
Conflicts of interest
The authors declared no conflict of interest.
Funding
This study is not funded.
Authors’ contributions
J. j, collected and analyzed data; M. G and B. K, designed the study, and wrote the manuscript.
Open access policy
JCHR does not charge readers and their institution for access to its papers. Full text download of all new and archived papers are free of charge.
Discussion
The objective of this study was to evaluate various factors influencing blood sugar control among diabetics. The socio demographic findings of diabetics in this study were consistent with the findings of the study conducted in an urban slum in Hyderabad by Chandrika K et al. (11) and the study by Chandra Sekhar Chittooru, et al. (12) in terms of the mean age of the study population and the presence of a slight female preponderance among the study population. A study by V Viswanathan, et al. (13) also indicated a similar mean and gender distribution among the subjects.
The present study showed a higher proportion of diabetics having diabetes for more than 5 years duration. This was consistent with the results of a study done in rural area of Tamil Nadu by Karthik RC, et al (14). However, the prevalence of high BMI of the present study was found to be lower when compared to study conducted by Karthik, et al. (14) which showed a majority of the study subjects to be overweight.
The following co-morbidities among diabetics were compared with the study conducted in urban primary healthcare centers at Bhubaneswar in 2017 by Pati S et al. (15) In the present study, the co-morbidities found were hypertension, followed by heart disease and thyroid disease which were similar to the findings by Pati S, et al. (15) ; their study also revealed the co-morbidities of hypertension, followed by heart disease, stroke, and thyroid disease. The findings of this study were also in accordance with the results found by Shyamsundar Jagdish Raithatha, et al. (16) where the main co-morbidity was also hypertension, followed by ischemic heart disease.
The present study showed a higher proportion of diabetics having diabetes for more than 5 years duration. This was consistent with the results of a study done in rural area of Tamil Nadu by Karthik RC, et al (14). However, the prevalence of high BMI of the present study was found to be lower when compared to study conducted by Karthik, et al. (14) which showed a majority of the study subjects to be overweight.
The following co-morbidities among diabetics were compared with the study conducted in urban primary healthcare centers at Bhubaneswar in 2017 by Pati S et al. (15) In the present study, the co-morbidities found were hypertension, followed by heart disease and thyroid disease which were similar to the findings by Pati S, et al. (15) ; their study also revealed the co-morbidities of hypertension, followed by heart disease, stroke, and thyroid disease. The findings of this study were also in accordance with the results found by Shyamsundar Jagdish Raithatha, et al. (16) where the main co-morbidity was also hypertension, followed by ischemic heart disease.
Adherence to diet and foot care practices in the present study were at a low level. These findings were comparable to those conducted in urban slums of Bengaluru by Dasappa, et al. (17) among 163 diabetics where adherence to diet was low, and good foot care practices were found to be much higher than the findings of this study. However, adherence to physical activity and medication were similar to the present study. A study conducted in Mumbai by Shyamsundar Jagdish Raithatha et al. (16) also suggested that the majority of diabetic patients followed good foot care practices compared to the current study. The difference in findings could be due to varied socio-demographic features of the population compared to those of the present study. The majority of the population was selected from urban slums of Hyderabad. Studies done in urban slums of other major Indian cities demonstrated comparable findings.
Conclusion
The findings of this study can be used to strengthen the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS). Knowledge levels of the patients as well as their care givers regarding self-care in diabetes must be increased through various information, education, and communication (IEC) campaigns as they play a significant role in glycemic control.
The strength of the study was using the validated questionnaire, ‘summary of diabetes self-care activities. History regarding a wide variety of diabetes risk factors.
Limitations of the study were recall bias which may have affected aspects such as diet, and the finding of the study cannot be generalized as it was done in a limited area.
Implications for future research
The strength of the study was using the validated questionnaire, ‘summary of diabetes self-care activities. History regarding a wide variety of diabetes risk factors.
Limitations of the study were recall bias which may have affected aspects such as diet, and the finding of the study cannot be generalized as it was done in a limited area.
Implications for future research
There is a great need for extensive research in developing nations in the field of self-care in diabetes. Additionally, field research should be promoted in developing countries regarding the perceptions of patients as well as their care givers on the effectiveness of various self-care methods in order to allocate resources more efficiently to curb diabetes related morbidities.
Acknowledgements The authors would like to thank all the participants and the department of community medicine and the field staff of urban health center who helped the researchers in identifying the patients and building rapport.
Conflicts of interest
The authors declared no conflict of interest.
Funding
This study is not funded.
Authors’ contributions
J. j, collected and analyzed data; M. G and B. K, designed the study, and wrote the manuscript.
Open access policy
JCHR does not charge readers and their institution for access to its papers. Full text download of all new and archived papers are free of charge.
References
- International Diabetes Federation, diabetes facts and figures, dec 2021. Available at: URL: https://www.idf.org/ aboutdiabetes/what-is-diabetes/facts-figures.html. Accessed May, 2023.
- World Health Organisation- Diabetes, Key facts, 5 April 2023. Available at: URL: https://www.who.int/news-room/fact-sheets/detail/diabetes. Accessed May 31, 2023.
- Rajasekharan D, Kulkarni V, Unnikrishnan B, et al. Self-care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India. Annals of medical and health sciences research. 2015; 5(1): 59-64.
- Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002: 288: 1775–9. doi: 10.1001/jama.288.14.1775
- American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010; 33(supplement 1): S11–S61
- 4. Sigal RJ, Kenny GP, Wasserman DH, et al. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004; 27(10): 2518–2539
- Tomky D, Tomky D, Cypress M, et aL. Aade position statement. The Diabetes Educator. 2008; 34(3): 445-9.
- Mohandas A, Bhasin SK, Upadhyay M, et al. Diabetes self-care activities among adults 20 years and above residing in a resettlement colony in East Delhi. Indian journal of public health. 2018; 62(2): 104-10.
- American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002; 25(1): 202–212.
- Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes care. 2000; 23(7): 943-50.
- Chandrika K, Das BN, Syed S, et al. Diabetes Self-Care Activities: A Community-Based Survey in an Urban Slum in Hyderabad, India. Indian J Community Med. 2020; 45(3): 307-310.
- Chittooru CS, Ananda KG, Panati D, et al. Self-care practices and its determinants among diabetic population in rural Andhra Pradesh, India: A cross-sectional study. Clinical Epidemiology and Global Health. 2022; 16: 101102.
- Viswanathan V, Thomas N, Tandon N, et al. Profile of diabetic foot complications and its associated complications—a multicentric study from India. Journal of Association of Physicians of India. 2005; 53: 933–936.
- Karthik RC, Radhakrishnan A, Vikram A, et al. Self-care practices among type II diabetics in rural area of Kancheepuram district, Tamil Nadu. Journal of family medicine and primary care. 2020; 9(6): 2912-8.
- Pati S, Schellevis FG. Prevalence and pattern of co morbidity among type2 diabetics attending urban primary healthcare centers at Bhubaneswar (India). PLoS One. 2017; 12(8): e0181661.
- Raithatha SJ, Shankar SU, Dinesh K. Self-care practices among diabetic patients in Anand district of Gujarat. International Scholarly Research Notices. 2014. doi: 10.1155/2014/743791
- Dasappa H, Prasad S, Sirisha M, et al. Prevalence of self-care practices and assessment of their sociodemographic risk factors among diabetes in the urban slums of Bengaluru. J Family Med Prim Care. 2017; 6(2): 218-221.
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution 4.0 International License. |
