EVALUATION OF ANTI- DIABETIC THERAPY, OUTCOMES AND …

www.wjpr.net Vol 9, Issue 6, 2020.

Koirala et al. World Journal of Pharmaceutical Research

1441

EVALUATION OF ANTI- DIABETIC THERAPY, OUTCOMES AND

IMPACT OF PATIENT COUNSELLING ON QUALITY OF LIFE IN

TYPE-2 DIABETES MELLITUS PATIENT IN A TERTIARY CARE

TEACHING HOSPITAL

*Dr. Jagrit Koirala, Dr. Peter Kandel, Dr. Dipendra Thapa and Dr. R. Parthasaradhi

Reddy

Pharm D Graduate, RRCOP, India.

ABSTRACT

Background: The aim of the study is to evaluate anti- diabetic

therapy, its outcomes and impact of patient counselling on QOL IN

Type- II DM patients. Method: The observational study included 120

diabetics. Patient were interviewed using structural questionnaire

developed by researchers, during the period of 6-months from

December-may (2016-2017). The data was collected using proforma of

patient data collection form and proforma to assess KAP which

contains 25 questionnaire and the data were analysed statistically using

Microsoft excel. Anti-diabetic therapies were evaluated using treatment

chart review, proforma of patient data collection form. Outcome and impact of patient

counselling were measured assessing the response of KAP and RBS. Result: Out of 120

patient 52 were male and 68 were female. The majority of patient, 30% were on the age

group 51-60 years. The patient with age group >50years were more affected. The majority of

patient 52(43.33%) were diseased for a period of 6-10 years 32(26.66%) were diseased for a

period of 1-5 years, 16 (13.33%) were diseased for a period of 11 -15 years, 12 (10%) were

diseased for a period of above 15 years and 8 (6%) below 1 year. Total number of drugs

prescribed were 810 with an average of 6.75 drugs per prescription. The most commonly

prescribed anti-diabetic drugs were biagunides(25%), insulin(20.8%), sulphonylurea(7.5%),

a-glucosidase inhibitor(5.83%). Second commonly prescribed drugs were antibiotics(22.83%)

and cardiovascular drugs(16.66%). Blood glucose values were measured before and after

patient counselling during the time of admission and follow up. After counselling there was

decrease in glucose value which was clinically significant but statistically not significant

World Journal of Pharmaceutical Research SJIF Impact Factor 8.084

Volume 9, Issue 6, 1441-1465. Research Article ISSN 2277– 7105

Article Received on

24 March 2020,

Revised on 14 April 2020,

Accepted on 04 May 2020,

DOI: 10.20959/wjpr20206-17458

*Corresponding Author

Dr. Jagrit Koirala

Pharm D Graduate, RRCOP,

India.

[email protected],

mailto:[email protected]



1442

(p>0.05). The KAP score of the patient in pre-counselling, knowledge score was 5.13±2.91,

attitude 1.4±0.748 and practice 2.26±0.378 and overall score was 8.81±4.378. In post

counselling the KAP score of patient, knowledge 6.8±3.05, attitude 3.3±1.25, practice

2.63±0.480 and the overall score was 12.63±4.78. Conclusion: Educational intervention is

necessary to improve knowledge, attitude and practices of diabetes patient for health benefits.

As evidenced by study patient who followed pharmacist counselling on medication, diabetic

diet, exercise and practice have achieved better health and quality of life.

KEYWORD: Hyperglycemia, Intervention, Counselling, Quality of life.

INTRODUCTION

The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized

by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism

resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes

mellitus include long-term damage, dysfunction and failure of various organs. Diabetes

mellitus may present with characteristic symptoms such as thirst, polyuria, blurring of vision,

and weight loss. In its most severe forms, ketoacidosis or a non-ketotic hyperosmolar state

may develop and leads to stupor, coma, and in absence of effective treatment leads to death.

Often symptoms are not severe, or may be absent, and consequently hyperglycaemia

sufficient to cause pathological and functional changes may be present for a long time before

the diagnosis is made. The long-term effects of diabetes mellitus includes progressive

development of the specific complications of retinopathy with blindness, nephropathy that

may lead to renal failure, and/or neuropathy with risk of foot ulcers, amputation, charcot

joints and features of autonomic dysfunction, including sexual dysfunction. People with

diabetes mellitus are at increased risk of cardiovascular, peripheral vascular and

cerebrovascular disease.

Several pathogenic processes are involved in the development of diabetes. These include

processes which destroy B-cells of the pancreas with consequent insulin deficiency, and

others that results in resistance to insulin actions. The abnormalities of carbohydrate, fat and

protein metabolism are due to deficient action of insulin on target tissues resulting from

insensitivity of lack of insulin.[1]

DIAGNOSIS: Severe hyperglycaemia detected under condition of acute infective, traumatic,

circulatory or other stress may be transitory and should not in itself be regarded as diagnostic



1443

of diabetes. The diagnosis of diabetes in asymptomatic subjects should never be made on the

basis of a single abnormal blood glucose value. For the asymptomatic person, at least one

additional plasma/blood glucose test result with a value in the diabetic range is essential,

either fasting, from a random (casual) sample, or from the oral glucose tolerance test(OGTT)

or HbA1C. If such samples fail to confirm the diagnosis of diabetes mellitus, it will usually

be advisable to maintain surveillance with periodic re-testing until the diagnostic situation

becomes clear. In these circumstances, the clinicians should take into consideration such

additional factors as ethnicity, family history, age, adiposity, and concomitant disorders,

before deciding on a diagnostic or therapeutic course of action. An alternative to blood

glucose estimation or the OGTT has long been sought to simplify the diagnosis of diabetes.

Glycated haemoglobin, reflecting average glycaemia over a period of weeks, was thought to

provide such a test. Although in certain cases it gives equal or almost equal sensitivity and

specificity to glucose measurement, it is not available in many parts of the world and is not

well enough standardised for its use to be recommended at this time.[2]

CLASSIFICATION: The first widely accepted classification of diabetes mellitus was

published by WHO in 1980[3]

and in modified form, in 1985[4]

the 1980 and 1985

classification of diabetes mellitus and allied categories of glucose intolerance included

clinical classes and two statistical risk classes. The 1980 experts committee proposed two

major classes of diabetes mellitus and named them, IDDM or type-1, and NIDDM or type-2.

In the 1985 study group report the terms type-1 and type-2 were omitted, but the classes

IDDM and NIDDM were retained, and a class of malnutrition-released diabetes mellitus

(MRDM) was introduced. In both the 1980 and 1985 reports other classes of diabetes

includes other type and impaired glucose tolerance (IGT) as well as gestational diabetes

mellitus (GDM). These were reflected in the subsequent international nomenclature of

disease (IND) in 1991, and the tenth revision of the international classification of diseases

(ICD-10) in 1992. The 1985 classification was widely accepted and is used internationally.

The recommended classification includes both staging of diabetes mellitus based on clinical

descriptive criteria and a complimentary aetiological classification.

Type-2 is the most common form of diabetes and is characterized by disorders of insulin

actions and insulin secretion, either of which may be the predominant features. Both are

usually present at the time when this form of diabetes clinically manifest. By definition,

specific reason for the development of these abnormalities is not yet known.[5]



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India leads the world with largest number of diabetic subjects earning the dubious distinction

of being termed the “diabetes capital of the world”. According to the Diabetes Atlas 2006

published by the International Diabetes Federation, the number of people with diabetes in

India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent

preventive steps are taken.[6]

Diabetes is a chronic condition that can lead to serious and

costly complications. Every 7 seconds a person dies from diabetes. In 2014, diabetes caused

4.9 million deaths globally.[7]

Various factor causes onset of diabetes mellitus e.g. genetic factor, constitutional factor,

environmental factor, insulin resistance, impaired insulin secretion Quality of life may be

thought of as a multidimensional construct incorporating an individual's subjective perception

of physical, emotional, and social well-being, including both a cognitive component

(satisfaction) and an emotional component (happiness).[8]

More than 50 years ago, the World

Health Organization stated that health was defined not only by the absence of disease and

infirmity, but also by the presence of physical, mental, and social well-being.[9]

It appears that

active and effective disease-specific coping can trigger a positive cascade of enhanced well-

being, more active diabetes self-management, better glycemic control, and fewer

complications. This suggests that people with diabetes who are not active or effective copers

may benefit from interventions designed to enhance their coping. Outpatient education

program that incorporated coping skills training interventions designed to improve some

aspects of quality of life. This intervention significantly improved diabetes self-efficacy and

emotional well-being (depression and anxiety) at follow-up, 6 months after the intervention

was completed. Interventions such as this hold promise for improving a broad range of

outcomes for people with diabetes.[10]

Nepal is estimated to reach 6,38,000 of diabetic patient by the year 2025.[11]

Diabetes can

lead to increased morbidity and mortality.[12]

There is improper guidance about the disease

due to lack of understanding of patients characteristics i.e. personality and attitude of the

patient A study from Pakistan highlighted the fact that a proper education and awareness

program can change the attitude of the public regarding diabetes. There is lack of public

awareness regarding DM in Nepal where, medical services are poor.[13]

Several interventions

have been carried out to improve the knowledge level of diabetes patients.[14-16]

Obtaining

information about the level of awareness about diabetes in a population is the first step in

formulating a prevention program for diabetes.[17]

, as a large gap between knowledge and



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attitude among the diabetes patients was found[18]

and proper knowledge regarding various

aspects of health education program can improve the knowledge of patients and change their

attitude. Another study showed that intensive diabetes education and care management can

improve the patient outcomes, glycemic control and quality of life in patients with diabetes

mellitus.

In Pakistan 9.5% of the urban and 9.4% of the rural population suffer from type- 2 diabetes.

Overall glucose intolerance (diabetes and impaired glucose tolerance) is 22.04% in urban and

17.15% in rural areas.[19]

According to the WHO estimates, Pakistan ranked seventh in

prevalence of Diabetes. These figures however represent tip of the iceberg with many cases

still undiagnosed.[20-22]

Despite all the research, diabetes remains under diagnosed. This then

ultimately presents with complications, the direct and indirect costs of which are

enormous.[23,24]

Diabetes care aims at improving the quality of life of patients with type 2

diabetes through good glycaemic control[25]

, control of risk factors, lifestyle

modification,[26,27]

prevention of complications and diabetes education. Diabetes education is

the cornerstone of diabetes care.[28,29]

Improved training of the primary health care providers

and patients with diabetes is therefore beneficial.[30]

Several studies of family physicians

identified the need for improvement in their practices for treating and educating

diabetics.[31,32]

In Pakistan, there is paucity of information about knowledge and attitudes

concerning glycaemic control, complications and the health impact of diabetes. There are

some studies from Karachi but data from other regions of the country is sparse especially

from Northern side. This study was designed to explore patients awareness about diabetes,

misconceptions about the disease itself, its treatment especially diet and insulin. The

information gained could subsequently be helpful to design and initiate comprehensive

programmes for detection and control of diabetes and its complications with self-care and

community support as its major components.[33]

The present study was conducted to study

demographic details of patient and to evaluate knowledge, attitude and practice of these

patients.

AIM AND OBJECTIVES OF THE STUDY

AIM: To evaluate anti diabetic therapy, outcome and impact of patient counselling on

quality of life in type-2 diabetes mellitus patient in tertiary care teaching hospital.



1446

Objectives of the Study

To assess the medication regimen, symptoms and complication of diabetes mellitus

patient and to determine the glycemic control by reviewing and assessing the blood

glucose level.

To determine the outcome of patient counselling on quality of life and comprehend

knowledge, attitude and practice of type-2 diabetic patient.

METHODOLOGY

STUDY SITE

This observational study was carried out in In-patient & out-patient in general medicine

Department of Sapthagiri Institute of Medical Science & Research Center.

STUDY DESIGN

This study is a prospective and observational study conducted over six month’s period.

STUDY DURATION

6 months study with data collection for a period of 3 months.

STUDY POPULATION

120 patients with type-2 diabetes mellitus who according to physician needs insulin treatment

and/or oral hypoglycemic drug with or without insulin who were in inpatient and outpatient

department.

STUDY CRITERIA

INCLUSION CRITERIA

The study populations are both men & women having type -2 diabetes mellitus, above age of

18 years.

EXCLUSION CRITERIA

End stage renal failure, cardiac failure, hepatic failure & history of drug abuse, clinically

relevant medical or physiological condition.

SOURCE OF DATA

Patient data collection form.

Prescriptions of patients.

Patient medication chart review.



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Lab reports

Verbal communication with patient.

STUDY MATERIAL

Proforma of patient data collection form: A common patient profile form was prepared as

per the need of study, to enter the patient data. (Annexure 1)

Proforma to assess KAP: A Knowledge, attitude and practice (KAP) questionnaire was

prepared and validated, which consists of 25 questions. Among 25 questions 18 were

knowledge related, 4 were attitude and 3 practice related. (Annexure 2)

STUDY PROCEDURE

Patient data was collected in patient data collection proforma which includes

demographic details of patient, lab data, diagnosis, medication.

Response of KAP about the disease by the patient was assessed before and after

counseling of patients using KAP proforma. Each correct answer was given a score of 1

& each wrong was given a score of 0.

STATISTICAL ANALYSIS

Statistical Analysis was done using MS Excel, Student T-test was performed to calculate the

P - value and the results were appropriately interpreted and reported.

RESULTS

The prospective observational study was conducted for 6 months in Sapthagiri Institute of

Medical Science & Research Center. A total of 120 type 2 diabetes mellitus patient were

included in the study.

Patient Distributions Based on Demographic Data

Out of 120 patients 68 (56.66%) were females and 52 (43.33%) were males which is

represented in table-1 and figure-1.

Table 1: Patient Distribution Based on Gender.

Total No. of patients (%) No. of Male patients (%) No. of Female patients (%)

120 (100%) 52 (43.33%) 68 (56.66%)



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Fig 1: Pie chart of Patient Distribution Based on Gender.

Patient Distribution with Respect to their Age Groups

Patients were categorized according to their age groups. Out of 120 patients majority 36

(30%) of them were found in the age group between 51-60 years, followed by 28(23.33%) in

the age group between 61-70 years, 24(20%) in the age group between 41-50 years, then

20(16.66%) were found between 30-40 years and 12 (10%) were >70 years which is

represented in table-2 and figure-2.

Table 2: Patient Distribution with Respect to their Age Groups.

Age group of

patients

No. of Male Patients

(%)

No. of Female Patients

(%)

Total No. of

Patients (%)

30-40 16 (80) 4 (20) 20 (16.66)

41-50 12 (50) 12 (50) 24 (20)

51-60 12 (37.5) 24 (66.66) 36 (30)

61-70 8 (25) 20 (71.42) 28 (23.33)

>70 4 (33.33) 8 (66.66) 12 (10)



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Fig 2: Graphical Representation of Patient Distribution with Respect to their Age

Groups.

Distribution of Patients Based on Duration of Disease

Out of 120 patients 52 (43.33%) were diseased for a period of 6-10 years, 32(26.66%) were

diseased for a period of 1-5 years, 16 (13.33%) were diseased for a period of 11 -15 years, 12

(10%) were diseased for a period of above 15 years, and 8 (6%) below 1 year. Results are

shown in tables-3 and figure-3.

Table 3: Distributions of Patients Based on Duration of Disease.

Duration of Disease

(Years)

No. of Male

patients (%)

No. of Female

Patient (%)

Total No. of

Patients (%)

<1 4 (50) 4 (50) 8 (6.66)

1-5 16 (50) 16 (50) 32 (26.66)

6-10 20 (38.46) 32 (61.15) 52 (43.33)

11-15 8 (50) 8 (50) 16 (13.33)

>15 4 (33.33) 8 (66.66) 12 (10)



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Fig 3: Graphical Representation of Distributions of Patients Based on Duration of

Disease.

Distribution of patients based on diabetic symptoms

In 120 patient total number of male were 52 and total number of female patient were 68. The

commonest symptoms observed in the patient were polyuria (100%), polyphagia (95%), and

polydipsia (97.5%). Vision impairment (49.16%), dizziness (59.16%), and foot problems

(32.5%) were less common but these complications cannot be ignored.

Table 4: Distribution of Patients Based on Diabetic Symptoms.

Diabetic

symptoms

No. of male

patient (%)

No. of female patient

(%)

Total No. of

patient(%)

Polyuria 52(100) 68(100) 120(100)

polydipsia 52(100) 65(95.58) 117(97.5)

Polyphagia 51(98.07) 63(92.64) 114(95)

Vision impairment 22(42.30) 37(54.41) 59(49.16)

Dizziness 28(53.84) 43(63.23) 71(59.16)

Foot problem 12(23.07) 27(39.70) 39(32.5)



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Fig 4: Graphical Representation of Comparison of Diabetic Symptoms.

Different types Drugs Prescribed

A total of 810 drugs were prescribed in the study population of 120 patients. Anti-diabetics

were the commonest class of drugs prescribed accounting for 275 (33.95%) of the total drugs

followed by cardiovascular drugs 135 (16.66%), antibiotics 185 (22.83%) and others

(NSAIDS, PPIs, IV fluids, Corticosteroids, Antihyperlipidemi) 215 (26.54%) as shown in

table no 5 and figure no. 5.

Table 5: Different drugs prescribed in diabetic patient.

Drugs prescribed Total No. of drugs Percentage (%)

Anti-diabetic 275 33.97%

Cardiovascular 135 16.66%

Antibiotics 185 22.83%

Others 215 26.54%



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Figure 5: Pie chart representing different drugs prescribed in diabetic patient.

Evaluation of anti- diabetic therapy

In the case study of 120 diabetic patients we observed that biguanides (metformin) utilization

was high as monotherapy (32.15%). Regular insulin + metformin was used most widely

(24.16%) as a combination therapy as shown in the table No. 6 and figure No. 6.

Table 6: Evaluation of anti-diabetic therapy.

Treatment Name of the drug NO. of time

prescribed

Percentage

(%)

MOnotherapy

Metformin 30 25%

Actrapid 25 20.83%

Glimipiride 9 7.5%

Acarbose 7 5.83%

Regular insulin 5 4.16%

Combination therapy

R.Insulin+ metformin 20 16.66%

Actrapid + acarbose 8 6.66%

Metformin+acarbose 5 4.16%

Rapeglinide+ metformin 4 3.33%

Glimepiride+metformin 4 3.33%

Glimepiride+acarbose 3 2.5%



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Fig 6: pie chart Representing evaluation of anti-diabetic therapy.

Effects of patient counselling on Blood Glucose levels

On the given scale, before counselling majority of patient 45(69.23%) RBS values lies in

between range of (221-280). After counselling majority of patient 52(72.22%) lies in between

the RBS range of (140-220). The RBS values of the patients are high in pre counselling, after

counselling the patient the RBS values were reduced as shown in table-7 and figure-7.

Table 7: Effect of Patient Counselling on RBS Values of Diabetic Patients.

RBS Range

(mg/dl)

No. of patient

in pre

counselling (%)

No. of patient

in post

counselling (%)

Total number

of patient (%) P value

140-220 20(27.77) 52(72.22) 72(35.46)

0.48474 221-280 45(69.23) 20(30.76) 65(32.01)

281-350 33(80.48) 8(19.51) 41(20,19)

>350 22(88.00) 3(12.00) 25(12.31)



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Fig 7: Graphical Representation of RBS Values of Diabetic Patients.

Response to knowledge questions

The response of the patients regarding the knowledge related questions are listed in Table 8.

Table 8: Response to knowledge questions.

Questions

Number of patients

answering correctly (%)

Before

counselling

After

counselling

Diabetes is a condition in which the body contains… 36(30) 70(58.33)

Regular urine tests will help in knowing….. 24(20) 40(33.33)

The important factors that help in controlling blood sugar are 28(23.33) 45(37.75)

A regular exercise regimen will help in…… 40(33.33) 55(45.83)

The well-balanced diet includes 28(23.33) 44(36.66)

For proper foot care, a diabetic patient….. 28(23.33) 43(35.55)

Treatment of diabetes comprises 24(20) 35(29.16)

Diabetes cannot be treated with….. 36(30) 51(42.5)

Upon control of diabetes, the medicines 4(3.33) 20(16.66)

How do you manage hypoglycemic symptoms…..? 64(53.33) 70(58.33)

The major cause of diabetes is…… 28(23.33) 35(29.16)

Diabetes, if not treated……. 12(10) 20(16.66)

The most accurate method of monitoring diabetes is... 36(30) 32(26.66)

The symptom(s) of diabetes is/are….. 64(53.33) 73(60.83)

In a diabetic patient, high blood pressure can increase or worsen…. 12(10) 22(18.33)

A diabetic patient should measure his or her blood pressure….. 28(23.33) 34(28.33)

The lifestyle modification(s) required for diabetic patients is/are….. 20(16.66) 35(29.16)

A diabetic patient should have his or her eyes checked…. 48(40) 55(45.83)



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Response to attitude questions

The response of the patients regarding the attitude related questions are listed in Table 9.

Table 9: Response to attitude questions.

Questions

Number of patients

answering correctly (%)

Before

counselling

After

counselling

Do you exercise regularly…………..? 20(16.66) 70(58.33)

Are you following a controlled and planned diet……? 44(36.66) 65(54.16)

Do you miss taking the doses of your diabetic

medication……? 52(43.33) 80(66.66)

Are you aware of blood sugar levels falling below normal

when you are taking drugs…….? 16(13.33) 40(33.33)

Response to practice questions

The response of the patients regarding the practice related questions are listed in Table 10.

Table 10: Response to practice questions.

Questions

Responses

Before counselling After counselling

Yes no Yes no

BP checkup 53 67 97 18

Eye check-up 25 95 43 55

Adherence to therapy 32 88 83 21

The mean ± SD scores of the study population regarding the knowledge, attitude and

practice outcomes were evaluated and the details are mentioned in Table 11.

Table 11: Mean scores of the patients.

Variables Mean ± SD score before

counselling

Mean±SD score After

counselling p- value

Knowledge 5.13±2.91 6.8±3.05 0.0236s

Attitude 1.4±0.748 3.2±1.25 0.0462s

Practice 2.26±0.378 2.63±0.480 0.1075ns

Overall 8.81±4.036 12.63±4.78

S= Statistically significant, Ns= statistically not significant



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Figure 8: graphical representation KAP scores.

DISCUSSION

This study was carried out with aim to analyse the drug evaluation of anti-diabetic therapy in

general medicine department of the tertiary care teaching hospital and to assess the

pharmacist provided patient education on knowledge, attitude and practice in diabetic

patients.

One hundred and twenty patients participated in the study. Demographic details show that

female patients were 68 (56.66%) and male patients were 52 (43.33%). The study shows that

female patients are more than male patients, however in earlier study male predominance

were seen which is not in agreement with our result supported by Dinesh K Upadhyay et.al[39]

The patient were divided in five age group such as 30-40, 41-50, 51-60, 61-70 and >70. The

majority of patients, 30% were on age group 51-60 years. Patient with age group >50 years of

age were affected more, this may be due to fact that age is a risk factor for developing

diabetes mellitus supported by S Sai Sri Harsha et al.[6]

The duration of illness of the patient were divided into <1year, 1-5 year, 6-10 year, 11-15

years and >15years. The majority of patient (43.33%) were diseased for a period of 6-10

years and (26.66%) patient were diseased for a period of 1-5years, 13.33% patient were

diseased for period of 11-15 years, 10% patient were diseased for a period >15 years and

minority 6.66% patient were diseased for a period <1year.



1457

The common symptoms seen in diabetic patients were polyuria, polydipsia, and polyphagia.

Vision impairment, dizziness, foot problems were seen in most of patient this may be due to

poor knowledge attitude and practice towards diabetes.

Total number of drug prescribed were 810 with an average of 6.75 dugs per prescription. The

risk of drug interaction may increase with increase in number of drugs per prescription which

ultimately lead to prescribing errors and in hazardous to the health of patient. Anti-diabetic

drugs were the most common drugs prescribed which accounts for 275 (33.97%) of total

drugs. Anti-diabetic drugs commonly prescribed as monotherapy were metformin(25%),

actrapid(20.8%), glimepiride(7.5%), acarbose(5.83%), regular insulin(4.16%) and as

combination therapy regular insulin+metformin(16.66%), actrapid+ acarbose(6.66%),

rapeglinide+metformin(3.33%), glimepiride+metformin(3.33%), glimepiride+acarbose

(2.5%). Biguanides (metformin) (25%) utilization was high as monotherapy in prescription,

this may be due to its high advantages of no weight gain. In combination therapy regular

insulin + metformin combination was most widely used (16.66%). Antibiotics were the

second commonest drug prescribed which accounts for 185 (22.83%) drugs, cardiovascular

drugs accounts for 135 (16.66%) and others (NSAIDs, PPIs, IV fluids, corticosteroids,

antihyperlipidemic) 215 (26.54%) were prescribed.

In the present study 70% patient reported hypertension along with diabetes mellitus, these

results were supported by Mahesh Gottipati et al.[57]

This study indicates that hypertension is

the commonest co-morbidity seen with diabetes mellitus.

The blood glucose values were measured before and after patient counselling during the time

of admission and follow up, blood glucose values were decreased in number of patient after

counselling. This may be due to awareness about knowledge, attitude, practice and

importance of adherence of medication gained. After counselling there was decrease in

glucose value which was clinically significant but statistically not significant (P>0.05).

The study assessed the level of knowledge, attitude and practice response of patient on

diabetes mellitus. The KAP questionnaire contained 25 questions regarding diabetes, 18

questions for knowledge, 4 questions for attitude and 3 questions for practice. These

questionnaires impart the concept of causes, symptoms, complication, and lifestyle

modification and have given lot of information to the patient on how to control the disease.

KAP score of the patient was found to be low before counselling. Patient counselling on



1458

disease and medication followed by dietician and nutritionist advice is generally not followed

hence, may have contributed to low level of KAP.

The KAP score of the patient in pre-counselling, knowledge score was 5.13±2.91, attitude

1.4±0.748 and practice 2.26±0.378 and overall score was 8.81±4.378. In post counselling the

KAP score of patient, knowledge 6.8±3.05, attitude 3.3±1.25, practice 2.63±0.480 and the

overall score was 12.63±4.78. It is well understood that diabetes management requires patient

involvement for a better disease control.[58]

Patient counselling by pharmacist can play vital

role in imparting education to the diabetics.[59]

CONCLUSION

Education is critical to social and economic development and has profound impact on

population health. We review evidence for the health benefits associated with education,

where we found the leading cause of complications in diabetic was non- adherence to

medication and unplanned diabetic diet and practice towards diabetes. Lack of knowledge

about the adherence, diet and practice leads to rise in blood glucose level and deterioration of

the symptoms. All these upstream factors may contribute to health outcomes and eventually

the quality of life of the patients. Quality of life is the standard of health, comfort, and

happiness experienced by an individual. Patient counselling can create dramatic difference in

morbidity-, mortality and the risk factors which increase quality of life of patient which is

also influenced by education and income of the patient.

Clinical pharmacist imparted patient education through counselling improved quality of life

through knowledge and adherence to therapy.

As he is the first and the last, we thankfully bow with reverence before the almighty who is

the source of all wisdom and knowledge, the creator who by his wishes and blesses made us

to attain successful completion of this dissertation.

With great pleasure and sense of gratitude, we express our most cordial and humble thanks to

our eminent respected HOD DR.GEETHA JAYAPRAKSH, Professor and HOD,

Department of Pharmacy Practice, RRCP, for her valuable guidance, keen interest,

inspiration, unflinching encouragement and moral support throughout our project work. We

express sincere thanks to her for stimulating discussion, meticulous guidance, illimitable

enthusiasm and support since the beginning of our course.



1459

We express our sincere gratitude to our research guide DR. SHAILESH YADAV, assistant

professor, department of pharmacy practice, RRCP with his guidance and support throughout

the work.

We express our deepest sense of gratitude to DR.B GOPALAKRISHNA, Principal of

RRCP, for his sincere guidance and support.

We express our deepest sense of gratitude to our honourable secretory MR. H. R KIRAN,

for providing the facilities and extending his support.

Our sincere thanks to PROF. R RAVINDAR, DR. PETER KANDEL, DR.

PARTHASARATHY, MS. APARNA, MS POORNIMA NB, MR. HEMANTH S.H, MR.

NAGRAJ MR. SUBASH PG, DR. SPANDANA and all other teachers for providing their

support to accomplish this wonderful work.

We would like to express our deep sense of love and affection to our colleagues for their kind

help, co-ordination and support throughout our graduation. You all are the one who made

everything beautiful, funny and happy.

At this moment we would love to express our thanks to our juniors, non-teaching staffs for

supporting us throughout our work in their own way.

We take this opportunity to thank the Liberian for extending library facilities throughout this

study.

We are greatly indebted to our beloved parents PARTHAMANI BHATTARAI, ANJU

DEVI BHATTARAI (GODFATHER), PRITHVINATH KOIRALA, DURGA DEVI

KOIRALA, BAIKUNTHA KOIRALA, SANGITA KOIRALA, SURAKSHYA

KOIRALA. TIRTHA BAHADUR THAPA, KARNAMAYA THAPA, NAGENDRA

THAPA, KABITA THAPA, NABIN THAPA. R LINGA REDDY, K JAYALAKSHMI

for their unending Prayers, Love, Faith, Encouragement and Support throughout this

wonderful journey. We are sure about experiencing such sweetest love and care in our future

ahead too.

We express our deepest and sincere thanks to the general medicine department (Dr.

RAGEVENDRA Dr. TAMIL SELVAN, Dr.SAM AHUJA, and Dr.SOMASEKHAR. C),



1460

other Doctors, Pharmacists, Management, Lab technician, Nurses of Tertiary Care Hospital

for allowing us to collect all the primary information’s required for the study. We are grateful

to you all.

We extend our special thanks to computer operator, printers and binders for their technical

assistance and preparation of this manuscript on time. Last but not the least, we extend our

thanks to all those who have been directly or indirectly associated with our study.

LIST OF ABBREVIATIONS

ABBREVIATIONS FULL FORMS

ADR Adverse Drug Reaction

BLP Basic Lifestyle Programme

BMI Body Mass Index

BMQ Brief Medication Questionnaire

DM Diabetes mellitus

DSME Diabetes Self-Management Education

ELP Enhanced Lifestyle Programme

GDM Gestational Diabetes Mellitus

HBA1C Glycated haemoglobin

ICD International Classification of Disease

IDDM Insulin Dependent Diabetes Mellitus

IGT Impaired Glucose Tolerance

IND International Nomenclature of Disease

IV Intra-venous

KAP Knowledge Attitude and Practice

LDL Low Density Lipoproteins

MEMS Medication Events Monitoring system

MRDM Malfunction-Released diabetes Mellitus

NIDDM Non- Insulin Dependent Diabetes Mellitus

NSAIDs Non-steroidal Anti-inflammatory Drugs

OGTT Oral Glucose Tolerance Test

PPBG Post Prandial Blood Glucose

PPIs Proton Pump Inhibitors

PR Pulse Rate

RBS Random Blood Sugar

SD Standard Deviation

TC Total Cholesterol

TGL Triglycerides

WHO World Health Organization

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