Diabetes mellitus (DM) is a rising public health problem with a projected prevalence of 4.4 percent in 2030 and an estimated global incidence of 2.8 percent in 2000. (171 million in 2000 to 366 million in 2030). Diabetes mellitus prevalence increased steadily in India, a developed country undergoing a rapid epidemiologic shift, from 7.1 percent in 2009 to 8.9 percent in 2019. Even though DM's aetiology is unknown, numerous of its modifiable lifestyle-related risk factors have been identified and studied [1-2].

According to the rising corpus of research, DM might be curable if its risk factors are identified and treated early. Lifestyle changes (such increased physical activity and weight loss) have been demonstrated to be more effective than medicine in preventing or delaying the onset of DM in persons who are at high risk of getting the condition. However, in order to transform such studies into an effective community intervention programme, it is vital to understand the specific needs of these communities before implementing any form of intervention [3-4].

In order for people to make their own decisions about whether to live a healthy lifestyle, the first step in prevention is educating the public about DM risk factors and preventative measures. Additionally, both policymakers and public health practitioners need precise and reliable data about the prevalence and causative factors of DM-related health issues in the general population. These data are necessary to develop, implement, and evaluate efficient intervention programmes [5-6].

A number of studies have done in different parts of the India on Diabetes Mellitus’s knowledge but such studies are limited in hilly state of Himachal Pradesh having different type of customs and cultural pattern. The study was an attempt to identify the level of knowledge about Diabetes Mellitus, its risk factors and  preventive measures so that a more culturally focused, relevant, education plan as a health promotion intervention can be taken up.

Objectives of the Study

To evaluate the knowledge about Risk factors and Preventive measures for Diabetes Mellitus among general population of Himachal Pradesh

• Research Approach: Descriptive

• Research Design:  Cross-sectional survey design

• Study Area:  Hilly state of Himachal Pradesh

• Study Duration: Between January 2021 to March 2021

• Study population: All adults above 18 years of age who were staying in the Himachal Pradesh   for 12 months or more.

• Sample Size: 400 Adults  assuming 50%   have adequate knowledge regarding Risk factors  and Preventive measures for Diabetes Mellitus, 5% absolute error, 95% confidence level, and 5% non response rate

• Sampling Technique: Convenience & snowball Sampling technique

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography, Risk factors and Preventive measures for Diabetes Mellitus was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents 

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: Age, gender, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about Risk factors and Preventive measures for Diabetes Mellitus (10 each) having three options i.e. Yes, No and Don’t Know.  The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 10 and minimum score was zero in each category. Scoring was done on the basis of marks as >80%(9-10) = very good,60-79%(7-8) = Good,41-59% ( 4-6 ) = Fair,<40% (< 4) = poor

• Validity of Tool: By the experts in this field

• Inclusive Criteria: Who were willing to participate in the study

• Exclusion Criteria: Who were not willing to participate in the study

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin in both rural and urban area of Himachal Pradesh till the 400 responses were collected.  Responses were then recorded in a Google Excel spreadsheet

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The present study was Non-experimental descriptive study carried out to evaluate knowledge of risk and preventive factors for Diabetes Mellitus among general population of Himachal Pradesh.

A total of 400 respondents including 150(37.5%) were from urban area and 250(62.5%) were from rural area were participated in the study. Among the participants of the majority 268(67.0%) were males, 182(45.5%) were between 18-30 years, 152(38.0%) were Graduate, 254 (63.5%) were employee, 247(61.75%) were married and 383 (95.75%) were Hindu (Table 1).

Table 1: Socio-demographic characteristics of study participants

Table 2: Knowledge about risk factors of Diabetes Mellitus among participants

Table 3: knowledge of participants towards Preventive measures of Diabetes Mellitus

Table 4: Knowledge towards Risk Factor and Preventive Measures among study participants

In the present study 66(16.5%)  study participants had very good knowledge (9-10 marks) towards risk factors for Diabetes, 259(64.75%) had good knowledge  (7-8 marks), 70(17.5%) had fair knowledge  (4-6 marks) and 5(1.25%) had poor knowledge  (<4 marks) towards risk factors for Diabetes. Similarly, 39(9.75%) study participants had very good knowledge (9-10 marks) towards preventive measures about Diabetes, 288(72%) had good knowledge (7-8 marks), 54(13.5%) had fair knowledge (4-6 marks) and 19 (4.75%) had poor knowledge (<4 marks) towards preventive measures about Diabetes (Table 4).

Lack of awareness of a disease's risk factors, as in this case of Diabetes Mellitus, might thwart preventive measures like adopting healthy lifestyle adjustments. Therefore, many preventative health actions seem to be influenced by a knowledge-based appraisal of one's own illness risk [6-7].

Many participants in this study were unable to correctly identify more than two diabetes risk factors or preventative interventions. Education level and rural background could be a factor in this ignorance. The public's profound ignorance about diabetes may also be reflected in their failure to recognize risk factors. It is likely to have detrimental effects on diabetes prevention or early detection. The economies of emerging nations may likewise be severely harmed by it. This study highlights the critical need to raise diabetes awareness, particularly in hilly state of Himachal Pradesh. Studies from India had demonstrated that in order to achieve treatment recommendation compliance, multiple exposures to information on healthy lifestyles were required [7-10].

In State like Himachal Pradesh, where diabetes prevalence is rising, there are no facilities for such integrated patient education methods. The first stage in the fight against the disease is raising knowledge of the condition, its risk factors, and preventive actions. A coordinated state or national campaign to raise diabetes awareness should be prioritized as a matter of public health where the illness is extremely prevalent [11-12].

Limitations

We may have underestimated the level of knowledge, as a limitation of having used unaided open-ended questions within the questionnaire as opposed to mentioning specific risk factors. However, we believe that this question type allowed for identification of the most known Diabetes Mellitus risk factors and preventive measures.

Many survey participants were still unaware of the risk and protective factors for diabetes mellitus. The primary prevention of Diabetes Mellitus should focus on community health education programmes, according to a number of study findings. The programme should take into account each person's distinctive position, allow for interpersonal variance, and, in particular, take into account the needs of the local, elderly and undereducated population.

1. Aljoudi, A.S. and A.Z. Taha. “Knowledge of diabetes risk factors and preventive measures among attendees of a primary care center in eastern Saudi Arabia.” Annals of Saudi Medicine, vol. 29, no. 1, Jan.–Feb. 2009, pp. 15–19.

2. Khan, M.A.B. et al. “Epidemiology of type 2 diabetes—global burden of disease and forecasted trends.” Journal of Epidemiology and Global Health, vol. 10, no. 1, Mar. 2020, pp. 107–111.

3. Tuso, P. “Prediabetes and lifestyle modification: Time to prevent a preventable disease.” The Permanente Journal, vol. 18, no. 3, Summer 2014, pp. 88–93.

4. Wu, Y. et al. “Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention.” International Journal of Medical Sciences, vol. 11, no. 11, 6 Sept. 2014, pp. 1185–1200.

5. Galaviz, K.I. et al. “Lifestyle and the prevention of type 2 diabetes: A status report.” American Journal of Lifestyle Medicine, vol. 12, no. 1, 24 Nov. 2015, pp. 4–20.

6. Mathew, A.C. et al. “Knowledge about risk factors, symptoms and complications of diabetes among adults in South India.” International Journal of Medical Science and Public Health, vol. 3, 2014, pp. 1086–1092.

7. Lim, S. et al. “COVID-19 and diabetes mellitus: From pathophysiology to clinical management.” Nature Reviews Endocrinology, vol. 17, 2021, pp. 11–30.

8. Shobhana, R. et al. “Patients’ adherence to diabetes treatment.” Journal of the Association of Physicians of India, vol. 47, 1999, pp. 1173–1175.

9. Shahpurwala, M.M. et al. “General medical practitioners in Pakistan fail to educate patients adequately about complications of diabetes: A major cause of concern for a developing country.” Practical Diabetes International, vol. 23, no. 2, Mar. 2006, pp. 57–61.

10. Sicree, R. et al. “Diabetes and impaired glucose tolerance (chapter 1). Part 1.1. Prevalence and projections.” Diabetes Atlas, 3rd ed., International Diabetes Federation, 2006, pp. 16–104.

11. Viswanathan, V. et al. “Need for education on footcare in diabetic patients in India.” Journal of the Association of Physicians of India, vol. 47, no. 11, 1 Nov. 1999, pp. 1083–1085.

12. Shobana, R. et al. “Improving psychosocial care: The Indian experience.” Diabetes Voice, vol. 50, no. 1, 2005, pp. 19–21.