BackgroundNonadherence to diet and physical activity is a major problem in the management of diabetes mellitus and its complications. This study was undertaken to measure the factors associated with nonadherence to diet and physical activity advice among Nepalese type 2 diabetic patients.MethodsAn analytical cross-sectional study was conducted among type 2 diabetic patients (age, M ± SD, 54.4 ± 11.5 yrs) and interviewed using three days recall method for dietary history and Compendium of Physical Activity for physical activity. Data were analysed by univariate and multivariate statistics.ResultsOut of 385 patients, 87.5% were nonadherent and 12.5% poorly adherent to dietary advice. 42.1% were nonadherent, 36.6% partially adherent while 21.3% good adherent to physical activity. Adherence to dietary advice was higher in males than females (M ± SD, 33 ± 16.7 vs 27 ± 15.5, p = 0.001), those staying nearer to hospital than farther (M ± SD, 32 ± 18.6 vs 28 ± 13.5, p = 0.013), those advice by physician than others (p = 0.001) and from nuclear family than joint and extended (p = 0.001). With increasing age, dietary advice adherence decreased (p = 0.06) and was positively correlated with the knowledge about diabetes mellitus (r = 0.115, p = 0.024). Physical activity adherence was higher in those with positive family history of diabetes than others (M ± SD, 74 ± 24.2 vs 65 ± 23.6, p = 0.001), upper middle socioeconomic class respondents than lower ones (p = 0.047) and from extended family than nuclear or joint ones (p = 0.041). Divorced were more nonadherent to physical activity than married and widowed patients (p = 0.021).ConclusionsDeterminants of nonadherence to dietary advice: Female gender, increasing age, joint or extended family members, farther distance from hospital, poor knowledge about diabetes mellitus and advice by others than physicians. Determinants for nonadherence to physical activity: negative family history of DM, divorced status, lower socioeconomic class.

BackgroundNon-adherence to lifestyle modification among diabetic patients develops the short-term risks and the long-term complications as well as declines the quality of life. This study aimed to find out the association between non-adherence to self-care practices, medication and health related quality of life (HR-QoL) among type 2 diabetic patients.MethodsAt least 1 year diagnosed patients with type 2 diabetes (N = 500), age>25 years were conveniently selected from the Out-Patient Department of Bangladesh Institute of Health Sciences Hospital. Patients’ self-care practices were assessed via interviewer-administered questionnaires using an analytical cross-sectional design. HRQoL was assessed by an adapted and validated Bangla version of the EQ-5D (EuroQol Group, 2009) questionnaire which has five domains- mobility, self-care, usual activities, pain/discomfort and anxiety/depression and two levels on each dimension. EQ-5D responses were further translated into single summery EQ-5D index using UK TTO value set. Patients’ were considered as non-adhered to self-care practices according to the guidelines of Diabetic Association of Bangladesh. Multivariable linear regression was used to assess the association between non-adherence towards self-care practices and HRQoL.ResultsAmong the study patients, 50.2% were females and mean ± SD age was 54.2 (±11.2) years. Non-adherence rate were assessed for: blood glucose monitoring (37%), diet (44.8%), foot care (43.2%), exercise (33.2%) and smoking (37.2%). About 50.4% patients had problem in mobility, 28.2% in self-care, 47.6% in usual activities, 72.8% in pain/discomfort and 73.6% in anxiety/depression. On chi-squared test, significant association was found between non adherence to foot care and problem with mobility, self-care and usual activities (p < 0.05). Significant association was also found between non-adherence to exercise and poor mobility, self- care, usual activities, pain and anxiety (p < 0.05). Non-adherence to diet was associated with poor mobility (p < 0.05). In multivariable linear regression non-adherence to foot care (p = 0.0001), exercise (p = 0.0001), and smoking (p = 0.047) showed significant association with EQ-5D index after adjusting co-variates.ConclusionsIn this study, patients who have a non-adherence rate also have a lower quality of life.

BackgroundLevels of knowledge about diabetes mellitus (DM) among newly diagnosed diabetics in Bangladesh are unknown. This study assessed the relationship between knowledge and practices among newly diagnosed type 2 DM patients.MethodsNewly diagnosed adults with type 2 diabetes (N = 508) were selected from 19 healthcare centers. Patients’ knowledge and self-care practices were assessed via interviewer-administered questionnaires using a cross-sectional design. Knowledge questions were divided into basic and technical sections. Knowledge scores were categorized as poor (mean + 1 SD). Chi square testing and multivariate logistic regression were conducted to examine the relationship between diabetes-related knowledge and self-care practices.ResultsApproximately 16%, 66%, and 18% of respondents had good, average, and poor (GAP) basic knowledge respectively and 10%, 78%, and 12% of respondents had GAP technical knowledge, about DM. About 90% of respondents from both basic and technical GAP did not test their blood glucose regularly; a significant relationship existed between basic knowledge and glucose monitoring. Technical knowledge and foot care were significantly related, though 81% with good technical knowledge and about 70% from average and poor groups did not take care of their feet. Approximately 85%, 71%, and 52% of the GAP technical knowledge groups, consumed betel nuts; a significant relationship existed between technical knowledge and consumption of betel nuts. Around 88%, 92%, and 98% of GAP technical knowledge groups failed to follow dietary advice from a diabetes educator. About 26%, 42%, and 51% of GAP basic and technical sometimes ate meals at a fixed time (p < 0.05). Approximately one-third of respondents in each basic knowledge group and 29%, 32%, and 32% of GAP technical knowledge groups partially followed rules for measuring food before eating. Total basic knowledge (TBK) and business profession were significant independent predictors of good practice. OR for TBK: 1.28 (95% CI: 1.03 to 1.60); OR for business profession 9.05 (95% CI: 1.17 to 70.09).ConclusionsNewly diagnosed type 2 diabetics had similar levels of basic and technical knowledge of DM. Health education and motivation should create positive changes in diabetes-control-related self-care practices.

Non-adherence to preventive and therapeutic life-style recommendations among patients with diabetes is special challenge in the management of these patients. This study aimed to measure the proportion of non-adherence to life-style modification and factors associated with these among a group of Bangladeshi type 2 diabetic patients. Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were selected from different health care centers operated by the Diabetic Association of Bangladesh. Non-adherence rate were assessed for: Diet (88%), exercise (25%), routine blood glucose testing (32%), foot care (70%), smoking (6%) and betel quid chewing habit (25%). Binary logistic regression suggests that higher education group (P = 0.013), rural area (P = 0.013) and attendance to diabetes education classes (P = 0.043) showed good adherence to diet and non-attendance to diabetes education class (P = 0.014), older age (P = 0.037) are associated to non-adherence to exercise. Unemployed patients showed more non-adherence to blood glucose testing (P = 0.045) than others. Non-attendance to diabetes education class (P = 0.037) and business occupation group (P = 0.039) showed significant association to smoking and betel quid intake habit respectively.

BackgroundThe management of diabetes requires a fundamental change in the lifestyle of patients, and one of the important outcome criteria is the quality of life. We assessed the health-related quality of life (HR-QoL) and examined the factors associated with it in type 2 diabetes.MethodsAn analytical cross-sectional study was conducted among 500 type 2 diabetes patients (age >25 years and duration of diabetes >1 year). They were selected conveniently from the Out-Patient department of the Bangladesh Institute of Health Sciences Hospital. The HR-QoL was assessed using an adapted and validated Bangla version of the EQ-5D (© 1990 EuroQol Group. EQ-5D™) questionnaire. It has five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression and two levels (problem and no problem) on each dimension. The responses to the EQ-5D were further translated into a single summary EQ-5D index using the UK TTO value set.ResultsOf the patients, 50.2 % were female, and 49.4 % were aged >55 years. Only 28.4 % had completed higher secondary education, and 50.8 % were from lower-middle-income families. Around 78.8 % either had overweight or were obese. About 50.4 % had problems in mobility, 28.2 % in self-care, 47.6 % in usual activities, 72.8 % in pain/discomfort, and 73.6 % in anxiety/depression. Results of binary logistic regression analysis showed that age, gender, lower-middle income, and HbA1C were significantly (p < 0.05) associated with mobility. Self-care was significantly (p < 0.05) related to age, family history and duration of diabetes mellitus (DM). Gender, family history of DM, and lower-middle income had a significant (p < 0.05) association with usual activities. Pain was significantly (p < 0.05) associated with age, lower-middle income, and upper-middle income. Rural area, higher education, and HbA1C were significantly (p < 0.05) related to anxiety. Results of multiple linear regression analysis showed that age (p = 0.0001), female gender (p = 0.0001), and prescribed treatment (p = 0.048) were associated with the EQ-5D index.ConclusionsThe large majority (73 %) of the patients had problems in pain/discomfort and anxiety/depression; 50 % had problems in mobility and usual activities; and three in ten in self-care. Age, female gender, income, education, family history and duration of DM, and prescribed treatment are important factors that are associated with the HR-QoL in type 2 diabetes.

Prevention and management of obesity largely depends on patient motivation and education and these, in turn, can be greatly facilitated by adequate baseline data on the knowledge, attitude and practice (KAP) of patients. The aim of this study is to assess KAP on obesity among Bangladeshi type 2 diabetics. Under a cross-sectional design 160 type 2 diabetics were selected from outpatient department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine & Metabolic Disorders. A standard questionnaire was constructed in local language and interview was administrated. Age and body mass index (BMI) of the respondents were 45.17±5.68 years and 25.6 ±4 kg/m2 respectively. Among them 45% were male, 38% had primary education, 25% belonged to normal weight, 1/2 of them were overweight and rest were obese. KAP score of the respondents was [mean ±SD(%)] 60.03±13.82, 79.30±8.27, 55.50±19.21 respectively. Majority were unaware about ideal body weight, energy requirement and the weight measurement techniques. A substantial proportion of the respondents considered fast food, soft drinks, mayonnaise as healthier food. Majority of them positively agreed on willingness to follow proper diet, maintaining ideal body weight, dietary management and exercise. More than half of the normal weight and overweight respondents did exercise >45 min, while 1/3 obese did not do exercise (35%). KAP score were significantly associated with respondents’ level of education (P=0.0001, P=0.007, P=0.05 respectively) practice score was significantly associated with sex (P=0.0001), occupation (P=0.003) and BMI (P=0.0001). There is a need for increased effort towards developing and making education programs focusing on empowering the persons to transform their knowledge and attitude into practice.

BackgroundAwareness regarding risk factors is a prerequisite for the prevention of diabetes in general population. However, there are great variations in the level of this awareness from population to population and this needs to be explored in different ethnic and social groups for designing appropriate preventive strategies. The purpose of the study was to assess the level of awareness regarding the risk factors responsible for the development of type 2 diabetes and its determinants among individuals who attended a tertiary care hospital.MethodsUnder an analytical cross-sectional design, 400 non-diabetic respondents, aged >30 years, were conveniently selected from the Out-Patient Department of BIRDEM, the tertiary care hospital of the Diabetic Association of Bangladesh. A pretested, semi-structured questionnaire was developed to assess knowledge and attitude of the respondents. Respondents’ level of knowledge and attitude were categorized as good, average and poor (GAP). Multivariate along with bivariate statistics was used to measure knowledge and attitude of type 2 diabetes.ResultsAmong the respondents the levels of knowledge and attitude were 13%, 10% good; 68%, 75% average and 19%, 14% poor respectively. In multivariate analysis, high literacy (p = 0.0001), respondents who are in service (p = 0.02) and family history of diabetes (p = 0.02) were found significantly associated with the knowledge score after adjustment. Respondents who had passed secondary and higher secondary education had a significant association (p = 0.03) with the attitude score. Housewives had a significantly lower attitude score than others (p = 0.04). Family history of diabetes and knowledge on the risk factors of diabetes showed significant positive association with the attitude score (p = 0.013 and p = 0.0001 respectively).ConclusionsOverall, respondents participating in this study have average awareness regarding risk factors of diabetes. From a public health perspective, there is a decisive need of innovative prevention programs for targeting people including high-risk individuals.

Kala-azar, a worldwide disease, is caused by the parasitic protozoan species of genus Leishmania and transmitted by species of sandflies. Awareness of the population about the disease is essential to run a successful control-strategies program. This cross-sectional study was conducted to assess the awareness of residents about it and related practices in two highly-endemic areas of Bangladesh. In total, 511 household respondents were selected conveniently from two unions (Kushmail and Kanihari) under two sub-districts (Trishal and Fulbaria) of Mymensingh district. Interviewer-administered questionnaires were used for assessing the awareness of the respondents about kala-azar and their practices. Knowledge scores were categorized as poor (mean +1SD). Statistical tests were considered significant at p value of �5% (�0.05). Chisquared and Student's t-tests were performed for statistical analysis. The mean knowledge score of the respondents of Kanihari union regarding kala-azar was significantly higher than that of the respondents of Kushmail union (mean ±SD, 4.30 ±0.86 versus 4.12 ±0.75, p = 0.002). Of the respondents, 11% and 20% had good (>5.04), 77% and 72% had average (3.43-5.04), 12% and 8% had poor (<3.43) (GAP) knowledge on kala-azar in Kushmail union and Kanihari union respectively. However, the mean knowledge score of the respondents of Kanihari union relating sandfly was significantly lower compared to that of the respondents of Kushmail union (mean ±SD, 2.49 ±0.79 versus 2.65 ±0.85, p = 0.03). Of them, 22% and 19% had good (>3.39), 67% and 64% had average (3.39-1.75), and 11% and 17% had poor (<1.75) knowledge on sandfly in Kushmail union and Kanihari union respectively. More than 70% of the respondents from Kushmail and Kanihari mentioned only injection as the preferred treatment of kala-azar. Eighty-seven percent and 88% of the respondents in the two unions had chosen upazilla health complex for the treatment of their kala-azar. About 50% of the respondents in Kushmail and Kanihari liked to use coil or mat as a preventive measure to avoid sandfly bites. The findings of this study indicate the importance of awareness and related practices of the community people in two endemic areas that will help implement the kala-azar-elimination program successfully in Bangladesh.