Assessing the Knowledge, Attitude and Practice of Diabetes Mellitus among Diabetes Patients in Dhaka City, Bangladesh
This study was undertaken to find out the knowledge, attitude and practice of diabetic patients at three centers BIRDEM at Shahbag, Dhaka, BIRDEM at Rampura, Dhaka and Baridhara Park, Dhaka. A wellstructured questionnaire was used to collect information on knowledge, attitude and practice along with socio demographic data of the patients and clinical history of diabetes and clinical data reflecting diabetes complications. Out of 202 patients, 97.52% were aware of the signs and symptoms of diabetes, 78.71% were aware of the risk factors of diabetes and 51.49% had knowledge of causes of diabetes. About 88.61% of patients were aware of the symptoms of hyperglycemia; a lower percentage, 59.9% were aware of the symptoms of hypoglycemia whereas HbA1C level was known to only 27.72% patients. Majority of patients reported regular routine follow up diet and exercise etc. for controlling DM. However, glycemic control was poor among 46.67% of respondents and 62.38% patients never performed self blood sugar test due to lack of knowledge or lack of the feeling of necessity to do it. Knowledge and attitude towards diabetes mellitus is showing improvement in Dhaka, however more efforts should be taken by healthcare professionals so that patients improve self control of sugar. Keyword: Diabetes mellitus; diabetes patient; knowledge of diabetes; practice pattern of diabetes Nafisa Tanjia et al 65 J Pharm Chem Biol Sci March May 2016; 4(1):64 75 diabetes in the year of 2014. In 2012 around 1.5 million people died because of diabetes. Developing countries account for more than 80% of the diabetes deaths [2] The percentage of population affected by diabetes is increasing day by day among all age groups. Worldwide diabetic prevalence was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people suffering from diabetes is assumed to increase from 171 million in 2000 to 366 million in 2030. The top three countries estimated to have the highest numbers of people with diabetes in 2000 and 2030 are India, China, and U.S. In the both time period Bangladesh, Brazil, Indonesia, Japan, and Pakistan are considered within the top ten countries [3] Universally adopted classification of diabetes mellitus was given in 1997 by The Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Autoimmune destruction of beta cells is the reason of Type 1 diabetes. The reason may also be idiopathic. Adults are mainly affected by the Type 2 DM (Diabetes Mellitus) as a result of insulin resistance. Other types are impaired fasting glucose (IFG) impaired glucose tolerance (IGT) gestational diabetes and some genetic defects of beta cells [4] Diabetes screening is important for both symptomatic patient and individuals without having any symptoms [7] Individuals are considered to be at high risk of developing diabetes mellitus and its complication if impaired fasting glucose (IFG) impaired glucose tolerance (IGT) or a glycated hemoglobin (A1C) of 6.0% to 6.4% is observed during diagnosis. Usually this condition is referred as "Prediabetes" [6] Screening will detect either individual is at low risk or high risk for developing diabetes. Strategies for screening may vary depending on the type of diabetes and effective ways to prevent the development of diabetes from prediabetes and/or to minimize the risk of complication that are associated with diabetes [7] Early prediction of individual's risk of developing type 1 diabetes is possible from profiling immunity and genetic markers [9] and from family history of type 1 diabetes with the information about the age of onset and sex of that family member [8] Active researches are still trying to find out the preventive measure of type 1 diabetes. It is proved that lower rates of cardiovascular disease and renal failure, overall significant health benefits can be achieved because of delayed onset of type 2 diabetes [5] Primary approaches for preventing diabetes in a population can be promoting physical activity and healthy diet intake among general population and targeting high risk individuals [10, 11] Active patient participation in the management of the disease condition and self monitoring of the physiological processes is known as Selfmanagement Education (SME) [12] Monitoring of relevant health parameters, healthy eating, physical activity, pharmacotherapy, prevention and management of hypo hyperglycemia, and prevention and surveillance of complications should be included in basic knowledge of diabetes mellitus Self management Education (SME) Skill training should include using selfmonitoring of blood glucose (SMBG) making appropriate dietary choices, incorporating an exercise regimen, using medications as recommended and adjusting medication [14, 15] Insulin therapy is initiated among the patients immediately after being diagnosed with type 1 diabetes. At this point insulin regimen selection and patients' education is very important [16] Patients of type 2 diabetes are from heterogeneous group. In this type of diabetes, glucose levels worsen over time because of ongoing decline of beta cell function. That's why individualized treatment regimens and therapeutic targets are required [17] Detailed Nafisa Tanjia et al 66 J Pharm Chem Biol Sci March May 2016; 4(1):64 75 information on how to care for and use insulin; prevention, recognition and treatment of hypoglycemia; sick day management; adjustments for food intake (e.g. carbohydrate counting) and physical activity; and selfmonitoring of blood glucose (SMBG) should be included in the initial and ongoing education programme [16] MATERIALS AND METHOD The study was conducted between the period of November 2014 to April 2015 at three centers BIRDEM (Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders) at Shahbag, Dhaka, BIRDEM at Rampura, Dhaka and Baridhara Park. The patients having diabetes were included in the study and given predesigned questionnaire. Children and pregnant women were excluded from the survey. The questionnaire did not contain any questions which can reveal the identity of patients or their treating doctors. Out of 225 patients who were given questionnaire, only 202 patients were included for the final analysis. Rests were excluded due to incomplete or irrelevant information and poor handwriting. In addition to KAP, we collected sociodemographic data that include gender, age, occupation, marital status, educational level, income, family history of diabetes, duration of diabetes and medications. Clinical data, including diabetes complications and HbA1c (within six months prior to the survey) of participants were retrieved from medical records (HbA1c available for 30 patients only) Glycemic control was considered good, acceptable or poor when HbA1c levels were less than 7% 7 to 8% and greater than 8, respectively, according to the American Diabetes Association's recommended guidelines [18] In the questionnaire, patients' knowledge of diabetes was assessed using questions related to definitions, symptoms, causes and complications of DM. Attitudes were assessed using a series of questions on positive and/or negative attitudes towards having the disease, the ability to self manage diabetes and awareness of the importance of adherence to DM (self) care. Patients' practices were assessed using questions on self care, dietary modification, compliance with medications, weight control, self monitoring of blood sugar, and regular follow up. Information about their treatment was collected either from the patient or from their prescription, Data were analyzed using Microsoft Excel 2007.