Knowledge, Attitude and Practice of Diabetic Patients regarding Diabetic Retinopathy in a Tertiary care Hospital.

 

Sarumathy S¹*, Leya Annie Johnson²

¹Department of Pharmacy Practice, SRM College of Pharmacy, SRM University, Kattankulathur-603203,

Kancheepuram (DT), Tamilnadu, India.

²Department of Pharmacy Practice, School of Pharmaceutical Sciences, Vels University (VISTAS), Velan Nagar, Pallavaram-600117, Chennai, Tamilnadu, India.

 

ABSTRACT:

The main objective of this study was to find out the knowledge, awareness and practice among diabetic retinopathy (DR) patients at a tertiary care hospital. Diabetic retinopathy is the micro vascular complication of Diabetes Mellitus (DM) that damages the tiny blood vessels of retina that can lead to blindness. DR usually occurs due to poor management of DM and lack of knowledge on the complications of diabetes mellitus. Diabetic retinopathy patients were randomly selected and requested to fill the pretested questionnaire before and after counselling regarding diabetic mellitus and retinopathy complications. All statistical analyses were done using graph pad prism and Microsoft excel. Knowledge, Attitude and Practice (KAP) scores were found to be 81.02 % (knowledge), 76.19% (awareness) and 70.13% (practice) respectively after counselling. A paired t test was done to analyze the difference in KAP scores before and after counselling which showed a significant difference (p<0.0001) confirming the importance of improvement in KAP. These results suggest that awareness to DR is very important and we need to propagate aggressive and comprehensive awareness models to educate rural populations on DM and its retinopathy complications.

 

 

 

 

INTRODUCTION:

Diabetes mellitus, particularly type II, is a major public health concern worldwide1. According to WHO, there will be an alarming increase in the population with type II diabetes mellitus, both in the developed and developing countries over the next two decades. In the developed world, the estimated increase is approximately 46%, from 55 million in 2000 to 83 million in 2030; whereas, among developing nations, the estimated increase is approximately 150%, from 30 million in 2000, to 80 million in 2030¹.

 

Eye is the ‘window of brain’ and organ of sight, which is the most precious sense organ and many people fear blindness more than any disability. As per ‘WHO’ diabetic retinopathy is the 5^th leading cause of blindness all over the world.²

 

Diabetic retinopathy is the micro vascular complication of Diabetes Mellitus that damages the tiny blood vessels of retina that can lead to blindness. It is estimated that about 40% of people with diabetes will have at least mild retinopathy. It is an embarrassing truth that India is the leading nation which has the highest incidence of Diabetes Mellitus. More than 5.6 million people are affected by Diabetic Retinopathy in India. Since most of these victims represent low educational and economic status; this background creates a great burden which leads to ineffective prevention of blindness due to Diabetic Retinopathy³.

Studies such as the Wisconsin Epidemiological Study have proved that micro vascular complications such as diabetic retinopathy (DR) in the diabetic population are linked to the duration of the disease^. While the occurrence of DR cannot be prevented, the vision threatening complications can be minimized⁴. Prevention of diabetes through awareness and education of the community is the most cost effective management of diabetes and its related complications^{5, 6}.

 

In order to create awareness in the community, insight into the gaps of knowledge, attitudes and practices regarding diabetes and blindness due to diabetes is important. Hence the present study was undertaken to assess the awareness level or knowledge of diabetes and DR in a tertiary care hospital, and its association with their attitude and practice.

 

 

MATERIALS AND METHODS:

This prospective interventional study was carried out in the ophthalmic department of a tertiary care hospital for a period of 6 months from November 2015- April 2016. The desired sample size was 70 patients out of which 38 were males and 32 were females. The inclusion criteria included diabetic retinopathy patients with or without co-morbid disease conditions of both genders and the exclusion criteria included pregnant and mentally challenged patients. Patients were assessed for their knowledge, attitude and practice regarding the diabetic retinopathy and were asked to fill a structured questionnaire in their local language prior to the counseling and also after the counseling regarding DM and DR. The questionnaire was validated using a pilot study pretested in a sample group of a representative population and also with the opinion of the ophthalmologists. Consent from the hospital authorities and ophthalmologists were obtained. The study protocol was approved by the institutional ethics committee. All the statistical analyses were done using Microsoft Excel and Graph pad prism 6.0. A two tailed p-value of less than 0.05 was considered significant throughout the study.

 

RESULTS:

A total of 70 patients participated for the study out of which 38 were males and 32 were females. Most of the respondents were from the age group of 61-70 (43%) followed by 71-80 years (35%). The demographic details are depicted in Table 1. The knowledge scoring of the DR patients before and after patient counselling is depicted in table 2. The knowledge regarding the diabetes, diabetic complications and diabetic retinopathy was found to be increased after the patient counselling.

 

Table 1: Demographic details of the patients

Gender	No. of patients (N=70)	Percentage of patients (%)
Male	38	54.20
Female	32	45.70
Age Group (y)
50-60	12	17.10
61-70	30	42.80
71-80	25	35.71
>81	3	4.20
Marital Status
Married	56	80
Unmarried	14	20
Duration of DM more than 5 years (y)
5-10	14	20
11-15	20	28.5
>15	36	51.4

 

Table 2: Knowledge Scoring of DR patients

Q.NO	Question (s)	No. of patients who answered before counselling	Percentage	No. of patients who answered after counselling	Percentage	P value
1.	Do you know what DM is?	64	91.42%	70	100%	<0.0001
2.	Do you know what the complications of DM are?	28	40.00%	56	80%	<0.0001
3.	Do you know what Diabetic retinopathy is?	24	34.28%	62	88.57%	<0.0001
4.	Do you know how often do you have to check your eye once you have DM?	15	21.42%	57	81.42%	<0.0001
5.	Do you know whether DM can cause any visual disturbances?	35	50%	68	97.14%	<0.0001
6.	Are you aware of the side effects of diabetic drugs?	30	42.85%	63	90%	<0.0001

 

The attitude scoring of the DR patients is depicted in Table 3. About 91.42% of the DR patients monitor their blood glucose regularly and 80% were aware of their treatment regimen after counselling (Table 3).

 

 

Table 3: Attitude Scoring of DR patients

Q.NO	Question (s)	No. of patients who answered before counselling	Percentage	No. of patients who answered after counselling	Percentage	P value
1.	How often do you monitor your blood glucose?	54	77.14%	64	91.42%	<0.0001
2.	Are you aware that improper management of DM has negative effects on end organs?	12	17.14%	47	67.14%	<0.0001
3.	Do you know what you have to do when you experience anti diabetic drug side effects?	11	15.7%	58	82.85%	<0.0001
4.	Are you aware about the signs of DR?	15	21.42%	32	45.71%	<0.0001
5.	Are you aware of your treatment regimen?	20	28.57%	56	80%	<0.0001
6.	Do you know uncontrolled diabetes affects your vision?	22	31.42%	45	64.28%	<0.0001

 

The practice scoring of the DR patients is shown in table 4.  68.57% of the DR patients were taking medications as prescribed by the physician after counselling and 35% go for eye checkup regularly every 3 months which is comparatively better than the attitude scoring before the patient counselling.

 

Table 4: Practice scoring of DR patients

Q.NO	Question (s)	No. of patients who answered before counselling	Percentage	No. of patients who answered after counselling	Percentage	P value
1.	Are you taking your medications properly?	45	64.28%	64	91.42%	<0.0001
2.	Did you have your eye checkup in 3 months?	3	4.28%	25	35.71%	<0.0001
3.	Do you take your medications as prescribed by your physician?	34	48.57%	48	68.57%	<0.0001
4.	Did you come across any side effect of any drug? Were you able to manage it?	22	31.42%	54	77.14%	<0.0001
5.	Are you having any visual disturbances now?	55	78.57%	68	97.14%	<0.0001
6.	Are you aware that you should consult your physician if you have problems with vision?	40	57.14%	64	91.42%	<0.0001

*Statistically Significant difference by student T test at the value <0.005

 

The total scores of knowledge, attitude and practice of DR patients before and after counselling is shown in Table 5. The mean KAP score was found to be increased among DR patients after patient counselling.

 

Table 5: KAP scores before and after counselling

Study Parameter	Before counselling (n = 70, %)	Mean KAP Score	After Counselling (n = 70, %)	Mean KAP Score
Knowledge	40	2.80	81.02	5.73
Attitude	31.90	1.91	76.19	4.571
Practice	38.16	2.71	70.13	4.9
Total mean KAP score		7.371 ± 1.94		15.1 ± 1.75

 

DISCUSSION:

Inspite of very few existing literature on knowledge and awareness creation among Indian patients, the results of our study suggest that knowledge among DR patients should be evaluated and more awareness should be created among those patients. The KAP scores was found to be increased after the patient counselling in our study population. Awareness creation is a vitally important step in the creation of a successful program to battle against any disease in the community. This is especially true of the growing problem of DR. Studies previously completed have revealed that DR, despite its status as one of the greatest causes of blindness in both developed and developing countries, is virtually unknown to a large majority of the population. Without awareness of the disease it is impossible for any individual to aid the cause of preventing blindness from DR, either in him or herself or in the community as a whole. Awareness creation is therefore necessary as one of the first steps in any program aimed at reducing DR⁷. Dandona et al⁸ also reported in her study regarding the increased awareness about the possibility of diabetes causing impaired vision among subjects aged older than 30 years, among those with any level of education and among those belonging to upper and middle socioeconomic strata; however, they reported results in urban population of India. Rani et al⁹ conducted a study among the rural population and found out more awareness should be given to the rural population in India. Namperumalsamy et al¹⁰ found very low levels of awareness among non-medical persons in south India. We found similar trends of low awareness in KAP study of General practitioners (GPs)¹¹. While several advances have taken place in the treatment of DR, little has been done to initiate any mass awareness program on diabetes and its microvascular complications such as DR.

 

People with diabetes have the right to understand their disease, make informed choices and receive care based on best practice. They must be part of the team that manages their condition. This can only be achieved if interdisciplinary teams and people with diabetes have the information and tools to make changes based on best practice and recognized improvement strategies are used to support meaningful system change¹².

 

CONCLUSIONS:

There is general awareness of diabetic retinopathy amongst a majority of patients (75%), there is however little or no knowledge of its risk factors and prevention. There is therefore a need for increasing awareness and also the provision of access to retinopathy screening services to the patient. Aggressive and comprehensive awareness is needed to educate diabetic patients on diabetic retinopathy.

 

CONFLICT OF INTEREST:

There are no conflicts of interest.

 

FINANCIAL SUPPORT:

Nil

 

REFERENCES:

1.       Wild S. et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 27; 2004:1047-1053.

2.       K Viswanath. Diabetic Retinopathy: Clinical findings and management. Journal of Community Eye Health. 6(46); 2003:21–24.

3.       M Rema. Diabetic Retinopathy: An Indian perspective. Indian Journal of Medical Research. 2007;297 – 310.

4.       Klein R, Klein B and Moss S. The Wisconsin Epidemiological Study of Diabetic Retinopathy: a review. Diabetes and Metabolic Review. 5; 1989:5559-5570.

5.       The Finnish Diabetes Association. Program for the prevention of type 2 diabetes in Finland. 2003. [2013 Oct 25]. Availablefrom:http://www.diabetes.fi/files/1108/Programme_for_the_Prevention_of_Type_2_Diabetes_in_Finland_2003-2010.pdf.

6.       Schwarz PE et al. The European perspective of type 2 diabetes prevention: diabetes in Europe—prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. Exp Clin Endocrinol Diabetes. 116; 2008:167–172.

7.       Vision 2020 e-resource (2004). Diabetic Retinopathy Awareness Strategies. 1(11); 2004.

8.       Dandona R et al. Awareness of eye diseases in an urban population in Southern India. Bulletin of the World Health Organization. 79(2); 2001:96-102.

9.       Rani PK et al. Diabetic retinopathy screening model for rural population: awareness and screening methodology. Rural and Remote Health. 5(4); 2005:350.

10.     Namperumalsamy P et al. A pilot study on awareness of diabetic retinopathy among non-medical persons in South India. The challenge for eye care programmes in the region. Indian Journal of Ophthalmology. 52; 2004:247-251.

11.     Rajiv R et al. Knowledge and attitude of general practitioners towards diabetic retinopathy practice in South India. Community Eye Health Journal.19; 2006:13-14.

12.     IDF (2010), Diabetes Education http://www.diabetesatlas.org/ content/diabetes education, accessed on 18th August 2010.

 

 

 

 

 

Accepted on 15.06.2017          © RJPT All right reserved