Assessment of Level of Risk for Type II Diabetes Mellitus andEffectiveness of STP on Knowledge Regarding Identification of RiskFactors and Prevention of Type II Diabetes Mellitus Among Adults

INTRODUCTION

“An ounce of prevention is worth a pound of cure.”

                                                                       - Henry De Bracton.

Diabetes mellitus is a disease known during the period of 1500 BC and it was described by Ebers Papyrus of ancient Egyptian¹ . The term “diabetes mellitus” is derived from the Greek word, “diabetes” meaning “to go through” or a siphon and the word “mellitus” is derived from the Latin word “mel” meaning “honey” describing the sweet odour of urine² .The dramatic worldwide increase in the prevalence of type II diabetes is posing a massive health problem in both developed and developing countries³ .

The global prevalence of type II diabetes is expected to double in the period between 2000 and 2025. It is predicted that by the year 2025, the maximum prevalence of diabetes would be in India. In a period of five years the prevalence has increased from 8.2% to 11.6% in urban south India⁴ . A study was conducted to assess the knowledge of diabetes in an urban south Indian population revealed that 75.5% of the population was aware and 25% of the population was unaware about the condition called diabetes⁶ .

Early identification of, at risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would greatly help in preventing or postponing the onset of diabetes⁵ .

Every 5th person who suffers from diabetes in the world today is an Indian. Out of total number of persons suffering from diabetes in the world, around 150 million roughly in which 35 million are Indians⁷ . Globally in 1985, 30 million people had diabetes and number rose to 150 million in 2000¹⁴. In 2010, 285 million people that is 6.6% of the global populations in the age group of 20-79 were found to be diabetic and by 2030, an estimated 435 million people are expected to suffer from this disease⁸ .

A cross sectional community survey of adults more than 18 years of age was done in central Kerala. Among 3,069 subjects surveyed, 276 were known to have diabetes⁹ . World diabetes day 2011 campaign marks third year of international diabetes federation’s five year focus on “Diabetes education and prevention”, theme chosen for period 2009-2013¹⁰.

The primary prevention is more important as this effort is likely to reverse or halt the epidemic of disease¹². It is stated that 80% of type II diabetes is preventable by changing diet, increasing physical activity and improving living environment¹³. This study aimed to assess the level of risk for type II diabetes mellitus and evaluate the effectiveness of structured teaching programme on knowledge regarding identification of risk factors and prevention of type II diabetes mellitus.

METHODOLOGY

The study was based on Imogene king’s Goal attainment theory. The research design was quasi experimental one group pre-testpost-test design. The study was conducted in Mangalore refineries and petroleum limited [MRPL], Mangalore, Karnataka. There were two phase of data collection. In first phase an explorative survey approach was used to assess the level of risk for type II diabetes mellitus. The sample consisted of 150 adults selected by purposive sampling technique. The tool used for data collection in phase I was Indian diabetes risk score [IDRS], formulated by Dr.Mohan, Diabetes specialty centre, Chennai. The scale contains total score of 100, in which score of less than 30 indicates low risk of type II diabetes mellitus, score of 30-50 denotes moderate risk for and score of ≥60 denotes high risk for having type II diabetes mellitus. In the second phase an evaluative research approach with one group pre-testposttestdesign was adopted. Proportionate stratified random sampling technique was used to select 60 adults. The tool consisted of two sections;section-I: consisted of demographic proforma with items such as age, sex, educational qualification, marital status, type of food consumed, type of work, usage of leisure time and occupation of spouse. Section 2 consisted of structured interview schedule with 30 multiple choice questions, divided into four areas of knowledge, namely blood sugar and insulin, diabetes mellitus, identification of risk factors,prevention of type II diabetes mellitus. Each correct answer was given one score. Content validity of the tool was established by 13 experts. The reliability obtained was 0.96 for the IDRS scale and 0.82 for the knowledge questionnaire. Prior to the data collection written permission was obtained from the concern authorities and study subjects. Risk assessment and pre-test was conducted followed by STP on identification of risk factors and prevention of type II diabetes mellitus. Post test was conducted after 7 days. The data was analysed manually. 

RESULTS

I. Demographic characteristics

Majority (33.33%) of the adults were in the age group of 31-40 years. Most (66.67%) of were men and married (83.34%), 43.34% belonged to the Hindu community, 33.3% were graduates and above, majority (85%) had their food habit as mixed diet, 36.7% were heavy workers, 70% spent their leisure time doing heavy activities and 40% of the adults spouse were skilled workers.

II. Level of risk for type II diabetes mellitus among adults. 

Of the total 150 adults 22.6% showed low risk, 42.7% moderate risk, and 34.7% high risk. (Figure 1) 

III. Pre-test and post-knowledge of adults regarding identification of risk factors and prevention of type II diabetes mellitus

Majority (86.67%) of the adults had poor knowledge 13.33%had average knowledge while none of them had good knowledge regarding identification of risk factors and prevention of type II diabetes mellitus before the administration of STP. Whereas in the post-test majority (71.1%) adults had good knowledge and 28.3% had average knowledge. (Figure 2)

IV. Effectiveness of STP regarding identification of risk factors and prevention of type II diabetes mellitus 

There was a significant difference between the mean pre-test (9.88 ± 2.3)and post-test (9.88 ± 2.3) knowledge scores of adults regarding risk factors and prevention of type II diabetes mellitus. The obtained t value was greater than the table value at 0.05 level of significance.(Table 1)

V. Association between the pre-test level of knowledge score and selected demographic variables of adults

There was a significant association between the educational qualification (χ2 =8.49, P<0.05) and the pre test level of knowledge and there was no association with other demographic variables.

DISCUSSION

In the present study level of risk for diabetes score showed that majority (42.7%) adults were under moderate level of risk for type II diabetes mellitus, for type II diabetes mellitus.The findings of the present study were consistent with a community based cross-sectional study which was conducted in west Bengal. Out of 250 samples surveyed using Indian Diabetic Risk Score (IDRS) 235 responded and among that 108 (46%) had moderate risk (IDRS 30-50); 74(31.5%) had high risk (IDRS≥60) and 53(22.6%) had low risk (IDRS<30).

In the present study the pre-intervention score showed that the majority of the adults (86.7%) had poor knowledge, 13.3% had average knowledge while none of them had good knowledge regarding identification of risk factors and prevention of type II diabetes mellitus. The above findings were supported with a descriptive survey conducted in Chennai, [Chennai Urban Rural Epidemiology Study (CURES)].CURES that reported nearly 25% of the population was unaware of a condition called diabetes. Only around 40% of the participants felt that the prevalence of diabetes was increasing and only 22.2% of the population and 41% of known diabetic subjects felt that diabetes could be prevented.

There was a significant difference between the mean pre-test (9.88 ± 2.3)and post-test (9.88 ± 2.3) knowledge scores of adults regarding risk factors and prevention of type II diabetes mellitus. The calculated‘t’ value (t59=30.91) was greater than the table value (t(59)= 1.68) at 0.05 level of significance,. This confirms that STP was an effective teaching strategy in improving the knowledge of adults regarding risk factor and prevention of diabetes.

CONCLUSION

Nurses have to be prepared to face the pandemic of diabetes mellitus. This study helps to raise awareness among nurses and nurse educators about the global epidemic of diabetes mellitus and to propose that nursing curriculum focus more on health promoting activities to raise awareness about identification of risk factors and prevention of type II diabetes mellitus, which will decrease health care cost burden. Structured teaching programme is considered as an effective education strategy to improve the awareness about identification of risk factors and prevention of type II diabetes mellitus in order to practice healthy life style. The key person in the control ofdiabetes is the person himself. Nurses should place health in hands of people who are at risk to develop type II diabetes, as they are in need of long term care.