Aa_Knowledge of Residents of Selected Barangay New

7/27/2019 Aa_Knowledge of Residents of Selected Barangay New

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CHAPTER I

INTRODUCTION

Background of the Study

Diabetes mellitus is one of the major chronic

diseases which affect millions of people worldwide. It is

a metabolic disorder characterized by glucose

intolerance. This systemic disease is caused by an

imbalance between insulin supply and insulin demand. It

is one of the serious, complex chronic diseases, which

tend to accelerate degenerative changes throughout the

body by widespread vascular changes in the large blood

vessels and the micro-vessels if not treated properly. It

affects mostly adults from the age of 25 years to 74

years, although it also affects children as young as 3

years old. Two types of diabetes mellitus are identified,

type I and type II. About 5-10% of people with diabetes

have type I and 90-95% have type II (Smeltzer & Bare

1992).

The outcome of diabetes mellitus depends almost

entirely on the patients self-management. Health

professionals have a major responsibility in assisting

patients to gain the necessary knowledge, skills and


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attitudes for self-management (Phipps, Long & Woods

1987).

Diabetes mellitus currently affects an estimated 11

million people in the United States. About 500,000 new

cases of diabetes are diagnosed annually. It is prevalent

in the elderly, though studies indicate that even

children are affected. Diabetes is a leading cause of new

blindness among 25-74 year olds in the United States and

the third leading cause of death, mostly because of the

high rate of coronary artery diseases which are a

complication of diabetes mellitus (Smeltzer & Bare 1992).

The incidence of diabetes mellitus in South Africa for

children is 0.07-3.5 per 10 000 population (Smeltzer &

Bare 1992). It was estimated in 1996 that 0.5 million

people suffered from diabetes mellitus in South Africa

(Working Group of the National Diabetes Advisory Board

1997).

The aim of the treatment of diabetes mellitus is to

achieve blood glucose levels as close to the non-diabetic

state as feasible. Patients must take responsibility for

their own care and should therefore acquire the knowledge

and technical skills to monitor urine and blood glucose,

recognize and prevent hypoglycemia or hyperglycemia and

complications (Matwa, Chabeli, Muller & Levitt 2003).


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The control of diabetes mellitus can be better

maintained if patients adhere to a prescribed treatment

regimen (Lewis & Collier 1992). According to Coates

(1994), patients may monitor their blood glucose levels

by testing the urine or blood, though recently blood

testing is preferred to urine testing because the latter

is known to be inaccurate and may not warn the diabetic

of impending hypoglycemia. Patients can monitor

themselves at home using reagent strips or a glucose

meter. Monitoring of glucose at home enables patients to

check the glucose level regularly and to use the results

to decide on the management of their diabetes

complications. Complications become a reality when

treatment is not adhered to and this can be due to lack

of knowledge. According to Hamera (1992) research results

of studies done on diabetes mellitus reveal only the

positive aspects of the disease, e.g., a positive

attitude about having diabetes, and ignore the negative

aspects. The experience is therefore not representative.

For a sample to be representative, both positive and

negative aspects should be included.


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Statement of the Problem

As Community Health Nursing (CHN) affiliates in

Barangay 9, Tigbauan Iloilo, we applied the concept of

metabolism to include glucose metabolism. Diabetes

Mellitus is one illness included in this concept. Based

on the case findings (epidemiology), we have surveyed

several cases of adults aging forty (40) years old and

above diagnosed of diabetes, some claimed to have a

maintenance medication and others are saying they have

diabetes but have neglected to have follow-ups with their

doctor as well as monitoring of their blood sugar level.

It seems that this serious disease or illness is being

taken for granted. As nursing students, aware of the

severe complications of diabetes we would like to find

out if how informed are these adult residents about this

illness. Thus, this study will focus on the knowledge of

diabetes mellitus among the residents of Barangay 9,

Tigbauan, Iloilo.

Specifically, this study will answer the following

questions:

1. What is the level of knowledge on diabetes mellitus

among residents when taken as a whole and when

categorize according to age, gender, educational

attainment and monthly family income?


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2. Is there as a significant difference in the level of

knowledge on diabetes mellitus among residents when


attainment and monthly family income?

Objectives of the Study

This study aims to determine the knowledge of

residents about diabetes mellitus in Brgy. 9, Tigbauan,

Iloilo.

Specifically, this study aims to determine:

1. The level of knowledge on diabetes mellitus among

residents when taken as a whole and when categorize

according to age, gender, educational attainment and

monthly family income.

2. If there is a significant difference in the level of

knowledge on diabetes mellitus among residents when


attainment and monthly family income.

Hypotheses

In consonance with the study, this hypothesis will

be tested, that there is no significant difference in the

level of knowledge on diabetes mellitus among residents

when categorize according to age, gender, educational



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Definition of Terms

For clarity of meaning, the following terms are

defined as to how they are used in this study.

Knowledge. The fact or condition

of knowing something with familiarity gained through

experience or association; the fact or condition of being

aware of something (meriam-webster.com).

In this study, this refers to the familiarity gained

or a condition of being aware to the disease, diabetes

mellitus of the adult residents in Barangay 9, Tigbauan,

Iloilo.

Resident. One who resides in a particular place

permanently or for an extended period

(thefreedictionary.com)

In this study, residents refer to an adult

population in barangay 9, Tigbauan, Iloilo ages forty

(40) and above and the respondents of this investigation

or study.

Diabetes Mellitus. Is a metabolic disorder

characterized by glucose intolerance, a systemic disease

caused by an imbalance between insulin supply and insulin

demand (Smeltzer & Bare 1992).

In this study, diabetes mellitus refers to a

metabolic disorder or disease which the researchers would
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like to find out if how well the respondents of this

study are informed.

Barangay. Is the smallest administrative division in

the Philippines (encyclopedia.thefreedictionary.com)

In this study, barangay refers to Barangay 9,

Tigbauan, Iloilo, the place where we affiliate for our

Community Health Nursing (CHN) practice and the research

locale of this study.

Significance of the Study

Residents. The result of this study will provide

criteria as to whether their knowledge is adequate or not

about Diabetes Mellitus. In such, this could be a

baseline in providing the amount of health teachings and

health interventions in order to improve or augment

information regarding the disease being studied.

Community. The result of this study can provide the

community with considerable basis on certain knowledge

related to improving prevention strategies and cure of

the disease and promotion of health.

Family. Knowing that the disease is hereditary, the

result of this study can be a guide as they go through

their daily activities and everyday experiences. It can

shed a light and to give them a sense of living with the

people who are sick of Diabetes Mellitus just as them.
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Health Workers. The result of this study will serve

as a baseline for these workers where to improve or where

to strengthen health care delivery among their

constituents in the community and specifically with

Diabetes Mellitus that ranks number 2 among the leading

cause of morbidity.

Scope and Limitation of the Study

A descriptive research design will be used in this

study. The study will be limited to the adult residents

of Barangay 9, Tigbauan, Iloilo aging forty (40) and

above.

The dependent variable of this study will be the

knowledge on diabetes mellitus of the residents while the

independent variable will be age, gender, educational


This study will be conducted on the first semester

of the school year 2013-2014.

The sample population of this study will be computed

using the Slovins formula and a simple random technique

will be used to determine the respondents of the study.

The researchers will use a researchers-made

questionnaire to determine the level of knowledge on

diabetes mellitus of the residents of the selected

barangay.


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Statistical computations will be computed using

Statistical Package for Social Sciences (SPSS) software.

For the descriptive data analysis the mean and the

standard deviation will be used and for the inferential

analysis, the t-test will be used for a two-category

variable and analysis of variance (ANOVA) for more than

two categories of variables.


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CHAPTER II

Review of Related Literature

Diabetes Mellitus

Diabetes mellitus, or simply diabetes, is a group of

metabolic diseases in which a person has high blood

sugar, either because the pancreas does not produce

enough insulin, or because cells do not respond to the

insulin that is produced (Shoback et al, 2007). Diabetes

mellitus has several long-term complications and thus

plays a major role in increasing morbidity and mortality

in the patients.

It is defined as "a clinical syndrome characterized

by hyperglycemia in the fasting state, due to absolute or

relative deficiency of insulin or defect in its receptors

or other abnormalities" ( Kahn, et al, 2005).

It comprises a heterogeneous group of disorders,

which arise in many different ways, but all are

associated with a variable degree of hyperglycemia, with

or without glucosuria. The condition is incurable and is

often associated with disabilitating complications

particularly in patients with a poor diabetic control.

The deficiency in insulin or inefficiency of its action

has a major effect on almost all metabolic pathways of

carbohydrate, proteins, lipids, minerals and water
http://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Insulin


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metabolism. Metabolic derangements associated with

diabetes have resulted in its classification as a `major

metabolic syndrome'. Long-standing derangements result in

structural and hence functional changes in the cells of

the body and often cause permanent or irreversible

damage, which lead to various complications of diabetes

mellitus including biochemical, functional, symptomatic

and morphological alterations (Porte, et al, 2003).

Historical Background

Historical reviews report that the first mention of

diabetes as a condition causing `polyuria' was first made

about 1500 B.C. in Papyrus Eber's found at Luxor in

Egypt. A report from China indicated that the urine of

diabetic patients was so sweet that dogs were attracted

to it and a little later, around 400 B.C., the sweetness

was referred to as "honey urine". Around the sixth

century AD, the association between excessive indulgence

in food and drinks and the development of diabetes led to

its description as the "disease of the rich". It was

Aretaeus of Cappedocia (about 81-138 AD) who gave the

name `diabetes', which is a Greek word meaning "to run

through a siphon", since the polyuria state associated

with diabetes was well known. The first suggestion that

glucose was first elevated in blood before it was


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a `substance' from the pancreas of dogs by Banting and

Best in 1921 for which they got the Noble Prize (LeRoith,

2004). This substance had a hypoglycaemic effect and was

later named "Insulin". In 1960, Sanger elucidated the

chemical structure of insulin and Yallow and Berson, by

which minute quantities of insulin could be detected

(Lack, E. E., 2003), introduced the Radioimmunoassay

(RIA). Large scale preparation of insulin was initiated

and pancreas from different animals was used for this

purpose. For over a decade the hog, bovine or porcine

insulin was widely used for the treatment of diabetes

mellitus and different oral hypoglycemic were introduced.

More recently, since the advent of recombinant DNA

technology, insulin preparation has taken a new turn and

now using the human proinsulin gene, introduced into a

bacterial plasmid, large quantities of human insulin are

prepared and purified and used for treatment of diabetic

patients. In the same way, during the last two and a half

decades tremendous progress has been made in almost all

aspects of diabetes including diagnosis, immunological

and genetic aspects and treatment (Kahn et al, 2005).

However, despite tremendous efforts several fields still

remain unveiled and there is still no cure for this

condition.


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Classification of Diabetes Mellitus

Several attempts have been made to classify diabetes

mellitus and various classification systems have existed.

However, the most widely accepted is the World Health

Organization (W.H.O.) classification (WHO, 2012) which

was originally proposed by Irvine, later adopted by the

National Diabetes Data Group and was later updated in

1985.

There are three main types of diabetes mellitus

(UCSF Medical Center).

Type 1 DM results from the body's failure to produce

insulin, and presently requires the person to inject

insulin or wear an insulin pump. This form was

previously referred to as "insulin-dependent diabetes

mellitus" (IDDM) or "juvenile diabetes".

Type 2 DM results from insulin resistance, a

condition in which cells fail to use insulin properly,

sometimes combined with an absolute insulin

deficiency. This form was previously referred to as

non insulin-dependent diabetes mellitus (NIDDM) or

"adult-onset diabetes".

The third main form, gestational diabetes occurs

when pregnant women without a previous diagnosis of
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diabetes develop a high blood glucose level. It may

precede development of type 2 DM.

Insulin-Dependent Diabetes Mellitus

Insulin-dependent diabetes mellitus (IDDM), commonly

referred to as type-I diabetes, is a condition caused

when an autoimmune response induces the death of insulin-

secreting b cells in the pancreas. Insulin is the

protein that is responsible for transporting glucose

(secreted by pancreatic a cells) from the blood into the

cells, where the glucose is metabolized for energy.

When b cells are killed the body has no way of producing

insulin, so glucose levels in the blood are unable to be

controlled, leading to hyperglycemia, or high blood

glucose level. Longterm complications of hyperglycemia

include cardiovascular, kidney, and eye diseases, as well

as various nervous system disorders (diabetes.com, 2000).

Causes

IDDM tends to run in families, and there is

substantial evidence that genetics plays a significant

role in causing the disease. However, studies have shown

that the concordance rate for IDDM among monozygotic

twins is less than 50 percent, meaning that environmental

factors must also play a significant role (Tisch and

McDevitt, 2002). The fact that both environment and


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Although IDDM susceptibility has an apparent genetic

origin, what exactly is responsible for stimulating the

autoimmune response remains unclear. The most common

examples of the various possible external factors that

have been shown to trigger a response leading to IDDM

include:

Viruses Strong correlations between IDDM and

exposure to certain viruses such as those causing

German measles, mumps, and certain variants of

Polio, especially at a young age, suggest that these

viruses can stimulate a b cell autoimmune response.

It is possible that these viruses induce activation

and proliferation of T cells specific for a viral

epitope that mimics a protein unique to b cells,

therefore causing armed T cells to respond to

the b cell autoantigens (Diabetes.com, 2000).

Drugs and chemicals Pyriminil (rat poison) and

pentamidine, a drug used to treat pneumonia, are

among several synthetic chemicals and drugs that

have been shown to induce IDDM (Diabetes.com, 2000).

Cows milk Although it remains controversial, one

theory suggests that exposure to cows milk during

infancy can induce an autoantibody response to p69,

a protein often expressed by b cells. Expression of


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p69 on b cells can be induced by IFN-g, which could

be present due to a viral infection. This theory

therefore works in conjunction with the virus

theory, claiming that infant exposure to cow's milk

elicits antibodies capable of attacking b cells

later in life following a viral infection (Fauci et

al, 2008).

Pathogenesis

The two distinctive features of IDDM are the

infiltration of pancreatic islets by macrophages and

lymphocytes, a condition known as insulitis, and the

presence of auto antibodies in the serum (Le Roith, et

al, 2004). Both of these events serve as markers for the

prediabetic phase of IDDM.

More than a dozen islet-cell proteins that elicit

antibody responses in type-I diabetics have been

identified, and the presence of these auto antigens

(and/or their corresponding auto antibodies) serve as

important diagnostic tools for early identification of

IDDM. Among the apparently more significant auto

antigens are:

37k antigen--The antibodies to this auto antigen are

found in over half of all type-I diabetics, and

these auto antibodies are unique to diabetes and are


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not found in patients suffering from other

endocrine-related autoimmune diseases.

b-granule antigen--This auto antigen has not been

completely identified yet, but it is known the be

the target for the Th1 T cell clones derived from

NOD mice.

P69

Insulin

GAD--Glutamic acid decarboxylase (GAD) exists in two

isoforms of 65kD (GAD65) and 67kD (GAD67).

Insulin and GAD are the two evidently self-reactive

proteins that have been studied most in depth since both

of these autoantigens consistently indicate autoimmune

activity in the pancreatic islets (Von Herath, 2001).

However, although the identification of autoantibodies in

the serum has been valuable to the study of which

proteins are involved in b cell autoimmunity, the precise

role of these antibodies in the pathogenesis of IDDM

remains unclear. Therefore, a greater emphasis has been

placed on studying the cell-mediated (T cell) rather than

the humoral (antibody) response. This shift in focus has

led to the discovery that many of these autoantigens,

including GAD and insulin, are targeted not only by


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autoantibodies, but also by T cells (Le Roith, et al,

2004).

Non-Insulin Dependent Diabetes Mellitus

Genetics

NIDDM is known to occur more often in some families

than others. Recent advances have led to a better

understanding of how insulin is produced and released

have led to the discovery of several genes that cause

diabetes in a small proportion of affected families. A

major effort is now underway to discover the other genes

that cause diabetes in the majority of patients

(csua.berkeley.edu).

Researchers have announced that they have identified

mutations in at least 3 genes involved in the subset of

Type 2 called MODY (Maturity - Onset - Diabetes of the

Young), which tends to be diagnosed prior to age 25, and

there are some mitochondrial disorders implicated in some

types of Type 2 diabetes, but the cause for the majority

of people with Type 2 diabetes does not seem well-

understood (csua.berkeley.edu).

Aging and obesity are commonly identified risk

factors for diagnosis of Type 2 diabetes but these are

correlations not causes; we do know that it is a

genetically- or congenitally-based disease and that


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predisposing genes are necessary. In fact, the

correlation among identical twins for Type 2 diabetes is

virtually 100% (csua.berkeley.edu).

Diet

Hyperinsulinemia exists in childhood in populations

at high risk for NIDDM. Stimulated by obesity, upper body

obesity, and physical inactivity, insulin resistance

develops, accompanied by impaired glucose tolerance. The

pressure of the NIDDM risk factors continues this process

of insulin resistance/hyperinsulinemia/hyperglycemia,

until glucose toxicity to the beta cell results in

inability to secrete sufficient insulin, resulting in

decompensated fasting hyperglycemia" (csua.berkeley.edu)

Other Environmental Factors

A number of researchers, particularly those in the

U.K., have been reporting on interesting epidemiological

studies of Type 2 diabetics, which suggest that prenatal

environment may have a significant role in the causation

of Type 2 diabetes, as well as hypertension. More than 20

studies have shown that lightweight babies, babies who

are long and thin at birth, or those who are short and

have disproportionately small bellies grow into adults

with high blood pressure, elevated cholesterol, high

blood sugar levels, and increased risk of dying from


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cardiovascular disease. In one study of 15,000 adults in

Hertfordshire, men who weighed less than 2.5 kg (5.5 lbs)

at birth were found to have 3 times the incidence of Type

2 diabetes than men born weighing more than 4.5 kg (9.9

lbs). Several hypotheses have been developed about this

idea, including that maternal glucocorticoids reprogram

the fetal hormone system, or that maternal deprivation at

the end of pregnancy when the liver is forming affects

its development and leads to NIDDM (csua.berkeley.edu)

Pathophysiology of Diabetes Mellitus

The pathophysiology of all types of diabetes is

related to the hormone insulin, which is secreted by the

beta cells of the pancreas. In a healthy person, insulin

is produced in response to the increased level of glucose

in the bloodstream, and its major role is to control

glucose concentration in the blood. What insulin does is,

allowing the body cells and tissues to use glucose as a

main energy source. Also, this hormone is responsible for

conversion of glucose to glycogen for storage in the

muscles and liver cells. This way, sugar level is

maintained at a near stable amount.

In a diabetic person, there is an abnormal

metabolism of insulin hormone. The actual reason for this

malfunction differs according to the type of diabetes.


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not responding to insulin as they do in a healthy person.

Since the body cells and tissues are resistant to

insulin, they do not absorb glucose; instead it remains

in the bloodstream. Thus, the Type 2 diabetes is also

characterized by elevated blood sugar. It is commonly

manifested by middle-aged adults (above 40 years). As

insulin is not necessary for treatment of Type 2

diabetes, it is known as Non-insulin Dependent Diabetes

Mellitus (NIIDM) or Adult Onset Diabetes.

The third type of diabetes is called Gestational

diabetes. As the term clearly suggests, it is exhibited

by pregnant women. Over here, high level of blood glucose

is caused by hormonal fluctuations during pregnancy.

Usually, the sugar concentration returns to normal after

the baby is born. However, there are also instances, in

which it remains high even after childbirth. This is an

indication for increased risks of developing diabetes in

the near future.

As already mentioned, the symptoms and effects of

all the three forms of diabetes are similar. The

noticeable symptoms include increased thirst

(polydipsia), increased urination (polyuria), and

increased appetite (polyphagia). Other diabetes signs and

symptoms include excessive fatigue, presence of sugar in


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the urine (glycosuria), body irritation, unexplained

weight loss, and dehydration. Elevated blood sugar and

glycosuria are interrelated; when sugar amount in the

blood is abnormally high, the reabsorption by proximal

convoluted tubule is reduced, thereby retaining some

glucose in the urine (buzzle.com).

Risk Factors

There are many studies show that obesity,

hypertension and lifestyle factors suchas diet, physical

activity, smoking and drinking habits are related to

diabetes.

According to the study among people age 20 years and

over in Oman, the overall prevalence of diabetes was

11.6% and varied according to urban or rural residence,

age, marital status, educational level, smoking status,

measure of obesity, cholesterol and systolic blood

pressure. The prevalence of hypertension is 21.1 (Al-

Moosa et al., 2006).

Signs and Symptoms

Lack of insulin causes hyperglycemia responsible for

most of the signs and symptoms. Hypoglycemia occurs in

Diabetics due to medications and inappropriate dietary

habits.


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Frequent urination. Water retention is an important

function of kidney. Water retention is co-related with

the absorption of glucose and sodium. In Diabetes there

is excess Glucose excretion in urine, condition termed

as Glycosuria. Hence there is also excess excretion of

water, resulting in increased urine output known

as Polyuria.

Increased thirst. Naturally as there is increased

water loss, there is increased requirement for water

consumption to avoid dehydration. It is known

as Polydipsia.

Extreme hunger. Insulin redistributes glucose from

blood to the tissues. Hence in Diabetes there

is decreased availability of glucose to cells and tissues

as most of the glucose is present in blood. Other neural

mechanisms are responsible for hunger. This increased

appetite is known as Polyphagia.

Other nonspecific symptoms like lethargy, gastric

symptoms like nausea, vomiting may also occur sometimes.

Most diabetics also have co-existing entities like

Hypertension, Thyroid Disorders etc. It is important to

note that many diabetics (especially type II patients)

have prolonged symptom free periods as we said before.

Symptom free periods correlate with good control over
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blood glucose level and proper diet. Hence these two

things form an important part of therapy.

Complications

Type 1 and type 2 diabetes are chronic, life-long

conditions that require careful monitoring and control.

Without proper management they can lead to very high

blood sugar levels which can result in long term damage

to various organs and tissues.

Cardiovascular disease. Affects the heart and blood

vessels and may cause fatal complications such as

coronary heart disease (leading to heart attack) and

stroke. Cardiovascular disease is the major cause of

death in people with diabetes, accounting in most

populations for 50% or more of all diabetes fatalities,

and much disability.

Kidney disease. Can result in total kidney failure

and the need for dialysis or kidney transplant. Diabetes

is an increasingly important cause of renal failure, and

indeed has now become the single most common cause of end

stage renal disease, i.e. that which requires either

dialysis or kidney transplantation, in the USA2, and in

other countries.

Nerve disease. Can ultimately lead to ulceration and

amputation of the toes, feet and lower limbs. Loss of


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The initial approach to the older adult with

diabetes mellitus requires assessment of the patient's

current medical status and estimated life expectancy.

Motivation and commitment of the patient and family also

play a large role in determining what level of treatment

is appropriate. Support services available in the

community and financial status should also be considered

(health.am).

Oral Hypoglycemic Agents. Increasingly, therapy for

type 2 diabetes builds on diet and exercise and has

become more mechanistically focused. Single or

combination chemotherapy is used. A significant amount of

improvement can be expected with improved therapy.

Currently, 54% of elderly diabetic patients have

hemoglobin A1clevels above normal and 27%of the total had

A1c levels greater than 8. Thus, nearly a quarter has

"poor" control. Current best practices require a normal

hemoglobin A1c, certainly less than 7. For those

individuals in whom the demands of therapy are too great,

medication side effects are too great, or access to

monitoring is not possible, a reduction in expectations

and greater complication rates will be higher.

Medications currently available can promote insulin


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secretion, increase insulin sensitivity, or slow the

digestion/processing of complex carbohydrates.

Diet. Diet alone has varying degrees of success.

Elderly patients with diabetes are able to improve

diabetes control with diet and weight loss. However, they

may find it difficult to adhere to a strict dietary

regimen and maintain weight loss. Older adults with

mobility problems may find exercise to increase caloric

expenditure impossible. If dramatic dietary restriction

is employed to reduce weight, nutrient and vitamin

deficiencies may develop. Aggressive dietary management

cannot be recommended under these circumstances. Other

considerations specific to older adults may limit the

effectiveness of dietary therapy.

A diabetic diet is relatively high in carbohydrates

(50%-60% of total calories), low in fat (30% of total

calories from fat, with 10% saturated fat, 10%

polyunsaturated fat, and 10% monosaturated fat), and

moderate in protein (~20% of total calories). If

malnourished or chronically ill, the elderly patient

should increase protein and energy intake. Vitamin and

mineral supplements are indicated when caloric intake

falls below 1000 kilocalories per day.


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People suffering from diabetes mellitus are at

greater risk of contracting colorectal cancer.

They found that diabetes was associated with an

increased risk of colon cancer in both men and women.

However, the risk of rectal cancer was 20 percent higher

in men.

This data suggests that diabetes mellitus is an

independent risk factor for colon and rectal cancer, and

people with diabetes should be aware of the risk of

contracting colon cancer and follow their doctor's advice

and screen themselves for the cancer.

The researchers have also recommended that the

doctors be aware of an increased colorectal cancer risk

in patients who smoke and are obese; more so, in fact,

than the ones who have diabetes.

A study related to the current study entitled The

New-Onset Diabetes: How to Tell the Difference between

Type 1 and Type 2 Diabetesby Largay (2012). The result

showed that with the increase in the incidence of type 2

diabetes in children and adolescents and of type 1

diabetes in adults, making a correct diagnosis has become

more challenging. Type 1 diabetes results from autoimmune

destruction of the pancreatic -cells that produce


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insulin and can occur at any age (ECDC, 2003). When it

occurs in adults, type 1 diabetes can progress to total

insulin deficiency at different rates. The slowly

progressive form is known as LADA (sometimes called type

1.5 diabetes). There is also a more rapidly progressive

form that mimics type 1 diabetes seen in children.

Diabetic ketoacidosis (DKA) is a common feature but

may not be present early in the presentation, occurring

in only 1725% of those with new-onset diabetes

(Wolfsdorf et al, 2006).

Patients with LADA appear to have a lower prevalence

of the metabolic syndrome. While comparing patients with

new-onset type 1 and type 2 diabetes, one study 5 found

those with LADA had a lower BMI, lower triglycerides and

total cholesterol, higher HDL, and a lower prevalence of

hypertension than those with type 2 diabetes. At

diagnosis, fasting C-peptide levels were lower in LADA

than in type 2 diabetes, perhaps confirming the typical

observation of little or no response to oral agents and

the need for insulin earlier in the course of the

disease.

Antibody testing can assist in diagnosis. Autoimmune

antibodies associated with type 1 diabetes include GAD-

65, islet cell antibodies (ICAs), insulinoma-associated
http://clinical.diabetesjournals.org/content/30/1/25.full#ref-5http://clinical.diabetesjournals.org/content/30/1/25.full#ref-5


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course of the trial. Although it is common for background

therapy to change during the course of a relatively long

outcomes trial, trials that test strategies rather than

specific therapies have the additional problem of

therapeutic approaches changing over time. Both

revascularization strategies employed in BARI 2D evolved

during the course of the trial, with higher use of drug-

eluting stents and greater use of minimally invasive

surgical techniques as the trial progressed.

Although they stop short of requiring that drugs

that improve glycemic control actually reduce

cardiovascular risk, which is a worthy if not elusive

goal, these new requirements are aimed at ensuring that

drugs that improve glycemic control do not result in

cardiovascular harm.

A study related to the current study entitled,

Prevention of Type 2 Diabetes Mellitus by Changes in

Lifestyle among Subjects with Impaired Glucose Tolerance

by Tuomilehto et al (2009). This study provides evidence

that type 2 diabetes can be prevented by changes in the

lifestyles of both women and men at high risk for the

disease. The overall incidence of diabetes was reduced by

58 percent. Our estimate of the effect of the


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relatively small reduction in weight in the prevention of

diabetes.

It is possible to achieve primary prevention of type

2 diabetes by means of a nonpharmacologic intervention

that can be implemented in a primary health care setting.

According to our results, 22 subjects with impaired

glucose tolerance must be treated in this way for one

year or 5 subjects for five years to prevent one case

of diabetes.


Infections in Diabetes Mellitus by Schaberg (2008).

According to the study, individuals with diabetes can

have any infection that affects the general population.

However, people with diabetes are at increased risk of a

variety of specific infectious complications. Infections

associated with either increased frequency or severity

among individuals with diabetes include mucormycosis;

cystitis; complicated urinary tract infections, including

pyelonephritis; intrarenal abscesses; perinephric

abscesses; pneumonia; lower-extremity soft tissue

infection, including polymicrobial gangrene;

emphysematous cholecystitis; and malignant otitis

externa.


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The most dramatic example of the interaction of

angiopathy, acidosis, and poor glycemic control in

infection is mucormycosis. Mucormycosis is a severe

infection caused by fungi of the order Mucorales. These

fungi are ubiquitous and are often found on decaying

matter, such as moldy bread. Patients with diabetes are

at particular risk of a form of the disease known as

rhinocerebral mucormycosis.

This infection is thought to be caused by inhalation

of the spore forms of the organisms, which are presumed

to then lodge in the nasal tissue. The spores

subsequently germinate and invade adjacent tissue, with a

particular tropism for blood vessels. The orbit and

central nervous system can subsequently become affected.

The infection usually presents with facial or ocular

pain. Fever and symptoms of sinusitis may be present.

About 50% of patients are in diabetic ketoacidosis (DKA)

at the time of presentation.

Urinary tract infections are also more common among

patients with diabetes. Women with diabetes are at a

particularly increased risk of urinary tract infection.15

Upper tract infection has been shown to be significantly

more common in patients with diabetes. E. coli is the

most common causative organism, followed by other gram-
http://spectrum.diabetesjournals.org/content/15/1/37.full#ref-15http://spectrum.diabetesjournals.org/content/15/1/37.full#ref-15


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negative bacteria. Because of the high incidence of often

unsuspected upper tract infection, a 7- to 14-day course

of therapy has been recommended for treatment of cystitis

among patients with diabetes.

Pyelonephritis is clearly more common in patients

with diabetes. It is treated similarly to pyelonephritis

in nondiabetic patients. Other renal infections that are

more common in individuals with diabetes include renal

carbuncles (intrarenal abscesses caused by the

hematogenous spread of S. aureus), renal corticomedullary

abscesses (intrarenal foci of infection associated with

reflux and obstruction caused by the same organisms that

typically cause pyelonephritis), and the rare but

devastating emphysematous pyelonephritis, associated with

gas formation within the kidney

The latter infection is usually caused by E. coli or

other gram-negatives and is typically detected by a

routine X-ray of the abdomen. A combination of surgery

and medical therapy is usually required. Perinephric

abscesses are caused either by the rupture of intrarenal

abscesses into tissue surrounding the kidney or by the

hematogenous or lymphatic deposition of organisms into

that tissue. Gram-negative organisms such as E. coli are

the most common reported causative bacteria. However, a


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wide variety of organisms, such as S. aureus, fungi,

anaerobes, and mycobacteria, have been reported as

causes.

Diabetes is very clearly associated with these

infections. Underlying renal pathology, such as

vesicovesicular reflux and obstructive uropathies, are

also strongly associated with these abscesses.

Local Studies


Philippine cardiovascular outcome study-diabetes mellitus

(PHILCOS-DM): A cohort study of the eight-year incidence

of Diabetes Mellitus in NCR, Region 3 and Region 4 by

Velandria et al (2008). The study determined the 8-year

incidence of diabetes mellitus (DM) and impaired fasting

glucose (IFG), and the current prevalence of DM, IFG, and

impaired glucose tolerance (IGT), among respondents of

the 1998 Food and Nutrition Research Institute 5th

National Nutrition Survey (FNRI-NNS) in the

National Capital Region (NCR), Region 3, and Region 4 of

the Philippines.

It was a descriptive cohort study. A community-based

study including all previous respondents of the 1998

FNRI-NNS survey in NCR, Region 3, and Region 4. Out of


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the previous 1,316 individuals in the 3 areas of the 1998

FNRI-NNS data, a total of 1,085 respondents were included

in the Philippine Cardiovascular Outcome Study (PhilCOS,

2007) with a response rate of 82 percent. The study

determined the 9-years incidence rate of DM and IFG, and

the 2006 If prevalence of DM, IFG, and IGT of the cohort.

The 8-years incidence of DM using fasting Wood

glucose (FBG) was 9 percent, and of IFG was 10 percent.

The prevalence of DM was 19 percent (combined FBG, 2H PG,

and interview). The prevalence of IFG was 9 percent based

on the cut-off IFG level of 110-125mg/dL. However, using

the newer cut-off level of 100-125mg/dL, the prevalence

of IFG increased to 30 percent. The prevalence of IGT was

25 percent.

The PhilCOS-DM has reported the first 8-year

incidence rate of DM and IFG in NCR, Region 3, and Region

4. PhilCOS-DM also determined significant proportions of

DM, IFG, and IGT in the cohort that warrant early

aggressive intervention for prevention and management.

An experimental study related to the current study

entitled, The Effect of Momordica Charantia Capsule

Preparation on Glycemic Control in Type 2 Diabetes

Mellitus by Dans et al (2009). This is the first


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randomized controlled trial to shed light on the issue

concerning the hypoglycemic effects of M. charantia. The

investigators targeted a 1% decline in A1c at the outset

with an estimated power of 88%. With the observed decline

of 0.24%, the achieved power was only 11%. For this

reason, we are unable to make a definite conclusion about

the effectiveness of M. charantia. However, the results

of this study can be used estimate the sample size for

bigger studies. It is a randomized, double-blind,

placebo-controlled trial was conducted between April and

September 2004 at the outpatient clinics of the

Philippine General Hospital. The trial included 40

patients, 18 years old and above, who were either newly

diagnosed or poorly controlled type 2 diabetics with A1c

levels between 7% and 9%. On top of the standard therapy,

the patients were randomized to either M. charantia

capsules or placebo. The treatment group received two

capsules of M. charantia three times a day after meals,

for 3 months. The control group received placebo at the

same dose. The primary efficacy endpoint was change in

the A1c level in the two groups. The secondary efficacy

endpoints included its effect on fasting blood sugar,

serum cholesterol, and weight. Safety endpoints included

effects on serum creatinine, hepatic transaminases


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(Alanine aminotransferase/ALT and Aspartate

aminotransferase/AST), sodium, potassium, and adverse

events.


Metabolic Syndrome in the Philippine General Population:

Prevalence and Risk for Atherosclerotic Cardiovascular

Disease and Diabetes Mellitus by Morales et al (2008).

The prevalence of MS in the general population in the

Philippines in 2003 to 2004 for adults aged 20 years and

above, representing 42.6 million Filipinos, varied

significantly depending on the criteria used. Using the

clinical definitions, namely the original NCEP-ATP III

and that modified by the AHA/NHLBI, the prevalence of MS

in the Philippines in 2003 was 11.9% and 18.6%,

respectively. The 1998 survey utilized capillary blood

analyzed with a Cholestec LDX desktop unit whereas the

2003 survey used venous blood analysed by a validated

Cobas-Mira machine located in a central laboratory.

There have been many controversial issues and

debates on MS. The main ones concern the definition and

criteria for the diagnosis, the underlying aetiology and

pathogenesis, the prevalence rates, predisposition to

atherosclerotic cardiovascular disease and DM and the


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specific treatment. At the present time, diagnosing MS

allows clinicians to identify and stratify individuals

with these risk factors. It must be stressed that all

cardiovascular risk factors should be treated

individually and aggressively and that treatment should

be based on evidence-based approaches to the management

of the individual components.

In conclusion, the MS is common in the adult

Filipino population. The most prevalent components are

low HDL-C and abdominal obesity. In the population

surveyed, the MS had robust predisposition to DM, to

stroke and, by the IDF definition alone, to MI as well.

A study related to the current study entitled, Type

2 Diabetes and Metabolic Syndrome in Filipina-American

Women a High-risk Nonobese Population by Araneta et al

(2008). In this study, community-dwelling Filipina-

American women had a sixfold higher risk of diabetes and

nearly a threefold risk of the metabolic syndrome

compared with community-dwelling Caucasian women from the

same county. This higher prevalence was not explained by

differences in education, parity, body size, fat

distribution, and percentage of body fat, behaviors, or


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Several recent studies have shown that the reference

(wild-type) allele at several of the IL4R SNPs examined

here is associated with atopic asthma and increased IgE

levels (Sandford et al, 2000; Howard et al, 2002). Thus,

it appears that the same alleles at IL4R SNPs confer an

increased risk for a canonical Th1 (T1D) and Th2 (atopic

asthma) disease. If true, these associations argue

against an effect on Th1/Th2 balance mediated by

polymorphism in the IL4R gene and suggest instead that

these variations may influence some aspect of immune

regulation and homeostasis in both Th1 and Th2 pathways

and possibly B cell activation, as well. Conceivably, the

observed patterns of disease association reflect the

effect of IL4R polymorphisms on the balance between the

activation of Th1 and Th2 cells and that of T regulatory

cells. Finally, the extent of risk for T1D may be

determined by specific combinations of variants at the

IL4R locus and at the genes encoding its two ligands, IL4

and IL13.

Theoretical Framework

This study was guided by Orems conceptual model of

nursing. Orems model includes three related theories:

theory of self-care, theory of self-care deficit, and


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general or specific self-care requisites, thus persons

who are in a stage of self-care deficit may need nursing

help. Nurses will design a nursing system to meet an

individuals self-care deficit or to develop the

individuals self-care agency.

In helping the individuals to develop self-care

agency, nurses exercise their nursing agency through

social, interpersonal and professional technological

systems. The organized efforts of nurses are called

nursing systems, which consist of three types: wholly

compensatory, partly compensatory and supportive

educative.

In the supportive-educative nursing system, an

individuals self-care agency is, for the most part,

adequate in meeting self-care requisites.

Nurses only provide support for the maintenance of the

individuals self-care, or education to further develop

their self-care agency.

Diabetes mellitus is a chronic disease that affects

bio psychosocial and economic factors. It is necessary

for patients to develop self-care management abilities

and integrate self-care activities in their daily lives.

A person who is diabetes is able to meet self-care

requisites to control his/her blood glucose levels. Nurse


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can enhance patients perceived self-care efficacy to a

high level and thereby increase self-confidence and

motivation in behavior modification through the

continuous development of self-care agency.

Therefore, a supportive-educative nursing system, by

using methods such as teaching, guiding, supporting, and

providing a developmental environment, make important

contributions to self-care agency, thereby increasing the

ability to control the disease.

In summary, Orems conceptual model of nursing was

used to guide this study. Helping methods were

systematically blended and emphasized both of the group

process and the individual process. The nurse is a

resource for patients and should use effective

instruction media to increase patients learning. All the

methods are based on a good relationship between the

nurse and patient.

This supportive-educative program should increase

self-care agency as reflected by an increase in self-

confidence in performing self-care, and improve control

of blood glucose and body mass index, which reflect a

good diabetic control.


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Chapter III

Methodology

Research Design

The researcher will use the Descriptive research

design in the conduct of this study. Descriptive research

design is a scientific method that involves observing and

describing the behavior of a respondent without

influencing in anyway (Shuttleworth, 2008). It will be

used to describe the characteristics of the variables of

the study.

Identification of the Respondents

The participants of the study will be the adult

residents ages forty (40) and above residing at Brgy. 9,

Tigbauan, Iloilo. The sample size will be computed using

the Slovins formula and a simple random technique will

be used to determine the respondents of the study.

Data gathering Instrument

A researcher-made questionnaire will be used as the

main data-gathering instrument for this study. It will

consist two parts. Part I will contain the demographic

data such as the respondents name, age, educational

attainment, gender and monthly family income.


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The survey questionnaire will be divided into two

parts. First, it contains of the respondents profile

data. Part II will be the questionnaire about the

knowledge level of the respondents in Diabetes Mellitus.

Validity and Reliability of the Questionnaire

To test for the validity of the instrument, the

questionnaire will be subjected for face and content

validation of three (3) experts wherein critiquing and

corrections will be made and will then be reproduced and

distributed personally to the respondents.

Reliability is a measure of how well the study

actually measures what it is supposed to measure. This

will be done by administering the instrument to ten (10)

adults to test for the reliability in order to see if the

same results will be obtained.

Data gathering procedure

In gathering data, the researcher will ask

permission from the Dean to conduct study outside of the

school. Write a letter to Barangay Captain informing that

the researchers choose his barangay as research locale. A

schedule will be set for the administration of the

instrument. The researcher will personally administer the

questionnaire and retrieve after making sure that no


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questions are left unanswered.

Statistical Data Analysis

Data gathered from this investigation will be

subjected to certain computer-processed statistical

tests.

Mean. The obtained mean scores will be used to

ascertain the knowledge of the residents of Brgy. 9,

Tigbauan Iloilo on Diabetes Mellitus.

Standard Deviation. The SD will be used to

determine the dispersion of the mean.

t-test for independent sample. The t-test will be

employed to determine the significance of the differences

in the two-level categories of variables with

significance level at 0.05 alpha.

Analysis of Variance (ANOVA). The ANOVA will be

used to determine the significance of differences in the

three or more level categories of the variables with the

significance level set at 0.05 alpha.

All statistical computations will be computer-

processed through Statistical Package for the Social

Sciences (SPSS) software.

For scoring and statistical interpretation, the

respondents will indicate their answers by placing a


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ST. THERESE MTC-CollegesLa Fiesta Site

M.H Del Pilar St. Molo, Iloilo City

DIABETES MELLITUS: KNOWLEDGE OF RESIDENTS AT BARANGAY 9, TIGBAUAN, ILOILO

PART I

A. Personal Data Information

Name (Optional):_________________________________________

Age: _______ Gender: _______

Educational Attainment: _________________________________

Monthly Family Income: __________________________________

Instruction: Please check the appropriate column that correspond your

choice.( Palihog butang sang tsek sa idalum sang inyo sabat.)

Strongly Agree (1)-means that the respondents believe that the statement is

absolutely true.

(Ang buot hambalon nagapati kamo sang bug-os nga ang pamangkot tama gid ka

matuod.)

Agree (2) - means that the respondents believe that the statement is

true.

(Ang bout hambalon nagapati kamo nga ang pamangkot matuod.)

Disagree (3) - means that respondents believe that the statement is false.

(Ang buot hambalon nagapati kamo nga ang pamangkot hindi matuod.)

Strongly Disagree (4)- means that the respondents believe that the statement

is very unlikely to be true.

( Ang buot hambalon nagapati kamo sang bug-os nga ang pamangkot hindi gid

matuod.)


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PART II

QUESTIONS

StronglyAgree (1)

Agree(2)

Disagree(3)

StronglyDisagree

(4)

The following are signs andsymptoms of Diabetes Mellitus.

Ang mga masunod amo ang mga

senyales kag sintomas sang

diabetes.

1.) Frequent urination. Pirmi gaihiihi

2.) Excessive hunger.

Permi gina gutom.

3.) Increased thirst.

Permi gina uhaw.

4.) Extreme fatigue.

Sobra nga pagkakapoy

5.) Irritability.

Pagka-iritable.


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Etiology/Causes

Kabangdanan sang sakit.

6.)The body failed to produce

insulin.Ang aton lawas wala naga pagwa

sang insulin.

7.)The body cells fail to use the

insulin properly.

Ang cells sang aton lawas indi

makagamit maayo sang insulin

8.)Impaired glucose intolerance as

a result of hormonal changes

during pregnancy.(gestational

diabetes)

Ang kabangdanan sang diabetes

sa nagabusong amo ang pagbaylo

sang pag usar sang glucose sang

aton cells.

9.) Increased age contribute to

the risk of Diabetes Mellitus.

Ang pagtaas sang edad amo ang isa

ka kabangdanan sang Diabetes


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Prevention.

Ang Pag Tapna.

10.) Avoid sugary beverages at

home as much as possible.

Likawan ang tanan nga

mga matam-is nga ilimnon sa

sulod sang balay.

11.) Limit fatty food intake.

Limitahan ang mga matambok nga

pagkaun.

12.) Exercise regularly.

Mag ehersisyo kada adlaw.

13.) Daily insulin injections are

required as prescribed.

Ang reseta sang pag.painsulin

injection sa adlaw-adlaw nga tanan

kinahanglanon gid.

14.) Maintenance oral medication

should not be neglected.

Ang pag-inom sang

maintenance nga bulong para sa

diabetes hindi gid dapat

paglipatan.

15.) Seek a medical advice for a

diabetic diet.

Mag bisita sa sentro para ma

hatagan sang ihibalo kon ano nga

mga pagka-on ang naga kadapat sa

mga tao nga may diabetes.

16.) Decrease physical activity to


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lessen fatigability.

Buhinan ang mga pisikal nga

aktibidades para hindi matam-an

sang kakapoy.

17.) In persons with diabetic

lesions, daily cleansing should be

done.

Kinahanglan limpyohan adlaw-adlaw

ang mga pilas nga resulta sang

diabetes.

18.) A person with diabetes should

be extra careful not to cause

injury to the skin.

Ang tao nga may diabetes

kinahanglan gid nga mag andam nga

hindi mapilasan ang iya panit.

19.) Seek immediate medical

consultation for any injury to the

skin.

Kon mapilasan, mag

pakonsulta gilayon sa doctor

20.) Regular monthly monitoring of

blood glucose level is very

important for people with

diabetes.

Kinahanglan mag pa check-up

sang glucose (sugar)kada bulan ang

mga tao nga may diabetes.

Documents

Aa_Knowledge of Residents of Selected Barangay New