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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 230-234

Misconceptions about diabetes mellitus among diabetes patients: A cross-sectional study


Department of Community Medicine, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

Date of Submission16-Dec-2021
Date of Acceptance03-Mar-2022
Date of Web Publication17-Sep-2022

Correspondence Address:
Dr. Sulakshana Shridhar Baliga
Department of Community Medicine, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_383_21

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  Abstract 


BACKGROUND: Diabetes mellitus is a lifestyle-related painless disease. India has the highest diabetes burden in the world and is called as the “Diabetic Capital of the world.” Even though the disease is so rampant, there are ample misconceptions about diabetes and this has become a hurdle in effective management and control of the disease.
MATERIALS AND METHODS: A cross-sectional study was conducted at the urban health center among 200 diabetics. Patients were asked about their belief in misconceptions regarding diet, exercise, treatment-seeking behavior, and self-care of diabetes.
RESULTS: From a total of 200 participants, 112 (56%) were females. Majority 183 (91.5%) were self-monitoring their blood glucose. More than half of the participants were on oral hypoglycemic drugs. In this study factors such as low educational status, participants staying in joint family, low socioeconomic class, participants on oral hypoglycemic drugs, participants on both oral hypoglycemic drugs and insulin, participants on herbal treatment had more prevailing misconceptions regarding diabetes.
CONCLUSION: There were many prevailing misconceptions among the diabetic patients, especially related to diet, treatment, and self-care. Regular health education programs regarding misconceptions can change the attitude of diabetic patients and improve their compliance toward treatment.

Keywords: Determinants, diabetes, misconceptions, urban


How to cite this article:
Nalavadey S, Baliga SS. Misconceptions about diabetes mellitus among diabetes patients: A cross-sectional study. Indian J Health Sci Biomed Res 2022;15:230-4

How to cite this URL:
Nalavadey S, Baliga SS. Misconceptions about diabetes mellitus among diabetes patients: A cross-sectional study. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Sep 25];15:230-4. Available from: https://www.ijournalhs.org/text.asp?2022/15/3/230/356280




  Introduction Top


Diabetes is a lifestyle-related disease. As of 2019, it has a global prevalence of 9.3% (463 million people).[1] It is estimated that 415 million people are living with diabetes in the world, which is about 1 in 11 of the world's adult population.[2] In 2016, an estimated 1.6 million deaths were directly caused by diabetes.[3] India has the highest diabetes burden in the world, with a prevalence of 11.8% and hence is called as “the diabetic capital of the world.”[4]

Even with such high prevalence of this disease, there is a lack of clear knowledge about it among the general public. The false beliefs become a part of their social behavior and they will have a strong influence on their lifestyle and treatment seeking behavior as well. Despite having a National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke by the Government of India, health education and counseling are neglected by the physicians, especially regarding misconceptions about diabetes mellitus.

Therefore, it becomes seemingly important for physicians to understand the false beliefs and misconceptions in a particular community about a disease to improve patient care, especially when dealing with chronic diseases like diabetes. Hence, the present study was planned to determine the various misconceptions about diabetes among the diabetic patients.

Objective

The objective of the study is to determine the various misconceptions about diabetes among the diabetic patients.


  Materials and Methods Top


Source of data

The present study was conducted in urban field practice area of the Department of Community Medicine, Jawaharlal Nehru Medical College, KAHER, Belagavi.

Study design

A community-based cross-sectional study conducted for a period of 6 months.

Sample size

Two hundred type 2 diabetic patients were selected using universal sampling method.

Sampling method

A total of 226 type 2 diabetics are registered in the Diabetic clinic of urban health center attached to Department of Community Medicine, J. N. Medical College Belagavi. Only 200 had diabetes for more than 6 months. Hence, 200 were enrolled in the study as study participants. A pilot study was carried out on 20 diabetic patients (not included in the final analysis) to test our tool and make necessary modifications.

Data collection procedure

The subjects were interviewed by using predesigned and pretested questionnaire. A detailed questionnaire included information on information regarding sociodemographic details, various misconceptions about diabetes among the diabetic patients.

Patients were asked about their belief in misconceptions regarding diet, exercise, treatment-seeking behavior, and self-care of diabetes. The patient's responses on these aspects were scored as 1 or 0 if he/she had a misconception or not, respectively. The sum of all scores was computed as misconception score. A total of 32 questions were enquired. A cut-off point of 16 was chosen.

Mean score >16 was considered as high misconception.

Mean score <16 was considered as low misconception.

All the subjects were informed about the purpose of study, and after obtaining informed consent, they were interviewed.

Inclusion criteria

  • Registered diabetic patients in diabetic clinic of urban health center
  • Have type 2 diabetes for more than 6 months.


Exclusion criteria

  • Freshly diagnosed patients
  • Type 1 diabetic patients
  • Any patient with physical and psychological illness
  • Written informed consent was taken from every participant
  • Ethical clearance was obtained from Institutional Ethics Committee with reference number MDC/JNMCIEC/452 dated 21/10/2021.


Data analysis

Data were coded and entered in Microsoft Excel software and statistical analysis was done using SPSS. Data were analyzed using Data was analyzed using Statistical Package for the Social Sciences (SPSS) for Windows, Version 24, SPSS Inc. by International Business Machines Corporation (IBM), Chicago, Illinois, USA. Respondent's sociodemographic characteristics were stated using descriptive statistics. Significant variables on univariate analysis were entered into multivariate logistic regression analysis.


  Results Top


Out of the total 200 study participants, 112 (56.0%) were females and 88 (44.0%) were males. In our study, majority of the participants were aged more than 50 years. 124 (62%) were Hindus, 66 (33%) were Muslims, and only 10 (5%) were Christians. Out of total, 13 (6.5%) of them were on Insulin, 123 (61.5%) on oral drugs, 34 (17%) on both on oral drugs and insulin, 17 (8.5%) on herbal medicines, and 3 (1.5%) were not on any treatment. Among the participants, 32 (16%) of them monitored blood glucose monthly, 61 (30.5%) once in 3 months, 60 (30%) once in 6 months, and 30 (15%) once in a year. Whereas only 17 (8.5%) of them never self-monitored blood glucose. 55 (27.50%) of all the participants had some complication associated with diabetes. Most common complications recorded were diabetic foot ulcer 16 (8%), followed by kidney complications 12 (6%), heart complications 11 (5.50%), eye complications 4 (2%), and nerve complications 4 (2%).

[Table 1] shows the sociodemographic profile of study participants.
Table 1: Sociodemographic profile of study participants (n=200)

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[Table 2] shows the common misconceptions among study participants. In the present study, almost all the participants had one or the other misconceptions regarding diabetes. Majority of the participants, 167 (83.5%) had a misconception that toenails should be clipped curved. More than half of them had misconception like bitter food reduces elevated sugar level, jaggery/honey is better than for diabetes, medications should be stopped during acute illness. [Table 3] shows the association of the selected sociodemographic variables on the total misconception score. It shows that patients with little or no education, type of treatment, diet control, and self-monitoring of glucose were significantly (*P < 0.05) associated with high misconception scores. However, age, gender, and family history of DM were not significantly associated with total misconception scores in diabetic patients.
Table 2: Prevalence of misconceptions among study population

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Table 3: Association between sociodemographic and diabetes characteristics with levels of misconceptions

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The variables such as age, gender, family size, socioeconomic status, history of diabetes, presence of glucometer, and diet control had a strong correlation with misconceptions. Whereas, on the other hand, educational qualification, marital status, monthly income were inversely corelated with misconceptions [Table 4].
Table 4: Correlation between misconceptions and its dimension scores with other variables

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Multivariate logistic regression analysis showed that participants with primary education (odds ratio [OR]: 29.23 [95% confidence interval {CI} 3.79–225.72] P = 0.0010), secondary education (OR: 22.59 [95% CI: 3.42–149.25] P = 0.0010), participants staying in joint family (OR: 10.11 [95% CI: 1.63–62.65] P = 0.0130), participants with socioeconomic Class III (OR: 73.17 [95% CI: 4.13–1295.85] P = 0.0030), participants on oral hypoglycemic drugs (OR: 58.66 [95% CI: 5.43–634.13] P = 0.0010), participants on both oral hypoglycemic drugs and insulin (OR: 26.17 [95% CI: 2.08–328.88] P = 0.0110), participants on herbal treatment (OR: 106.92 [95% CI: 4.61–2477.99] P = 0.0040) had more prevailing misconceptions regarding diabetes [Table 5].
Table 5: Multivariate logistic regression analysis of misconceptions by different characteristics

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  Discussion Top


Diabetes has become the modern epidemic. Educating the masses about diet control and exercise, taking small and frequent meals, regular monitoring of blood glucose levels, and self-care will help prevent and treat the disease better.

In our study, all the participants had one or the other misconception regarding diet, exercise, treatment-seeking behavior, and self-care of diabetes. More than half of participants believed that by eating bitter food, the elevated blood glucose levels can be controlled, which is not true. In our study, this finding could be due to the belief in people that increased sugar can be nullified by bitter food as “sweet” and “bitter” are opposite to each other. Similarly, 68.5% of the study participants also believed that jaggery/honey is better than sugar for diabetics. However, the fact is, although complex both jaggery and honey have the same gram-to-gram calorie content. That means it is as harmful as any other form of sugar.[5] Overall, there were strong dietary misconceptions seen in our study similar to studies conducted in Pondicherry, Haryana, Bihar, Saudi Arabia, New York.[6],[7],[8],[9],[10]

Misconception related to physical activity that diabetics cannot take part in exercise or sports was believed by almost half of them in our study. However, in reality, exercise reduces blood glucose levels by increasing the uptake of glucose by the muscles and also helps avoid long-term complications, especially heart problems.[11]

In the present study, almost half of the diabetic patients believed that diabetes occur only when the blood glucose levels are high and when the glucose levels are controlled, they do not have diabetes and there is no need to take regular medications. 61% also believed that medications should be stopped during an episode of acute illness. However, the fact is that, when the glucose levels are controlled, the medications have to be continued because it plays a vital role in preventing or delaying the onset and progression of diabetic complications.[12] It prevents sudden shoot of glucose levels which causes end-organ damage. 58.5% of the participants believed that diabetes can be managed by soaking the feet in water, which reduces the elevated blood sugar levels. This belief of theirs could be due to total ignorance of the nature and the cause of the disease. Soaking feet in water, oiling, and massaging are preventive measures.[13] The participants were also unaware about the way of clipping toe nails. If toe nails are clipped curved, it will lead to in-growing of nails which can have superimposed infections.[14]

Out of the total participants, 64% of them also believed that all fruits or fruit juice consumption is healthy, but in reality, certain fruits with high fructose content, i.e., high glycemic index like mango, banana, melon, peach have to be limited.[15] Almost half of the participants in our study believed that if insulin therapy has been started, then they are in the final stage of the disease. However, in reality, insulin is used for severe uncontrolled diabetes; once the blood glucose levels revert back to normal, the patient is switched back to other antidiabetic drugs.[16] Around 54.5% of participants had a misconception that herbal treatment can cure diabetes. Hence, it is very important to create awareness that diabetes is a lifestyle and lifelong acquired disease and cannot be cured but can be controlled.

Study participants with primary education and secondary education, participants staying in joint family, socioeconomic Class III, participants on oral hypoglycemic drugs, participants on both oral hypoglycemic drugs and insulin, participants on herbal treatment had more prevailing misconceptions regarding diabetes which was similar to studies done in various parts of India like Haryana, Bihar, West Bengal, Pondicherry.[6],[8]


  Conclusion Top


This study revealed that there were many prevailing misconceptions among the diabetic patients, especially related to diet, treatment, and self-care. This affects their health-seeking behavior and can affect the control of disease. In this study factors such as low educational status, participants staying in joint family, low socioeconomic class, participants on oral hypoglycemic drugs, participants on both oral hypoglycemic drugs and insulin, participants on herbal treatment had more prevailing misconceptions regarding diabetes. This study also shows that more than half of the patients were not aware of the risk of taking herbs along with their diabetic medications. Suboptimal knowledge and false beliefs can be corrected by providing education on diabetes self-management. Hence, this study highlights the misconceptions about diabetes and reflects the need for health education which should focus on these one or more predictors of misconceptions.

Recommendation

It is necessary to give appropriate health education, especially regarding false beliefs about diabetes. Health education should be given at regular intervals to promote better knowledge about diabetes among the general public, especially in diabetic clinics and improve their treatment seeking behavior and compliance toward the treatment which will in turn have a positive impact on the quality of life.

Limitations

Misconceptions about the lifestyle of diabetic patients and sources of misconceptions were not assessed. HbA1C values if recorded for all the patients under the study could have given a clearer and accurate picture of the misconceptions.

Acknowledgment

The authors would like to acknowledge the principal for granting the permission to conduct the study. The authors also would like to acknowledge the study participants for their cooperation throughout the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019;157:107843.  Back to cited text no. 1
    
2.
The Global Diabetes Community Booklet. Available from: https://www.diabetes.co.uk/diabetes-prevalence.html. [Last accessed on 2019 Jan 15].  Back to cited text no. 2
    
3.
WHO. Diabetes. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes. [Last accessed on 2018 Oct 30].  Back to cited text no. 3
    
4.
5.
Jaggery Instead of Sugar, The Right Choice? Blog. Available from: http://yourbld.com/jaggery-instead-of-sugar/. [Last accessed on 2019 Mar 26].  Back to cited text no. 5
    
6.
Patil R, Nasrin AN, Datta SS, Boratne AV, Lokeshmaran. Popular misconceptions regarding the diabetes management: Where should we focus our attention? J Clin Diagn Res 2013;7:287-91.  Back to cited text no. 6
    
7.
Patil R, Palve SB, Jayaramachandran, Nisha AN. False beliefs about causation of diabetes mellitus among adults in urban Pondicherry – A cross sectional study. Natl J Res Community Med 2017;6:125-8.  Back to cited text no. 7
    
8.
Singh M, Pal R, Ranjan R, Sarkar G, Bhartia DR, Pal S, et al. Diabetes mellitus: Myths and reality. J Krishna Inst Med Sci Univ 2017;6:1-6.  Back to cited text no. 8
    
9.
Alsunni AA, Albaker WI, Badar A. Determinants of misconceptions about diabetes among Saudi diabetic patients attending diabetes clinic at a tertiary care hospital in Eastern Saudi Arabia. J Family Community Med 2014;21:93-9.  Back to cited text no. 9
    
10.
Mann DM, Ponieman D, Leventhal H, Halm EA. Misconceptions about diabetes and its management among low-income minorities with diabetes. Diabetes Care 2009;32:591-3.  Back to cited text no. 10
    
11.
Colberg SR, SigalRJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes. J Med Sci Sports Exerc Diabetes Care 2010;33:2696.  Back to cited text no. 11
    
12.
Chaudhury A, Duvoor C, Reddy Dendi VS, Kraleti S, Chada A, Ravilla R, et al. Clinical Review of Antidiabetic Drugs: Implications for Type 2 Diabetes Mellitus Management. Front Endocrinol (Lausanne) 2017;8:6.  Back to cited text no. 12
    
13.
Park K. Textbook of Preventive and Social Medicine. 25th ed. Jabalpur: Banarsidas Bhanot; 2019. p. 425.  Back to cited text no. 13
    
14.
Why Do Diabetics have to be Careful Cutting Their Toenails? Blog. Available from: http://lovesoks.com/blog/why-do-diabetics-have-to-be-careful-cutting-their-toenails. [Last accessed on 2015 Aug 11].  Back to cited text no. 14
    
15.
An Overview of Eating Fruit When You Have Diabetes. Blog (Online). (Cited on 2 November 2019). https://www.verywellhealth.com/fruits-to-avoid-if-you-have-diabetes-1087587.  Back to cited text no. 15
    
16.
Okamoto T, Okamoto L, Lisanti MP, Akishita M. Switch to oral hypoglycemic agent therapy from insulin injection in patients with type 2 diabetes. Geriatr Gerontol Int 2008;8:218-26.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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