Self-care activities among patients with diabetes attending a tertiary care hospital in Biratnagar , Nepal

Background: Diabetes mellitus is a complex disease and has emerged the worldwide. Self care management is very important to control and prevent from complications. Although it can be preventable by adopting the healthy numerous skills and health education . Method and Materials: A cross-sectional study of 141 patients with >1-year duration of type 2 diabetes mellitus (DM) were interviewed at Nobel Medical College Teaching Hospital using a non-probability sampling technique to select the sample between October 2017 -January 2018 to respond the diabetic self care questionnaire. For the analysis the descriptive statistics was used. T test and anova were used for the association between the variables. Result: A total of 141 diabetic were participated in the study, in which 50.4% were male and 49.6% female. Among the respondents 27% were in the age group below 50 years, 50.4% were illiterate , 42.6 % were overweight and most of the respondents had duration of disease between 1 to 5 years. The mostly performed self care activities was foot care whereas least was blood sugar monitoring. The mean score of self care behavior of respondents was 53.56 ± 4.48. Among them 50.4% of respondents had self care behavior below 69.5% i.e. had poor practice and 78% scored 69.5% and above 49.6% i.e. had good practice. The obtained results showed that there is significant association of self care behavior with age, education level, occupation and age at diagnosis but not with sex. Conclusion: The scenario of self care activities in some areas were found not up to the mark. So health personnel should provide education to the people with diabetes as it has significant benefit with regard to have better quality of life and prevention of complications. Keyword: Self Care Activities, Type II Diabetic Mellitus Introduction Diabetes mellitus (DM) has been a fast leading problem all over the world [1]. In 2015 it was estimated that there were 415 million people suffering from diabetes, mostly with aged 20-79years, 5.0 million deaths and by 2040 the number is likely to increase by 642 million [2]. The currently pandemic diabetic threatens to both developed and developing countries as a result it affect in social, economic and health [3]. In Nepal, approximately Dejina Thapa, Journal of Nobel Medical College *Corresponding Author: Dejina Thapa, Lecturer | E-mail: dejinathapa21@gmail.com 12 18.56% of population suffers from the type 2 diabetes mellitus [4]. Furthermore in Nepal it has been found that noncommunicable diseases a major public health concern [5,6]. In addition, diabetes associate with its complications affect high on the finances of the families aswell as the economies burden of the country [7]. As a result there is a high risk of physical disability [8]. Diabetes is a serious, chronic disease associated with wide range of comorbidities which required multisectorial approach for its management and individual can play an important role for being adopting the healthy lifestyle [9]. Effective approaches are available such as healthy eating as per the physician, regular exercise, blood sugar monitoring, taking medication, avoiding alcohol and smoking, and controlling blood pressure and lipids to prevent from premature death and its complications [10]. All these approaches have been found to be effective in controlling blood glucose and to prevent from life threatening major and minor complications like stroke, kidney failure, heart disease and nerve damage and ultimately enhance the quality of life [5,11 ] Evidence from earlier studies showed patient self-care activities focused interventions has good outcome on diabetes, therefore there is a need of health education program to the diabetic and general population [12]. Despite the fact, adherence to these behavior has been found minimum, especially when looking for a future changes. In order to find a baseline assessment of the self-care activities, taking into consideration these issues, so the objective of our study is to assess the self-care activities of the type 2 diabetic patients and its association with demographic variables.. Materials and Methods A hospital based cross-sectional study was carried out at Nobel Medical College Teaching Hospital, Biratnagar, Nepal in medicine OPD from October 2017 to January 2018. A total of 141 with T2DM adult patients (≥20years) were recruited as a sample and purposive sampling technique were adopted. In the study, patient who has DM2 for less than one month were excluded. The sample size was calculated by using a population proportion formula. Prevalence from the previous studies was found 58 % of good practice on self care [5], 15 % margin of error, 95% confidence interval and 20 % non-response rate. The interview method was used to collect the information regarding self-care activities using the revised version of summary diabetes self-care activities questionnaire (SDSCA) [13] and tool is highly valid and used in various areas. There are seven components; among these we included exercise, diet, blood sugar testing, medication practices and foot care. Except in blood sugar testing, there is uniform pattern to all the compontents. The questionnaire was translated in Nepali and pretesting was done and necessary modification was also done.. Ethical clearance was obtained before doing the study. The collected data was calculated by using Statistical Software Package for Social Sciences (SPSS 22 version). Demographic variables, Diabetic profile and Self care activities was calculated using descriptive statistics whereas coorelation between self care activities and demographic variables was calculated using T test and avova test. Results Demographic characteristics of the sample Among the 141 sample, 50.4% were males compared to females 49.6% . We found that over represented age was found to be below 50 years 27% . Similarly majority of the respondents were Dejina Thapa, Journal of Nobel Medical College *Corresponding Author: Dejina Thapa, Lecturer | E-mail: dejinathapa21@gmail.com 13 illiterate 50.4%.24.1% of the respondents were business man followed by agriculture 12.8%. The details of socio-demographic of the study respondents are shown in below (Table 1) Table 1 Demographic characteristics of the sample (n=141) Demographic Characteristic s Category Frequenc y (n=141) Percentag e (%) Age (in years) Below 50 38 27


Introduction
Diabetes mellitus (DM) has been a fast leading problem all over the world [1].In 2015 it was estimated that there were 415 million people suffering from diabetes, mostly with aged 20-79years, 5.0 million deaths and by 2040 the number is likely to increase by 642 million [2].The currently pandemic diabetic threatens to both developed and developing countries as a result it affect in social, economic and health [3].In Nepal, approximately 18.56% of population suffers from the type 2 diabetes mellitus [4].Furthermore in Nepal it has been found that noncommunicable diseases a major public health concern [5,6].In addition, diabetes associate with its complications affect high on the finances of the families aswell as the economies burden of the country [7].As a result there is a high risk of physical disability [8].Diabetes is a serious, chronic disease associated with wide range of comorbidities which required multisectorial approach for its management and individual can play an important role for being adopting the healthy lifestyle [9].Effective approaches are available such as healthy eating as per the physician, regular exercise, blood sugar monitoring, taking medication, avoiding alcohol and smoking, and controlling blood pressure and lipids to prevent from premature death and its complications [10].All these approaches have been found to be effective in controlling blood glucose and to prevent from life threatening major and minor complications like stroke, kidney failure, heart disease and nerve damage and ultimately enhance the quality of life [5,11 ] Evidence from earlier studies showed patient self-care activities focused interventions has good outcome on diabetes, therefore there is a need of health education program to the diabetic and general population [12].Despite the fact, adherence to these behavior has been found minimum, especially when looking for a future changes.In order to find a baseline assessment of the self-care activities, taking into consideration these issues, so the objective of our study is to assess the self-care activities of the type 2 diabetic patients and its association with demographic variables..

Materials and Methods
A hospital based cross-sectional study was carried out at Nobel Medical College Teaching Hospital, Biratnagar, Nepal in medicine OPD from October 2017 to January 2018.A total of 141 with T2DM adult patients (≥20years) were recruited as a sample and purposive sampling technique were adopted.In the study, patient who has DM2 for less than one month were excluded.The sample size was calculated by using a population proportion formula.Prevalence from the previous studies was found 58 % of good practice on self care [5], 15 % margin of error, 95% confidence interval and 20 % non-response rate.The interview method was used to collect the information regarding self-care activities using the revised version of summary diabetes self-care activities questionnaire (SDSCA) [13] and tool is highly valid and used in various areas.There are seven components; among these we included exercise, diet, blood sugar testing, medication practices and foot care.Except in blood sugar testing, there is uniform pattern to all the compontents.The questionnaire was translated in Nepali and pretesting was done and necessary modification was also done.. Ethical clearance was obtained before doing the study.The collected data was calculated by using Statistical Software Package for Social Sciences (SPSS 22 version).Demographic variables, Diabetic profile and Self care activities was calculated using descriptive statistics whereas coorelation between self care activities and demographic variables was calculated using T test and avova test.

Demographic characteristics of the sample
Among the 141 sample, 50.4% were males compared to females 49.6% .We found that over represented age was found to be below 50 years 27% .Similarly majority of the respondents were illiterate 50.4%.24.1% of the respondents were business man followed by agriculture 12.8%.The details of socio-demographic of the study respondents are shown in below (Table 1) Table 1

Discussion
Diabetes mellitus is a chronic disorder which requires life long medical treatment and patients should follow a healthy life style in order to prevent from complications .Currently it is a major public health challenge.Among the study respondents , nearly half are the over weight and obese similar findings have found in srilanka [14].Canidian Diabetes association states that 80-90% of DM patients in the world are overweight and obese [15].The reason for overweight and obese may be over consumption of carbohydrate containing foods and lack of knowledge on dietary pattern.The findings of the present study show that 70.21% respondents follows a regularly healthy diet plan.The findings were similar which was observed by [16].The reasons for not consuming healthy diet may be lack of education; recommended healthy diet is very expensive and may be busy with family commitments [17].Regular consumption of health diet is very important as it helps to maintain blood sugar control and proper weight management.Regular activity is a key part of managing diabetes.In our study the physical exercise is found to be poor, as only 56.7% .of the respondents did a 30 min exercise at least 5 days in a week.Similar findings were observed in studies done in [18].The reasons for poor exercise may be lack of motivation or social influence [17].Regular exercise helps to maintain ideal body weight, blood sugar and pressure control [19].Awareness on diabetic foot care will help to decrease the chances of diabetic foot complications as well as amputation of legs.With regard to foot care, all the respondents take care of their foot.The findings is similar to a study done in Malaysia which is 80.9% of the respondents washed their feet on daily basis [20].This may be due to the religious aspect which enables them to washing feet daily.Similarly the findings is contrast with the findings of study done in Nigeria which is only 10.2% practice foot care [21].This finding of poor practice in nigeria may be illiteracy or low socio economic status.In our study 69.5% checked the blood sugar every 3 month which is similar were observed to a study done in [22].The level of education appeared to play a magnificent role in medication adherence in accordance with the previous studies [23].To assess the effectiveness of ongoing treatment blood sugar should be regularly monitored.In our study we found that adherence to oral hypoglycemic drugs (86.52%) and insulin injections (78%) was high which is contrast with the findings of previous studies [23]

Conclusion
Today, DM is an important challenge for health care providers and health care system in addressing the self care activities .So keeping in mind, there is need of interventional health education to the patient, making them conscious regarding the disease condition, adopting the healthy life style, These helps to minimize the cost of the treatment and maintain the control of the disease with reduce the risk of complications.Recommendations Hospital based lifestyle modification intervention program should be launch which include multidisciplinary team including physician, nurses, dietician, psychologist and social worker should be involved.

Limitations
It was carried out in only one hospital so findings cannot be generalized to entire country.We couldn't establish the casual relationship as ours was a cross-sectional study.

Funding
No fund was provided.

Declarations Competing interest
No conflict of interest was stated..