Self-care practices and factors influencing self-care among type 2 diabetes mellitus patients in a rural health center in South India.

BACKGROUND: Self-care for diabetes is very important in preventing complications of diabetes and also improving quality of life. This study aims to find the various self-care practices of type 2 diabetes patients who are being treated at a rural health center of a medical college and the factors influencing self-care. MATERIALS AND METHODS: This is a hospital-based cross-sectional study. Type 2 diabetes patients registered and receiving treatment from the noncommunicable disease clinic of a rural health center were administered a pretested questionnaire, developed based on different diabetes self-care questionnaires making changes as appropriate and including most aspects of self-care practices. The proportion of compliant was then cross-tabulated with background characteristics and their glycated hemoglobin (HbA1c) levels. SPSS version 16.0 was used for the analysis. RESULTS: Among 390 patients with a mean age 56 years, 25.5% adhered to at least four dietary modifications, 46% were physically active, and 57% had good compliance to drugs; hypoglycemia prevention practices ranged from 21% to 51%. Except for avoiding barefoot walking (90%), other foot-care practices were followed by only a quarter of them. Among ever users, 69.2%, 64.3%, and 29.4% have quit smoking, alcohol, and tobacco use, respectively. Adherence to dietary modifications and drug compliance were associated with a lower HbA1c level of ≤7 g% (P < 0.05). CONCLUSION: In this study, the compliance to physical activity or medications is much better than dietary changes and foot-care practices. Focused education programs and monitoring during follow-up visits will improve self-care in the less adhered to aspects. Those who are adherent to dietary modifications and drugs have better glycemic control.

Prevalence of Eating Disorders and Its Associated Risk Factors in Students of a Medical College Hospital in South India.

Background and objectives Eating disorders are some of the most under-researched and difficult to diagnose psychiatric conditions, with a high mortality rate, especially among the adolescent age group. The aim of this study is to determine the prevalence and risk factors for eating disorders among students of a medical college hospital in South India. Materials and methods An observational, cross-sectional study was conducted among 332 students of four constituent colleges of a tertiary-care hospital selected by simple random sampling. Their height and weight were recorded. Four major questionnaires were distributed among the students - Demographic details, Eating Attitudes Test (EAT26), Body Shape Questionnaire (BSQ34), and Perceived Stress Scale (PSS). The results were tabulated and analyzed using SPSS software version 16.0 (IBM Corporation, Somers, New York, USA). Results The proportion of students who had a high risk for eating disorders was 13%. It was prevalent almost equally in both males and females. High risk for eating disorders was associated with high stress and severe body shape concerns (p<0.001). Other influencing factors were history of counselling, peer pressure, excessive exercise as well as the history of any behavioral symptoms like the use of laxatives and diet pills (p<0.001). Conclusions Eating disorder risk is prevalent in a high percentage of medical and paramedical students. High stress and body shape concerns are associated with eating disorders. Only if diagnosed early, with screening programs using questionnaires and further psychiatric evaluation, we can hope to mitigate the complications they incur.

Prevalence and Risk Factors of Diabetes, Hypertension and Other Non-Communicable Diseases in a Tribal Population in South India.

INTRODUCTION: The prevalence of non-communicable diseases is increasing in tribal areas of India owing to the development and adoption of modern lifestyle. This study was done to assess the prevalence and risk factors of obesity, diabetes and hypertension in a tribal area in South India. MATERIALS AND METHODS: A cross-sectional study was conducted among all men and women 40 years and above in ten randomly selected villages in three village panchayats located in a hilly area in Vellore district, Tamil Nadu. Minimum sample size calculated was 370. Data collection was done using a pretested questionnaire, clinical examination, and capillary blood glucose measurement. Prevalence and 95% confidence interval were estimated for diabetes and hypertension. By univariate and multivariate logistic regression, the Odds Ratio was calculated to identify the risk factors. SPSS version 16.0 was used. A value of P < 0.05 was considered statistically significant. RESULTS: The study included 502 subjects, 212 (42.2%) males and 290 (57.8%) females. The proportion of generalized and abdominal obesity was 21% and 36.5%. The prevalence of diabetes and hypertension among the tribal population was 7.4% and 36.5%. Approximately 62% of diabetes and 68% of hypertension were newly diagnosed during this study. Higher age, female sex, generalized and abdominal obesity, and diabetes were risk factors for hypertension and abdominal obesity and hypertension were risk factors for diabetes. CONCLUSION: The prevalence of diabetes and hypertension is high with two-thirds being newly diagnosed during study in this tribal population mandating early screening, awareness campaigns for early health-seeking and improvement in health access.

Prevalence of Vascular Complications Among Type 2 Diabetic Patients in a Rural Health Center in South India.

Introduction: Vascular complications are the major cause of morbidity in patients with diabetes mellitus. Screening for these complications is crucial in early detection and tertiary prevention. Hence, this study aimed at finding the prevalence of micro and macrovascular complications and their associated factors in type 2 diabetes mellitus patients in a rural health center by using simple and easily available tools. Methodology: This hospital based cross sectional study was conducted in Rural Health and Training Centre (RHTC) of Sri Ramachandra medical college from Jan 2017 to Aug 2017. All type 2 diabetes patients registered at RHTC were included in the study. By the use of questionnaire, clinical examination and laboratory investigations, the prevalence of macro and microvascular complications and associated factors were ascertained. Multiple logistic regression was used to identify factors associated with vascular complications of diabetes. Results: The study included 390 type 2 diabetes patients. The overall prevalence of macrovascular and microvascular complications in our study population was 29.7% and 52.1%, respectively. Among the macrovascular complications, both coronary artery disease (CAD) and peripheral vascular disease (PVD) had a prevalence rate of 15.1%. Among the microvascular complications, peripheral neuropathy (44.9%) had the highest prevalence followed by nephropathy (12.1%) and diabetic foot (7.2%). Multiple logistic regression analyses showed high HbA1c level, lower education, high postprandial blood sugar, hypertension, abdominal obesity were significantly associated with increased risk of vascular complications of diabetes. Conclusion: This study demonstrated the increased prevalence of vascular complications in Type 2 diabetes patients in rural India. Regular screening to identify those patients at risk could prevent further progression of complications.

Active case finding for Tuberculosis among migrant brick kiln workers in South India.

BACKGROUND: "Active case finding among key populations" is one of the four main thrust areas under the National Strategic Plan for Tuberculosis (NSP) 2017-25. OBJECTIVE: This study aims to actively screen for TB symptoms and disease among migrant brick kiln workers and their care seeking behaviour for the symptoms through a private-public partnership effort. METHODS: This was a cross sectional study conducted among all migrant brick kiln workers working in the brick kilns in the field practice area of the Rural Health Centre of a medical college hospital. A pretested structured questionnaire was used for the interview. Productive Cough with or without other symptoms for 2 weeks or more was considered suggestive of TB. Sputum smear microscopy and Gene Xpert were used to diagnose TB among symptomatics. SPSS version 16.0 was used for analysis. RESULTS: Among 580 brick kiln workers, the prevalence of TB symptoms was 9.7%. Upon sputum examination, one was found to be positive for TB. Smoking was found to be associated with TB symptoms (p < 0.05). Only 50% of the symptomatics sought health care and the main reason for not seeking was low severity of symptoms. CONCLUSION: Active case finding is helpful in screening and diagnosing TB among the marginalised community of brick kiln workers.

Prevalence of Hypoglycemia Among Patients With Type 2 Diabetes Mellitus in a Rural Health Center in South India.

Introduction: One of the greatest threats to achieving tight glycemic control is hypoglycemia, which can lead to decreased drug compliance, cardiovascular events, and even mortality. There is lack of literature on this complication in the Indian setting. This study will aid the primary care physician to achieve better glycemic control of the diabetic patients and provide patient education to prevent hypoglycemia. Materials and Methods: It was a cross-sectional study in which 390 patients with type 2 diabetes mellitus getting treated in a primary health center were assessed for symptoms of hypoglycemia. Results: Prevalence of hypoglycemia was 57.44% (95% CI 52.48-62.25). Severe hypoglycemia was found in 10.7% of the patients. The first reported symptom of hypoglycemia was dizziness (72.3%). The most common etiological factor leading to hypoglycemia was missing a meal (89.3%). Females were at a significant higher risk of developing hypoglycemia (OR 1.2, 95% CI 1.04-1.3, P < .05). Conclusion: This study has established the high prevalence of self-reported hypoglycaemia in the rural settings where resources are limited to monitor the glucose levels. The high prevalence urges the need for the primary care physicians to enquire about the hypoglycemic symptoms to all diabetic patients at each visit. It is also important to educate these patients about the symptoms of hypoglycemia and the importance of reporting of such symptoms, which will help in adjusting dose and preventing future attacks.

Are Patients With Type 2 Diabetes Not Aware or Are They Unable to Practice Self-Care? A Qualitative Study in Rural South India.

Background: Lack of awareness and poor adherence to dietary, lifestyle modifications, and medications among patients with diabetes result in poor health outcomes. Aim: This study aimed to understand patients' perceptions about barriers to self-management of diabetes. Materials and Methods: This was a descriptive qualitative study among patients with diabetes attending a rural health center. Five focus group discussions were conducted with 8 to 11 participants using a topic guide. Results: Many were unaware of target levels and complications of diabetes. Some aspects of the dietary information were found to be quite confusing. Physical constraints prevented many from going for outdoor walking. They have not received any information on foot care. Conclusions: Understanding the barriers for self-care will help health care workers manage diabetes better.

Reported hypoglycemia in Type 2 diabetes mellitus patients: Prevalence and practices-a hospital-based study.

INTRODUCTION: Hypoglycemia tops the list of hurdles in preventing tight glycemic control in diabetic patients. It is even considered as a cardiovascular risk factor. However, it continues to be a neglected complication with very limited epidemiological data in our country. AIM: To study the self-reported prevalence of hypoglycemia among type 2 diabetic patients and the practices adopted by them during and after the episodes to manage and avert future occurrences. MATERIALS AND METHODS: It is a questionnaire-based cross-sectional study done using systematic random sampling selecting every 5th patient attending the diabetic Out-Patient (OP) in a tertiary medical college hospital. RESULTS: There were 366 participants with median age of 60 years. Around 96% reported any one symptom of hypoglycemia, but 78% had eaten following the episode and got relieved of the symptoms. Weakness (76.2%) and dizziness (74%) were the most common symptoms reported by the patients. A quarter of them reported having severe attacks requiring somebody's assistance. Most patients resorted to timely meals (85%) to avert future attacks. Patients who took insulin along with oral hypoglycemic agents (OHAs) were at a higher risk (OR = 2.3) for hypoglycemia compared to patients taking only OHAs (P < 0.01). CONCLUSION: The reported prevalence of hypoglycemia among type 2 diabetes patients is quite high. This finding reiterates the importance of enquiring and educating every diabetic patient about hypoglycemic episodes during every health visit.

Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India.

INTRODUCTION: Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD) of a medical college hospital. MATERIALS AND METHODS: Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire. RESULTS: The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126 (34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242 (66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia. CONCLUSION: Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

National health programs in the field of endocrinology and metabolism - Miles to go.

The endocrine and metabolic diseases of childhood obesity, diabetes mellitus, hypertension, iodine deficiency disorders, vitamin D deficiency, and osteoporosis are major public health problems. Different programs including National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke address these problems although some are yet to be addressed. National surveys have shown high prevalence of these disorders and their risk factors. Most of the programs aim at awareness raising, lifestyle modification, (primary prevention) and screening (secondary prevention) for the disease conditions as these are proven to be cost-effective compared to late diagnosis and treatment of various complications. Urgent concerted full scale implementation of these programs with good coordination under the umbrella of National Rural Health Mission is the need of the moment. The referral system needs strengthening as are the secondary and tertiary levels of health care. Due attention is to be given for implementation of these programs in the urban areas, as the prevalence of these conditions is almost equal or even higher among urban poor people where primary and secondary prevention measures are scarcely available and treatment costs are sky-high.

Are the current Indian growth charts really representative? Analysis of anthropometric assessment of school children in a South Indian district.

BACKGROUND: India currently is posed by the double threat of thinness and overweight/obesity among children. Different growth charts have taken different population and give different cut-off points to assess these conditions. OBJECTIVE: The objective of this study is to assess the anthropometry of school children, 5-18 years of age and thereby estimate the prevalence of childhood thinness, overweight and obesity. To analyze how the study population compares with that of Agarwal's growth chart. MATERIALS AND METHODS: The anthropometric measurements of all the students who were studying from 1(st) to 12(th) standards were taken from 27 randomly selected Government and private schools. Prevalence of thinness, overweight and obesity were assessed using two standards - Indian standard given by Agarwal and International Standards given by International Obesity Task Force (IOTF). RESULTS: The prevalence of thinness, overweight and obesity among 18,001 students enrolled as per Indian standard were 12.2%, 9.5% and 3% and as per International standard were 15.3%, 8.1% and 2.6% respectively. The mean and the 95(th) percentile values of body mass index for both boys and girls at all ages in this study are falling short of Agarwal's and IOTF values. Using international cut-offs as well as Indian cut-offs given by Agarwal, underestimate the prevalence of obesity among boys and girls of all age groups. CONCLUSION: This study shows that under and over-nutrition among school children is in almost equal proportions. There is an underestimation of obesity among children whenever an Indian or an International growth chart is used. Thus, this study brings out the need for a really representative growth chart.

Awareness of gestational diabetes mellitus among antenatal women in a primary health center in South India.

BACKGROUND: Gestational diabetes mellitus (GDM) is a perfect window of opportunity for the prevention of DM in two generations, and its incidence is increasing in our country. Awareness of the condition among antenatal women will translate into prevention and early diagnosis of the disease. This study was done to determine the awareness of GDM among all the antenatal women who attend a Primary Health Center (PHC) for antenatal care. MATERIALS AND METHODS: A pretested questionnaire consisting of details on background characteristics, 12 questions focusing on Type 2 DM and GDM, and a question on the source of knowledge was administered to all women attending the antenatal clinic. Their responses were scored and the women were graded as having good, fair, or poor knowledge about GDM. RESULTS: One hundred and twenty antenatal women participated in the study. Mean age of the women was 23.8 years (SD: 2.94). Overall, 17.5% women had good knowledge, 56.7% had fair knowledge, and 25.8% women had poor knowledge about GDM. The major sources of awareness of GDM were reported to be television/radio, neighbors/friends, and family members. DISCUSSION: Only a small proportion of rural antenatal women had good knowledge about GDM. The awareness that untreated GDM may pose a risk to the unborn child was high among the study women. Health care workers have to play a greater role in bringing about awareness about GDM among antenatal women.