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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 276-281

A comparative study on knowledge and awareness regarding type-2 diabetes mellitus and its complications among urban and rural patients


Department of Community Medicine, ESIC Medical College, Hyderabad, Telangana, India

Date of Submission21-Feb-2022
Date of Decision12-Apr-2022
Date of Acceptance23-Apr-2022
Date of Web Publication09-Sep-2022

Correspondence Address:
Surendra Babu Darivemula
Department of Community Medicine, ESIC Medical College, Sanath Nagar, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_35_22

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  Abstract 


BACKGROUND: Type-2 diabetes mellitus (DM) is the most challenging public health problem. Most of the people are unaware of the disease and its preventive measures and complications. It is important to acknowledge the gap in the knowledge and awareness of the disease to prevent the disease and effectively plan public health care.
METHODOLOGY: This was a cross-sectional study with the objective to assess the level of knowledge and awareness regarding type-2 DM and its complications among urban and rural population and to compare them. The sample size was calculated as 404 among >30 years of age with Type-2 DM with >1 year of duration with or without complications. Data was collected on demographic details, knowledge, awareness, complications and lifestyle modifications by using the structured questionnaire. The collected data was compared among urban and rural patients and the association was seen between different factors by appropriate statistical test.
RESULTS: The knowledge on normal blood sugar was (45.6% and 27.2%) in urban and rural, HbA1C (63.8% and 49.5%), family history of diabetes (59.4% and 43.1%), whether DM2 is a multi system disorder, monitoring of blood sugar levels and frequency of monitoring and checkups were found to be more in the urban compare to the rural with P < 0.05. The awareness on complications like the rate of complications with increase in time (66.3% and 57.0%), awareness of diabetic foot (52.9% and 37.1%), prone to infections (67.3% and 58.9%), prone to COVID 19 infection (74.7% and 64.9%), most common organ involved as the complication arise was kidney (39.6% and 33.7%) with P < 0.05.
CONCLUSION: The study suggests that there is a need to improve knowledge about DM and its complications, and there is a need for diabetes-specific health awareness campaigns on behavior and lifestyle changes, adherence to treatment and self-care.

Keywords: Awareness, complications, diabetes type-2, knowledge, rural, urban


How to cite this article:
Darivemula SB, Vishwajeeth G, Pooja G, Prathyusha G, Pavani G, Sahithya G, Dharani G, Shankar G R, Katkuri S. A comparative study on knowledge and awareness regarding type-2 diabetes mellitus and its complications among urban and rural patients. BLDE Univ J Health Sci 2022;7:276-81

How to cite this URL:
Darivemula SB, Vishwajeeth G, Pooja G, Prathyusha G, Pavani G, Sahithya G, Dharani G, Shankar G R, Katkuri S. A comparative study on knowledge and awareness regarding type-2 diabetes mellitus and its complications among urban and rural patients. BLDE Univ J Health Sci [serial online] 2022 [cited 2023 Feb 7];7:276-81. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/2/276/355852



According to the World Health Organization, noncommunicable diseases (NCDs) accounted for 74% of deaths globally in 2019, of which diabetes resulted in 1.6 million deaths, thus becoming the ninth leading cause of death globally.[1],[2] By 2035, nearly 592 million people are predicted to die of diabetes.[3] Type 2 diabetes, which constitutes 90% of all cases of diabetes, earlier considered to be a disease of the affluent “Western” countries, has now spread globally and has become a major cause of disability and death, affecting even younger age group. This could have grave implications on the social and economic sectors of the developing country. It is important to know about the awareness level of a disease condition in a population, which plays a vital role in future development, early detection, and prevention of disease. Education is one of the key components in ensuring better treatment and control of diabetes.[4] There is also evidence to show that increasing knowledge regarding diabetes and its complications has significant benefits, including increase in compliance to treatment, thereby decreasing the complications associated with diabetes.[5] Moreover, conventional approaches to the management of the disease, and prevention of its complications, are not only expensive but also largely inaccessible to certain communities.[6],[7]


  Methodology Top


Aims and objectives

The objective of the study was to assess the level of awareness regarding type-2 diabetes mellitus (DM) and its complications among urban and rural population who are the beneficiaries of ESIC dispensary and to compare the awareness of diabetic complications with respect to different determinants in urban and rural settings.

Study design and settings

A cross-sectional study was conducted at two training health centers of urban (UHTC) of Jeedimetla and rural (RHTC) of Ramachandrapuram (RC Puram) of ESIC dispensaries under the field practice area under the department of community medicine. The study was done in 2 months, from June 1, 2021, to July 31, 2021. We approached the patients on the day of Non Communicable Disease clinic held on every Tuesday and Friday for the data collection. The inclusion criteria were patients who are more than 30 years of age with more than one year of the duration of type-2 DM on medication with or without complications, and participants who are not given consent and not willing to participate in the study were excluded. The sample size was calculated by taking the overall urban residents who had higher awareness rates (58.4%) compared to rural residents (36.8%) from the study done by the ICMR in multicentric areas.[8] Hence, the average of the prevalence of the awareness of both the settings was 47.6%. The sample size was calculated by taking prevalence as 50% with a 95% level of confidence and 5% margin of error. The final sample size was 384. After adding 5% oversampling, the minimum calculated sample was 404, Trying to achieve at least 50% form both the centers.

Ethical clearance

The ethical clearance was obtained from the institutional ethical committee with the certificate number of ESICMC/SNR/IEC-S0122/09-2021. Before collecting data, informed consent and participation information sheet were provided to the participants.

Data collection and analysis

The data were collected using a predesigned semistructured questionnaire, which included demographic data, information about the prevalence of awareness of type 2 DM and its complications, and lifestyle modifications. The health education and counselling was done to those with poor knowledge. The patients were approached on the NCD clinic day at both the centers. The data collected were compared among urban and rural population using IBM SPSS Statistics 21.0 version (Armonk, NY: IBM Corp). The data was represented in frequencies, proportion, mean, standard deviation and appropriate statistical test Chi square was applied with P < 0.05 considered statistically significant.


  Results Top


A total of 404 patients were included in the study, 202 rural and 202 urban settings. Among them, 214 (54%) were male and 190 (46%) were female. [Table 1] shows the demographic details of the participants included in the study. Majority, 146 (36.1%), of the participants belonged to 51–60 years' age group, and 116 (28.7%) belonged to more than 60 years' age group. More than three forth of the participants were 344 (85.1%) were married, 52 (12.9%) were widower, 4 were single, and 4 were divorced. Half of them, 202 (50.0%) (85 in urban and 117 in rural), belonged to the illiterate, 155 (40.0%) had completed their primary and upper primary schooling, and only 47 (10.0%) were completed intermediate and above. Half of the (193) of the participants had more than 1–5 years of history of diabetes, 160 (39.7%) had 6–10 years of history of diabetes, and the remaining 51 (12.6%) had more than 10 years of history of diabetes
Table 1: Distribution of participants according to their sociodemographic factors

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The awareness of type-2 DM and its association comparison with the urban and rural participants was shown in [Table 2]. According to the level of awareness, 147 (36.3%) were aware and 257 (63.7%) were not aware about the normal blood sugar levels, and the association with respect to urban and rural was statistically significant with P < 0.002. More than half, 229 (56.6%), of them were aware and 175 (43.4%) were not aware about glycated hemoglobin levels (HbA1C), and it was statistically significant with P value 0.003. Majority, 327 (81.0%), of the participants were using oral hypoglycemic agents (OHA), 59 (6.0%) of them were using both insulin and OHA, and only 18 (4.4%) were using insulin as the medication for diabetes. Almost three-fourth of the participants had a family history of diabetes and half of the participants were not aware of that diabetes is a multisystem disorder in rural settings compared to the urban, and it was statistically significant with P < 0.000. Majority, 119 (58.9%), of the urban area people monitored their blood glucose levels by self-monitoring compared to the rural area, 44 (21.7%), and it was statistically significant with P < 0.0001. Among them, 70 (58.9%) monitored on a monthly basis from urban and 41 (56.1%) from rural areas.
Table 2: Distribution of participants according to their knowledge on diabetes mellitus type 2

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[Table 3] shows the distribution of the participants according to the awareness of complications of diabetes type-2. More than half of 126 urban (59.4%) 99 rural (49.0%) were aware that alcohol consumption and smoking 119 (58.9%) and 94 (46.5%) increases the complication of diabetes respectively it is statistically significant with P value less than 0.02. In urban areas, 168 (83.1%) were aware that preventive measures were followed to avoid complications of diabetes than in the 117 (57.9%) rural area, it is statistically significant P < 0.000. More than three fourth 166 (80.2%) of the urban participants were aware that lifestyle modification and on medication, have an effect on preventing complications than the142 (75.2%) rural participants and it is statistically significant with P value less than 0.01. The distribution of participants according to the awareness of complications of DM type 2 were shown in [Table 4]. Almost three forth, 289 (71.5%), of the participants were aware and 115 (28.5%) were not aware of the rate of complications increases with the passage of time, respectively and more than 50% (222) of the participants were not aware of the diabetic foot care and 182 (45.1%) were not aware of the foot care. As per the knowledge on the chances of infections, more than 257 (63.6%) participants were aware of infections and 83 (20.5%) were not aware of infections and 64 (15.9%) were in dilemma. Out of them, 282 (69.9%) participants were aware that diabetic patients are high risk to get a severe form of COVID-19 infection, 63 (15.5%) were not aware, and 59 (14.6%) were in dilemma. Nearly two-third of the participants knew the complications of diabetes from the doctor or health-care provider and nearly half of them were not aware of the complications. The most common organ if complication involved in the diabetes was kidney 148 (36.7%), followed by 101 (25.0%) eyes, 79 (19.5%) heart, 45 (11.1%) and and nearly half 198 (49.1%) were not aware of the organs involved for the complications
Table 3: Distribution of participants according to the awareness of complications of diabetes mellitus type-2

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Table 4: Distribution of participants with the level of awareness of complications of diabetes mellitus type 2

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[Figure 1] shows more than half, 109 (53.9%) and 105 (51.9%), of the participants are reported that roti and green leafy vegetables are the most appropriate diet option for the diabetic population, followed by fruits and rice, respectively, from both the urban and rural areas. In [Figure 2] shows the lifestyle modification in diabetic patients of them majority 132 (65.3%) were reported brisk walking, 116 (57.4%) were cycling, exercise, and swimming, 42 and 40 were reported fruits and 24 and 38 were reported rice as the lifestyle modification, respectively
Figure 1: Distribution of the participants according to the level of diet modification. A = Coke, burger, and fries, B = Sweets, C = Rice, D = Roti with green leafy vegetable, E = Fruits

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Figure 2: Distribution of the participants according to appropriate lifestyle modification. A = Brisk walking, cycling, and exercise, swimming, B = Regular sleep, C = Yoga and meditation, D = Sedentary lifestyle

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  Discussion Top


The study revealed the knowledge and awareness of type-2 DM and its complications in urban and rural area patients. The study included both males and females of aged 30 years and above, and the mean age of the participants was 46.8 years. The present study showed the knowledge is more in the urban compared to the rural patients about the normal blood sugar levels (45.6% and 27.2%), glycated hemoglobin (63.8% and 49.5%), use of medication,family history of diabetes (59.4% and 43.1%), and it is statistically significant. Similar studies on knowledge and awareness were done by IPhase I of the ICMR INDIAB study,[8] which was conducted in three states randomly selected to represent the South (Tamil Nadu), West(Maharashtra), and East (Jharkhand) of India and one UT representing Northern India (Chandigarh) also showed the knowledge on the urban people was more than the rural. Overall 46.7% of males and 39.6% of females reported that they knew about a condition called diabetes (P < 0.001). Males had better awareness rates about diabetes than females in all regions. However, WHO fact sheet[9] and Ashwini et al.[10] was done in the population-based sample and the present study was done with sample in the field practice area of south India. Similar studies done at different settings Chennai in 2005[11] and 2007[12] and Hawal et al.[13],[14] reported that only 25% and 10% of the participants, respectively, had not heard of diabetes. The higher rates of awareness in Chennai could be due to the extensive diabetes awareness activities in Chennai carried out by multiple stakeholders. The previous studies in Asia and developing countries revealed that knowledge related to diabetes is poor among people with diabetes.[14],[15],[16],[17] Some research also indicates that knowledge of diabetes is not sufficient among diabetic patients, especially in the elderly.[18]

The present study revealed that the awareness of the complications from diabetes like the rate of complication with increase in time (66.3% and 57.0%), awareness of diabetic foot (52.9% and 37.1%), prone to infections (67.3% and 58.9%), prone to COVID 19 infection (74.7% and 64.9%), most common organ involved as the complication arise was kidney (39.6 33.7%) in both the urban and rural areas and urban patients had more knowledge and it was statistically significant with P < 0.05. The present study's finding is consistent with previous studies conducted in India,[18] Ghana,[19] and Ethiopia,[20] and whereby most participants had inadequate knowledge of diabetes complications. Conflicting findings were reported in Nigeria, where 90.5% of T2DM patients had adequate knowledge of diabetes complications.[21] The variation in the knowledge and awareness among urban and rural patients could be due to the difference in socioeconomic and cultural characteristics, which have been established to have an influence on patient's knowledge.[22] Knowledge, attitude, and practice (KAP) regarding diabetes have been demonstrated to have an essential role to ensure better management of the disease. KAP data can be critical to building health promotion and public health response.[23] The present study after assessing the knowledge on diabetes and its complications planning to do the health education camps on NCD clinic days at respective centers on every fortnight.

Limitations

The cross-sectional nature of the study design makes it impossible to form causal relationships between exposure and outcome variables. Second, the study is conducted in one community and one cultural group; therefore, the findings might not necessarily be generalized to be the same in rural areas.


  Conclusion Top


The present study provides a snapshot of the current situation of knowledge and awareness of diabetes in urban and rural areas. The study emphasizes the need for improvement in knowledge and awareness among both the urban and rural population as well as diabetic subjects to achieve prevention and better control of diabetes and its complications. Education about risk factors, complications, diet control, physical activity, regular checkups, and screening will go a long way in achieving better control of diabetes and thus reduce the burden due to diabetes complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Tracey ML, Gilmartin M, O'Neill K, Fitzgerald AP, McHugh SM, Buckley CM, et al. Epidemiology of diabetes and complications among adults in the Republic of Ireland 1998-2015: A systematic review and meta-analysis. BMC Public Health 2016;16:132.  Back to cited text no. 1
    
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Visser A, Snoek F. Perspectives on education and counseling for diabetes patients. Patient Educ Couns 2004;53:251-5.  Back to cited text no. 2
    
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International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium: International Diabetes Federation; 2019.  Back to cited text no. 3
    
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World Health Organization. The Top 10 Causes of Death. Available from: http://www.who.int/en/newsroom/factsheets/detail/the-top-10-causes-of-death. [Last accessed on 2021 Jun 04].  Back to cited text no. 4
    
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Tao Z, Shi A, Zhao J. Epidemiological perspectives of diabetes. Cell Biochem Biophys 2015;73:181-5.  Back to cited text no. 5
    
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Mao W, Yip CW, Chen W. Complications of diabetes in China: Health system and economic implications. BMC Public Health 2019;19:269.  Back to cited text no. 6
    
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Rani PK, Raman R, Subramani S, Perumal G, Kumaramanickavel G, Sharma T. Knowledge of diabetes and diabetic retinopathy among rural populations in India, and the influence of knowledge of diabetic retinopathy on attitude and practice. Rural Remote Health 2008;8:838.  Back to cited text no. 7
    
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World Health Organization. Diabetes Mellitus. Fact Sheet N1382014. Available from: http://www.who.int/mediacentre/factsheets/fs138/en/. [Last accessed on 2014 Oct 16].  Back to cited text no. 9
    
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Ashwini S, Anitha R. Antihyperglycemic activity of Caralluma fimbriata: An in vitro approach. Pharmacogn Mag 2017;13:S499-504.  Back to cited text no. 10
    
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Somannavar S, Lanthorn H, Pradeepa R, Narayanan V, Rema M, Mohan V. Prevention awareness counselling and evaluation (PACE) diabetes project: A mega multi-pronged program for diabetes awareness and prevention in South India (PACE- 5). J Assoc Physicians India 2008;56:429-35.  Back to cited text no. 11
    
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Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A, et al. Awareness and knowledge of diabetes in Chennai – The Chennai Urban Rural Epidemiology Study [CURES-9]. J Assoc Physicians India 2005;53:283-7.  Back to cited text no. 12
    
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Hawal NP, Shivaswamy MS, Kambar S, Patil S, Hiremath MB. Knowledge, Attitude and Behaviour Regarding Self-Care Practices Among Type 2 Diabetes Mellitus Patients Residing in an Urban Area of South India. Int Multidiscip Res J 2013;2. https://updatepublishing.com/journal/index.php/imrj/article/view/1652.  Back to cited text no. 13
    
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Abbasi YF, See OG, Ping NY, Balasubramanian GP, Hoon YC, Paruchuri S. Diabetes knowledge, attitude, and practice among type 2 diabetes mellitus patients in Kuala Muda District, Malaysia – A cross-sectional study. Diabetes Metab Syndr 2018;12:1057-63.  Back to cited text no. 14
    
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Murugesan N, Snehalatha C, Shobhana R, Roglic G, Ramachandran A. Awareness about diabetes and its complications in the general and diabetic population in a city in southern India. Diabetes Res Clin Pract 2007;77:433-7.  Back to cited text no. 15
    
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Gautam A, Bhatta DN, Aryal UR. Diabetes related health knowledge, attitude and practice among diabetic patients in Nepal. BMC Endocr Disord 2015;15:25.  Back to cited text no. 16
    
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Hussain R, Rajesh B, Giridhar A, Gopalakrishnan M, Sadasivan S, James J, et al. Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study. Indian J Ophthalmol 2016;64:272-6.  Back to cited text no. 17
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Obirikorang Y, Obirikorang C, Anto EO, Acheampong E, Batu EN, Stella AD, et al. Knowledge of complications of diabetes mellitus among patients visiting the diabetes clinic at Sampa Government Hospital, Ghana: A descriptive study. BMC Public Health 2016;16:637.  Back to cited text no. 19
    
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Belsti Y, Akalu Y, Fekadu H, Animut Y. Awareness of complications of diabetes mellitus and its associated factors among type 2 diabetic patients at Addis Zemen District Hospital, northwest Ethiopia. BMC Res Notes 2019;12:602.  Back to cited text no. 20
    
21.
Ademeyi O, Timothy TF, Oluwanimodimu DV, Tosin TO. Knowledge of diabetes complications and practice of routine medical check-up among type 2 diabetics in Nigeria. JAMMR 2018;25:1-8.  Back to cited text no. 21
    
22.
Otero LM, Zanetti ML, Ogrizio MD. Knowledge of diabetic patients about their disease before and after implementing a diabetes education program. Rev Lat Am Enfermagem 2008;16:231-7.  Back to cited text no. 22
    
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