INTRODUCTION AND BACKGROUND OF THE STUDY:

Diabetes mellitus is a group of metabolic disorder characterized by elevated levels of glucose in the blood due to defects in insulin secretion, insulin action, or both resulting in hyperglycaemia.

Diabetes is an “Ice Berg” disease. Diabetes can occur at any age. Insulin is a hormone produced by the pancreas which controls the levels of glucose in the blood by regulating the production and storage of glucose.¹

It is also characterised by the three "polys" and inability to re- absorb water, resulting in increased frequency of urination (polyuria), excessive thirst (polydipsia) and excessive eating (polyphagia). Diabetes is mainly characterised into 2 types such as Type 1, Type 2 diabetes mellitus . Type 1 diabetes occurs abruptly, characterised by an absolute deficiency of insulin due to a marked decline in the number of insulin producing beta cells (perhaps caused by the auto immune destruction of beta cells) even though target cells contain insulin receptors.²

Insulin is a hormone that is responsible for regulation of carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. When control of insulin levels fails, diabetic mellitus will result. Insulin is used medically to treat some forms of diabetes mellitus especially patients with type 1 diabetes depend on external insulin (most commonly injected subcutaneously) for their survival because the hormone is no longer produce internally.³

Early insulin therapy in patients with newly diagnosed type II diabetes aids the recovery and maintenance of beta-cell function, while oral hypoglycaemic agents that increase the production of endogenous insulin may speed failure of beta-cell function. The goal of insulin therapy is to mimic the way the pancreas would produce and distribute its own insulin, if it were able to manufacture it. Taking insulin simply means that your body doesn’t produce or use enough of it on its own to cover the foods you eat.⁴

Vardar B, Kizilci S.(2007) was conducted a study in Turkey on Incidence of lipohypertrophy among 215 diabetic patients, who had been using insulin for at least 2 years by using observation and palpation technique. The result showed that about 48.8% patients developed lipo-hypertrophy and it revealed that the incidence of lipohypertrophy was affected by their level of education, the frequency that they changed the needles, the frequency of changing their injection site and the amount of time they had been using insulin. The difference providing to be statistically significant (p<0.05).⁵

According to WHO Diabetes Mellitus is an iceberg disease and its prevalence in adults is around 4% worldwide, i.e., over 143 million persons are now affected. It is projected that the disease prevalence will be 5.4% by the year 2025, with global diabetic population reaching 300 million. Of this close to 77% of the global burden of disease is projected to occur in the developing countries.⁶

OBJECTIVES OF THE STUDY:

1. To assess the effectiveness of PTP on knowledge regarding insulin therapy among the diabetic patients attending OPD of selected hospitals of Sri Muktsar Sahib, Punjab.

2. To find out association between post-test mean knowledge scores with their selected socio-demographic variables.

MATERIAL AND METHODS:

Research approach and design:

Quantitative evaluative research approach/ Pre experimental one group pre- test, post- test design

Research Setting:

The study was conducted in Adesh Hospital and Research Centre, Civil Hospital, Guru Nanak Hospital, Sri Muktsar Sahib

Sample and Sampling Technique:

Non- Probability Convenient sampling technique was used to select the sample. The sample size of study comprised of 50 diabetic patients.

Selection and development of research tool:

Section-I: Structured interview questionnaire.

It consists of two parts:

Part (I) Socio-demographic variables:

It consists of 12 items to obtain socio- demographic information such as age, gender, marital status, habitat, educational status, occupational status, monthly family income, dietary preference, duration of diabetes, family history of Diabetes mellitus, using insulin therapy from and any previous exposure to education regarding insulin therapy.

Part (II) Knowledge interview questionnaire:

Interview schedule included 30 multiple choice questions. It included introduction about diabetes mellitus, definition of insulin therapy, indications, insulin regimen, storage, sites, precautions, dosage, technique, complications and sick day rules.

Section-II: Planned Teaching Programme (PTP):

The planned teaching programme (PTP) consists of introduction about diabetes mellitus, definition of insulin therapy, indications, insulin regimen, storage, sites, precautions, dosage, technique, complications and sick day rules

Ethical Consideration:

Ethical permission was obtained from ethical committee of College of Nursing, Adesh Institute of Medical Sciences and Research Centre. Written permission was obtained from concerned authority of selected hospitals of Sri Muktsar Sahib. Written informed consent was obtained from the subjects.

RESULTS:

The sociodemographic results revealed that the frequency and percentage distribution of sample characteristics. It shows that according to Age the distribution of study subjects reveals that majority of study subjects i.e. 17(34%) were in the age group of 41-50 years whereas 12(24%) were in the age 31-40 years while 8(16%) were in the age 20-30 years on the other hand 7(14%) were in the age group of >60 years furthermore 6 (12%) were in the age group of 51-60 years. According to Gender the distribution of study subjects represents that majority of study subjects i.e. 28 (56%) were females whereas minority of study subjects i.e. 22 (44%) were males. According to Marital status the distribution of study subjects depicts that majority of study subjects i.e. 32 (64%) were married whereas 10(20%) were widow/widower while 6(12%) were single on the other hand 2(4%) were divorced and separated. According to Habitat the distribution of study subjects shows that majority of study subjects i.e. 21(42%) belonged to rural area while 20(40%) belonged to urban area whereas 9(18%) belonged to suburban area. According to Educational status the distribution of study subjects represents that majority of study subjects i.e. 28(56%) were Up to 10+2 while 11(22%) were graduate moreover 9(18%) were illiterate whereas minority of study subjects i.e. 2 (4%) were post graduate. According to Occupational status the distribution of study subjects represents that majority of study subjects i.e. 19(38%) belonged to other category whereas 15(30%) were farmer while 10(20%) were employed moreover 4(8%) were unemployed on the other hand 2(4%) were businessman. According to Monthly family income the distribution of study subjects reveals that majority of study subjects i.e. 23(46%) had >15,001 income whereas 13(26%) had 10,001-15,000 income while 11(22%) had 5,001-10,000 income moreover 3 (6%) had <5,000 income. According to Dietary preference the distribution of study subjects represents that majority of study subjects i.e. 28 (56%) were vegetarian whereas minority of study subjects i.e. 22(44%) were non- vegetarian. According to Duration of diabetes the distribution of study subjects as represents that majority of study subjects i.e. 25(50%) were 1-3 years duration while 11(22%) were 4-6 years duration whereas 8(16%) were >6 years duration moreover 6(12%) were <1 year duration. According to Family history of diabetes mellitus the distribution of study subjects reveals that majority of study subjects i.e. 34 (68%) had no history followed by minority of study subjects i.e. 16 (32%) had history. According to Using insulin therapy from the distribution of study subjects represents that majority of study subjects i.e. 20 (40%) were < 1 year whereas 17(34%) were 1-3 years while 12(24%) were 4-6 years moreover 1 (2%) were >6 years. According to Any previous exposure to education regarding diabetes mellitus the distribution of study subjects represents that majority of study subjects i.e. 50 (100%) had no exposure.

Table 1: Frequency and percentage distribution of level of knowledge regarding insulin therapy among diabetic patients in pre test and post test group N-50

Level of knowledge score	Pre test		Post test
Level of knowledge score	Frequency	%	Frequency	%
Excellent (80-100%)	00	00%	03	06%
Good (61-80%)	00	00%	45	90%
Average (41-60%)	27	54%	02	04%
Below Average (21-40%)	23	46%	00	00%
Poor (0-20%)	00	00%	00	00%

Table 1 shows that Frequency and percentage distribution of knowledge regarding insulin therapy among diabetic patients reveals that in pre test 54% were having average knowledge and 46% were having below average knowledge while in post test 90% were having good knowledge, 04% were having average knowledge and 03% were excellent. The result shows that in post test there is increase in knowledge.

Table 2: Comparison of pre test and post test Mean knowledge score and SD regarding insulin therapy among Diabetic patients N-50

Subject

Mean

Standard deviation

t value

p value

Pre test

12.70

2.485

21.123*

(p<0.001)

Post test

21.86

1.927

*Significant (p<0.05)

Table 2 indicates that the comparison between pre test mean knowledge score 12.70 with SD 2.485 and post test mean knowledge score 21.86 with SD 1.927. paired ‘t’ test applied to compare pre and post test mean knowledge score, and the calculated t value is 21.123, the result indicates that there is statistically significant increase in post test knowledge (p<0.001). This finding indicated that PTP is effective.

Table 3 Association of the post-test mean knowledge scores regarding insulin therapy among diabetic patients with their selected socio demographic variables. N-50

S. No.	Socio-Demographic variables	Samples	Level of knowledge Score					Chi Square value (χ²)	Df
S. No.	Socio-Demographic variables	Samples	Poor	Below average	Average	Good	Excellent
1.	Age (in years
	a) 20-30	08	00	00	01	07	00	11.710 NS	8
	b) 31-40	12	00	00	01	10	01
	c) 41-50	17	00	00	00	17	00
	d) 51-60	06	00	00	00	06	00
	e) >60	07	00	00	00	05	02
2.	Gender							4.140 NS	2
	a) Male	22	00	00	01	18	03
	b) Female	28	00	00	01	27	00
3.	Marital status							3.080 NS	6
	a) Single	06	00	00	00	06	00
	b) Married	32	00	00	01	28	03
	c) Widow/ Widower	10	00	00	01	09	00
	d) Divorced/ Separated	02	00	00	00	02	00
4.	Habitat							3.097 NS	4
	a) Rural	21	00	00	01	19	01
	b) Urban	20	00	00	00	18	02
	c) Suburban	09	00	00	01	08	00
5.	Educational status							3.007 NS	6
	a) Illiterate	09	00	00	00	08	01
	b) Up to 10+2	28	00	00	02	24	02
	c) Graduate	11	00	00	00	11	00
	d) Post graduate	02	00	00	00	02	00
6.	Occupational status							8.671 NS	8
	a) Businessman	02	00	00	00	02	00
	b) Farmer	15	00	00	01	11	03
	c) Employed	10	00	00	00	10	00
	d) Unemployed	04	00	00	00	04	00
	e) Others	19	00	00	01	18	00
7.	Monthly family income (in Rs.)							9.405 NS	6
	a) <5,000	03	00	00	00	03	00
	b) 5,001-10,000	11	00	00	00	11	00
	c) 10,001-15,001	13	00	00	02	09	02
	d) >15,001	23	00	00	00	22	01
8.	Dietary preferences							4.906 NS	2
	a) Vegetarian	22	00	00	02	20	00
	b) Non- vegetarian	28	00	00	00	25	03
9.	Duration of diabetes (in years)							10.770 NS	6
	a) <1	06	00	00	01	05	00
	b) 1-3	25	00	00	00	24	01
	c) 4-6	11	00	00	01	10	00
	d) > 6	08	00	00	00	06	02
10.	Family history of diabetes							0.317 NS	2
	a) Yes	16	00	00	01	14	01
	b) No	34	00	00	01	31	02
11.	Using insulin therapy from (in years)							18.370 S	6
	a) <1	20	00	00	01	18	01
	b) 1-3	17	00	00	00	17	00
	c) 4-6	12	00	00	01	10	01
	d) >6	01	00	00	00	00	01
12.	Any previous exposure to education regarding diabetes mellitus							0 NS	1
	a)Yes	00	00	00	00	00	00
	b)No	50	00	00	02	45	03

*S – Significant (p<0.05)

NS- Non significant

Table 3 depicts that there was statistically significant association of the post test knowledge scores of subjects with using insulin therapy from. Hence hypothesis H₂is accepted for using insulin therapy from.

There was no statistically significant association of the post test knowledge scores of subjects with their selected socio demographic variables such as age, gender, marital status, habitat, educational status, occupational status, monthly family income, dietary preference, duration of diabetes, family history of Diabetes mellitus and any previous exposure to education regarding diabetes mellitus.

DISCUSSION:

The Study analysis findings showed that the post-test mean value ±SD i.e. 21.86 ± 1.927 was higher than pre-test mean value± SD i.e. 12.7 ± 2.485. At 0.05 level of significance the calculated t-value i.e. 21.123 was more than the table value i.e. 2.0096. There was statistically significant (p<value) enhancement of post-test knowledge score as compare to pre-test knowledge on insulin therapy.

These findings are supported by similar study conducted by Sarkar P (2012) on effectiveness of structured teaching programme on knowledge and practice regarding self- administration of insulin among insulin requiring diabetic patients in Salem. The study showed that there was a significant difference in knowledge regarding self-administration of insulin after administration of structured teaching programme [‘t’ = 12.3, p<0.05]. There was significant difference in the practice regarding self-administration of insulin after administering structured teaching programme [‘t’=25.2, p<0.05]_. So the structured teaching programme was found to be effective.⁷

These findings are also supported by similar study conducted by Pare catty T. (2005) on effectiveness of individual planned teaching on self-administration of insulin for patient with diabetes mellitus receiving insulin in selected hospital at Mangalore. The result of the study revealed that the mean post test knowledge score (x₂=80.86) was higher than mean pre test knowledge score (x₁= 66.86). The computed t value (t=12.98, p<0.05) showed a significant difference suggesting that individual teaching programme was effective in increasing the knowledge of diabetic patients on self-administration of insulin.⁸

On the basis of findings of analysis post-test mean knowledge scores of study subjects with their selected socio-demographic variable e.g. using insulin therapy from was statistically significant (p<0.05).

These findings are supported by similar study by Viral N Shah, P K Kamdar (2009) on effectiveness of structured teaching programme (STP) on self administration of insulin in Kempegowda Institute of Medical sciences hospital and research centre, Bangalore. Findings of the study revealed that the post test mean knowledge scores of the diabetic patients with their selected socio demographic variables, the χ2 test was carried out it was found to be statistically significant with duration of diabetes (χ2=0.05) education (χ2=0.01), type of family (χ2- 0.01) and use of insulin therapy (χ2=0.05).⁹

CONCLUSION:

The study has concluded that baseline knowledge of diabetic patients inadequate regarding insulin therapy. In pre-test it was found that few of the patients were not aware about the technique of giving insulin injection and complications of insulin therapy. After planned teaching programme (PTP) the concept regarding insulin therapy was clear to them as indicated by significant increase in post-test mean knowledge scores. It can be concluded that planned teaching programme (PTP) and using insulin therapy from put great impact on the knowledge regarding insulin therapy. Urgent steps are needed to improve the knowledge of diabetic patients to create appropriate awareness regarding insulin therapy.

REFERENCES:

1. Smeltzer S.C., Barre B.G., Brunner and Suddharth. Text Book of Medical-Surgical Nursing. United States of America: Lippincott Williams and Wilkins; 2007. Pg No: 1377 – 1378.

2. Watson’s clinical Nursing and Related science. 6th edition Pg No: 575.

3. Encyclopaedia Insulin. Available from www.wikipedia.org.

4. Coulter FC. Early insulin initiation. A review of the literature and case studies. The Internet Journal of Family Practice [internet]. 2012. Available from: URL:http://www.ispub.com/journal/the-internet-journal-of-family-practice/volume-10-number-1/early-insulin-initiation-a-review-of-the-literature-and-case-studies.html#sthash.zorbjCF4.dpbs

5. Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Research clinical practice 2007;77(2):231-6

6. Park K. Textbook of Preventive and Social Medicine. 7th edition. Jabalpur: M/s. Banarsidas Bhanot Publishers; 2002.

7. Sarkar P. A study to assess the effectiveness of structured teaching programme on knowledge and practice regarding self- administration of insulin among insulin requiring diabetic patients. Asian Journal of Cardiovascular Nursing 2004 June; 12(2):2-8.

8. Pare Catty T. Effectiveness of individual planned teaching on self-administration of insulin for patients with diabetes mellitus receiving insulin in selected hospital at Mangalore. Thesis submitted to Rajiv Gandhi University, Bangalore; 2005.

9. Viral N Shah, P K Kamdar, A study on effectiveness of structured teaching programme (STP) on self administration of insulin in Kempegowda Institute of Medical sciences hospital and research centre, Bangalore; 2009.

Received on 27.10.2022 Modified on 15.11.2022

A and V Pub Int. J. of Nursing and Medical Res. 2022; 1(1):8-12.

DOI: 10.52711/ijnmr.2022.03