A descriptive study of knowledge and attitude of diabetes mellitus and its management in rural population

: Diabetes Mellitus (DM) is a chronic disease, requiring long term medications and frequent monitoring of blood sugars. Education is one of the key components in ensuring better treatment and control of diabetes. Good glycaemic control with frequent monitoring of blood glucose, healthy diet, and adequate physical activity can go a long way in prolonging longevity of patients with DM and also in preventing morbidity. This study was taken up to assess the knowledge and attitude of people in Rural India towards DM. This being a hospital based descriptive cross sectional study, 550 Diabetics were evaluated by detailed questionnaire.: The mean age observed was 49.6±8.6 years, 73% of patients were illiterates. Majority of patients were farmers who indulged in heavy work (55%). (11%) was aware about diabetic diet while only 5%actually followed it. Majority (86.2%) were adherent to medications, while only 15.3% were actually aware regarding consequences and complications of missing medications dosage. None of patients were having facilities for home monitoring of glucose and only 9% got their sugars checked regularly. Only, 62.5% of patients used footwear regularly. Only 21.6% patients were aware regarding importance of foot examination, while only 7.4% performed it regularly.75% did not come to hospital for regular glycemic monitoring as there was no one to accompany them. Spreading knowledge regarding diabetes and its management in the form strict adherence to prescribed medications, diabetic diet, and regular physical activity will motivate individuals with diabetes to visit hospitals regularly. This is an important step in preventing diabetes-related complications. Awareness methodology specific for rural populations needs to be adopted

Abstract P218: Dietary Prescription in the Coronary Care Unit, Missed Opportunity to Improve Care?

Introduction: A notable portion of the excess burden of cardiovascular disease [CVD] risk factors in African Americans [AA] is believed secondary to the diet. Hypothesis: Dietary assessment and prescribed diets are inadequate in patients admitted to the coronary care unit [CCU]. Results: Cohort: 267 consecutively patients, AA 83%, male 55%, mean age 65 yrs, were assessed for cardiovascular [CV] risk factors, clinical status and appropriateness of prescribed diets. Patients were at increased CV risk as evidenced by 65% older than 60 yrs, Body Mass Index (BMI) >30 in 40% with women almost twice as likely to be obese [p<0.006], history of smoking 55%, hypertension 90%, diabetes 54%, and mean ejection fraction 43%. Established CAD acknowledged in 60%. Breakdown of diet orders: normal diet 11%, diabetic diet 38% and a form of low sodium, low cholesterol diet in 51%. CCU length of stay: 2.5 days with no significant difference by sex, diabetic or obesity status. Dietary assessment documentation was missing in 40% of the CCU admissions. A significant percentage of the patients missing this documentation were women [45%], diabetics [47%], obese--BMI>30 [42%] and older--age >60 [68%]. Incongruence is seen between the disease burden and the appropriate dietary order. For example, 54% of patients had DM. However, only 38% were given a diabetic diet. A form of low Na diet was provided to 51% of the patients yet 90% of them were hypertensive or had a history of hypertension. The statistic, dietary assessment not recorded in 40% of the patients, may have been affected by the relatively short CCU stay. One limitation of our study is that we did not examine if this decreased dietary assessment rate was affected by week-day vs. weekend stay in the CCU or by the severity of the patient’s illness. Conclusion: Dietary assessment and appropriate dietary prescription matters. Recent studies show that dietary pattern is one of the largest mediating factors for differences in the incidence of CV risks, i.e. hypertension, in blacks vs. whites accounting for some of the excess risk among blacks. Not adequately addressing nutrition in a CCU setting leads to the loss of a critical teachable moment.

249 Is Our Diabetic Control Too Tight? An Audit of Management of Type II Diabetes in a Long Term Care Setting

Background Recent guidelines on diabetes management recommend individualisation of management particularly in those with frailty or significant co-morbidities. The aim of our audit was to assess diabetic control of residents in a long term care setting. Studies have shown that intensive control in an older population increases the risk of hypoglycaemia and does not necessarily improve clinical outcomes. There is also evidence that increased pill burden and hypoglycaemic events negatively affect quality of life among older people. Methods 176 nursing home residents were assessed. Detailed chart review was carried out on the 47 residents with a diagnosis of type 2 diabetes. Information collated included age, sex, diabetes type, frequency of blood sugar monitoring, weight, BMI, Clinical Frailty Scale, allocation of diabetic diet and treatments including insulin and oral hypoglycaemic agents. Diabetic control was assessed by HbA1c. Evidence of hypoglycaemia in the preceding four weeks was documented. Results Of 47 patients (33 female), average age was 79.8 years and median BMI was 25. 41/47 residents had a Clinical Frailty Score of 6 or greater. The median HbA1c overall was 44mmol/l (range was 29-116mmol/l). All patients were on a diabetic diet. 23/47 residents on oral hypoglycaemic agents and the median HbA1c of this group was 51mmol/l. 6/47 were on insulin. Sugars were checked weekly (daily in those on insulin) and HbA1c was checked in the previous 6 months in 36/47.There was 1 recorded hypoglycaemic episode. Conclusion Our data showed that long stay residents continue to have tight diabetic control despite low BMI, evidence of frailty, significant co morbidities and dependency. HbA1c can also decrease due to renal disease, weight loss and poor oral intake. In line with recent guidelines our data shows there is scope to rationalise diabetic treatment regimens with reduction in polypharmacy and improvement in quality of life.

HUBUNGAN TINGKAT PENGETAHUAN DAN DIABETES SELF-MANAGEMENT DENGAN TINGKAT STRES PASIEN DIABETES MELITUS YANG MENJALANI DIET

Pengetahuan sangat penting dalam mengembangkan diabetes self-management untuk mencegah resiko komplikasi jangka panjang dengan diet yang ketat. Tujuan penelitian ini untuk mengetahui hubungan antara pengetahuan dan diabetes self-management dengan tingkat stress pasien diabetes melitus yang menjalani diet. Penelitian ini menggunakan desain cross-sectional. Jumlah total sampel didapatkan sebesar 106 responden dengan multistage sampling, Kriteria inklusi meliputi pasien DM <5 tahun dengan rentang usia 35-55 tahun, tidak menggunakan insulin injeksi, Pasien DM masih berkeluarga dan tinggal dengan keluarganya. Data didapatkan dengan kuesioner Knowledge of Diabetic Diet Questionnaire, Self-Management Dietary Behaviors Questionnaire, dan tingkat stress menjalani diet. Kemudian dianalisis dengan uji Spearman test. Hasil penelitian menunjukkan bahwa tingkat pengetahuan (p=0,049; r=-0,192) dan diabetes self-management (p=0,000; r=-0,341) memiliki hubungan terhadap tingkat stress saat menjalani diet. Diabetes self-management memiliki hubungan yang sangat kuat dari pada tingkat pengetahuan terhadap tingkat stress pasien diabetes yang menjalani diet. Penelitian selanjutnya diharapkan bisa menggunakan responden dengan wilayah yang lebih luas dan serta mengembangkan intervensi yang lebih baik untuk meningkatkan pengetahuan tentang diet pada pasien diabetes melitus. Kata Kunci: diabetes melitus, diet, self-management, tingkat stres Abstract The correlation between knowledge level and diabetes self-management towards stress level of patients DM with diet. Knowledge is very important in developing diabetes self-management to prevent the risk of long-term complications with a strict diet. The purpose of this study was to determine the relationship between knowledge and diabetes self-management with stress levels of people with diabetes mellitus who went on a diet. This study uses a cross-sectional design. The total samples obtained were 106 respondents with multistage sampling, inclusion criteria included patients with DM <5 years with a range of ages 35-55 years, did not use insulin injection, DM patients were still married and lived with their families. Data are obtained with questionnaire of Knowledge of Diabetic Diet Questionnaire (KDDQ), a Self-Management Dietary Behaviors Questionnaire (SMDBQ), and a stress level on a diet. Data analyzed by the Spearman Rho. The results showed that the level of knowledge (p=0.049; r=-0.192) and diabetes self-management (p=0,000; r=-0,341) had a relationship to stress levels while on a diet. Diabetes self-management has a very strong relationship to the level of knowledge of the stress level of diabetics with diet. Future studies are expected to be able to use respondents with a wider area and develop better interventions to increase knowledge about diets in people with diabetes mellitus. Keywords: diabetes mellitus, diet, self-management, stress level