Assessment of the knowledge and self- care practice on hypoglycemia among patients with diabetic mellitus attending medical OPD at SMCH
Автор: Cecyli C., Preethi K., Priyadarsini A.
Журнал: Cardiometry @cardiometry
Рубрика: Original research
Статья в выпуске: 23, 2022 года.
Бесплатный доступ
Introduction: Hypoglycemia is a clinical emergency that needs to be recognized and treated promptly to avoid organ damage and death. Knowledge of hypoglycemia prevention is an essential step in self-care practices due to the fact knowledgeable individuals are much more likely to practice hypoglycemia prevention. Prevention of hypoglycemia relies on adequate awareness and rightself-care. Objectives: To evaluate the level of knowledge and to self - care practice of hypoglycemia with their selected demographic variables among diabetic patients. Methods: A cross sectional descriptive research design was adopted with hundred samples who met the inclusion criteria in the hospital setting. Self-structured questionnaire method was used to acquire the data. Data have been through descriptive and inferential statistics. Result: Of 100 samples, 76(76%) had adequate knowledge and 63(63%)had good self-care practice on hypoglycemia. Spearman’s correlation showed positive relationship between knowledge and self-care practice of hypoglycemia (r value = 0.720, p
Knowledge, self-care practice, hypoglycemia, diabetes mellitus, diabetic patients
Короткий адрес: https://sciup.org/148326560
IDR: 148326560 | DOI: 10.18137/cardiometry.2022.23.103110
Текст научной статьи Assessment of the knowledge and self- care practice on hypoglycemia among patients with diabetic mellitus attending medical OPD at SMCH
Cecyli C, Preethi K, Priyadarsini A. Assessment of the Knowledge and Self- Care Practice on Hypoglycemia among Patients with Diabetic Mellitus Attending Medical Opd at Smch. Car-diometry; Issue 23; August 2022; p. 103-110; DOI: 10.18137/ cardiometry.2022.23.103110; Available from:
Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycaemia due to insufficient insulin secretion, inadequate insulin action, or both (World Health Organization [WHO], 2016) (1). According to the International Diabetes Federation, more than 382 million people (8.3%) worldwide have diabetes, which is expected to increase to more than 592 million by 2035. China and India lead the way. the world in terms of number of cases. For example, an estimated 98.4 million adults in China and 65.1 million adults in India have diabetes (2). Insufficient insulin secretion can lead to diabetes. The three most common types of diabetes are type 1 diabetes (DM1), type 2 diabetes (DM2), and gestational diabetes (1). In 2000, about 171 million people worldwide had diabetes; By 2011, that number had grown to more than 366 million people, and that number is expected to grow to more than 552 million by 2030 [1].
A systematic review and meta-analysis in patients with type II diabetes reported that the prevalence of mild, moderate, and severe hypoglycemia was 45% and 6%, respectively [3]. Another multicenter study to evaluate the incidence and predictors of hypoglycemia reported that 83.0% of type I diabetic patients and 46.5% of type II diabetic patients had hypoglycemia. [4] Hypoglycemia is defined as “abnormally low blood sugar (<70 mg/dl)” and is one of the acute complications of diabetes [2]. Symptoms of low blood sugar vary from person to person and change over time. People with low blood sugar may sweat, shiver, feel hungry and anxious at initial period. Difficulty walking, weakness, impaired vision; Personality changes, confusion, and loss of consciousness or convulsions may be observed [5].
Hypoglycaemic events are the most common side effects of insulin and stomach upset caused by oral hypoglycemic agents. 60.3% of patients did not adhere to routine glycemic control [6]. Multiple reports indicate that different drugs such as metformin and rosigli-tazone have broad-spectrum side effects, including weight gain, hypoglycemia, and risk of coronary heart disease [7]. A good understanding of hypoglycemia is positively correlated with good hypoglycemia prevention practices [8]. The goal of self-care is to achieve optimal glycemic control and avoid complications. Regular exercise, good nutrition practices, daily foot care practices, adherence to medication regimens, and management of hypoglycemic episodes are all examples of such activities [9].
This study aimed to determine the level of understanding and practice of hypoglycemia self-management in patients with diabetes, in order to predict the latent state of knowledge and maintain the patient’s ability to self-manage hypoglycemia.
METHODS AND MATERIALS
A quantitative research approach with a cross-sectional descriptive study design was used to conduct the study in medical OPD at SMCH. A sample of 100 patients was selected using convenience sampling technique. The sampling criteria were adult diabetic patients aged 45-70 years with a diagnosis of type 1 and type 2 diabetes for more than one year and the patient was being treated with hypoglycemic agents or insulin or both within the past year in OPDunder medical consultation. People with mental disorders, pregnant women with gestational diabetes were excluded. The data collection phase was performed with prior authorization from the SMCH department head, and ethical permission was obtained from the Institutional ethics committee. The purpose of the study was explained to the patients and informed written consent was obtained from them. One instrument consists of part A demographic and clinical variables and part B has a self-structured knowledge assessment questionnaire consisting of 20 questions. Part C is a self-structured personal practice assessment questionnaire consisting of 20 questions that are evaluated using a rating scale with the options never = 0, sometimes = 1 and always = 2. Descriptive and inferential was wont for data analysis. Spearman’s correlation was used to find an association between knowledge and practice of self-care for hypoglycemia, and chi-square was used 104 | Cardiometry | Issue 23. August 2022
to relate self-care knowledge and practice with selected demographic variables.
RESULT AND DISCUSSION
Section A: Distribution of demographic characteristics
The total number of participants is 100. Among every 100 people, 48% are under 51-60 years old, and 57% are women the prominent educational status is35% of secondary education. Most of the participants are private employees (33%), and 36% of participants earn less than Rs. 5000/. Majority of Hindu participants participated in study (52%). Among the participants, 75% were married and 77% did not eat vegetarian food. 54% of the participants had no family history of diabetes. 66% of the participants had no bad behavior. Regarding the presence of comorbidities, 85% of participants had high blood pressure, 67% of participants had type 2 diabetes, and 44% of participants had blood glucose levels below 80 mg/dl. 56% of participants had diabetes ≤ 5 years. 62% of the participants followed the OHS treatment method, and 53% of the participants took the drug twice a day. 63% of the participants had a history of hypoglycemia, as shown in Table 1.
Table 2 shows the knowledge about hypoglycemia. Of 100 samples, 76 (76%) samples have adequate knowledge about hypoglycemia, 24 (24%) are inadequate and for the practice ofself-care,63 of 100 samples (63%) had a good self-care practice and 37 (37%) had poor self-care practice.
Similarly, a study by Mohammad Zeya Ansari et al.(2020)evaluated knowledge and attitudes about hypoglycemia in diabetic patients showed that 78.5% of the 130 patients had good knowledge.[10] Naif Mohammed Albaqami (2018) assessed knowledge of hypoglycemia in patients with type 2 diabetes. Of the 386 participants, 61.4% had a good knowledge of hypoglycaemia [11]. Therefore,the results of one study are consistent with those of Anthony Ejegi et al. (2016) found that most patients have a considerable or good understanding of hypoglycemia. [12] Vanishree shriraamet al.(2015) reported a similar finding that 242 (66.1%) diabetic patients had a good knowledge of hypoglycemia [13].
Thi Kim Cuc Ngo PharmB (2020) evaluated the knowledge, attitude and practice (KAP) of Vietnamese diabetic patients about hypoglycemia in an outpatient setting, and found that the proportions of partic-
Distribution of sociodemographic variables of study participants
|
Variable |
Category |
Frequency |
Percentage |
|
Age |
40-50 years |
31 |
31% |
|
51-60 years |
48 |
48% |
|
|
61-70years |
13 |
13% |
|
|
More than 70 years |
8 |
8% |
|
|
Gender |
Male |
43 |
43% |
|
Female |
57 |
57% |
|
|
Educational |
No formal Education |
25 |
25% |
|
Primary Education |
23 |
23% |
|
|
Secondary Education |
35 |
35% |
|
|
Graduate |
17 |
17% |
|
|
Occupation |
Daily Wages |
30 |
30% |
|
Government Employee |
22 |
22% |
|
|
Private Employee |
33 |
33% |
|
|
Unemployment |
15 |
15% |
|
|
Income |
below Rs. 5000 |
36 |
36% |
|
Rs. 5001- 10000 |
33 |
33% |
|
|
Rs. 10001-20000 |
19 |
19% |
|
|
above Rs.20001 |
12 |
12% |
|
|
Religion |
Hindu |
44 |
44% |
|
Muslim |
16 |
16% |
|
|
Christian |
34 |
34% |
|
|
Other |
6 |
6% |
|
|
Residence |
Urban |
48 |
48% |
|
Rural |
52 |
52% |
|
|
Marital status |
Married |
75 |
75% |
|
Single |
19 |
19% |
|
|
Divorced |
2 |
2% |
|
|
Widowed |
4 |
4% |
|
|
Dietary pattern |
Vegetarian |
23 |
23% |
|
Non vegetarian |
77 |
77% |
|
|
Family history of diabetic mellitus |
Yes |
46 |
46% |
|
No |
54 |
54% |
|
|
Any substandard behaviour |
Alcohol |
25 |
25% |
|
Smoking |
7 |
7% |
|
|
Drug abuse |
2 |
2% |
|
|
Nil |
66 |
66% |
|
|
Presence of co-morbidities |
Hypertension |
85 |
85% |
|
Dyslipidemia |
11 |
11% |
|
|
Renal failure |
1 |
1% |
|
|
Heart failure |
3 |
3% |
|
|
CLINICAL PROFILE: |
|||
|
Type of diabetes mellitus |
Type 1 (IDM) |
33 |
33% |
|
Type 2 (NIDM) |
67 |
67% |
|
|
Random blood glucose level |
less than 80 |
44 |
44% |
|
80-130mg/dl |
38 |
38% |
|
|
130-200mg/dl |
7 |
7% |
|
|
more than 200 |
11 |
11% |
|
|
Variable |
Category |
Frequency |
Percentage |
|
Diabetes mellitus- Duration |
≤ 5 years |
56 |
56% |
|
6-10 years |
29 |
29% |
|
|
> 10 years |
15 |
15% |
|
|
Current mode of treatment |
OHS |
62 |
62% |
|
Insulin |
34 |
34% |
|
|
both OHS and insulin |
4 |
4% |
|
|
Medication-Frequency |
once a day |
45 |
45% |
|
twice a day |
53 |
53% |
|
|
thrice a day |
2 |
2% |
|
|
History of hypoglycemia |
Yes |
63 |
63% |
|
No |
37 |
37% |
Table 2
Frequency and percentage distribution of knowledge and self – care practice of Hypoglycemia.
The results of the study found that knowledge of hypoglycemia was positively correlated withself-care practice (r value = 0.720), p <0.001.The results of study were supported by research by Thi Kim Cuc Ngo PharmB (2020),which showed that there is a positive correlation between good patient knowledge and good practice skills (p<0.001)[14], as shown in Table 3. Table 3
Correlation between knowledge and self-care management among hypoglycemia patients.
|
Variables |
Self-care practice |
||
|
N |
R |
P |
|
|
Knowledge |
100 |
0.720 |
0.001 |
The demographic variables of the level of knowledge of patients with hypoglycemia found age (χ2=134.522and P=0.001), education (χ2=147.290 and p=0.001), occupation (χ2=144.981 and p=0.001), income (χ2=157.372 and p=0.001), religion (χ2=134.721and p=0.001),marital status (χ2=132.783 and p=0.001)and family history of diabetic mellitus (χ2=156.532 p=0.001) were statistically significant as shown in Table 4.
Similarly, a study by Thenmozhi et.al (2018) evaluated the level of knowledge about hypoglycemia among diabetic patients in rustic communities indicating that age is associated with a level of p<0.05. [18] Vanishree Shriram et al. (2015) also studied the knowledge of hypoglycemia and related factors in patients with type 2 diabetes in tertiary hospitals and the results showed that advanced age, illiteracy and low socioeconomic status are associated to the knowledge of hypoglycemia. [13] Girma Nega Gezie et al. (2015) conducted a study to assess the knowledge and practice of the prevention of hypoglycemia and related factors in diabetic patients. The results of the study showed that educational level and knowledge are positively correlated. [15]
Table 5 Found the self-care practice and the demographic variables of hypoglycemia, age (χ2 = 106.146 and P = 0.001), sex (χ2 = 118.264 and p = 0.001),
Association between the level of knowledge on hypoglycemia and selected socio demographic variable among patients with diabetes mellitus
|
Variable Category |
Knowledge of Hypoglycemia |
Total |
χ2 / p Value |
|||
|
Inadequate |
Moderate |
Adequate |
||||
|
Age |
40-50 years |
11 35.49% |
7 22.58% |
13 41.93% |
31 100% |
χ2=134.522 P=0.001 |
|
51-60 years |
12 25% |
22 45.84% |
14 29.16% |
48 100% |
||
|
61-70 years |
4 30.77% |
2 15.38% |
7 53.85% |
13 100% |
||
|
More than 70 years |
0 0% |
3 37.50% |
5 62.50 % |
8 100% |
||
|
Educational |
No formal Education |
5 20% |
10 40% |
10 40% |
25 100% |
χ2=147.290 p=0.001 |
|
Primary Education |
6 26.08% |
10 43.47% |
7 30.45% |
23 100% |
||
|
Secondary Education |
10 28.57% |
7 20% |
18 51.42% |
35 100% |
||
|
Graduate |
6 35.29% |
9 52.94% |
2 11.76% |
17 100% |
||
|
Occupation |
Daily Wages |
8 26.66% |
8 26.66% |
14 46.68% |
30 100% |
χ2=144.981 p=0.001 |
|
Government Employee |
7 31.81% |
7 31.81% |
8 36.38% |
22 100% |
||
|
Private Employee |
9 27.27% |
9 27.27% |
15 45.46% |
33 100% |
||
|
Unemployment |
7 46.66% |
2 13.34% |
6 40% |
15 100% |
||
|
Income |
below Rs. 5000 |
8 22.24% |
14 38.88% |
14 38.88% |
36 100% |
χ2=157.372 p=0.001 |
|
Rs. 5001- 10000 |
9 27.27% |
12 36.38% |
11 33.35% |
33 100% |
||
|
Rs. 10001-20000 |
3 15.78% |
3 15.78% |
13 68.44% |
19 100% |
||
|
above Rs.20001 |
6 50% |
1 8.33% |
5 41.66% |
12 100% |
||
|
Religion |
Hindu |
11 25% |
12 27.27% |
21 47.72% |
44 100% |
χ2=134.721 p=0.001 |
|
Muslim |
5 31.25% |
3 18.75% |
8 50% |
16 100% |
||
|
Christian |
8 23.53% |
8 23.53% |
18 52.94% |
34 100% |
||
|
Other |
1 16.66% |
2 33.34% |
3 50% |
6 100% |
||
|
Marital status |
Married |
18 24% |
15 20% |
42 56% |
75 100% |
χ2=132.783 p=0.001 |
|
Single |
7 36.84% |
5 26.31% |
7 36.84% |
19 100% |
||
|
Divorced |
1 50% |
1 50% |
0 0% |
2 100% |
||
|
Widowed |
1 25% |
1 25% |
2 50% |
4 100% |
||
|
Family history of diabetic mellitus |
Yes |
12 22.22% |
18 33.33% |
24 44.44% |
54 100% |
χ2=156.532 p=0.001 |
|
No |
11 23.92% |
18 39.13% |
17 36.95% |
46 100% |
||
Association between the level of self-care on hypoglycemia and selected socio demographic variable among patients with diabetes mellitus
|
Variable Category |
Self-care Practice of Hypoglycemia |
Total |
χ2 / p Value |
|||
|
Poor |
average |
Good |
||||
|
Age |
40-50 years |
9 29.03% |
6 19.35% |
16 51.62% |
31 100% |
χ2=106.146 P=0.001 |
|
51-60 years |
14 29.16% |
16 33.33% |
18 37.51% |
48 100% |
||
|
61-70 years |
1 7.69% |
4 30.77% |
8 61.54% |
13 100% |
||
|
More than 70 years |
1 12.50% |
3 37.50 % |
4 50% |
8 100% |
||
|
Gender |
Male |
12 27.90% |
9 20.93% |
22 51.17% |
43 100% |
χ2=118.264 p=0.001 |
|
Female |
7 12.29% |
8 14.03% |
42 73.68% |
57 100% |
||
|
Educational |
No formal Education |
5 20% |
8 32% |
12 48% |
25 100% |
χ2=104.190 p=0.001 |
|
Primary Education |
6 26.08% |
7 30.45% |
10 43.47% |
23 100% |
||
|
Secondary Education |
9 25.71% |
6 17.15% |
20 57.14% |
35 100% |
||
|
Graduate |
5 29.42% |
4 23.53% |
8 47.05% |
17 100% |
||
|
Occupation |
Daily Wages |
7 23.33% |
7 23.33% |
16 53.34% |
30 100% |
χ2=112.347 p=0.001 |
|
Government Employee |
2 9.10% |
8 36.36% |
12 54.54% |
22 100% |
||
|
Private Employee |
7 21.22% |
9 27.27% |
17 51.51% |
33 100% |
||
|
Unemployment |
2 13.33% |
4 26.67% |
9 60% |
15 100% |
||
|
Income |
below Rs. 5000 |
8 22.22% |
10 27.78% |
18 50% |
36 100% |
χ2=114.605 p=0.001 |
|
Rs. 5001- 10000 |
11 33.35% |
9 27.27% |
12 36.38% |
33 100% |
||
|
Rs. 10001-20000 |
5 26.31% |
4 21.05% |
10 52.64.% |
19 100% |
||
|
above Rs.20001 |
1 8.34% |
5 41.66% |
6 50% |
12 100% |
||
|
Religion |
Hindu |
10 22.72% |
11 25% |
23 52.28% |
44 100% |
χ2=128.410 p=0.001 |
|
Muslim |
3 18.75% |
9 56.25% |
4 25% |
16 100% |
||
|
Christian |
10 29.42% |
8 23.53% |
16 47.05% |
34 100% |
||
|
Other |
1 16.66% |
3 50% |
2 33.34% |
6 100% |
||
|
Residence |
Urban |
11 22.92% |
14 29.16% |
23 47.92% |
48 100% |
χ2=7.648 p=0.129 |
|
Rural |
15 28.84% |
10 19.23 |
27 51.92% |
52 100% |
||
CONCLUSION
One of the difficulties with tight control of blood glucose levels is that such attempts may result in hypoglycemia, which causes far more serious complications than an increased level of blood glucose. Hypoglycemia, is a key limiting factor and a frequently overlooked complication of diabetes treatment, has far-reaching clinical consequences. Blood glucose management must be tailored to each individual’s unique characteristics while maintaining a certain level of safety. Healthcare professionals play a key role in educating diabetic clients about the risk factors of hypoglycemia, recognizing the symptoms of hypoglycemia, the first step to hypoglycemia, monitoring blood glucose, and choosing right treatment options and conducting proper education programmes using an information booklet/ Pamphlets for diabetic patients in preventing potential hypoglycemia complications. Effective patient education and Counseling is critical for reducing the risk and consequences of hypoglycemia. As a result, we recommend that patients receive hypoglycemia counseling during their visit to the diabetic clinic in hospitals.
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