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| From
the Editor |
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Editorial
A. Abyad (Chief Editor) |
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Original contribution/Clinical Investigation
Diabetes Mellitus
- Knowledge, Management and Complications: Survey
report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah
Haider, Muhammad Masood Ahmad
Alanine aminotransferase
indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa
Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley
Pocock
Comparative Analysis of Antimicrobial Peptides
Gene Expression in Susceptible/Resistant Mice
Macrophages to Leishmania major Infection
Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani,
Amir Tavakoli Kareshk, Arash Asadi
Does
socio-economic status of the patients have effect
on clinical outcomes after coronary artery bypass
grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed
Kouhpyma
Comparison of the uterine
artery Doppler indices during pregnancy between
gestational diabetes and diabetes mellitus and
healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud
Jaafarnejhad,
Parisa Bahrami Kamangar
Survey single dose
Gentamicin in treatment of UTI in children with
range of 1 month to 13 years old in Jahrom during
2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab
Evaluation of control of
bleeding by electro cauterization of bleeding
points of amplatz sheath tract after percutaneous
nephrolithotomy (PCNL) in Jahrom Peymanieh hospital
during year 2015-2016
Ali Reza Yousefi , Reza Inaloo
Comparison of the three-finger
tracheal palpation technique with triple ID
formula to determine endotracheal tube depth
in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza
Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori
Effect of Sevoflurane
and Propofol on pulmonary arterial pressure
during cardiac catheterization in children with
congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza
Mohseni, Azim Zaraki
Population and Community Studies
Prevalence
and risk factors of obesity in children aged
2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud
Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal
Darwish
Study and comparison
of psychological disorders in normal students
and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Comparative
study of self-concept, physical self-concept,
and time perspective between the students with
multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad
Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani
Relationship
between Coping Styles and Religious Orientation
with Mental Health in the Students of the Nursing-Midwifery
Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid
Dastras, Shirzad Arianmehr
Tuberculosis in Abadan,
Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood
Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi,
Rahil Hojjati,
Parvin Gholizadeh
Family Stability and Conflict
of Spiritual Beliefs and Superstitions among
Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad
; Hassan Zareei Mahmoodabadi ; Hossein Tavangar
; Seyed Mojtaba Yassini Ardekani ; Ali Akbar
Vaezi
A comparative
study of the self-actualization in psychology
and Islam
Simin Afrasibi, Zakieh Fattahi
The effectiveness
of cognitive - behavioral therapy in reducing
the post-traumatic stress symptoms in male students
survivors of earthquake in the central district
of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh
Reviews
Effects and mechanisms
of medicinal plants on stress hormone (cortisol):
A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley
Pocock
Comparing Traditional
and medical treatments for constipation : A
Review Article
Mohammad Yaqub Rajput
A review of anti-measles
and anti-rubella antibodies in 15- 25 year old
women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab
Review of percutaneous
nephrolithotomy in children below 12 years old
in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo
Physical and
mental health in Islam
Bahador Mehraki, Abdollah Gholami
International Health Affairs
The Challenges of Implementation
of Professional Ethics Standards in Clinical Care
from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh
Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi
Cognitive Determinants
of Physical Activity Intention among Iranian Nurses:
An Application of Integrative Model of Behavior
Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki,
Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi
Effect of resilience-based
intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader
Aghakhani, Vahid Alinejad, Yaser Moradi
Education and Training
Calculation of Salaries
and Benefits of Faculty Members in the Ministry
of Health and Medical Education of Iran
Abdolreza Gilavand
The effect of education
on self-care behaviors of gastrointestinal side
effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram
Razie, Lila Nezam Abadi Farahani
Creating and
Validating the Faith Inventory for Students
at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein
Maktabi, Ehsan Moheb
Creating
and Validating the Adjustment Inventory for
the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi,
Ehsan Moheb
Evaluating
the Quality of Educational Services from the
Viewpoints of Radiology Students of Ahvaz Jundishapur
University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl
An Investigation
of Psychosocial aspect of Iranian Nursing Students'
Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari
Anbohi, Amir Almasi-Hashiani, Fariba Borhani
Clinical Research and Methods
Comparison of the
Antibacterial Effects of Chlorhexidine Mouth
washes with Jaftex Mouth wash on Some Common
Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi
Study of the effect
of plasma jet on Fusarium isolates with ability
to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi
Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss
The comparison of
anti-inflammatory effect in two methods of topical
dexamethasone injection and topical application
of ginger alcoholic extract after removing mandibular
wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran
Mirzaie, Ramin Seyedian, Narges Aria, Saman
Jokar
The effect of curcumin
on growth and adherence of major microorganisms
causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami,
Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab
|
|
Chief
Editor -
Abdulrazak
Abyad
MD, MPH, MBA, AGSF, AFCHSE
.........................................................
Editorial
Office -
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Institute
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Phone: (961) 6-443684
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Email:
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|
|
|
| November 2017
- Volume 15, Issue 9 |
|
|
Diabetes Mellitus –
Knowledge, Management and Complications: Survey
report from Faisalabad-Pakistan
Ijaz Anwer (1)
Ahmad Shahzad (2)
Kashmira Nanji (3)
Farah Haider (4)
Muhammad Masood Ahmad (5)
(1) Anwer Clinic, Peoples Colony Faisalabad;
(2) Al Raheem Clinics, GM Abad, Faisalabad;
(3) Department of Family Medicine, The Aga Khan
University, Karachi;
(4) Jinnah Medical and Dental College, Karachi;
(5) Masood Medicare, Mian Colony, Faisalabad
Corresponding author:
Dr. Kashmira Nanji
Department of Family Medicine,
The Aga Khan University,
KarachiPakistan
Email: Kashmira.nanji@aku.edu
|
Abstract
Introduction: Diabetes
mellitus is a major health problem worldwide
that increases morbidity and mortality
rates due to its complications. The objective
of this study was to assess the knowledge
of diabetic patients about their disease,
its complications and management.
Methods: A cross-sectional study
was conducted in outpatient clinics of
Faisalabad, Pakistan during March to May
2017. A total of 691 diabetic patients
(verified from physician, medical records)
were consecutively approached and a pretested,
structured questionnaire was used to collect
their information. SPSS version 19.0 was
employed for entering and analysis of
the data.
Results:: Out of the total 691
patients 43.3% were male and 56.7% female.
About 49.1% of the patients were below
50 and 50.9% were above 50 years of age.
One third of patients (33.4%) think that
diabetes is a communicable disease. The
majority of the patients (90%) responded
that in diabetes sugar and sweets have
to be cut down and 82.6% knew that exercise
is important for the management of diabetes.
Approximately 58% patients responded that
they exercise, while 60.7% replied that
they monitor and control their blood pressure.
Conclusion: The overall level of
awareness in diabetics was found to be
low and there is a need to educate the
population on this topic. Public and private
health sectors need to offer holistic
services and training programs for health
care professionals. These programs should
focus on improving communication with
patients, addressing misconceptions and
sharing culturally sound strategies with
patients for improvement in diabetes management.
Key words: Diabetes
mellitus, Knowledge, Awareness, Complications,
Pakistan
|
Diabetes mellitus is a major public health
problem that accounts for increased morbidity
and mortality rates worldwide because of its
various complications mostly related to the
cardiovascular system(1). According to the International
Diabetes Federation (IDF) 415 million adults
are currently living with diabetes and this
figure is expected to increase to 642 million
by the year 2040(2). It is also reported that
41.7% of adults with diabetes are undiagnosed(3).
Diabetes in Pakistan is increasing at an alarming
rate. Currently, in Pakistan there are about
7 million people with diabetes and this number
is predicted to rise to 14.4 million by the
year 2040. With this, Pakistan will rank 8th
in the world in terms of prevalence(4, 5) of
this disease.
The risk of diabetes is determined by several
factors. Ethnicity, family history of diabetes,
and history of gestational diabetes, increasing
age, obesity, unhealthy diet, physical inactivity
and smoking increase the odds of developing
diabetes (6-8). Obesity and physical inactivity
are estimated to contribute largely towards
the global diabetes burden (9-11).
Studies suggest that diabetes related complications
can result in 10 to 30% decrease in life expectancy
(1, 12). There is a high burden of diabetes-related
complications in Pakistani patients. A study
conducted by Chavan et al concluded that there
is a lack of knowledge among diabetic patients
regarding complications and importance of compliance
to diabetic medications(13). Different studies
have documented a positive association between
patient’s knowledge about diabetes and
treatment compliance(1, 14). However, such studies
in Pakistan are limited and are mainly focused
around major cities.
Diabetes mellitus (DM) requires multifaceted
interventions where patients can make decisions
about exercise, weight control, blood glucose
monitoring, and compliance to treatment and
prevention of complications. Awareness about
diabetes and its complications will enable the
patients to cope and adjust to their illness.
Therefore, the objective of this study was to
assess the knowledge of diabetic patients about
their disease and its management. It may assist
physicians and patients to design strategies
to delay the progression of DM complications
with proper management and patient education.
This cross-sectional study was conducted in
the outpatient clinics of Faisalabad Pakistan
during March to May 2017. Faisalabad is the
third-most-populous city in Pakistan and its
residents are comprised of a diverse population
belonging to different ethnicities and socio-economic
groups. Diabetics patients (verified from physician
and the medical record) visiting the outpatient’s
clinics of more than 18 years of age and who
gave consent to participate were included in
the study. However patients suffering from serious
co-morbid conditions such as cancer were excluded.
A total of 691 patients were consecutively interviewed
for this study.
A structured pre-tested questionnaire was formulated
after extensive literature search and consensus
by study investigators. The final questionnaire
was comprised of three sections; the first section
included the socio-demographic profile of the
participants, the second part had questions
about knowledge of diabetes and the third part
dealt with questions about patients’ compliance
to various management strategies for diabetes.
The English version of the questionnaire was
translated into Urdu and was then back translated
into English to check for consistency between
the two versions.
Written informed consent was obtained from
all the participants. The data collectors were
trained for maintaining confidentiality of the
participant. Personal identifiers were removed
from study documents. The study was conducted
in accordance with the ‘Ethical principles
for medical research involving human subjects’
of the Helsinki Declaration. Data was entered
and analyzed using the Statistical Package for
Social Sciences (SPSS version 19). Frequencies
and proportion were reported for all variables
of interest. A p- value of less than 0.05 was
considered statistically significant throughout
the analysis.
A
total
of
720
patients
were
approached
out
of
which
691
agreed
to
participate
in
the
study
yielding
a
response
rate
of
95%
(691/720).
Demographic
characteristics
of
the
participants
are
presented
in
Table
1.
Out
of
the
total
691
patients,
43.3%
were
male
and
56.7%
female.
An
almost
equal
proportion
of
patients
were
below
50
(49.1%)
and
above
50
(50.9%)
years
of
age.
Three
quarters
of
the
patients
had
education
level
below
matriculation.
The
majority
(91%)
of
the
patients,
were
married
and
47.8%
of
the
patients
were
employed.
Almost
half
of
the
patients
(50.1%)
responded
that
they
have
comorbidities
other
than
diabetes.
Table
1:
Socio-demographic
characteristics
of
study
participants
n=691
Table
2
describes
the
knowledge
of
patients
regarding
diabetes.
Over
one
quarter
(26%)
think
that
diabetes
is
not
a
curable
disease
and
68%
believe
that
it
runs
in
families.
Interestingly,
about
one
third
of
the
participants
(33.4%)
think
that
diabetes
is
a
communicable
disease.
The
majority
of
the
patients
(90%)
responded
that
in
diabetes
sugar
and
sweets
have
to
be
cut
down
and
82.6%
knew
that
exercise
is
important
for
its
management.
Approximately
63.7%
of
the
patients
knew
that
it
is
important
to
maintain
a
healthy
weight
among
diabetics.
About
69.6%
patients
thought
that
an
individual
can
become
dependent
on
oral
tablets
for
control
of
sugar.
Upon
asking
about
the
risk
factors
of
diabetes
the
patients
responded
with
the
following
factors:
heart
disease
(63.4%),
stroke
(54.6%),
blindness
(78.4%),
amputation
(63.4%),
impotence
(35.3%)
and
infections
(63.5%).
Table
2:
Knowledge
about
diabetes
among
study
participants
(n=691)
Table
3
describes
management
strategies
of
diabetics.
Approximately
58%
of
the
patients
responded
that
they
exercise
and
81%
restrict
sweets,
sugar
and
oily
foods
to
manage
their
blood
sugar
levels.
About
80%
patients
use
tablets
to
control
their
blood
sugar.
Slightly
over
two
fifths
of
the
patients
(42.4%)
attempted
to
reduce
their
weight
and
a
similar
proportion
were
monitoring
their
cholesterol
levels.
Approximately
58.7%
self-monitored
their
blood
glucose
(p-0.24).
Three
fifths
(60.7%)
of
the
patients
replied
that
they
monitor
and
control
their
blood
pressure.
The
majority
of
the
patients
(97.7%)
were
using
allopathic
medications
to
manage
diabetes.
As
far
as
complications
of
diabetes
is
concerned
most
of
the
patients
responded
that
they
are
suffering
from
nephropathy
(14%).
Table
3:
Management
of
Diabetes
among
study
participants
(n=691)
The
results
of
the
study
reveal
that
the
level
of
awareness
of
patients
about
diabetes
mellitus,
its
complications
and
management
is
low.
There
is
a
need
to
formally
educate
the
diabetics
about
the
proper
management
of
this
disease
in
order
to
reduce
the
mortality
and
morbidity
rates
associated
with
it.
Several
studies
have
concluded
that
there
is
significant
association
between
knowledge
of
diabetes
and
the
adherence
to
treatment
(15-18).
Previous
studies
have
found
that
patients
with
adequate
knowledge
level
were
less
likely
to
be
non-adherent
(15-19).
These
observations
are
consistent
with
the
results
obtained
in
the
current
study,
wherein,
the
participants
having
better
knowledge
about
complications
of
diabetes
resulted
in
a
compliance
rate
of
oral
hypoglycemics
to
80%.
This
suggests
the
significance
of
providing
formal
knowledge
regarding
diabetes
for
better
compliance,
as
chronic
diseases
such
as
diabetes
require
proper
education
and
counseling
to
prevent
long
term
complications
and
also
to
decrease
the
financial
burden
of
these
diseases(20).
A
systematic
review
of
21
studies
on
barriers
and
promoters
of
management
of
diabetes
among
South
Asians
concluded
that
communication
with
the
healthcare
provider
was
a
significant
barrier
in
understanding
diabetes
education(21).
The
review
further
elaborated
that
for
exercise,
there
is
lack
of
resources
in
the
South
Asian
countries.
Lack
of
parks
and
affordable
sports
clubs
are
barriers
to
exercise(21).
Moreover,
there
are
some
misconceptions
about
exercise
such
as
fear
of
injury
or
worsening
health
due
to
lack
of
proper
formal
education.
In
the
current
study,
more
than
half
of
the
participants
responded
that
they
do
exercise
to
manage
their
blood
sugar
levels.
A
study
conducted
in
2012
in
Ethiopia
found
that
the
majority
of
patients
(67%)
had
good
knowledge
about
reasons
for
developing
acute
complications(17).
In
the
present
study
we
also
found
that
the
participants
had
a
good
knowledge
about
the
complications
of
diabetes,
whereby,
78%
of
the
patients
responded
that
blindness
can
occur
as
a
complication
of
diabetes.
Though
cardiovascular
diseases
(CVDs)
are
common
complication
of
diabetes
however,
in
this
study
63%
patients
labeled
CVDs
to
be
a
complication,
and
only
35%
thought
that
impotence
is
also
a
complication.
Therefore,
sound
education
is
needed
in
this
regard.
A
study
conducted
by
Rahman
et
al
(22)
in
Peshawar,
Pakistan
on
561
diabetics
reported
that
the
level
of
awareness
regarding
diabetes
and
its
management
was
inadequate
among
studied
participants.
Only
13%
of
the
female
diabetics
were
aware
of
why
glycemic
control
is
important,
and
32.4%
were
aware
of
the
complications.
Only
10%
of
respondents
knew
about
blood
glucose
monitoring(22).
This
is
inconsistent
with
our
study
findings
as
in
the
current
study
58%
of
the
patients
were
doing
self-blood
glucose
monitoring.
Though,
in
our
study
we
have
not
stratified
the
results
based
on
gender,
nonetheless
the
proportions
still
show
a
better
knowledge
of
the
study
participants.
Interestingly,
in
the
current
study
the
patients
had
better
knowledge
of
diabetes
complications
as
compared
to
the
other
studies
conducted
in
Pakistan(22,
23).
However,
almost
half
of
the
participants
didn’t
reply
or
said
that
diabetes
is
a
communicable
disease.
This
shows
that
the
general
knowledge
regarding
diabetes
among
the
population
is
poor.
Some
studies
have
shown
that
the
knowledge
level
of
some
health
care
professionals
is
also
inadequate
or
outdated
(24-27).
Therefore,
there
is
a
genuine
need
to
update
the
health
care
professionals’
knowledge
about
latest
interventions
that
can
assist
the
diabetics
in
management
of
their
disease.
Recommendations:
Patient
Education:
It
is
imperative
that
a
therapeutic
patient
education
program
should
be
planned
which
is
comprehensive
and
fulfills
individual’s
clinical
and
psychological
needs,
according
to
the
patients’
educational
level
and
cultural
background.
Person
Centered
Approach:
It
is
important
that
clinicians
should
follow
a
person
centered
approach
and
should
not
only
focus
on
the
disease
but
to
the
patient,
asking
about
their
responsibilities,
work
and
also
their
self-management
strategies.
Limitations:
This
study
had
several
potential
limitations.
In
this
study
we
did
not
focus
on
psychological
wellbeing
of
the
patients
which
is
an
important
aspect
and
a
major
factor
for
non-adherence
to
treatment.
The
chance
of
reporting
bias
cannot
be
eliminated
as
this
may
have
resulted
in
over
estimation
of
the
compliance
rate
of
oral
hypoglycemic,
exercise
and
doctors’
visit
among
the
study
patients.
Moreover,
since
this
study
was
conducted
in
an
urban
city
therefore,
the
results
may
differ
when
generalized
to
a
rural
population.
The
overall
level
of
awareness
in
diabetics
was
found
to
be
low
and
there
is
a
need
to
educate
the
population
about
this
disease.
Due
to
low
literacy
levels
and
diverse
sociocultural
backgrounds,
it
is
necessary
to
design
a
comprehensive
education
support
program
for
the
patients,
which
will
result
in
better
treatment
adherence
and
positive
health
outcomes.
The
public
and
private
health
sector
needs
to
offer
holistic
services
and
training
programs
for
health
care
professionals.
These
programs
should
focus
on
addressing
misconceptions,
improving
communication,
and
sharing
culturally
sound
strategies
with
patients
for
improvement
in
diabetes
management.
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