Abstract

Introduction: Type 2 Diabetes Mellitus (DM) has become a global epidemic with patients suffering significant disabilities and potential premature death. Due to a lack of education regarding diabetes, most patients suffer from diabetic complications. This study was conducted to determine the knowledge, attitudes and practices among patients with type 2 diabetes. Methods: A cross-sectional study was conducted using a non-probability sampling technique to select the diabetic patients. A total of 244 diabetic patients coming to the medical OPD at Jinnah Post Graduate Medical Center, were interviewed. The data was collected via interviews using a structured questionnaire. The data was collected using Non Probability Purposive Sampling technique and analyzed using Statistical Package SPSS software version 20.0. The patients’ knowledge about the disease, their attitudes and practices were the main outcome measures. A chi square test was run at 95 % confidence interval (CI).

Methodology: A Cross sectional study was conducted at the Medicine OPD and Ward of Jinnah Post Graduate Center, Karachi from April 2019 and August 2019. The sample size was calculated to be 220. The sample was selected using non probability purposive sampling technique. A structured questionnaire with close ended questions was our data collection tool. It was translated into simple Urdu and divided into 4 sections pertaining to: demographic details, knowledge about DM 2, attitude and practices adopted for DM 2. It was handed out to our data collectors who, after obtaining verbal consent, conducted personal interviews amongst patients coming to Medicine OPD and Ward of JPMC, diagnosed with DM type 2. Patients not diagnosed with DM type 2 or those unwilling to participate were excluded.

Data collected was analyzed using the SPSS software version 20.0 and a chi square test performed. Frequencies and percentages were taken out. The statistical analysis was conducted with a 95% confidence interval and a p-value of <0.05 as threshold of statistical significance. All ethical considerations were observed while seeking legal permission of concerned authorities to assess data. Any research misconduct was avoided and rights and well-being of research participants were protected.

Results: A total of 220 individuals participated in this study with ages ranging from 10 years to 78 years with the highest number of individuals, 9.5% (n=21) in the 50 year old age group. Of the diabetic patients 55.9% (n=123 ) of them were female and 44.1% (n=97 ) were males. Among the patients 85.5% (n=188 ) were married, 4.5% (n=10 ) were unmarried and 10% (n=22 ) were widowed. Regarding their level of education, 22.3% (n=49 ) were not formally educated, 15.9% (n=35 ) were primary educated, 20.5% (n=45 ) were secondary educated and 41.4% (n=91 ) were graduates. Most of the females who were 34.7% (n=75 ) were house wives while males represented all professions including government jobs 4.7 % (n=10), Engineers 4.1% (n=9), drivers 2.3% (n=5 ) and labourers 4.1% (n=9). Regarding the monthly income of the participants about 34.5% (n=76 ) earned from Rs 1000/- to Rs 29,999/- per month, 22.7% (n=50 ) earned from Rs 30,000/- to Rs 99,999/- per month and 6.8% (n=15 ) earned up to or more than Rs 3,00,000/-. Regarding their time since onset of diabetes, 11.4% (n=25 ) had it for less than one year. About 30.5% (n=67 ) had it for the last 1-5 years, 23.6% (n=52 ) had it from 6-10 years, 15.5% (n=33 ) had it for the last 11-15 years and 19.5% (n=43 ) had it for more than 15 years. When asked about any prior knowledge about diabetes, 60.9% (n=134 ) knew somewhat about diabetes and 39.1% (n=86 ) had no prior knowledge. Regarding the source of their knowledge, the majority who were 46.8% (n=103 ) had learnt from family and friends and 28.6% (n=63 ) had learnt about it from health care providers and only 4.1% (n=9) had learnt about it through the media. Of the patients, 77.3% (n=170 ) of them had the belief that diabetes was a genetic disease and 22.7% (n=50) did not believe it to be a genetic disease. 28.2% (n=62 ) of the diabetic patients correctly identified the symptoms of their disease such as increased thirst, appetite and urination. 92.3% (n=203) of diabetic patients declared their disease as a dangerous one while 56.4% ( n=124 ) believed it is a preventable illness; 23.2% (n=51) did not think of it as preventable and 20.5% (n=45 ) were not sure of terming diabetes as preventable. Responding to the question whether blood sugar levels rise in diabetes, 82.7% (n=182 ) knew about it and 17.3% (n=38 ) did not know about it. Almost 66.4% (n=146) patients knew how to measure sugar levels with a glucometer and 33.6% (n=74 ) did not know how to use a glucometer. 15.5% (n=34) patients daily checked their sugar levels, 57.7% (n=127 ) checked irregularly and 12.3% (n=27 ) did not check at all. Almost 50.5% (n=111 ) had their blood pressure checked a few days before, 26.4% (n=58 ) had it checked a few weeks ago, 15.5% (n=34 ) had it checked a few months ago and 7.7% (n=17 ) had it checked one year ago. Regarding the type of treatment, 17.3 (n=38 ) patients were on oral hypoglycemic agents and insulin, 63.2% (n=139 ) were on oral hypoglycemic, 10.5% (n=23 ) were on insulin only, 5.9% (n=13 ) were on dietary control and 3.2% (n=7 ) did not take any treatment. 67.3% (n=148 ) monitored diet regularly and 76.4% (n=168) did not ever miss taking their medicines. 18.2% (n=40 ) used to miss taking regular medication and 5.5% (n=12 ) were not sure about their regularity. 65.5% (n=144 ) termed insulin as the last level of treatment therapy for diabetes and 71.4% (n=157 ) knew that exercise can help prevent occurrence of diabetes complications. When the patients were asked whether insulin was an addiction, 34.5% (n=76) said yes, 49.1% ( n= 108) said no and 16.4% (n=36) said may be.

Conclusion: The majority had good overall knowledge and attitude towards their disease. Despite that, self-care practices were mediocre. We still have miles to go in ensuring that every patient, regardless of their education, not only fully comprehends but also implements their self-care practices rigorously via educational and awareness programs.

Key words: Type 2 Diabetes Mellitus (DM), Patients+,Attitude, Self Care