Evaluation Of Self Care Practices Among Known Type 2 Diabetic Patients in A Rural and Town Area of Bhavani, Erode District

Diabetes is a serious, chronic disease that occurs either when the pancreas does not produce enough insulin (a hormone that regulates blood glucose), or when the body cannot effectively use the insulin it produces. Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset diabetes) is characterized by deficient insulin production in the body. People with type 1 diabetes require daily administration of insulin to regulate the amount of glucose in their blood. Type 2 diabetes (formerly called non-insulin-dependent or adultonset diabetes) results from the body’s ineffective use of insulin. Type 2 diabetes accounts for the vast majority of people with diabetes around the world. Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normal blood glucose levels and diabetes (especially type 2), though the transition is not inevitable. Gestational diabetes (GDM) is a temporary condition that occurs in pregnancy and carries longterm risk of type 2 diabetes. The condition is present when blood glucose values are above normal but still below those diagnostic of diabetes. It is silent killer disease and affects millions of people in the world. It is estimated that in 2010 there was globally 285 million people suffering from this disease.

This number is estimated to increase to 430 million in the absence of better control or cure. Different types of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. Chronic hyperglycemia is a metabolic disorder caused by either a lack of insulin secretion, impaired insulin action, or both. Notably, in sulin plays an important role as an anabolic hormone, affecting the metabolism of carbohydrates, lipids, and proteins. The metabolic abnormalities associated with diabetes mainly affect tissues such as adipose tissue, skeletal muscles, and the liver due to insulin resistance. The severity of symptoms can vary depending on the duration and type of diabetes. Individuals with high blood sugar levels, particularly those with a complete lack of insulin, such as children, may experience symptoms such as increased appetite, polydipsia, dysuria, weight loss, increased appetite, and vision problems. Some people with diabetes may not experience any symptoms, especially type 2 diabetic patients in their early stages . Without proper treatment, uncontrolled diabetes can lead to various complications such as coma, confusion, and in rare cases, death from ketoacidosis or nonketotic hyperosmolar syndrome not treated. In 2014, the WHO announced that 8.5% of adults aged 18 and above were affected by diabetes. In 2019, diabetes was responsible for 1.5 million deaths, with 48% of these occurring before the age of 70. Additionally, diabetes led to another 460,000 deaths due to kidney disease, and roughly 20% of cardiovascular-related deaths were attrib uted to elevated blood glucose levels. From 2000–2019, there was a 3% rise in standardized mortality rates related to diabetes. In lower-middle- income countries, the mortality rate associated with diabetes increased by 13%. In contrast, the likelihood of succumbing to any of the four primary non-communicable diseases (which include cardiovascular diseases, cancer, chronic respiratory diseases, or diabetes) between the ages of 30 and 70 declined by 22% worldwide from 2000 to 2019 .

Herein, the search criteria were based on the screening of all the respected and available research and review articles in the literature about diabetes. The authors screened over 500 scientific articles from different databases like PubMed and Google Scholar. Type 1 diabetes Type 1 diabetes (T1D) can be detected well before abnormal insulin secretion starts, with a steady decline starting at least two years before diagnosis. Around the same time, there is a decline in β-cell sensitivity to glucose. As the first insulin response decreases, the last insulin response rises, potentially indicating a compensation mechanism. Early in the post-diagnosis phase, the decline in insulin responsiveness keeps speeding up. Within the first few years after diagnosis, a biphasic decline in insulin secretion has been seen, with the first year being steeper than the second. Once a diagnosis is made, the decrease in insulin secretion may continue for years, eventually leaving little to no insulin production. Higher glucose levels are a sign of T1D even when they are within the normal range. When T1D develops, there are significant glucose variations. It may be possible to anticipate the development of diabetes more accurately in at-risk persons by using metabolic markers, such as deglycation. Alteration in glucose and C-peptide levels can be utilized in risk ratings to further improve prediction.  Idiopathic T1D. A rare variant of T1D has been reported and known as “idiopathic diabetes”, which is not caused by autoimmunity having lesser severity than autoimmune T1D. People with idiopathic diabetes may experience episodic ketoacidosis as well as insulin insufficiency. This variant is more common in individuals of Asian or African heritage.  Fulminant T1D. This is a unique kind of T1D that was originally identified in 2000. It shares certain characteristics with idiopathic T1D, including not being immune-mediated. Keto-acidosis occurs shortly after the initiation of hyperglycemia, and serum C-peptide levels, which is a marker of the endogenous release of insulin, are undetectable while blood glucose levels are high (288 mg/dL). About 20% of Japanese people with acute-onset T1D (5000–7000 instances) have this condition, which has been mostly characterized in East Asian nations. It causes an incredibly quick and practically complete β-cell death that leaves almost no residual insulin output. This condition is mainly attributed to some environmental and hereditary causes. Through an increased immune response without discernible formation of autoantibodies attacking pancreatic β-cells, an antiviral immune response may cause the loss of pancreatic β-cells. There have also been reports of this type of diabetes and pregnancy.

Type 2 diabetes A key component of type 2 diabetes (T2D) pathogenesis is defective insulin secretion. Insulin secretion varies widely in response to in sulin sensitivity to maintain adequate glucose levels.

The disposition index is a measure of the curvilinear relationship between the sensitivity of insulin and the secretion of insulin. Besides, type 2 diabetic patients have a low disposition index; therefore, they are unable to appropriately enhance their insulin production to combat insulin resistance. Even when the absolute insulin levels in insulin-resistant obese T2D patients are higher than in insulin-sensitive lean control subjects, the levels are still too low given the severity of their insulin resistance. Insulin pro duction (first phase) is significantly reduced or eliminated due to glucose stimulation. T2D patients have a high ratio of proinsulin to in sulin (C-peptide). The maximal insulin production and hyperglycemia-induced potentiation of insulin responses to non-glucose stimuli are substantially diminished. Hyperglycemia tends to worsen and become more challenging to cure over time. The continuing decline in β-cell function is another feature of T2D progression.  Gestational diabetes Pregnancy-related hyperglycemia increases the risk of bad outcomes for the mother, fetus, and newborn. This risk is present whether the hyperglycemia adopts the T2D form diagnosed before or during preg nancy. Newborns born to mothers with gestational diabetes are at an elevated risk of developing diabetes in adulthood [1]

LITERATURE REVIEW

Samar A Antar et al., (2024) Nowadays, diabetes mellitus has emerged as a significant global public health concern with a remarkable in crease in its prevalence. This review article focuses on the definition of diabetes mellitus. [2]

Ahmed Abdelhalim Yameny et al., (2024): Diabetes Mellitus (DM) is a chronic, progressive metabolic disorder characterized by persistent hyperglycemia, arising from defects in insulin secretion, insulin action, or both. Affecting millions globally, DM is a significant public health challenge contributing to high morbidity and mortality rates.[3]

Caruso et al.,(2024): This multicenter cross-sectional study involving 540 adults with type 2 diabetes mellitus (T2DM) aimed to describe sex-related differences in self-care behaviors and identify determinants of self-care related to sex. The study found notable differences in self-care practices between sexes, influencing how patients manage their condition, including tendencies toward self-medication.[4]

Hofer   et al., (2023): Conducted a randomized controlled trial with 176 Hispanic and African American individuals with T2DM, examining the impact of a community health worker-led medication self-management intervention. [5]

Lin  et al.,(2023): This study explored the relationship between depression and diabetes self-care behaviors, revealing that coexisting major depression in diabetic patients is associated with poor self-care behaviors, including reduced medication adherence. Such psychological factors can exacerbate the risks associated with self-medication.[6]

Wolff  et al., (2023): In a randomized controlled trial involving 845 English- or Spanish-speaking individuals with T2DM, the study assessed the impact of providing patient-centered labels for medications. Findings indicated that patients with limited health literacy showed significant improvement in medication adherence, suggesting that inadequate understanding of medication instructions can lead to improper self-medication and associated health risks.[7]

Greenwood et al., (2022): This systematic review evaluated technology-enabled diabetes self-management education and support, emphasizing the need for integrating technological tools to enhance patient education and reduce reliance on self-medication.[8]

Caruso et al., (2022): The study recommends tailored interventions considering sex-related differences in self-care behaviors to improve diabetes management and reduce self-medication practices.[9]

Gonzalez et al., (2022): This study examines the impact of depressive symptoms on self-care behaviors and medication adherence among individuals with type 2 diabetes, highlighting that increased depressive symptom severity correlates with decreased adherence to self-care activities.[10]

 A.Shaghaghi  et al., (2021): This research identifies seven self-care practices—blood sugar monitoring, healthy eating, physical activity, medication adherence, healthy coping, risk reduction, and problem-solving—that collectively contribute to effective blood glucose control and reduced complications in diabetes management.[12]

 Mohammad amerzadeh et al., (2021): This study explores self-care behaviors and medication adherence in elderly patients with type 2 diabetes, identifying factors that influence adherence and emphasizing the need for targeted interventions to improve self-management in this population.[13]

Schmitt et al.,(2021): This article introduces the revised DSMQ-R, a tool designed to evaluate self-management practices in individuals with type 1 and type 2 diabetes, facilitating better assessment and support of patient behaviors suggesting that traditional medicine and cultural perceptions significantly influence self-care decisions.[14]

Thomas haak et al.,(2020): This study investigates the prevalence and factors associated with self-medication among type 2 diabetes patients in India, revealing a significant proportion of patients engage in self-medication, often due to easy availability of drugs and prior experience with the medication.[15]

 Yen jung chang et al., (2020): This research explores how health literacy influences self-medication behaviors in diabetic patients, finding that lower health literacy is associated with higher instances of self-medication, underscoring the need for patient education.[16]

Rashid.k et al., (2020): This study examines the impact of herbal medicine self-medication on glycemic control in type 2 diabetes patients, indicating that while some patients report benefits, there is a risk of adverse. [17]

AIM AND OBJECTIVES  

AIM

 To evaluate and compare self-care practices among known Type 2 diabetic patients in rural and town areas of Bhavani, Erode District, and to identify the factors influencing their self-management behaviors.

This aim ensures that your study focuses on assessing self-care practices while also considering rural-urban differences and identifying key influencing factors.  

OBJECTIVES

1. Analyze the prevalence of diabetes mellitus and self-medication practices among individuals in Bhavani, Erode District.

2. Evaluate the demographic characteristics of the study population, including age, gender, and sociocultural factors.

3. Identify the key factors influencing self-medication among diabetic patients, such as accessibility, cost, cultural beliefs, and lack of awareness.

4. To investigate healthcare-seeking behavior, including doctor visits, awareness levels, and reasons for self-medication.

5. To Find stratergies for improving awareness, healthcare access, and responsible and determine the prevalence of Diabetes Mellitus in Bhavani, Erode District.

6. Evaluate the types of Diabetes Mellitus (Type 1 and Type 2) in the study population.

PLAN OF STUDY

METHODOLOGY

Study Type: A Prospective Observational Study.

Study Period: Study was conducted from December (2024) to February (2025).

Study Site:  Bhavani and Erode  is a mix of rural and semi-urban populations, allowing a comparative study of self-care practices.Availability of diabetic patients visiting Pharmacy and clinics. Accessibility for data collection through structured interviews or surveys. 

Study Population: 52 patient’s Data were collected from Various Pharmacy.

Study Criteria

Inclusion Criteria:

• Type 2 DM who are more than 18 years of age.
• Duration of illness minimum 1 year.
• Those who are willins to participate include the study.
• Both sexes with Type 2 DM includes the study.

Exclusion Criteria:

• Newly dignosed diabetics and pregnant women.
• Patients with severe complications (e.g., advanced kidney failure, blindness, amputation, or severe cardiovascular disease)
• Patients with cognitive impairments or psychiatric illness affecting their ability to provide reliable responses.

STUDY PROCEDURE

The tool developed was a pretested semi- structured questionnaire. The items included were Gender Distribution, Age Group Distribution, Family Members by Gender, Frequency of Doctor Visits, Smoking and Alcohol Consumption, Common Symptoms Experienced, Diabetes-Related Complications, Methods of Medication Usage, Blood Glucose Level Distribution, Types of Physical Activities, Awareness About Diabetes, Reasons for Non-Adherence to Treatment, Types of Diabetes Mellitus, prevalence of Self medication.

Informed verbal consent was obtained from the patients before their inclusion in the study, and written consent was also obtained from the respondents. The analysis was conducted using percentages.

ETHICAL CONSIDERATION

 Data will be collected through face-to-face interviews conducted by trained field investigators, including healthcare workers or research assistants, to ensure consistency. Each interview will take approximately 10-20 minutes and will be conducted in a private setting at Pharmacy or participants’ homes to maintain confidentiality and encourage honest responses. Informed written or verbal consent will be obtained before the interview, ensuring voluntary participation.

In addition to self-reported data, anthropometric and clinical measurements such as body mass index (BMI), blood pressure (BP), and HbA1c levels (if available from medical records) will be recorded to assess the association between diabetes control and self-care behaviors.

DATA ANALYSIS

The data obtained was entered into MS Excel can be used to describe the data. Categorical variables - Frequencies and percentages were used for the research.^[19]

RESULTS

GENDER DISTRIBUTION:

Table 1: Gender Distribution in Diabetes Mellitus

The study had a higher proportion of male participants (71.5%) compared to females (28.84%). This indicates a gender imbalance in the sample, which could influence the findings.

Figure 1: Gender Distribution In Diabetes Mellitus

AGE GROUP DISTRIBUTION:

Table 2: Age Group Distribution Report

The age group of 40-50 years had the highest representation (40%), while both the 30-40 and 50-60 age groups accounted for 30% each. This suggests that middle-aged individuals were the primary focus of the study.

Figure Figure 2: Age Group Distribution Report

FAMILY MEMBERS BY GENDER:

Table 3: Family Members With Diabetes By Gender

Among family members, 51% were female, and 46% were male. The near-equal distribution indicates that health-related insights may be applicable to both genders within family settings.

Figure 3: Family Members With Diabetes By Gender

FREQUENCY DOCTOR VISITS:

Table 4: Frequency Of  Doctor Visits Of Diabetic Patient

More than half (53%) of the participants visited their doctor every six months, while 15% went every three months, and 3% had monthly visits. Surprisingly, 78% reported annual check-ups, which raises concerns about inadequate health monitoring.

Figure 4: Frequency Of Doctor Visits Of Diabetic Patient

PREVALENCE OF SMOKING AND ALCOHOL CONSUMPTION:

Table 5: Prevalence Of Smoking And Alcohol Consumption