Level of Knowledge and Self-Care in Diabetics in a Community Hospital in Najran
2000; King Faisal Specialist Hospital and Research Centre; Volume: 20; Issue: 3-4 Linguagem: Inglês
10.5144/0256-4947.2000.300
ISSN0975-4466
Autores Tópico(s)Chronic Disease Management Strategies
ResumoBrief ReportsLevel of Knowledge and Self-Care in Diabetics in a Community Hospital in Najran Latif Ahmed Khan and MD, MRCP Sarosh Ahmed KhanMD Latif Ahmed Khan Address reprint requests and correspondence to Dr. Latif Khan: Department of Medicine, Najran General Hospital, Najran, Saudi Arabia. From the Department of Medicine, Najran General Hospital, Najran, Saudi Arabia Search for more papers by this author and Sarosh Ahmed Khan From the Department of Medicine, Najran General Hospital, Najran, Saudi Arabia Search for more papers by this author Published Online:1 May 2000https://doi.org/10.5144/0256-4947.2000.300SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionDiabetes mellitus (DM) is very common in Saudi Arabia. It is estimated that nearly one in every five Saudis above the age of 30 years has diabetes.1 Given the very high prevalence of obesity in this population,2 more and more people can be expected to develop diabetes in the future. Patient education has been proven to be an important method of management of such a community health problem.3 In order to assess the level of awareness about the disease and self-care methods, we undertook this study which, we hope, will form the basis for further research in this direction in the future.PATIENTS AND METHODSA cross-sectional study on Saudi diabetic patients registered in our diabetic cum medical clinic was carried out at Najran General Hospital, Najran, in 1998. The following groups of patients were excluded from the study: 1) diabetics on diet control only; 2) patients with disease duration of less than two years; 3) patients below 20 years of age (still dependent on parents); and 4) patients above 80 years (as they could have senile forgetfulness dementia, etc.) We selected four diabetic patients daily (every fifth diabetic seen in the clinic). Patients were interviewed by one of the two authors. The data and responses were recorded on a previously prepared questionnaire. Patients' level of knowledge was assessed by asking questions on symptoms of hypoglycemia and chronic complications of diabetes. Knowledge about hypoglycemia was considered to be adequate if patient could correctly recall three of the following hypoglycemic symptoms: sweating, palpitations, hunger, tremor or feeling of impending disaster, each of which can be relieved by taking some food or glucose. Knowledge about chronic complications was assessed and deemed adequate if patients could specify at least three of the following: effect on vision (retinopathy), kidneys (nephropathy), sensation (neuropathy), potency (automatic neuropathy), heart (ischemic heart disease) and on the legs and feet (peripheral vasculopathy).5 Patients' level of self-care was assessed by asking about the following practices carried out at home: 1) urine testing by the dipstick method; 2) blood sugar testing by glucometer, and 3) self-injection of insulin. The responses were recorded as “yes” or “no.” All the data was tabulated and analyzed. Chi-squared test was used to assess significance (P-value) of differences between males and females.RESULTSWe studied a total of 342 patients with a mean age of 50.63±9.89 years. The duration of diabetes ranged from 2-30 years, with a mean of 12.97±4.88 years. Forty of our patients (12%) had insulin-dependent diabetes mellitus (IDDM), whereas 211 (62%) were taking insulin. The results are presented in Tables 1 and 2.Table 1. Level of knowledge in diabetics of Najran.Table 1. Level of knowledge in diabetics of Najran.Table 2. Level of self-care in Najran.Table 2. Level of self-care in Najran.DISCUSSIONThe results show that 56% of patients had adequate knowledge about the symptoms of hypoglycemia. Although it is well known that patients passively learn to recognize the symptoms once they suffer from it, it is noteworthy that almost half of them did not have adequate knowledge of the disease. Similar figures have been reported from the Al-Qassim region.5 The males in our study were more aware than females, possibly due to the fact that males discuss problems more readily with doctors who are predominantly non-Saudis than do females. Another reason could be that the females who are housewives have easier access to food compared to working males, who may thus experience hypoglycemic symptoms more often and thus learn from them.Knowledge about the chronic complications of diabetes was painfully low (15%), and the difference between males and females did not show any statistical significance. This is very alarming, bearing in mind that most of the diabetic patients will develop some form of complications eventually. Many of the males knew that impotence is one of the complications. Those who qualified as having adequate knowledge invariably included impotence in their response. This awareness could be exploited for imparting education regarding chronic complications to male diabetic patients.Data on home testing of urine and blood was more dismal. Only 6% of patients were performing urine sugar testing (dipstick method) regularly at home, although education regarding this is routinely given to all new diabetics admitted to the hospital. We found females performing the tests more regularly than males, possibly because most women in Saudi Arabia are housewives and have enough time to perform these types of tests, whereas most males are working away from home. Only three of our patients performed regular testing of blood glucose by glucometer. Low literacy rate and technical difficulties encountered in using the glucometer might be factors responsible for such poor self-care.The only positive aspect of self-care was self-injection of insulin. About 76% of those taking insulin performed it by self-injection. One reason could be that we have trained a number of diabetics in the last four years to use insulin themselves. Nevertheless, about 24% of our insulin-requiring diabetics were dependent on the PHC or a relative at home for injecting insulin.Although we studied the number of patients doing urine and blood testing, we did not study details such as whether the method they were using was correct or not. Similarly, the correct method of injecting insulin was not ascertained. Evaluation of these variables needs another study. A more detailed study would also be needed to assess the multiple socioeconomic variables involved in compliance besides knowledge and awareness.Health education is one of the areas which needs to be addressed immediately.6 DM has been cited as a model disease in which patient education makes a big difference.7 Home monitoring of blood glucose and urine testing for glucose5 are considered major requirements for long-term glycemic control, thereby postponing, if not avoiding, long-term complications. Diabetics have to make very important and crucial decisions daily. Considering the poor level of knowledge and self-care reported from Al-Qassim,5 the Eastern Province,9 and Najran, we recommend the following measures for Saudi Arabia: 1) A National Institute of Diabetes (NIB), based in Riyadh, should be started. The institute will coordinate all the diabetic management activities in the Kingdom and conduct further research into the disease. 2) Diabetic educator nurses should be posted in all primary health care centers. Young Saudi males and females should be assigned this job. They know the language, culture and customs, and are well versed in the common socioeconomic problems. These people should be given training at the NID, and be made responsible for education of diabetics at home, teaching them self-injection of insulin, home monitoring of glucose, urine testing and related functions. They would also pay home visits to patients who are unable to attend the PHC for any reason. 3) Specific groups of diabetics with poor compliance due to economic reasons should be given financial support from government as well as voluntary organizations because the cost of continuous care of diabetics is substantial.ARTICLE REFERENCES:1. Al-Zaid AA. "Time to declare war on diabetes (editorial)" . Ann Saudi Med. 1997; 17:154–5. Google Scholar2. El-Hazmi MAF, Warsy AS. "Prevalence of obesity in the Saudi population" . Ann Saudi Med. 1997; 17:302–5. Google Scholar3. Hassan TA. "The centrality of the patient's role in the management of insulin-dependent diabetes mellitus" . Saudi Med J. 1998; 19:370–5. Google Scholar4. El-Hazmi MAF, Warsy AS, Al-Swailem AR, Al-Swailem AM, Al-Meshari AA. "Diabetes mellitus and impaired glucose tolerance in Saudi Arabia" . Ann Saudi Med. 1996; 16:381–5. Google Scholar5. Elzubier AG, Al-Amri ADA, Al-Haraka EA, Abu-Samara IO. "Self-care, self-reliance and knowledge of diabetes among diabetics in Al-Qassim region, Saudi Arabia" . Saudi Med J. 1996; 17:598–603. Google Scholar6. El-Hazmi MAF, Al-Swailem AR, Warsy AS, Al-Sudairy F, Sulaimani R, Al-Swailem AM, et al. "The prevalence of diabetes mellitus and impaired glucose tolerance in the population of Riyadh" . Ann Saudi Med. 1995; 15:598–601. Google Scholar7. Strowig S. "Patient education: a model for autonomous decisionmaking and deliberate action in diabetes self-management" . Med Clin North Am. 1982; 66:1293–307. Google Scholar8. Skyler JS. "Self-monitoring of blood glucose" . Med Clin North Am. 1982; 66:1227–50. Google Scholar9. Binhemd TA. "Diabetes mellitus. Knowledge, attitude, practice and their relation to diabetes control in female diabetics" . Ann Saudi Med. 1992; 12:247–51. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 20, Issue 3-4May-July 2000 Metrics History Received10 July 1999Published online1 May 2000Accepted10 May 2000 ACKNOWLEDGEMENTSWe would like to thank Ms. Melani A. Consulta and Ms. Lissy Joseph for their secretarial assistance in preparing this manuscript.InformationCopyright © 2000, Annals of Saudi MedicinePDF download
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