AWARENESS OF COMPLICATIONS OF DIABETES AND MYTHS ABOUT
INSULIN IN PATIENTS WITH DIABETES MELLITUS
Dr. Shubhangi Sharma
Guided by: Dr. Manoj K. Rai, Dr. Sandhya Chandel & Dr. Vijay K. Shrivas
Abstract
The reduction of diabetes-related morbidity and mortality relies
heavily on the awareness of complications. This research aimed to
evaluate the level of awareness regarding diabetes complications
and the factors associated with it among patients with type 2
diabetes. Additionally, it also aimed to explore the prevailing
myths about insulin among these patients. A cross-sectional study
was conducted at a tertiary care institution from December 2023
to January 2024, utilizing a sample size of 50 patients and
predesigned interviewer-administered questionnaires.
Introduction
Diabetes Mellitus in Asian Indian population is characterized by
young age of onset and occurrence at low level of BMI. The
perception of diabetes in India has shifted, no longer only
affecting the wealthy. It now affects those in urban slums, middle-
income areas, and rural regions{1}. People from lower
socioeconomic backgrounds need immediate attention to increase
awareness and prevent complications. Research shows the
importance of understanding the disease, glycemic control, and
self-care practices for better outcomes{2}.
Over 70% of diabetes-related cost is attributed to its
complications, particularly for macro-vascular diseases that most
commonly occur in type 2 diabetics{3}. There is evidence available
that knowledge about DM and its complications has a positive
association with attitude and practices for self-care and glycemic
control among diabetics {4}. This article discusses the results of a
study conducted among people with DM, visiting the outpatient
and inpatient department at Apollo Hospitals, Bilaspur, with an
objective to assess their knowledge about DM and its
complications, practices, and myths about insulin among those
who are suffering.
COMPLICATIONS OF DIABETES AWARENESS PRESENT UNAWARE
DIABETIC NEPHROPATHY 46/ 92% 4/ 8%
DIABETIC FOOT 40 / 80% 10/ 20%
DIABETIC EYE DISEASE 30/ 60% 10/ 40%
DIABETIC NEUROPATHY 32/ 64% 18/ 36%
DIABETIC KETOACIDOSIS AND COMA 27/ 54% 23/ 46%
DELAYED WOUND HEALING 16/ 32% 36/ 72%
DIABETIC HEART DISEASE 29/ 58% 21/ 42%
STROKE 12/ 24% 38/ 76%
Methods and Materials
A pretested, predesigned, semi-structured questionnaire in local
language consisting of items on the demographic profile including
age, sex and occupation, was used. Questionnaire consisted of
items to assess their knowledge (cause, symptoms and
complications), practices for management and prevention of
complications (exercise, drugs and dietary modifications) and
myths about insulin. Questionnaire was pilot tested among adult
DM patients for assessing its feasibility and reliability. Opinion of
experts on each questionnaire item was obtained. Suitable
modifications were done afterward. Average time duration of each
interview was approximately 15 to 20 minutes. Subjects consisted
of 50 adult patients from OPD and IPD, of which only 21 (42%)
patients could read and write, and 29 (58%) were unable to read,
hence each component was verbally explained to obtain answers.
All patients were explained the purpose of the study and
confidentiality was assured.
Contact:
Dr. Shubhangi Sharma
Email: shubhangi.medicine @gmail.com
Institute: Apollo Hospitals, Bilaspur
Results
The sample included 72% male and 28% female patients. Out of 50
patients 58% of patients had been diagnosed with diabetes over 5
years ago, of which only 40% were aware of more than 2
complications of diabetes. Surprisingly, amongst patients with
diagnosis within the last 5 years, the awareness of more than 2
complications was 56%. Only 38% patients were aware about the
target blood sugar range. Increased urinary frequency was the
most commonly known symptom of hyperglycemia (70%). 60%
patients selected Glucometer as the best option to monitor blood
sugar at home, while 28% believed keeping track of dietary intake
to be sufficient, the rest 12% mentioned noticing signs of
hyperglycemia and hypoglycemia to be the best method. Taking
insulin and oral hypoglycemics on time was chosen as the most
effective way to control persistently high blood sugar by 68%
patients. 54% of the patients had suffered from one or more
complications of diabetes since diagnosis. 18% of patients even
mentioned taking insulin (8%) and exercising (10%) as correct
methods to manage hypoglycemia at home. 100% Patients were
aware that stopping alcohol and smoking could help in preventing
complications. Similarly, 98% patients were aware of dietary and
exercise recommendations for diabetes. Interestingly, 44%
patients believed drinking bitter juice could control high blood
sugar. There was not a significant difference between awareness in
patients who could read and write(48%) and those who could not
(44%).
Diabetic kidney disease was the most commonly known
complication of diabetes (92%), followed by diabetic foot
disease(80%).
The commonest myth (78%) about Insulin: If used once, they
would become dependent on insulin for life.
Least commonly known complications of diabetes were Stroke,
known by just 24% patients, and delayed wound healing by just
32% of the patients.
Discussion
The study's sample was predominantly male (72%), with a
significant proportion of patients (58%) having been diagnosed
with diabetes over five years ago. It was found that long-term
patients had less awareness of more than two complications of
diabetes (40%) compared to those diagnosed within the last five
years (56%). This suggests that recent diagnostic procedures may
include more comprehensive patient education. However, general
knowledge about diabetes management, such as the target blood
sugar range, was low (38%), indicating a gap in patient education.
The majority of patients relied on glucometers to monitor their
blood sugar (60%), highlighting the importance of these devices in
diabetes management. Interestingly, misconceptions about insulin
use were common, with 78% of patients believing that insulin use
would lead to lifelong dependency. This misconception could be a
barrier to effective diabetes management for some patients {5}.
Conclusions
This study underscores the crucial role of patient education in
managing diabetes and preventing complications. While patients
demonstrated some knowledge about diabetes complications and
management strategies, several gaps and misconceptions were
identified. These findings highlight the need to improve patient
education, dispel myths, and promote a comprehensive
understanding of diabetes. This could potentially improve disease
management, prevent complications, and enhance patients' quality
of life.
References
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diabetic population in a city in southern India, Diabetes Research and Clinical Practice, Volume 77, Issue 3,
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