Shawon et al. BMC Res Notes (2016) 9:286 DOI 10.1186/s13104-016-2081-8
BMC Research Notes Open Access
RESEARCH ARTICLE
Attitude towards diabetes and social and family support among type 2 diabetes patients attending a tertiary‑care hospital in Bangladesh: a cross‑sectional study Md. Shajedur Rahman Shawon1*†, Fariha Binte Hossain1†, Gourab Adhikary1, Rajat Das Gupta2, Mohammad Rashidul Hashan2, Md. Fazla Rabbi2 and G. U. Ahsan1
Abstract Background: Bangladesh has been suffering from an epidemiological transition from infectious and maternal diseases to non-communicable lifestyle-related diseases like diabetes, cardiovascular diseases, cancers etc. The burden of diabetes has been increasing rapidly due to high incidence as well as poor glycemic control leading to various macro and micro-vascular complications. In this study, we aim to assess the attitude towards diabetes and social and family support among the Bangladeshi type 2 diabetic mellitus (T2DM) patients. Methods: This was a cross-sectional study among 144 patients with T2DM at the medicine outpatient department of Dhaka Medical College Hospital (DMCH) in Dhaka, Bangladesh between 1 July and 31 July 2014. Data collection was done by interviewing patients using structured questionnaire. Understanding diabetes, education/advice received, attitude towards diabetes, family and friend support were measured by validated scales adapted from diabetes care profile. Results: This study includes a total of 144 patients (101 males and 43 females) with type 2 diabetes aged between 20 and 84 years. 87 % of the patients had inadequate blood glucose control (fasting blood sugar >7.2 mmol/L or >130 mg/dl). Statistically significant differences were observed in the mean scores of various attitude scales (i.e. positive, negative, care ability and self-care adherence scale) among patients with adequate and inadequate blood glucose control (p 130 mg/dl) and found only 13 % patients had adequate control. Attitudes towards diabetes
Attitude towards diabetes was analyzed into five different dimensions i.e. positive attitude, negative attitude, care ability, importance of care and self-care adherence. Statistically significant differences were observed in the mean score of positive attitude scale, negative attitude scale, care ability scale and self-care adherence scale among patients with adequate and inadequate blood glucose control (see Fig. 1). Social and family support
Patients with adequate blood glucose control had higher mean scores than patients with inadequate blood glucose control on support needed scale (4.2 vs. 3.8; p = 0.160), support received scale (3.7 vs. 3.2; p = 0.056) and support attitude (4.1 vs. 3.7; p = 0.067). Statistically significant positive correlations were found between these three categories of social and family support (see Table 3). Spouse (29 %) and family members (28 %) are found to be the care-giver for most of the diabetic patients. Approximately 14 % of the patients said that they had no caregiver for their diabetes (see Fig. 2). Self‑perception and satisfaction about diabetes
Most of the patients had good perception about their glycemic control and only 29 % patients perceived their glycemic control as “poor” or “very poor”. 42 % patients
Shawon et al. BMC Res Notes (2016) 9:286
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Table 1 Socio-demographic and clinical characteristics of the participants (n = 144)
Table 2 Information related to diabetes and diabetic care among the participants
Variables
Categories
Number (%)
Variables
Gender
Male
101 (70.1 %)
Age of diabetes diagnosis, in years
Mean ± SD
45.62 ± 10
Female
43 (29.9 %)
Duration of diabetes, in years
Mean ± SD
8.9 ± 7.1
Family history of diabetes
Categories
Number (%)
Age in years
Mean ± SD
54.4 ± 11.7
Yes
73 (50.7 %)
Marital status
Married
113 (78.5 %)
No
35 (24.3 %)
Widowed
21 (14.6 %)
Don’t know
36 (25 %)
Separated/divorced
05 (3.5 %)
OAA only
60 (41.7 %) 43 (29.9 %)
Religion
Employment status
Smoking status
Concurrent history of hypertension Concurrent history of dyslipidemia
Treatment modalities
Never married
05 (3.5 %)
Insulin only
Islam
124 (86.1 %)
OAA and insulin
41 (28.5 %)
Hindu
19 (13.2 %)
Regular checkup for diabetes
Yes
72 (50 %)
No
72 (50 %)
Following treatment plan advised by the physician
Yes
115 (79.9 %)
No
29 (20.1 %)
Unemployed or laid off and 07 (4.9 %) looking for work
Following diet plan advised by physician/dietitian
Yes
101 (70.1 %)
Unemployed and not looking for work
18 (12.5 %)
No
43 (29.9 %)
Physically active
Yes
72 (50.3 %)
Homemaker
34 (23.6 %)
No
71 (49.7 %)
Retired
21 (14.6 %)
Yes
89 (61.8 %)
Others
05 (3.5 %)
Suffered from any diabetes related complications
No
55 (38.2 %)
Non-smoker
78 (54.2 %)
Testing blood sugar level regularly
Yes
114 (79.2 %)
Current smoker
39 (27.1 %)
No
30 (20.8 %)
Keeping record of blood sugar test results
Yes
44 (30.6 %)
No
56 (38.9 %)
Others
01 (0.7 %)
Working full time
42 (29.2 %)
Working part-time
17 (11.8 %)
Ever smoker
27 (18.8 %)
Yes
89 (61.8 %)
No
30 (20.8 %)
Don’t know
25 (17.4 %)
Yes
48 (33.3 %)
No
35 (24.3 %)
Don’t know
61 (42.4 %)
Only unusual values 44 (30.6 %) Availability of HbA1C information Availability of fasting blood sugar information
Yes
80 (55.6 %)
No
64 (44.4 %)
Yes
132 (91.7 %)
No
12 (8.3 %)
OAA oral anti-hyperglycemic agents; HbA1c glycated hemoglobin
were either “very satisfied” or “somewhat satisfied” if they were to spend the rest of their lives with current diabetes treatment. Self-satisfaction with diabetic care was significantly associated with adequate blood glucose control (p = 0.05).
Discussion The noteworthy findings of this study are: (i) Type 2 diabetes patients, in general, lack information about HbA1C and other related clinical parameters; (ii) The proportion of T2DM patients with inadequate blood glucose control is 87 % according to fasting blood sugar cutoff ≥7.2 mmol/L or 130 mg/dl; (iii) Significant differences have been observed in the mean scores of attitude between patients with adequate and inadequate blood glucose control; (iv) Significant positive correlation was observed between support attitude of friends and family and support received; (v) Most of the diabetes patients had good perception as well as satisfaction about their
diabetes management despite the fact that most of them failed to achieve the recommended level of fasting blood glucose for T2DM patients. The proportion of T2DM patients with poor management of their diabetes was high (87 %) among the participants, and it was much higher than the findings from studies conducted in many countries. For instance, studies with large sample sizes conducted in the UK [30], Canada [31], Brazil [32] and Venezuela [29] found that the prevalence of inadequate diabetes control were 76, 73, 73 and 75 %, respectively. However, some studies found much lower prevalence of poor diabetes control [33, 34]. Furthermore, in the US, estimates from the National Health and Nutrition Examination Survey (NHANES) showed a decreasing trend in the prevalence of poor diabetes management (i.e. from 63 to 43 % over the period from 1999 to 2004) [35]. In spite of the fact that these variations in prevalence of
Shawon et al. BMC Res Notes (2016) 9:286
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Fig. 1 Box-plots showing distribution of mean scores of a positive attitude towards diabetes, b negative attitude towards diabetes, c attitudes towards diabetic care ability and d attitudes towards diabetic self-care adherence by blood glucose control categories among the participants
Table 3 Correlation matrix for support needed, support received and support attitude among the participants Support needed Support received Support needed 1 a
Support received 0.269
b
Support attitude 0.193
0.269a
0.193b
1
0.675a a
0.675
a
Pearson correlation is significant at the 0.01 level (2-tailed)
b
Support atti‑ tude
Pearson correlation is significant at the 0.05 level (2-tailed)
1
poor glycemic control across different settings might be true, methodological differences (i.e. selection of study populations, methods/definition of outcome ascertainment) might lead to the differences in prevalence estimates [29]. We found that poor blood glucose control was more common among patients who did not follow the advised diet plan. Therefore, patients should be encouraged to follow the diet plan as prescribed by the physician or dietitian. Despite the importance of physical activity and
Shawon et al. BMC Res Notes (2016) 9:286
Page 6 of 8
Fig. 2 Most caring person helping with diabetes self-care management among the participants (n = 144)
regular checkup by healthcare professionals in controlling diabetes status, a major portion of the participants was found physically inactive as well as not followed on regular
basis (see Table 4). Therefore, public health interventions focusing on educating and motivating T2DM patients on regular physical activity and follow-up are crucial.
Table 4 Variables associated with adequate blood glucose control among the type 2 diabetes patients Variables
Categories
Adequate blood glucose control n (%)
Inadequate blood glucose control n (%)
P value
Age, in years
Mean ± SD
49.7 ± 8.8
54.4 ± 12.1
0.133**
Sex
Male
12 (13.2 %)
79 (86.8 %)
0.875*
Female Duration of suffering from diabetes
BMC Research Notes Open Access
RESEARCH ARTICLE
Attitude towards diabetes and social and family support among type 2 diabetes patients attending a tertiary‑care hospital in Bangladesh: a cross‑sectional study Md. Shajedur Rahman Shawon1*†, Fariha Binte Hossain1†, Gourab Adhikary1, Rajat Das Gupta2, Mohammad Rashidul Hashan2, Md. Fazla Rabbi2 and G. U. Ahsan1
Abstract Background: Bangladesh has been suffering from an epidemiological transition from infectious and maternal diseases to non-communicable lifestyle-related diseases like diabetes, cardiovascular diseases, cancers etc. The burden of diabetes has been increasing rapidly due to high incidence as well as poor glycemic control leading to various macro and micro-vascular complications. In this study, we aim to assess the attitude towards diabetes and social and family support among the Bangladeshi type 2 diabetic mellitus (T2DM) patients. Methods: This was a cross-sectional study among 144 patients with T2DM at the medicine outpatient department of Dhaka Medical College Hospital (DMCH) in Dhaka, Bangladesh between 1 July and 31 July 2014. Data collection was done by interviewing patients using structured questionnaire. Understanding diabetes, education/advice received, attitude towards diabetes, family and friend support were measured by validated scales adapted from diabetes care profile. Results: This study includes a total of 144 patients (101 males and 43 females) with type 2 diabetes aged between 20 and 84 years. 87 % of the patients had inadequate blood glucose control (fasting blood sugar >7.2 mmol/L or >130 mg/dl). Statistically significant differences were observed in the mean scores of various attitude scales (i.e. positive, negative, care ability and self-care adherence scale) among patients with adequate and inadequate blood glucose control (p 130 mg/dl) and found only 13 % patients had adequate control. Attitudes towards diabetes
Attitude towards diabetes was analyzed into five different dimensions i.e. positive attitude, negative attitude, care ability, importance of care and self-care adherence. Statistically significant differences were observed in the mean score of positive attitude scale, negative attitude scale, care ability scale and self-care adherence scale among patients with adequate and inadequate blood glucose control (see Fig. 1). Social and family support
Patients with adequate blood glucose control had higher mean scores than patients with inadequate blood glucose control on support needed scale (4.2 vs. 3.8; p = 0.160), support received scale (3.7 vs. 3.2; p = 0.056) and support attitude (4.1 vs. 3.7; p = 0.067). Statistically significant positive correlations were found between these three categories of social and family support (see Table 3). Spouse (29 %) and family members (28 %) are found to be the care-giver for most of the diabetic patients. Approximately 14 % of the patients said that they had no caregiver for their diabetes (see Fig. 2). Self‑perception and satisfaction about diabetes
Most of the patients had good perception about their glycemic control and only 29 % patients perceived their glycemic control as “poor” or “very poor”. 42 % patients
Shawon et al. BMC Res Notes (2016) 9:286
Page 4 of 8
Table 1 Socio-demographic and clinical characteristics of the participants (n = 144)
Table 2 Information related to diabetes and diabetic care among the participants
Variables
Categories
Number (%)
Variables
Gender
Male
101 (70.1 %)
Age of diabetes diagnosis, in years
Mean ± SD
45.62 ± 10
Female
43 (29.9 %)
Duration of diabetes, in years
Mean ± SD
8.9 ± 7.1
Family history of diabetes
Categories
Number (%)
Age in years
Mean ± SD
54.4 ± 11.7
Yes
73 (50.7 %)
Marital status
Married
113 (78.5 %)
No
35 (24.3 %)
Widowed
21 (14.6 %)
Don’t know
36 (25 %)
Separated/divorced
05 (3.5 %)
OAA only
60 (41.7 %) 43 (29.9 %)
Religion
Employment status
Smoking status
Concurrent history of hypertension Concurrent history of dyslipidemia
Treatment modalities
Never married
05 (3.5 %)
Insulin only
Islam
124 (86.1 %)
OAA and insulin
41 (28.5 %)
Hindu
19 (13.2 %)
Regular checkup for diabetes
Yes
72 (50 %)
No
72 (50 %)
Following treatment plan advised by the physician
Yes
115 (79.9 %)
No
29 (20.1 %)
Unemployed or laid off and 07 (4.9 %) looking for work
Following diet plan advised by physician/dietitian
Yes
101 (70.1 %)
Unemployed and not looking for work
18 (12.5 %)
No
43 (29.9 %)
Physically active
Yes
72 (50.3 %)
Homemaker
34 (23.6 %)
No
71 (49.7 %)
Retired
21 (14.6 %)
Yes
89 (61.8 %)
Others
05 (3.5 %)
Suffered from any diabetes related complications
No
55 (38.2 %)
Non-smoker
78 (54.2 %)
Testing blood sugar level regularly
Yes
114 (79.2 %)
Current smoker
39 (27.1 %)
No
30 (20.8 %)
Keeping record of blood sugar test results
Yes
44 (30.6 %)
No
56 (38.9 %)
Others
01 (0.7 %)
Working full time
42 (29.2 %)
Working part-time
17 (11.8 %)
Ever smoker
27 (18.8 %)
Yes
89 (61.8 %)
No
30 (20.8 %)
Don’t know
25 (17.4 %)
Yes
48 (33.3 %)
No
35 (24.3 %)
Don’t know
61 (42.4 %)
Only unusual values 44 (30.6 %) Availability of HbA1C information Availability of fasting blood sugar information
Yes
80 (55.6 %)
No
64 (44.4 %)
Yes
132 (91.7 %)
No
12 (8.3 %)
OAA oral anti-hyperglycemic agents; HbA1c glycated hemoglobin
were either “very satisfied” or “somewhat satisfied” if they were to spend the rest of their lives with current diabetes treatment. Self-satisfaction with diabetic care was significantly associated with adequate blood glucose control (p = 0.05).
Discussion The noteworthy findings of this study are: (i) Type 2 diabetes patients, in general, lack information about HbA1C and other related clinical parameters; (ii) The proportion of T2DM patients with inadequate blood glucose control is 87 % according to fasting blood sugar cutoff ≥7.2 mmol/L or 130 mg/dl; (iii) Significant differences have been observed in the mean scores of attitude between patients with adequate and inadequate blood glucose control; (iv) Significant positive correlation was observed between support attitude of friends and family and support received; (v) Most of the diabetes patients had good perception as well as satisfaction about their
diabetes management despite the fact that most of them failed to achieve the recommended level of fasting blood glucose for T2DM patients. The proportion of T2DM patients with poor management of their diabetes was high (87 %) among the participants, and it was much higher than the findings from studies conducted in many countries. For instance, studies with large sample sizes conducted in the UK [30], Canada [31], Brazil [32] and Venezuela [29] found that the prevalence of inadequate diabetes control were 76, 73, 73 and 75 %, respectively. However, some studies found much lower prevalence of poor diabetes control [33, 34]. Furthermore, in the US, estimates from the National Health and Nutrition Examination Survey (NHANES) showed a decreasing trend in the prevalence of poor diabetes management (i.e. from 63 to 43 % over the period from 1999 to 2004) [35]. In spite of the fact that these variations in prevalence of
Shawon et al. BMC Res Notes (2016) 9:286
Page 5 of 8
Fig. 1 Box-plots showing distribution of mean scores of a positive attitude towards diabetes, b negative attitude towards diabetes, c attitudes towards diabetic care ability and d attitudes towards diabetic self-care adherence by blood glucose control categories among the participants
Table 3 Correlation matrix for support needed, support received and support attitude among the participants Support needed Support received Support needed 1 a
Support received 0.269
b
Support attitude 0.193
0.269a
0.193b
1
0.675a a
0.675
a
Pearson correlation is significant at the 0.01 level (2-tailed)
b
Support atti‑ tude
Pearson correlation is significant at the 0.05 level (2-tailed)
1
poor glycemic control across different settings might be true, methodological differences (i.e. selection of study populations, methods/definition of outcome ascertainment) might lead to the differences in prevalence estimates [29]. We found that poor blood glucose control was more common among patients who did not follow the advised diet plan. Therefore, patients should be encouraged to follow the diet plan as prescribed by the physician or dietitian. Despite the importance of physical activity and
Shawon et al. BMC Res Notes (2016) 9:286
Page 6 of 8
Fig. 2 Most caring person helping with diabetes self-care management among the participants (n = 144)
regular checkup by healthcare professionals in controlling diabetes status, a major portion of the participants was found physically inactive as well as not followed on regular
basis (see Table 4). Therefore, public health interventions focusing on educating and motivating T2DM patients on regular physical activity and follow-up are crucial.
Table 4 Variables associated with adequate blood glucose control among the type 2 diabetes patients Variables
Categories
Adequate blood glucose control n (%)
Inadequate blood glucose control n (%)
P value
Age, in years
Mean ± SD
49.7 ± 8.8
54.4 ± 12.1
0.133**
Sex
Male
12 (13.2 %)
79 (86.8 %)
0.875*
Female Duration of suffering from diabetes
