Background: Low knowledge about diabetes risk factors coupled with high disease prevalence is common in low-resource countries. This study evaluated diabetes-related knowledge, attitudes, and practices in the general population in Punjab (Pakistan). Methods: A cross-sectional study was conducted in five districts in Punjab from January to March 2017. Data were collected from 2019 adults aged 18–90 years through face-to-face interviews using a semi-structured questionnaire. The total knowledge score ranged from 0–9; a score ≥6 was considered adequate diabetes awareness. Descriptive statistics, chi-square tests, and linear and binary logistic regression were used for the analyses. Results: Respondents’ mean age was 32.92 ± 11.4 years. In total, 85.9% of respondents had heard of diabetes, and 30.1% knew about the glucose tolerance test. We found 2.3% of respondents scored zero for diabetes knowledge, 11.3% scored 9, and 47.4% scored ≥6 (adequate awareness). Being female (β = 0.37, 95% confidence interval [CI]: 0.16, 0.05; p = 0.001), socioeconomic status (β = 0.24, 95% CI: 0.12, 0.36; p < 0.001), being diabetic (β = 0.82, 95% CI: 0.53, 1.10; p < 0.001), and higher education (β = 0.25, 95% CI: 0.17, 0.33; p < 0.001) were significantly associated with knowledge score. Respondents with high socioeconomic status showed significantly higher positive attitudes compared with those with low socioeconomic status (adjusted odds ratio 1.57, 95% CI: 1.12, 2.24). Only 8.7% (30/343) of those diagnosed with diabetes had never undergone blood glucose screening since diagnosis. Conclusions: Knowledge of diabetes risk factors, management, and care is low in Pakistan’s general population. Targeted public education programs should be instigated at a national level to increase understanding of diabetes prevention and treatment.

https://www.mdpi.com/1660-4601/15/9/1906/pdf

Knowledge, Attitudes and Practices Regarding Diabetes in the General Population: A Cross-Sectional Study from Pakistan.

Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.

https://www.mdpi.com/2072-6643/12/11/3516/pdf

Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care.

Introduction: To evaluate the vascular complications and their correlation with different risk factors among type-2 diabetic patients in Hyderabad, Sindh, Pakistan. 
Methodology: Cross-sectional study was conducted at the department of medicine Isra University Hospital, Hyderabad from March to September 2021. Type 2 diabetics of either sex, between ages 20 and 70 years, on diabetic medication, were included in the study. While patients with type I diabetes, unconscious or with any mental health issues were excluded. A Non-random consecutive sampling technique was applied for the selection of participants. Socio-demographic, disease and medication information was collected using a written questionnaire while serum glucose level, albumin and lipid profile was analyzed. 
Results: Over half of the participants (51.72%) were females, while most (70.87%) of the participants were aged < 40 years. A total of 124(28.5%) patients showed symptoms of macro-vascular complications with most (16.78%) of them having coronary artery disease. A significant relation (p<0.05) was found between coronary artery disease and age, duration of diabetes, blood pressure, body mass index and serum triglycerides. Peripheral vascular disease was significantly related (p<0.05) to the duration of diabetes, systolic blood pressure and serum triglyceride. While significant relation (p<0.05) between cerebrovascular disease with age, systolic and diastolic BP was there. 
Conclusion: Coronary artery disease seems to be the most common macro-vascular complication among type 2 diabetic patients, with a high prevalence of risk factors such as advanced age, duration of DM, male sex, hypertension, Body Mass Index, and serum triglycerides. 
Keywords: Coronary artery disease, diabetes mellitus type 2, Macro-vascular complications, peripheral vascular disease.

Vascular Complications and their Risk Factors in Patients of Diabetes Mellitus, Type 2

Background: India currently leads the world, as it has the largest number of diabetics and is considered as the “Diabetes capital of the world”. Noncompliance leads to lack of metabolic control, which contributes to development and acceleration of diabetic complications also dramatically increase the financial cost of the patient as well as public health services. Objectives: 1. To study the compliance rate of the patients with type II DM. 2. To find out the factors influencing the noncompliance of known diabetic patients. Methods: A case series study was done in HSK Hospital, Bagalkot from May to July 2014. Indicators used to evaluate the compliance were Diet, Exercise, Medication and regular physician visit. These indicators were graded as Always, Most times, Some times and Never. Chi square test was used to find the association. Results: In this study, the total participants were 214, in which majority (62.15%) were male and 50.93% were more than 60 years. The compliance rate was 53.27%. Among the study participants only 15.89%, 7.48%, 15.89% and 14.95% had been following the advice regarding diet, exercise, medication and physician consultation regularly respectively. The most common reason for not following the advice were, they couldn’t resist eating sweets (56.11%), not interested (26.26%), forgetfulness (67.78%) and being busy at work schedule (40.66%) respectively. Conclusion: The compliance of diabetic patients was poor. An integrated approach from doctors, patients and their family are needed to improve the compliance and to fight against harsh effects.

/pdf/a-case-series-study-on-compliance-and-its-influencing-lorma36nru.pdf

A Case Series Study on Compliance and its Influencing factors among Type II Diabetes Mellitus Patients Attending a Tertiary Healthcare Centre at Bagalkot District, Karnataka

Introduction: Non-adherence to a drug regimen is an important issue for the management of diabetes, and it leads to therapeutic failure. Uncontrolled diabetes is a prime reason for other complications, specifically hypertension (HTN). Thus, we evaluated the factors associated with therapeutic adherence to diabetes medication and factors associated with HTN among a population with diabetes in Punjab, Pakistan. Materials and methods: A descriptive cross-sectional study was conducted from December 2015 to March 2016. Systemic sampling technique was adopted to recruit patients. The eight-item Morisky Medication Adherence Scale-8 was used to evaluate adherence. Descriptive statistics were used to elaborate on the variables, bivariate, and multivariable analyses. These were conducted to classify factors independently associated with moderate-high adherence to medication therapy and factors associated with HTN. Results: A total of 299 people completed the study, with a mean age ± standard deviation, 48.8 ± 14.6 years. One hundred and sixty-nine (56.5%) participants were men, 270 (90.3%) were married. High adherence was found in 85 (28.4%), moderate in 69 (23.1%), and low in 145 (48.5%) patients. Patients who were taking help from the family members in taking medicine correctly and patients who believe that drug therapy caused side effects were showing reduced moderate-high adherence (adjusted odds ratio [AOR] = 0.562; 95% confidence interval [CI] = 0.328, 0.961) and (AOR = 0.349; 95% CI = 0.192, 0.635), respectively. A total of 44.4% of patients had HTN as a comorbidity. Family history of HTN (AOR = 23.42; 95% CI = 9.655, 56.853; p < 0.001), and abnormal cholesterol levels (AOR = 23.401; 95% CI = 10.195, 53.765; p = 0.01) were significantly associated with a hypertensive status of diabetic patients in our population. Conclusions: Patients who were depending on family members to take medication correctly at a proper time, and the patients who believed that drugs caused side effects were showing a reduced level of adherence to our study group. The risk factors of HTN (i.e., abnormal cholesterol levels) were prevalent among the patients of diabetes; these must be monitored and controlled.

/pdf/evaluation-of-factors-associated-with-medication-adherence-4l6b87pxwf.pdf

Evaluation of factors associated with medication adherence and hypertension among diabetic patients in Pakistan

Background: Diabetes is defined as syndrome and is accompanied by number of micro and macro-vascular complications. The burden is quite high in developing countries so the main aim of this study is to evaluate complications in diabetes patients of Pakistan. Methods: A cross-sectional descriptive study was undertaken from December 2015 to March 2016 using a paper based questionnaire. Patients were selected from the 3 private clinics and 3 hospitals employing the systematic sampling technique and anthropometric readings were taken for each individual. The complications were measured by the standards measuring procedures. The demographics were elaborated by the descriptive statistics and the binary logistic regression model was used to analyze the factors associated with the complications by using SPSS version 18. Results: Mean age± SD of the respondent’s was 48.8±14.6 year. One hundred and thirty (43.5%) were females, 270 (90.3%) were married, 103 (34.5%) were rural resident, 189 (63.2%). Sixty five (21.7%) patients accompany Cardiovascular disease (CVD), 51 (17.0%) had diabetic nephropathy, 96 (32.1) had diabetic neuropathy and 124 (41.5%) had diabetic retinopathy. Age (AOR=2.477 95%CI=1.085, 5.654, p=0.031) and abnormal blood glucose level (AOR=1.872 95%CI=1.005, 3.487, p=0.048) is the significantly affecting factors of CVD. Body mass index was the strongest independent predictor for diabetic nephropathy (AOR=0.233 95%CI=0.067, 0.806, p=0.021) and diabetic retinopathy (AOR=3.558 95%CI=1.884, 6.719 p=0.00). Conclusion: The complications seem to be high among the diabetic patients with high frequency of the risk factors accompanying them. Imparting appropriate knowledge and preventing strategies will prove to be of immense benefits in reducing the co-morbidities. Key words: Micro-Vascular complications, Macro-Vascular complications, Diatbetes, Pakistan.

Macro and Micro-Vascular Complications and their Risk Factors in Diabetes Mellitus Patients of Southern Punjab, Pakistan

Introduction: The prime focus of this study is the evaluation of the factors associated with diet and exercise compliance and smoking prevalence among the diabetic population in the Southern Punjab in Pakistan. Materials and Methods: Research was carried out in between December 2015 and March 2016 employing the descriptive, cross-sectional design using a paper-based questionnaire. We undertook systemic sampling procedure and choose every 3rd diabetic patients visiting three public hospitals and three private clinics. Cholesterol and blood glucose levels were monitored during the survey. Data were summarized by descriptive statistics. A 3-day recall method for macronutrient was used to assess the dietary history and diet compliance. At least a 30 min rigorous walk per day or a total of 2.5 h per week was a requirement for exercise compliance. Those patients who admitted smoking tobacco in the past 12 months were taken as current smokers. Statistical analysis was done using SPSS Version 18.0 (SPSS, Chicago, IL, USA). Results: Diet and exercise compliance and smoking prevalence were shown by 36.5%, 58.8%, and 15.4% patients, respectively. Patients feeling easy with a diet plan [adjusted odds ratio (AOR) = 20.874, 95% confidence interval (CI) = 9.876, 44.119] and patients who were aware which diet was harmful to them (AOR = 7.106, 95% CI = 3.529, 14.309) were significantly associated with dietary compliance. Age (AOR = 0.971, 95% CI = 0.951, 0.991) and patients who believe that exercise will lead to weight loss (AOR = 4.978, 95% CI = 2.725, 9.093) were independently associated factors of exercise compliance. Gender was only an associated variable with smoking (AOR = 0.127, 95% CI = 0.048, 0.331). Conclusion: Determinant factors of diet compliance were feeling ease with diet plan and knowledge about a harmful diet. Age and belief that exercise will lead to weight loss are significant factors to adhere to exercise compliance. Male gender significantly indulges in more smoking practices than females.

/pdf/associated-factors-with-diet-and-exercise-compliance-and-m4ui06qwzs.pdf

Associated Factors with Diet and Exercise Compliance and Smoking Habits in Diabetic Patients of Punjab, Pakistan

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Macro and Micro-Vascular Complications and their Risk Factors in Diabetes Mellitus Patients of Southern Punjab, Pakistan

Associated Factors with Diet and Exercise Compliance and Smoking Habits in Diabetic Patients of Punjab, Pakistan