INTRODUCTION:

Nutrition related risk factors often work synergistically to adversely affect the health status of older people, and these risk factors may lead to and increased rate of medical complications and result in loss of independence, institutionalization and higher health care costs for people affected.¹ Diabetes Mellitus is silent killer¹¹ and a major health problem in the world. It is one of the most prevalent metabolic diseases which can lead to enormous medical as well as socioeconomic consequences.²

Diabetes mellitus refers to a group of chronic disorders of metabolism characterized by elevated blood glucose level and disturbances in metabolism of carbohydrate, fats and protein. Diabetes affects approximately 16 million people in the United States, and this number is expected to rise in the future. The majority of patients, approximately 1.4 million have type 1 diabetes and the remaining 14.5 million have 2 types diabetes³

Diabetes mellitus (DM) is one of the most common non-communicable illnesses worldwide²The world prevalence of DM among adults is increasing and is estimated research 7.7% by 2030. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.^3,12 There are three main types of diabetes mellitus:⁴

Type 1 DM results from the pancreas's failure to produce enough insulin due to loss of beta cells. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes" The cause is unknown.⁴

Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.² As the disease progresses, a lack of insulin may also develop.² This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is a combination of excessive body weight and insufficient exercise.³

Diabetes mellitus (DM) leads to alarming clinical, social, financial, and public health issues with devastating long-term effects on the well-being, affecting quality of life including neuropathy, retinopathy, nephropathy, dementia and cognitive problems.⁴Self-monitoring of blood sugar and apt self-care with effective metabolic regulation affect hypoglycemia, ketoacidosis, or microvascular and macrovascular complications. The major long-term complications relate to damage to blood vessels. Diabetes doubles the risk of cardiovascular disease and about 75% of deaths in diabetics are due to coronary artery disease. Other macrovascular diseases include stroke, and peripheral artery disease.⁵

There is no known preventive measure for type 1 diabetes. Type 2 diabetes-which accounts for 85–90% of all cases worldwide-can often be prevented or delayed by maintaining a normal body weight, engaging in physical activity, and eating a healthy diet.² Higher levels of physical activity (more than 90 minutes per day) reduce the risk of diabetes by 28%. Dietary changes known to be effective in helping to prevent diabetes include maintaining a diet rich in whole grains and fiber, and choosing good.

fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish. Limiting sugary beverages and eating less red meat and other sources of saturated fat can also help prevent diabetes. Tobacco smoking is also associated with an increased risk of diabetes and its complications, so smoking cessation can be an important preventive measure as well.⁶

NEED OF THE STUDY:

According to WHO it is said that India is the diabetic capital of the world. Total 3.5 Crore diabetes are present in India which is expected to raise up to 5.2 crore by 2025.⁷

According to Indian Council of Medical Research (ICMR), a lower proportion of the population is affected in states of Northern India (Chandigarh 0.2 million, Jharkhand 0.96 million) as compared to Maharashtra (9.2 million) and Tamil Nadu (4.8 million).²

Diabetes is the cardinal cause of death globally. From a total of 3.7 million deaths linked to blood glucose level in 2012, diabetes was the direct cause of 1.5 million deaths worldwide and additional 2.2 million deaths were caused by increasing risk of cardiovascular and other diseases due to hyperglycemia. It expected for diabetes to become the 7th leading cause of death by 2030.²

Diabetes education is considered an essential tool as its management largely depends on knowledge, motivation, and ability to pursue self-care in activities of daily living.¹³ Therefore, counseling and health education should be given paramount importance by the physicians and nurse to elaborate advice on lifestyle modifications and diet^.7 Although, evidences suggest that diabetics with more knowledge and motivated self-care help to achieve better glycemic control, there is difference of opinion on effectiveness of methods of health education and educational efforts to improve interventions are key components of effective treatment plan for DM.⁹

PROBLEM STATEMENT:

A Comparative study to assess the knowledge and attitude regarding diabetes mellitus among diabetic and non diabetic patients attending medicine OPD

OBJECTIVES OF STUDY:

1. To assess the knowledge regarding diabetes mellitus among diabetic and non diabetic patients attending medicine OPD

2. To assess the attitude regarding diabetes mellitus among diabetic and non diabetic patients attending medicine OPD

3. To compare the knowledge and attitude regarding diabetes mellitus among diabetic and non diabetic patients attending medicine OPD

OPERATIONAL DEFINITIONS:

Assess:

It refers to statistical evaluation of patients knowledge regarding diabetes mellitus

Knowledge: It refers to ability of patients to respond to questions dealing with diabetes mellitus as evident from structure knowledge questionnaire

Attitude: It refers to approach of patients to respond to statement dealing with diabetes mellitus as evident from attitude scale.

Diabetic patients:

Patients who are attending medicine OPD and are suffering from diabetes mellitus.

Non diabetic patients:

Patients who are attending medicine OPD and not suffering from diabetes mellitus.

RESEARCH METHODOLOGY:

Research Approach:

Quantitative research approach.

Research Design:

Comparative descriptive research design.

Target Population:

The target population for the study is patients attending medicine OPD

Sample and Sampling Technique:

The sampling technique used was non probability convenient sampling technique.

In the present study the investigator selected the sample composed of 100 patients 50 diabetic patients and 50 with non diabetic patients.

Inclusion criteria:

Study subjects who were

· Available during the period of data collection.

· Willing to participate in the study

· Who could converse in English or Punjabi

Selection and Development of Research Tool:

The following data collection instruments were constructed in order to obtain data.

· A self structured knowledge questionnaire

· An attitude scale

Organization and Presentation of findings:

Sample characteristics:

· Majority of study subjects 25 (50%) were in the age group of 50 years above in diabetic patients and majority of the study subjects 17 (34%) were in the age group of 41-50 years in non diabetic patients.

· Majority of the study subjects 27(54%) were males in diabetic patients and same majority of the study subjects i.e. 29 (58 %) were females in non diabetic patients.

· Maximum of the study subjects 24(26%) were having primary level of education in diabetic patients and majority of the study subjects 20(40%) were primary level of education in non diabetic patients.

· Majority of the study subjects 20(40%) were unemployed in diabetic patients and same majority of the study subjects 17(34%) were unemployed in non diabetic patients.

· Majority of study subjects 23(46%) were doing the daily living of activity in diabetic patients and same majority of the study subjects 28(56%) were doing the daily living activity in non diabetic patients.

· Majority of the study subjects 42(84%) were not consuming alcohol in diabetic patients. and Majority of the study subjects 7(14%) respondents were consuming alcohol in non diabetic patients.

· Majority of the study subject 29(58%) family members had knowledge about diabetes mellitus in diabetic patients and Majority of study subject 32(64%) respondents were family history of non diabetic patients.

· Majority of the study subjects 24(48%) respondents got knowledge from the family members in diabetic patients and same majority of the study subjects 24(48%) respondents got the knowledge from the family members in non diabetic patients.

Table 1: Mean, mean difference, standard deviation of difference, standard error of mean difference, t value from knowledge score obtained by diabetic and non diabetic patients. N=100

Knowledge test

Mean

difference

SEMD

t value

Diabetic

15.02

1.32

0.843

1.57*

Non diabetic

13.88

t (98) ≥ 1.98 at p= 0.05 level

Table 1 shows that the t value is non significant at 0.05. The computed t value, t (98)=1.57 at p.0.05 indicates a non significant difference between the diabetic and non diabetic knowledge score. Thus, it is established that the difference between obtained in the mean diabetic knowledge score and non diabetic knowledge score was not a true difference and it was by chance.

Table 2: Mean, mean difference, standard deviation of difference, standard error of mean difference t value from attitude score obtained by diabetic and non diabetic patients. N=100

Knowledge test

Mean

Mean difference

SE_MD

t value

Diabetic

54.54

0.8

1.039

0.76

Non diabetic

53.74

t (98)>1.98 at p. 0.05 level.

It shows that the t value is non significant at 0.05 level. The computed t value, t- (98)=0.76 p.0.05 indicates a non significant difference between the diabetic and non diabetic attitude score. Thus, it is established that the difference between obtained in the mean diabetic attitude score and non diabetic attitude score was not true difference and it was by chance.

Table 3 Correlation of knowledge and attitude regarding diabetes mellitus among diabetic patient N=50

S. No	Variables	Mean	Standard deviation	R
1.	Knowledge	15.22	3.38	0.22
2.	Attitude	54.54	5.79	0.22

r = (48)≥ 0.22

It shows that coefficient of correlation between knowledge and attitude regarding diabetes mellitus among diabetic patients is 0.22. It shows that there was moderately positive correlation between knowledge and attitude. The computed r value (0.22) indicates statistically significant relationship at .05 level between knowledge and attitude among diabetic patients.

Table 4: Correlation between the knowledge and attitude regarding diabetes mellitus among non diabetic patient N=50

S. No

Variables

Mean

Standard deviation

Knowledge

13.88

4.91

0.25

Attitude

53.74

4.55

r (48)≥0.22

Table 4 shows that coefficient of correlation between knowledge and attitude regarding diabetes mellitus among non diabetic patients is 0.25. It shows that there was moderately positive correlation between knowledge and attitude. The computed r value (0.25) indicates statistically significant relationship at .05 level between knowledge and attitude among non diabetic patients.

RECOMMENDATIONS:

· A similar study can be replicated using large scale sample.

· A similar study can be done to evaluate effectiveness of STP on knowledge and attitude regarding diabetes mellitus of diabetic patients.

· A similar study can be conducted with an experimental research approach and pre test post test control group design.

· A follow up study can be conducted to assess the practices regarding diabetes mellitus among diabetic patients.

LIMITATIONS:

The study was limited to

· Diabetic and non diabetic patients between the age group (above 50 years)

· Knowledge and attitude

· Only 50 diabetic and 50 non diabetic patients.

REFERENCES:

1. Virendra Singh Choudhary, Geeta Chaudhary. A Descriptive Study to Assess the Knowledge Regarding Diabetes Mellitus, Its Risk Factors and Complication among the Rural Community Sadiq, Faridkot (Punjab). Asian J. Nur. Edu. and Research. 5(2): April-June 2015; Page 251-253. doi: 10.5958/2349-2996.2015.00049.X

2. Toijam Monika Devi. Effectiveness of Structured Teaching Program on Knowledge regarding Management of Hypoglycemia among people with Diabetes mellitus in selected rural areas. International Journal of Advances in Nursing Management. 2022; 10(4):415-9. doi: 10.52711/2454-2652.2022.00090

3. Suzanne C. Smeltzer. Brend Bare. Textbook of Medical Surgical Nursing. 10 Edition. Lippincott Williams And Wilkins; P 1151

4. Shoback Dg, Gardner D, Eds. (2011). "Chapter 17". Greenspan's Basic & Clinical Endocrinology (9th Ed.). New York: Mcgraw-Hill Medical. Isbn 978- 0-07-162243-1

5. Bandyopadhyay A, Mohanta Pk, Sarker G, Kumar K, Sarbapalli D, Pal R. Appraisal of Cognitive Function of Diabetics in A Rural Healthcare Teaching Institute. Ann Trop Med Public Health. 2016; 9: 48-55.

6. Singh M, Pal R, Ranjan R, Sarker G, Bharati Dr, Pal S. Diabetes and Dementia: Myth and Reality. J Krishna Inst Med Sci Univ. 2017; 6:12-7

7. Willi C, Bodenmann P, Ghali Wa, Faris Pd, Cornuz J (December 2007). "Active Smoking AND The Risk of Type 2 Diabetes: A Systematic Review and Meta- Analysis". Jama. 298 (22): 2654–64. Doi:10.1001/Jama.298.22.2654. Pmid 18073361.

8. Shoback Dg, Gardner D, Eds. (2011). "Chapter 17". Greenspan's Basic & Clinical Endocrinology (9th Ed.). New York: Mcgraw-Hill Medical. Isbn 978- 0-07-162243-1

9. Who. October 2013. Archived From the Original On 26 August 2013. Retrieved 25 March 2014.

10. Joshi Sr, Pasikh Rm – Indian Diabetes Capital of The World: Now Leading Towards Hypertension J Assosc Physician India 2007; 55:323-4

11. Gursharanpreet Kaur, Archna Garg. A Comparative Study to assess the Knowledge Regarding Diabetes Mellitus among Adults in Selected Rural and Urban Community, Hoshiarpur, Punjab. Int. J. Nur. Edu. and Research. 2016; 4(4): 421-426. doi: 10.5958/2454-2660.2016.00076.4

12. Sumanpreet Kaur, Harmanpreet Kaur. A Descriptive Study to Assess the Knowledge Regarding Diabetes Mellitus among the Residents of Selected Rural Community, Gurdaspur, Punjab. Int. J. Nur. Edu. and Research. 2017; 5(1): 19-26.

13. S. Parimala, R. Deepa. A Study to Assess the Level of Knowledge regarding Diabetes Mellitus among selected community, Coimbatore. International Journal of Nursing Education and Research. 2021; 9(3):317-1.

Received on 12.12.2022 Modified on 18.03.2023

Int. J. Nur. Edu. and Research. 2023; 11(3):255-258.

DOI: 10.52711/2454-2660.2023.00058