Chapter 1

Introduction
INTRODUCTION

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from

defects in insulin secretion, insulin action, or both. The chronic hyperglycemia in diabetes is
associated with long-term dysfunction, and failure of various organs, especially the eyes,
kidneys, nerves, heart, and blood vessels.13
Several pathogenic processes are involved in the development of diabetes. These range from
autoimmune destruction of the -cells of the pancreas with consequent insulin deficiency to
abnormalities that result in resistance to insulin action. 5
CLASSIFICATION
Diabetes can be classified into the following general categories:
1. Type 1 diabetes is mainly due to -cell destruction, usually leading to absolute insulin
deficiency occurring only in adults.5
2. Type 2 diabetes due to a progressive loss of insulin secretion on the background of insulin
resistance.5
3. Gestational diabetes mellitus (GDM) is diabetes diagnosed in the second or third trimester of
pregnancy that is not clearly overt diabetes.5
4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as
neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine
pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with
glucocorticoid use, in the treatment of HIV/AIDS or after organ transplantation) .5

Assessment of diabetes related health knowledge, attitude and practice among diabetics and non
diabetics using self prepared questionnaire for awareness of health promotion
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Introduction

AWARENESS ON DIABETES
Diabetes Mellitus (DM) has emerged as one of the most challenging public health problems in
the 21st century with an extreme effect on quality of life. It currently affects over 366 million
people worldwide and this figure is likely to double by 2030. 1 It is important to know about the
awareness level of a disease condition in a population, as knowledge is a critical component of
behavior change. Once awareness is created, people are more likely to participate in prevention
and control activity. Research has shown that education about diabetes resulted in a significant
increase in knowledge of a population, which plays a vital role in future development and early
prevention and detection of the disease. This study therefore set out to find the awareness and
knowledge about DM amongst diabetic and non diabetic.2
Patients knowledge on diabetes, its treatment and its complication still remain a major
challenge, particularly in context of developing countries like India. It is rightly said that
Prevention is better than Cure. Prevention is important because the burden of the diabetes and
its complications on health care and its economic implications are enormous, especially for a
developing country like India. Patient education is always considered an essential element of DM
management. Studies have consistently shown that improved glycemic control and strict
metabolic control can delay or prevent the progression of complications associated with diabetes.
Evidences suggest that patients, who are knowledgeable about DM self-care, have better long
term glycemic control. Thus it is indispensable to ensure that patients knowledge, attitudes and
practices are adequate.3

Assessment of diabetes related health knowledge, attitude and practice among diabetics and non
diabetics using self prepared questionnaire for awareness of health promotion
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Risk factors
Awareness of risk factors is a prerequisite to prevent diabetes among general population and also
in high-risk groups, such as Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance
(IGT). If people are aware of the risk factors that develop diabetes, the rate of its occurrence can
be minimized. Evidence eventually reported that people who perceive themselves to be at risk of
a disease are more likely to engage in and comply with efforts to reduce their risk of developing
the problem. Thus, considerable efforts are needed to inform people about diabetes to judge their
risk including the severity and probability of ill effects, about the risk factors that modify their
susceptibility, as well as the ease or difficulty of avoiding harm. Acquiring knowledge on the
level of awareness among population about diabetes is the first step in formulating a prevention
program for diabetes.4
Risk factors for diabetes mellitus

Obesity
Family history of type 2 diabetes in first or second degree relative
Signs of insulin resistance like acanthosis nigricans
Hypertension
Dyslipidemia
PCOS
GDM

Diabetic complications

Assessment of diabetes related health knowledge, attitude and practice among diabetics and non
diabetics using self prepared questionnaire for awareness of health promotion
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Diabetes is a silent disease.6 According to the International Diabetes Federation Diabetes Atlas,
India already has 63 million people with diabetes. Major problem with diabetes is that if it is
poorly controlled it leads to increase in micro vascular and macro vascular complications such as
coronary artery disease, stroke, blindness, kidney failure, foot amputation, poor blood supply to
the limbs leading to increased morbidity.7 Most of these complications are not only irreversible,
but there are also costly to manage. Patient education becomes a central component in the
prevention and control of this disease. Such education should lead to diet modification, increased
physical exercise and lifestyle changes including the promotion of weight loss. These educational
programs should help people assess their risks of diabetes, motivate them to seek proper
treatment and care and inspire them to take charge of their disease.1
Complications of diabetes mellitus
Micro vascular complications which affects small blood vessels creating problems to eyes,
kidneys and nerves
Diabetic retinopathy
Diabetic nephropathy
Diabetic neuropathy
Macro vascular complications which affect large blood vessels which troll to the heart and
creating heart problems and stroke which effects brain.5
Self care practices
The self care practices of individuals are influenced by their knowledge about diabetes; the more
they know about their illness, more they would have self management skills. Many research
work published have shown that the diabetic population dont have enough awareness of
diabetes, the proper use of medications, life style modifications, dietary plans, myths associated
with insulin and other education programs on health issue..8
Assessment of diabetes related health knowledge, attitude and practice among diabetics and non
diabetics using self prepared questionnaire for awareness of health promotion
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Patient awareness about diabetes, complications, medications adherence, diet plans and life style
modifications can establish patient specific goals, like effectiveness of medications and decrease
in likely hood of adverse events in all types of diabetes and in all age groups of diabetic
population.8

Assessment of diabetes related health knowledge, attitude and practice among diabetics and non
diabetics using self prepared questionnaire for awareness of health promotion
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