INTRODUCTION

Background of the Study

In the last few decades, the world prevalence of diabetes among adults have increased more than twice, and expected to ascend to 380 million by 2030, according to a report from the InternationalDiabetes Institute.

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About 3.4 million, roughly 4.6 percent of the total population in the Philippines are diabetics. This figure is expected to rise to 7.8 million in the next 15 years.

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Despite such high incidence, awareness on diabetes, its complications and treatment remain major challenges, particularly in developing countries such as the Philippines. Prevention through patient education is imperative because the burden of disease on healthcare and its economic implications are of great magnitude. There is a significant amount of evidence that patient education is one of the most effective way to lessen the complications of diabetes.

^3,4,5,6

When coupled with appropriate medications, it is associated with decreased morbidity and mortality.

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Patient education is more likely to be effective if we know the characteristic of the patients in terms of what they know about their disease, their attitude towards it and what they practice in their medications, diet and lifestyle.

Very few studies has been made on our country to find the prevailing awareness, attitudes and practices among diabetic patients,

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which can aid in the development of future health education interventions targeting the disease.

In this study, we will determine the demographic characteristics of diabetic patients consulting at the Diabetes Clinic of a tertiary hospital in Davao City and assess their level of knowledge, attitude and practices (KAP) towards Diabetes Mellitus (DM) and the relationship of KAP and glycemic control among type 2 diabetic patients in an urban health care facility.

REVIEW OF RELATED LITERATURE

In the Philippines, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey) study is approximately 4.6-7.2%. This figure expands to 17.8% after adding those who have pre-diabetes (impaired fasting glucose or impaired glucose tolerance or both) which has a prevalence of 10.6%.

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Therefore, one out of every 5 Filipino could potentially have diabetes mellitus or pre-diabetes.

As such, the increasing trend of its incidence rate is causing alarm among medical practitioners, and among affected patients as well. In the context of an alarming increase in the magnitude of type 2 diabetes mellitus in our country, the prevailing knowledge, attitudes and practices of these diabetic patients assume immense importance in the control of the disease.

Across the globe, a number of studies have been done about perception and practice of diabetic patients

^10-14

, especially in third world countries. An Indian study made by Mukhopadhyay, et al 2010, looked into the perceptions and practices of patients with Diabetes Mellitus Type II in a tertiary hospital.

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In the Philippines, a similar study was done in the rural community of San Juan, Batangas, Philippines. A total of 156 diabetic residents were included as participants of the survey. Knowledge scores were relatively low, with an overall mean of 43%. There were also poor positive responses to attitude scale. The study emphasized the importance of evaluating knowledge, attitudes and practices as crucial means to understand observed behaviors and guide behavioral change.

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According to the American Diabetic Association, self management education is defined as the process of providing the person with diabetes the knowledge and skill that is needed to perform self care, manage immediate concerns and make life style changes.

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To achieve such effective self care, diabetic patients and their doctors should work hand-in-hand together. Some studies have shown that self-care among individuals with type 2 diabetes had improved glycemic control and reduced complications

^{15, 16, 17}

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For people with diabetes, self-management education training is vital since diabetics and their families provide most of their care themselves. It is imperative that regular patient counseling and group education at follow-up visits by health care professionals to help in improving patients’ knowledge and ultimately modify their practices.

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However, in our setting, adequate diabetes self-management education programs are lacking or weak in most government hospitals in tertiary care. Hence, results of this study could help us design our education programs targeting certain groups or issues that needs further strengthening.

Research Question

What is the level of knowledge, attitudes, and practices and its association with glycemic control among persons with type 2 diabetes in the Diabetes Clinic of Southern Phiilppines Medical Center?

Significance of the Study

The study will contribute to the understanding of the current status of diabetes care in our local setting, and help in the implementation of programs that would address pressing needs in our patient education and management, based on their knowledge, attitude and practices. It will also help us identify the association of KAP and glycemic control, and further assess the impact of diabetes self-management in disease control.

Objectives:

General Objective:

1. To determine the knowledge, attitudes, and practices of patients with type 2 diabetes in the Diabetes clinic of a tertiary hospital.

Specific Objectives:

1. To determine the demographic profile of the diabetic patients in the Diabetic clinic of a tertiary hospital in Davao City, in terms of :

1. Age
2. Gender
3. Highest level of educational attainment
4. Employment status
5. Duration of diabetes
6. Antidiabetic medications
7. Co-morbidities

2. To determine the association between patient factors such as age, sex, level of education, employment status, duration of diabetes, antidiabetic medications and co-morbidities and their level of knowledge, attitudes, and practices (KAP) regarding diabetes
3. To establish the association between the patients’ KAP and their corresponding glycemic control based on HBA1c levels

METHODOLOGY

Research Design:

The study will employ a clinic-based, cross-sectional analytic study design.

Research Setting:

This study will be conducted at the Diabetes outpatient clinic of a tertiary hospital in Davao City, from May 2014 to June 2014.

Participants:

All patients who are diagnosed with type 2 Diabetes Mellitus type 2 (T2 DM) who are seeking consult at the Diabetes Clinic in a tertiary hospital for the period of May to June 2014.

Inclusion Criteria:

1. Patients must be a diagnosed case of Diabetes Mellitus type 2 based on the following criteria:

1. Plasma glucose
   
   >
   
   126 mg/dL (7.0 mmol/L) after an overnight fast
   • Fasting is defined as no caloric intake for at least 8 hours up to a maximum of 14 hours,

or

2. Two-hour plasma glucose
   
   >
   
   200 mg/dl (11.1 mmol/l) during an Oral Glucose Tolerance Test
   • The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water after an overnight fast of between 8 and 14 hours,

or

3. A random plasma glucose
   
   >
   
   200 mg/dl (11.1 mmol/l) in a patient with classic symptoms of hyperglycemia (weight loss, polyuria, polyphagia, polydipsia) or with signs and symptoms of hyperglycaemic crisis.

2. Patient must have informed consent.

Exclusion Criteria:

1. Patients who does not meet the criteria for T2 DM but are seeking consult at the Diabetes clinic: Impaired fasting glycemia and Impaired glucose intolerance.
2. Patients who have intellect impairment and could not participate in the survey

Sampling Procedures

All the DMT2 patients visiting the diabetes centre during this period will be identified using the convenient sampling method. Assuming that the prevalence of knowledge among Filipinos is 43%

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and estimating the proportion within 95% confidence interval with 5% error, the sample size is 168( Raosoft Sample size formula).

Data Collection:

The data will be collected by giving out pretested predesigned questionnaire to participants with informed consent. Pre-testing of the questionnaire will be done prior to the research proper. Relevant information from the participants will be gathered including: age, gender, highest educational attainment, employment status, duration of diabetes, antidiabetic medications and co-morbidities. Questions pertaining to their knowledge, attitudes and practices will be given in order to assess their corresponding levels. The KAP questionnaire will be adapted from a Malaysian study by Shu Hui Ng et al

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, “Reality vs Illusion: Knowledge, Attitude and Practice among Diabetic Patients”. The questionnaire has been used in previous KAP studies among diabetics and has proven to be a reliable tool. The self-administered questionnaire had a total of 25 questions (knowledge-14, attitude-5, and practice-6). Each correct answer will be given a score of ‘one’ and the wrong answer was given a score of ‘zero’. Good knowledge attitude and/or practice will be considered if a patient attains >50% of the total score for each domain.

To assess the relationship between KAP towards DM and the actual disease control, most recent(4 +/- 2 weeks) levels of HbA1c will be obtained from the patient records. HbA1C > 7% is considered to have poor control of DM.

A. Independent Variables

Independent Variables include: sex, age, educational attainment, current employment status, co-morbidities, latest hba1c result.

B

. Dependent Variables

Dependent Variables include: levels of knowledge, attitude and practices

Data Handling and Analysis:

The principal investigator will ensure that all data collected in the study were of utmost confidential nature. Data analysis will be performed to ensure quality results using frequency, percentage, and statistical analysis.

The chi-square test will be used to determine the relationship between KAP and t-test to assess the association between KAP and diabetes control. Spearman correlation test will be used to determine the association between knowledge and attitude, and between knowledge and practice. The level of statistical significance will be set at p< 0.05.