|Year : 2019 | Volume
| Issue : 1 | Page : 12-17
Awareness of diabetic complications among rural and urban diabetes population in Chennai
M Sherlin1, Saratth Chandra Govindraj2
1 SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu, India
2 Senior Lecturer, Rajas Dental College and Hospital, Radhapuram, Tamil Nadu, India
|Date of Submission||06-Oct-2021|
|Date of Acceptance||08-Oct-2021|
|Date of Web Publication||29-Nov-2021|
Dr. M Sherlin
SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Diabetes is chronic, multisystem disorder with life-threatening complications. According to a study by the Lancet, India is ranked among the top three countries having high diabetic populations. Easily managed by glycemic control and simple alteration in lifestyle, it is most often allowed to escalate to the level of complications due to the lack of adequate knowledge of the disease and its management. Moreover, regional and socioeconomic differences among the rural and urban population of the city could result in skewed perceptions of the disease, in terms of treatment and control. The awareness of these patients is crucial to preventing acute complications and reducing the risk of long-term complications, in order to have a positive impact on the morbidity and mortality levels associated with the disease. Representative data on their levels of awareness would help plan large scale diabetes awareness programs to reach and masses. Thus, the present study aims to assess and compare the rural and urban diabetic population of Chennai city, on their knowledge of diabetes and associated complications. Materials and Methods: A cross-sectional, community-based study was carried out on 100 diagnosed diabetics, of which 50 belonged to rural areas and 50 belonged to urban. A predesigned questionnaire pertaining to knowledge, attitude, and practices relating to the disease was administered to them. Data obtained from the two groups were compiled and statistically analyzed on Microsoft Excel 2016. Results: Out of the 100 self-reported diabetic participants, with a mean age of 45–65 years, it was evident that urban residents had consistently higher awareness rates about diabetes mellitus, its management and complications, compared to rural populations. The results emphasize the interrelation between demography and awareness. Conclusion: Urban diabetic patients are more aware than rural diabetic patients about diabetes mellitus, its management, and complications. The present study emphasizes interrelation between demography and awareness levels. The results underscore the need to design and implement the awareness programs directed at increasing the awareness among the rural population.
Keywords: Awareness, complications, diabetes mellitus, rural, urban
|How to cite this article:|
Sherlin M, Govindraj SC. Awareness of diabetic complications among rural and urban diabetes population in Chennai. Int J Soc Rehabil 2019;4:12-7
| Introduction|| |
Diabetes is a chronic, multifactorial, multisystemic condition, characterized by hyperglycemia and associated with disorders of protein, fat, and lipid metabolism. The disease is associated with the high levels of morbidity and mortality levels, as a result of its micro- and macrovascular complications.
India has come to be known as the diabetic capital of the world; with studies estimating that every fifth diabetic in the world is an Indian. Statistics reveal that by 2030, up to 79.4 million individuals, in India alone, will be afflicted by the disease., This could have grave implications on the social and economic sector of the developing country. With most affected individuals expected to be in the 45–64 years' age group, the disease poses a threat to the productivity of working individuals, the consequences of which will fall on the sustainability of health-care financing of the individual as well as the government. Moreover, conventional approaches to management of the disease, and prevention of its complications, are not only expensive, but also largely inaccessible to certain communities.,
No longer considered a disease of the rich, its prevalence is rapidly increasing among the poor in urban slums, the middle areas, and those dwelling in rural areas. With poorer access to education and health care among people belonging to lower socioeconomic groups, it is the need of the hour to increase the awareness about the nature and complications of the disease, with emphasis on prevention. Evidence-based studies support the notion that patients' knowledge on the various aspects of the disease, importance of glycemic control and self-care practices is the key to the prevention of complications, as they show more compliance to treatment.,
A correlation between demography and awareness could provide an insight into the level of awareness and its adequacy. In this context, the current study was planned with the objective of assessing the comparative level of awareness of diabetic patients residing in the urban and rural areas of the city, regarding the complications of diabetes. The results could help shed light on the areas where emphasis needs to place in terms of planning public health programs.
| Materials and Methods|| |
Study design, setting, and participants
This is a cross-sectional, community-based study, carried out in November 2016. Hundred adult patients diagnosed with diabetes mellitus were included. Out of 100, 50 were from urban area (Adyar, Nungambakkam) and 50 from rural (Kattupakkam, Karyanchavadi) in and around Chennai city, based on convenience sampling.
A predesigned questionnaire consisting of items on demographic profile including name, age, sex, level of education, employment status, and specific questions to assess their knowledge of complications, practices for preventing and management of complications, as well as their health-seeking behavior. The questions used to obtain data were as follows:
- Are you aware diabetes has complications? Yes/No
- If yes, what were your sources of information? Physician/Newspaper/Television/Internet/Schools
- Uncontrolled DM can cause rapid breathing with fruity odor. Yes/No
- Uncontrolled DM can cause foot ulcers. Yes/No
- Uncontrolled DM can cause decreased sensation in feet. Yes/No
- Uncontrolled DM can cause eye-related complications. Yes/No
- Uncontrolled DM can cause kidney-related complications. Yes/No
- Uncontrolled DM can cause increased BP. Yes/No
- Uncontrolled DM can cause heart disease. Yes/No
- Uncontrolled DM can lead to stroke. Yes/No
- Uncontrolled DM can cause coma. Yes/No
- Which of the following practices do you follow to prevent complications?
- Wearing closed shoes
- Inspecting feet for cuts and bruises
- Regular monitoring of blood sugar levels
- Losing excess weight
- Consumption of high fiber diet
- Regular eye check-ups.
Patients were explained the purpose of the study, confidentiality assured, and verbal consent was obtained before the collection of the data. The questionnaire was translated to the local language and administered by interviewer.
Inclusion and exclusion criteria
All adult patients (aged 18 and above) diagnosed with diabetes. No patient refused to participate.
Data were compiled and analyzed on Excel 2016 version.
| Results|| |
The total number of surveyed participants were 100 (58 male and 42 female), as shown in [Figure 1], of which 50 belonged to the rural areas of Kattupakkam and Karyanchavadi and 50 belonged to urban areas of Adyar and Nungambakkam. The main feature of the study lies in the contrast between the two. The demographic characteristics of the study population are tabulated in [Table 1]. The mean participants interviewed were above the age of 45 years (73%), followed by those in the 35–45 years' age bracket (23%), and only 4% of the interviewed population were below 35 years [Figure 2].
Data were collected and tabulated based on the levels of literacy; participants were classified as illiterate, those who had received only primary level of education, those who had received up to secondary level of education, and those who were holders of a degree [Figure 3].
|Figure 3: Educational qualification among the rural (n = 50) and urban population (n = 50)|
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It was determined that majority of rural cohort had received only primary education (50%), while the urban population made up majority of the percentage who had received secondary education and degrees. On tabulating the participants' employment status, it was evident that it was higher among urban than the rural population [Figure 4].
When questioned on their sources of information [Figure 5], for both, the rural and urban population, majority reported their local physician to be their major source of information on the disease.
[Figure 6] showed that 49 participants of urban population reported that heart diseases are considered to be one of the diabetic complication.
|Figure 6: Awareness among the rural and urban population on complication|
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[Figure 7] showed that 52 participants of urban population reported that monitoring sugar level plays a very important part in controlling diabetes and helps in preventing its complications.
|Figure 7: Awareness among the rural and urban population on practices to prevent complications|
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| Discussion|| |
In this study, we sought to identify, investigate, and evaluate by means of exploratory and evaluatory research, the awareness of urban and rural diabetic patients about the disease. The strategy was to administer a questionnaire that would test their knowledge, attitudes, and practices regarding the disease, its complications, and management. The major finding is the general lack of awareness among Chennai residents, with urban diabetic residents much more knowledgeable compared to rural diabetic residents.
The results emphasize a need for imparting community-based diabetic education to the general population and to the diabetic population in particular. Chennai, metropolitan city in Southern India, where this study was carried out, is considered a model city in terms of diabetes education activities. It is known for having the first ever diabetic clinic in India, established at the Stanley Medical Hospital in 1948. It is also home to the highest number of government run diabetic clinics in the country. A survey conducted between 2004 and 2007 revealed that over 770 diabetes awareness and free screening camps were conducted as part of its prevention, awareness, counseling, and evaluation diabetes project. With such impressive credentials, it is a matter of concern when 18% of our interviewed participants were not aware that diabetes posed any serious threat to health. It is also worrisome to think where other cities might stand in terms of awareness when Chennai, after so many measures, shows unsatisfactory results.
The epidemic of noncommunicable lifestyle diseases poses a major public health concern, in developing countries such as India. While India is considered the diabetic capital of the world, not enough is done to tackle the problem. With more than 32 million diabetic participants in India currently, the numbers are expected to double by 2013. Moreover, the WHO reports the highest increase of affected individuals to be between the age group of 45 and 65 years; those falling into this age bracket are usually considered to contribute the most to the economic levels of the country., Apart from being a huge economic burden to the country, a price cannot be placed on intangible costs that come with compromised mental health and poor productivity as a result of the disease. Coincidentally, in our study, the mean age of the participants was between the age group of 45 and 55 years.
Increasing amount of evidence indicates that diabetes is a lifestyle disease, easily preventable by simple lifestyle alterations such as dietary modifications and improving exercise behaviors., This has been evidenced in studies such as the diabetes prevention program, the finish diabetes prevention study, and the Da Quingstudy. A studies conducted by Bjork S and Tham KY showed that early educational intervention improved patients' knowledge and long-term control of the disease. Previous studies have shown a clear link between patient education and prevention of complication of diabetes.,
The fact that self-reported diabetics in the study were generally unaware about the disease and its complications reveals an urgent need to implement programs to impart diabetes education to patients. The regional differences in awareness levels could be attributed to the varying levels of education, with those from the rural areas having limited access to resources to educate themselves. Those with no formal education had high unawareness rates compared to the educated group, which is in agreement with previous studies. The urban population scored higher on their awareness about complications compared to the rural populations.
Patients were asked to cite their sources of information on the disease. The popular option among both the urban and rural population was the primary care physician. This goes to show that nationwide programs aimed at providing evidence-based guidance to physicians, general practitioners and diabetes educators, ensures improved education and treatment outcome for the patient. Two such efforts by the Indian government, namely Certificate Course in Evidence-Based Diabetes Management and National Diabetes Educator's Program have made a difference to diabetes care and education. It was also disappointing to note that neither group ranked schools very high on the list. It is crucial that the high-risk group, which is the next generation, is targeted at the level of primary education in school. Early intervention makes a huge difference in the disease control and prevention of complications. Maximum individuals from the urban cohort chose Internet as their preferred source, which was in contrast to the rural cohort (1%). It was found that those having access to technology had higher health literacy as compared to individuals with no access. Accessible technology is crucial to understanding health information and can act as an enabler in diabetes self-care management.
A positive correlation has been found between the number of complications per patient and patients' health-care expenditure. The presence of complications weighed heavily on consultation, hospitalization, and generally overall costs. A study carried out in Chennai comparing diabetes care costs for patients with and without complications has revealed that the total costs for patients from 2008 to 2009 revealed that total costs incurred by patients without complications of the disease was INR 4493, compared to INR 14691.75 for patients with complications. On investigating different types of complications, it was found that foot complications incurred the highest costs, followed closely by renal, cardiovascular, and retinal complications.
The results of our study confirm the interrelation between awareness and socioeconomic status of the population. Our study observed that those belonging to a lower socioeconomic status were significantly less aware than those belonging to a higher class. A study by Shobhana et al. revealed low-income individuals bore the highest burden of diabetes. However, it was found in a study done in India on type II DM, from 1998 to 2005 that the urban population showed higher expenditure numbers in terms of absolute terms and as proportion of income. This could be attributed to higher charges for consultation, laboratory tests and drugs, and more expensive treatments in urban areas. These individuals, being economically better off, were found to seek health care in private hospitals with better health-care facilities, and hence, faced a better prognosis. On the other hand, those from lower socioeconomic strata could only afford public hospitals funded by the state; these were found to be crowded, with overworked staff and insufficient treatment options. The rural population were found to spend significantly lesser, more due to the issues of inaccessibility and affordability, rather than because of a lower need. A study by Rayappa found that unemployed, uneducated people from the rural areas were more likely to be diagnosed later as they could not afford to consult a doctor and thus, developed complications. Thus, early detection would provide as a means of cost reduction.
The participating individuals were questioned on their practices of prevention. Misconceptions due to inadequate education on the matter drive misguided perceptions on eating, food habits, and exercise behavior., Changing societal perceptions of health would drive the community toward making healthier life choices. With rapid epidemiological transition to urban areas, compounded by industrialization and rapid pace of growth, developing countries are most affected. A consequence of that being that communicable diseases are replaced by noncommunicable disease. Both cohorts were well aware of the importance of regularly monitoring blood sugar levels. However, urban population was more aware of the practice of losing excess weight. In a developing country such as India, which struggles with malnutrition and poverty, obesity is seen as a sign of good health and prosperity. However, with demographical transitions, obesity poses as a major public health concern, with underweight individuals being replaced by obese. Thus, rural individuals must be made aware of the dangers of excess weight and the benefits of exercise.
The present study emphasizes on a need for comprehensive diabetes education programs and community level awareness programs. Mobile health units can be implemented to access the remote areas of the country. Mass media campaigns, public lectures, and door to door campaigns can also make a difference. There is a need for policy-makers to review existing health coverage schemes and concentrate on reducing the economic burden of the disease.
The limitation of the study lies in its small sample size. While these values may provide a slice into the scenario in Chennai, extrapolating these values on a larger scale to generalize them to the entire Indian subcontinent may result in erroneous perceptions of the impact of the disease. Thus, the authors recommend more nationwide cross-sectional studies covering larger populations.
| Conclusion|| |
The present study provides direct evidence that urban diabetic patients are more aware than rural diabetic patients about diabetic mellitus and its complications. It is imperative that diabetes awareness campaigns are executed to provide education to the masses.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]