RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU , KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. NAME OF THECANDIDATE ANDADDRESS

Ms. HONEY MATHEWS 1ST YEAR M.Sc. NURSINGTHE OXFORD COLLEGE OF NURSING,NO.6/9 & 6/11, 1ST CROSS, BEGUR ROAD,HONGASANDRA, BENGALURU-68.

2. NAME OF THEINSTITUTION

THE OXFORD COLLEGE OF NURSING,NO.6/9 & 6/11 , 1ST CROSS, BEGUR ROAD,HONGASANDRA, BENGALURU-68.

3. COURSE OF STUDYAND SUBJECT

MASTERS OF SCIENCE IN NURSING

MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION TO COURSE

29/01/2011

5. TITLE OF THE TOPIC

A STUDY TO ASSESS THE

EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON

PREVENTION OF MICROVASCULAR

COMPLICATIONS OF DIABETES

MELLITUS AMONG DIABETIC

PATIENTS IN A SELECTED URBAN

COMMUNITY, BENGALURU.

6. BRIEF RESUME OF THE INTENDED STUDY

INTRODUCTION

“Diseases can rarely be eliminated through early diagnosis or good treatment,

but prevention can eliminate diseases”

- Denis Burkitt

Disease prevention is the deferral or elimination of specific illnesses and

conditions by one or more interventions of proven efficacy. One of the least known

and least practiced aspects of medicine is prevention. With respect to human services,

prevention typically consists of methods or activities that seek to reduce or deter

specific or predictable problems, protect the current state of wellbeing, or promote

desired outcomes or behaviours.

 Diabetes Mellitus (DM) is a group of metabolic diseases in which a person

has high blood glucose, either because the body does not produce enough insulin, or

because cells do not respond to the insulin that is produced. This high blood glucose

produces the classical symptoms of polyuria (frequent urination),

polydipsia (increased thirst) and polyphagia (increased hunger). There are three main

types of diabetes are Type 1 diabetes, Type 2 diabetes and Gestational diabetes. 1

Diabetes mellitus has reached epidemic proportions worldwide as we enter the

new millennium. World Diabetes Day (November 14) raises global awareness of

diabetes - its escalating rates around the world and how to prevent the illness in most

cases.. World Health Organization (WHO) estimates that more than 346 million

people worldwide have diabetes. This number is likely to more than double by 2030

without intervention. Almost 80% of diabetes deaths occur in low- and middle-

income countries. 2

Diabetes causes severe morbidity. Complications can be divided into three categories:

Metabolic complications of low blood glucose levels (hypoglycemia) and of

high blood glucose levels (hyperglycemia). Diabetic coma is one such

condition that particularly states to severe nature

Damage to small blood vessels (microvascular complications) leading in turn

to damage the retina ( retinopathy), kidney (nephropathy) and nerves

(neuropathy)

Damage to the larger arteries to the brain (leading to stroke) or to the heart

(leading to coronary heart disease) or to the legs and feet (leading to peripheral

vascular disease).1

Diabetes Education and Prevention’ is the theme for World Diabetes Day for the

period 2009-2013. The slogan for 2011 is ‘Act on Diabetes’. Globally, an estimated

346 million people have diabetes and this number is expected to double by 2030. In

the WHO South-East Asia Region, nearly 71 million people are estimated to be living

with diabetes and an equal number had impaired glucose tolerance. Diabetes increases

the risk of heart disease and stroke and causes immense disability and premature

mortality, and poses a significant economic burden. 3

The global prevalence of diabetes is 6.4%, the prevalence varies from 10.2% in

the Western Pacific to 3.8% in the African region. However, the African region is

expected to experience the highest increase.70% of the current cases of diabetes occur

in low- and middle income countries. With an estimated 50.8 million people living

with diabetes, India has the world's largest diabetes population, followed by China

with 43.2 million. The largest age group currently affected by diabetes is between 40-

59 years. In India, crude prevalence rate of diabetes in urban areas is about 9% and

that the prevalence in rural areas has also increased to around 3% of the total

population. By 2030 this “record” is expected to move to the 60-79 age group with

some 196 million cases. Diabetes is one of the major causes of premature illness and

death worldwide. Non-communicable diseases including diabetes account for 60% of

all deaths worldwide.4

India continues to be the “diabetes capital” of the world, and by 2030, nearly 9 per

cent of the country’s population is likely to be affected from the disease, warns the

fourth edition of the World Diabetes Atlas launched by the International Diabetes

Federation ( IDF) at the 20th World Diabetes Congress in Montreal, Canada. In 1970s

the prevalence of diabetes was approximately 2% among urban populations in India,

but at present the prevalence is more than 12%. A recent study conducted in 6

different cities support the prevalence rate, which shows very high prevalence in

Chennai (13.5%), Bangalore (12.4%), Hyderabad (16.6%), Mumbai (9.3%), Delhi

(11.6%) and Kolkata (11.7%).6

6.1. NEED FOR THE STUDY.

The burden of diabetes is increasing globally, particularly in developing

countries. In the last two decades there is marked increase in the prevalence of

diabetes among Indians, especially in urban areas. Among rural and semi urban areas

there is increase in prevalence in diabetes, but the increase is slower. The reason of

dramatic increase in prevalence in diabetes has been attributed to:

Lifestyle change due to modernization and industrialization.

Ageing of population.

Lower birth weight. Statistics have shown that more than 25% of the

children born in India are of low birth weight. Low birth weight with

stunting growth and muscle wasting which is followed by overweight

and obesity in later life have been postulated to contribute for diabetes

and the insulin resistance syndrome.7

The causes are a complex, but are in large part due to rapid increases in

overweight, obesity and physical inactivity. “The world needs to invest in integrated

health systems that can diagnose, treat, manage and prevent diabetes,” said Professor

Nigel Unwin, who leads the team of experts behind the International Diabetes

Federation Diabetes Atlas.5 Diabetes, is treatable and complications are preventable.  

Early screening, diagnosis and treatment also prevent or reduce the more serious

consequences of the disease (microvascular and macrovascular complications). Once

diagnosed, diabetes requires self-management, including testing, lifestyle

modification, regular exercise and monitoring blood glucose levels.

Although there is good evidence that a large proportion of cases of diabetes

and its complications can be prevented by a balanced diet, cessation of smoking.

Regular physical activity, maintaining a normal body weight and avoiding tobacco

and glycemic control this evidence is not widely implemented. Coordinated action is

needed from the level of international and national policy to reduce exposure to the

known risk factors for diabetes and to improve access to quality of life.

 With the introduction of new oral agents, insulin devices & better patient care

fortunately both Type-I & Type-2 diabetics now enjoy significant longivity but

unfortunately with that we are witnessing rising pool of micro & macro vascular

complications. This is going to put enormous financial & manpower burden on the

total health care system & medical faternity since the cost of treating complications

happens to be even more than five times then treating diabetes mellitus itself. All

diabetic patients are prone to microvascular complications namely – Diabetic

Neuropathy, nephropathy, retinopathy, which can impede their quality of life.

Vascular complications are one of the most serious consequences of diabetes and are

responsible for most of the excess mortality observed in diabetic patients. It is likely

that all blood vessels both small & large are abnormal in diabetic patients with long

standing disease. Although there is a generalized microangiopathy but microvascular

blood vessel in retina, renal glomeruli & microvessels of large nerves seem to have

significant pathology. Similarly, of the large vessels, the arteries of the lower limbs

are particularly affected, although the carotid & coronary vessels are also involved.8

Statistics for vascular disease in patients with Type-2 diabetes are alarming.

The risk of coronary artery disease or stroke is increased 2-4 folds compared with

general population, and the risk of peripheral vascular disease is increased four times.

Diabetic microvascular complications can occur in patients with either Type-1 or

Type-2 diabetes despite improvements in management of glucose, blood pressure and

lipid levels. As many as 37% of patients with diabetes suffer at least one

microvascular complication, and at least 13% have more than one. In a study of 3010

diabetics the prevalence of microvascular complications was – Retinopathy – 23.7%,

Nephropathy-5.5%, Neuropathy-27.5% & Prevalence of Coronary Heart Disease -

11.4% & Peripheral Vascular Disease was 4%.8

Eventhough, the prevalence for the microvascular complications are

increasing on a wider scale, it can be prevented. In preventing retinopathy, glycaemic

and blood pressure control is essential. The aim of preventing nephropathy lies on

meticulous glycaemic control, dietary protein limitation and vigorous control of blood

pressure. The highest priority at present to prevent diabetic neuropathy is the

education of patients and their physicians about the potential for detection and

treatment of early neuropathy. Glycaemic control is beneficial in reducing the

frequency of progression of neuropathy.9 Level of education is the most significant

predictor of knowledge regarding risk factors, complications and the prevention of

diabetes. Given that the prevalence of diabetes has been increasing since the last

decade, health promotion seems essential, along with other means to prevent and

control this emerging health problem.

Hence, the above information signifies the increasing burden of Diabetes

Mellitus and its various complications which brought about the researchers attention

to this topic. The recent trend in nurses role is extended and expanded. Nurses play a

major role in prevention of diseases, helps in reducing the mortality rate and

improvement of quality of life. Thus, the researchers being a strong thinker choose

this topic so as to prevent the complications of this devastating disease condition.

6.2 REVIEW OF LITERATURE

Researchers usually summarize relevant literature in the introduction to

research reports which in turn provides readers with a background for understanding

current knowledge on a topic and illuminates the significance for the new study.

A literature review can be a precursor in the introduction of a research paper. It is a

critical and in depth evaluation of previous research. It is a summary and synopsis of a

particular area of research, allowing anybody reading the paper to establish why we

are pursuing this particular research program. A good literature review expands upon

the reasons behind selecting a particular research question.

Review of literature is organised under following headings:

6.2.1 Studies related to microvascular complications of diabetes mellitus

6.2.2 Studies related to prevention of microvascular complications of diabetes

mellitus

6.2.3 Studies related to effectiveness of structured teaching programme

6.2.1 Studies related to microvascular complications of diabetes mellitus

A study was conducted in Peshawar among 200 known diabetic patients (both

type 1 and type 2), admitted with different clinical problems were included in the

study. Relevant information of all patients was recorded with the help of a

predesigned proforma. They were investigated for retinopathy, nephropathy and

neuropathy. The results were the following retinopathy was detected in 55% cases,

nephropathy in 67% cases while 68.5% patients had the problem of neuropathy. The

ratio of above complications was found to be higher in hypertensive subjects

(p<0.05). The study suggested that the prevalence of microvascular complications

was common in the admitted diabetic patients and hypertension was a commonly

associated condition among them.17

A study was conducted on 415 diabetic subjects attending a primary care

clinic to assess the risk of microvascular complications associated with the metabolic

syndrome in diabetes subjects. The prevalence of microvascular complications was

compared between 270 diabetic subjects with metabolic syndrome and 145 diabetic

patients without. The results were diabetic subjects with metabolic syndrome had a

significantly higher frequency of microvascular-related complications than diabetic

subjects without the syndrome (46.6% and 26.8% respectively, P= 0.0005). These

include microalbuminuria (41.5% vs. 23.9%, P= 0.013), neuropathy (10.4% vs. 7.5%,

P = 0.38), retinopathy (9.6% vs. 4.1%, P = 0.046) and leg ulcers (7.9% vs. 2.8%, P =

0.044). It concluded stating that hyperglycemia and disease duration, the metabolic

syndrome is a significant risk factor for the development of microvascular

complications in diabetic subjects.18

A cross-sectional study was conducted to assess the incidence and types of

macrovascular (MVC) and microvascular (mvc) complications and to analyse their

relation to the different risk factors and biomarkers in order to improve their

prevention, among 415 patients (219 men and 196 women) with an average age of 66

years were enrolled in the study. A total of 95% of patients with Diabetes Mellitus

Type 2 (DM2) had a history of hypertension, 27% had MVC (of which 55% had

ischemic heart disease), and 54% had mvc (of which 95% had diabetic nephropathy).

The results stated that the patients with vascular complications were significantly

older and had a longer history of DM2; they did not differ for their systolic blood

pressure, but had a higher pulse pressure and took more antihypertensives. Thus, the

study concluded by stating that patients with DM2 have a high incidence of vascular

complications significantly associated with age, DM2 history irrespective of the other

monitored parameters.19

A cross-sectional, retrospective study was conducted among 705(type 1) and

1910 (type 2) adult diabetic patients to obtain epidemiological data on the prevalence

of predefined stages of diabetic microvascular complications of patients in Germany.

Results were the following: patients with type 1 diabetes 59.3% had mild or moderate

non-proliferative retinopathy without macular oedema, 27.1% had macular oedema,

and 13.6% had severe retinopathy without macular oedema. In patients with type 2

diabetes, the distribution of retinopathy/maculopathy classes was 56.8%, 35.5%, and

7.7%, respectively. Type 1 diabetes patients with observed peripheral neuropathy,

81.4% had sensorimotor neuropathy, 8.9% had diabetic foot conditions, and 9.7% had

lower extremity amputations because of diabetes. In patients with type 2 diabetes, the

distribution of neuropathy classes was 78.2%, 12.1%, and 9.7%, respectively. The

proportions of patients with renal insufficiency in type 1 and type 2 diabetes groups

were 15.3% versus 13.5%, respectively.20

A retrospective study was conducted among 821 outpatients who underwent

hemoglobin A1c (HbA1c) testing, and presence of Sickle cell trait (SCT) was attained

using the HbA1c assay in African Americans(AA) to determine whether individuals

with DM and SCT have higher rates of microvascular complications relative to those

without SCT .The Analysis revealed that 36.3% of AA nontrait and 22.7% of AA

SCT participants had retinopathy, peripheral vascular disease, or end-stage kidney

disease (P = 0.01). Thus, the study concluded stating that SCT does not increase the

risk of microvascular complications in AA with diabetes mellitus. 21

A clinical trials that randomised 28614 participants with type 2 diabetes

(15269 to intensive control and 13345 to conventional control) was conducted to

assess the effect of targeting intensive glycemic control versus conventional glycemic

control on all cause mortality and cardiovascular mortality, non-fatal myocardial

infarction, microvascular complications, and severe hypoglycaemia in patients with

type 2 diabetes. The results stated that intensive glycemic control did not significantly

affect the relative risks of all cause or cardiovascular mortality, whereas it showed a

reduction of the relative risks for the composite microvascular outcome (P=0.01;

25600 participants, 3 trials) and retinopathy. (P=0.009; 10793 participants, 7 trials).22

A study was conducted on 1736 subjects to assess the relationship between

and risk factors for microvascular complications of diabetes in an urban South Indian

type 2 Diabetes population. The results overall was, Diabetic Retinopathy (DR) was

present in 282 (17.5%), neuropathy in 414 (25.7%), overt nephropathy in 82 (5.1%),

and microalbuminuria in 426 (26.5%) subjects. Eighteen subjects had all three

microvascular complications of diabetes. The risk of nephropathy (odds ratio [OR] =

5.3, P<0.0001) and neuropathy (OR = 2.9, P<0.0001) was significantly higher among

the subjects with sight-threatening DR compared to those without DR. Thus the study

concluded stating that there is association between DR and nephropathy is stronger

than that with neuropathy.23

6.2.2 Studies related to prevention of microvascular complications of diabetes

Mellitus

A Randomized Controlled Trial was conducted to examine whether intensive

glycemic control could decrease the frequency or severity of diabetic microvascular

complications, on 110 Japanese patients with  type 2 diabetes  (55 with

no retinopathy[the primary prevention cohort] and 55 with simple retinopathy [the

secondary intervention cohort]) were assigned to multiple insulin injection therapy

(MIT) groups or assigned to conventional insulin injection therapy (CIT) groups. The

result stated that the cumulative percentages of worsening

in retinopathy and nephropathy were significantly lower (P < 0.05) in the MIT group

than in the CIT group. In neurological tests after 8 years, the MIT group showed

significant improvement (P < 0.05) in the median nerve conduction velocities (motor

and sensory nerves), whereas the CIT group showed significant deterioration (P <

0.05) in the nerve conduction velocities and vibration threshold. Thus the study

concluded that Intensive glycemic control can delay the onset and progression of the

early stages of diabetic microvascular complications in Japanese patients with type 2

diabetes.10

A  Prospective observational study was conducted on 4801 white, Asian Indian,

and Afro-Caribbean United Kingdom Prospective Diabetes (UKPDS) patients, to

determine the relation between systolic blood pressure over time and the risk of

macrovascular or microvascular complications in patients with type 2 diabetes. The

result stated that incidence of clinical complications was significantly associated with

systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in

updated mean systolic blood pressure was associated with reductions in risk of 12%

for any complication related to diabetes, 15% for deaths related to diabetes, 11% for

myocardial infarction, and 13% for microvascular complications. No threshold of risk

was observed for any end point. Thus, the study concluded stating that in patients with

type 2 diabetes the risk of diabetic complications was strongly associated with raised

blood pressure. 11

A population based cohort study has been conducted on persons with Insulin

Dependent Diabetes Mellitus (IDDM) and Non Insulin Dependent Diabetes Mellitus

(NIDDM) diagnosed before age 30 and taking insulin (n = 996) and a probability

sample (based on duration of disease) of persons diagnosed with diabetes at age 30 or

older who were either taking insulin (n = 674) or not taking insulin (n = 696) to

determine the relation of glycemic control to diabetic microvascular complications in

DM. The result stated that glycated hemoglobin level at baseline was strongly related

to the incidence or progression, or both, of diabetic retinopathy, the incidence of gross

proteinuria, and the incidence of loss of tactile sensation or temperature sensitivity in

persons with either IDDM or NIDDM. Thus, the prospective epidemiologic data

suggest that glycemic control is similarly related to the incidence and progression of

diabetic microvascular complications in both IDDM and NIDDM.12

A 20 year follow up study was been conducted among 577 adults with impaired

glucose tolerance from 33 clinics in China who were randomly assigned to either the

control group or to one of three lifestyle intervention groups (diet, exercise, or diet

plus exercise) to determine the long-term effect of lifestyle interventions to prevent

diabetes. The results were compared with control participants, those in the combined

lifestyle intervention groups had a 51% lower incidence of diabetes during the active

intervention period and a 43% lower incidence over the 20 year period, controlled for

age and clustering by clinic. The average annual incidence of diabetes was 7% for

intervention participants versus 11% in control participants, with 20-year cumulative

incidence of 80% in the intervention groups and 93% in the control group.

Participants in the intervention group spent an average of 3·6 fewer years with

diabetes than those in the control group. There was no significant difference between

the intervention and control groups in the rate of first Cardiovascular Disease (CVD)

events. Thus the study concluded stating that Group-based lifestyle interventions over

6 years can prevent or delay diabetes for up to 14 years after the active intervention.13

A study was conducted involving 160 patients with type 2 Diabetes in Denmark

to determine Glycemic control and prevention of microvascular and macrovascular

disease. The results stated that Intensive and target-driven behaviour modeling and

polypharmacy for 7.8 years induced an absolute risk reduction of 20% in

cardiovascular disease events in patients with type 2 diabetes and the metabolic

syndrome in comparison with a conventional multifactorial treatment. The relative

risk reduction found for microvascular events after 4 years was maintained at a

similar level after 7.8 years of intervention: nephropathy 61%, retinopathy 58%, and

autonomic neuropathy 63%. The study concluded by stating that by Improving

glycemic control in patients with type 2 diabetes may be as important as, or even

more important than, treating hypertension and dyslipidemia for the prevention of

both microvascular and macrovascular complications, particularly when aggressive

treatment is initiated at an early stage of the disease.14

A Randomised controlled trial was conducted to determine whether tight control

of blood pressure prevents macrovascular and microvascular complications in 1148

hypertensive patients with type 2 diabetes (mean age 56, mean blood pressure at entry

160/94 mm Hg); 758 patients were allocated to tight control of blood pressure and

390 patients to less tight control with a median follow up of 8.4 years. Following were

the results : Mean blood pressure during follow up was significantly reduced in the

group assigned tight blood pressure control (144/82 mm Hg) compared with the group

assigned to less tight control (154/87 mm Hg) (P< 0.0001). After nine years of follow

up the group assigned to tight blood pressure control also had a 34% reduction in risk

in the proportion of patients with deterioration of retinopathy by two steps (99%

confidence interval 11% to 50%) (P= 0.0004) and a 47% reduced risk (7% to 70%) (P

= 0.004) of deterioration in visual acuity by three lines of the early treatment of

diabetic retinopathy study (ETDRS) chart. The study concluded stating that tight

blood pressure control in patients with hypertension and type 2 Diabetes achieves a

clinically important reduction in the risk of deaths and complications related to

Diabetes, progression of diabetic retinopathy, and deterioration in visual acuity.15

A Randomized, Controlled Trial was conducted to report the progress (after 9-

year follow-up) whether improved glucose control in patients with newly diagnosed

NIDDM is effective in reducing the incidence of clinical complications among 4209

patients. The result stated that all three modes of pharmacologic therapy in the

intensively treated group- sulfonylurea, insulin, and metformin—had similar efficacy

in reducing the fasting plasma glucose and glycated hemoglobin levels. Over 9 years,

patients assigned to intensive therapy with sulfonylurea or insulin had lower fasting

plasma glucose levels (median, 7.3 and 9.0 mol/L, respectively) and lower

hemoglobin A1c levels (6.7% and 7.5%, respectively) than patients assigned to

conventional therapy.. Nine years after the diagnosis of diabetes, 29% of the patients

had had a diabetes-related clinical end point, 20% had had a macrovascular

complication, and 9% had had a microvascular complication. The study concluded

stating that the obtained improvement in glucose control causes a 15% decrease or

increase in the incidence of major complications.16

6.2.3 Studies related to effectiveness of structured teaching programme

A study was conducted a study in Delhi to know the effectiveness of planned

teaching programme on rehabilitation of cancer breast patients after mastectomy in

terms of knowledge and expressed practices of nursing personnel among 50 samples

who were selected by purposive sampling technique. The findings revealed that the

mean post test knowledge score 66.50% of nursing personnel was found to be

significantly higher than their mean pre test knowledge score 50.68% with ‘t’ value

27.9,p 0.05 level suggesting effectiveness of planned teaching programme.24

A study was conducted among 100 to evaluate the effectiveness of Structured

Teaching Programme (STP) on knowledge regarding specific self care activities

among primi gravida women at selected hospital in Tumkur. The findings indicated

that the mean pre test knowledge score of 46.8% and‘t’ value of 24.20 and is

significant at p<0.001. It is evident that the STP is significantly effective method of

improving knowledge .25

A study conducted among 100 samples to determine the effectiveness of

planned teaching programme on selected aspects of adolescent reproductive health

among female students of selected pre university course at selected college of

Bangalore. The findings revealed that the mean post test knowledge score (80.9%) of

respondents found to be which was apparently higher than the mean pre test

knowledge score (51.2%) with‘t’ value of 23.20 which was found to be significant at

p<0.01 and p<0.05 level. This supports that the planned teaching programme is

effective method of providing information.26

A study was conducted in Delhi to assess the effectiveness of Structured

Teaching Programme (STP) on home care management of Diabetes Mellitus (DM)

among 50 samples. Who were selected by purposive sampling technique. The

findings revealed that the mean post test knowledge score 30.06% was higher than the

pre test knowledge score 19.50% with the‘t’ value of 12.91 and found to be

significant at the level of p<0.001. This supports that the STP is effective method of

providing information on home care management of DM.27

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON PREVENTION OF MICROVASCULAR COMPLICATIONS

OF DIABETIS MELLITUS AMONG DIABETIC PATIENTS IN A SELECTED

URBAN COMMUNITY, BENGALURU.

6.3 OBJECTIVES OF THE STUDY

6.3.1. To assess the knowledge of diabetic patients on prevention of microvascular

complications in terms of pre-test scores.

6.3.2. To develop and administer structured teaching programme on prevention of

microvascular complications among diabetic patients.

6.3.3. To determine the effectiveness of structured teaching programme on prevention

of microvascular complications in terms of pre-test and post-test scores.

6.3.4. To find out the association between the pre test knowledge scores with selected

demographic variables.

6.4 HYPOTHESES OF STUDY

This study is attempted to examine the following hypotheses.

6.4.1 RESEARCH HYPOTHESES

H1: There will be significant difference between the pre-test and post-test

knowledge scores on prevention of microvascular complications among diabetic

patients

H2: There will be significant association between the pre-test knowledge scores

with selected demographic variables of diabetic patients on prevention of

microvascular complications.

6.5 VARIABLES UNDER THE STUDY

INDEPENDENT VARIABLE:

In this study, independent variable is structured teaching programme on

prevention of microvascular complications among the diabetic patients.

DEPENDENT VARIABLE:

In this study, dependent variable is knowledge on prevention microvascular

complications among diabetic patients.

6.6 OPERATIONAL DEFINITIONS

Assess: In this study, assess refers to the way the level of knowledge as expressed by

the diabetic patients on prevention of microvascular complications as measured by

pre-test scores.

Effectiveness: In this study, effectiveness refers to the extent to which the structured

teaching programme on prevention of microvascular complications achieves the

desired effect in improving the knowledge and perceived needs of diabetic patients on

prevention of microvascular complications as evidenced by gain in post-test

knowledge scores.

Structured teaching programme: In this study, it refers to systematically developed

instructional method and visual aids designed and used for diabetic patients to provide

information on prevention of microvascular complications such as meaning, etiology,

clinical manifestations, treatment and the methods to prevent the complications.

Prevention: In this study, prevention refers to measures taken to reduce the risk of

microvascular complications among diabetic patients.

Microvascular complications: In this study, Microvascular complications refer to

retinopathy, nephropathy and neuropathy.

Diabetic patients: It refers to the individuals aged between 30-70 yrs who are

diagnosed with type II diabetes mellitus under regular medical treatment residing in a

selected urban community, Bengaluru.

Knowledge: In this study, knowledge refers to the correct response of diabetic

patients on prevention of Microvascular complications elicited through the Structured

Knowledge Questionnaire.

6.7 ASSUMPTIONS

The researcher assumes that:

6.7.1 The diabetic patients may have some basic knowledge regarding prevention

of microvascular complications

6.7.2 Patients with diabetes mellitus may develop microvascular complications.

6.7.3 Diabetic patients may have interest to know more about prevention of

microvascular complications

6.7.4 Structured teaching programme will enhance the knowledge of diabetic

patients on prevention of microvascular complications

6.8 DELIMITATION OF STUDY

The study is delimited to selected 50 diabetic patients who are residing in

selected urban community area, Bengaluru

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from diabetic patients of selected urban community area,

Bengaluru.

7.2. METHOD OF DATA COLLECTION

Structured Knowledge Questionnaire will be used to collect the data from the diabetic patients

7.2.1 RESEARCH APPROACH

Evaluative research approach will be used to conduct the study.

7.2.2 RESEARCH DESIGN

GROUP PRE TEST TREATMENT POST TEST

1 O1 K X O2 K

The research design for the study will be quasi experimental design, with one group

pre test – post test design.

Effectiveness = Post test score – Pre test score

O1K : Knowledge on prevention of microvascular complications of diabetes.

X : Structured teaching programme on the prevention of microvascular

Complications of Diabetes Mellitus.

O2K : Knowledge on prevention after the administration of Structured Teaching

Programme.

7.2.3 RESEARCH SETTING

The above study will be conducted in a selected urban community, Bengaluru.

7.2.4 POPULATION

The population of the present study comprises of diabetic patients who are residing in

a selected urban community, Bengaluru.

7.2.5 SAMPLE SIZE

The sample size of the present study consists of 50 diabetic patients who are residing

in selected urban community, Bengaluru.

7.2.6 SAMPLING TECHNIQUE

Purposive Sampling Technique will be adopted for this study.

7.2.7 SAMPLING CRITERIA

Inclusion criteria

Diabetic patients who are willing to participate in the study.

Diabetic patients between the age group of 30-70 years.

Diabetic patients free from microvascular complications

Diabetic patients who are available during the time of data collection.

Exclusion criteria

Diabetic patients who have attended any diabetic camps on prevention of

microvascular complications

7.2.8 TOOL FOR DATA COLLECTION

A structured knowledge questionnaire will be used to collect the data from the

diabetic patients. It consists of 2 parts-Part-I and Part- II.

Part-I:

It consists of items on demographic variables like age, gender, educational

qualification, occupation, religion, family history of diabetes, food habits, weight,

abdominal circumference, source of information related to microvascular

complications of diabetes mellitus.

Part-II:

It consists of Structured Knowledge Questionnaire on prevention of microvascular

complications among diabetic patients.

7.2.8 DATA ANALYSIS METHOD

Data analysis will be done through descriptive and inferential statistics.

DESCRIPTIVE STATISTICS

Frequency, mean, mean percentage and standard deviation to compute demographic

variables.

INFERENTIAL STATISTICS

A. Paired t-test will be used to compare the pre-test and post-test knowledge

scores.

B. The association between the pre-test knowledge score and demographic

variables will be calculated by chi-square test (X2).

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON PATIENTS, OR OTHER ANIMALS?

Yes, the study will have an impact on the diabetic patients on prevention of

microvascular complications.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION

Ethical clearance is obtained from the research committee of THE OXFORD

COLLEGE OF NURSING, and the copy of the certificate is enclosed.

Permission will be obtained from the authorities of the selected community,

Bengaluru, where the study is schedule to be conducted.

Informed consent will be obtained from the diabetes patients who are willing

to participate in the study at the time of data collection.

8. LIST OF REFRENCES:

1. Available from URL: http://en.wikipedia.org/wiki/Diabetes_mellitus

2. World Health Organisation .World Diabetes Day. 2011 Nov 14.

Available from URL:

http://www.who.int/mediacentre/events/annual/world_diabetes_day/en/

3. World health organisation. Non Communicable Diseases - World Diabetes

Day. 2011 Nov 14. Available from URL:

http://www.searo.who.int/en/section1174/section1459_16218.htm

4. World Diabetes Foundation. Diabetes Facts. 2011 Oct 19. Available from

URL:

http://www.idf.org/latest-diabetes-figures-paint-grim-global-picture.

5. Teena Thacker, India has largest number of diabetes patients, ‘Indian Express’

2009 Oct 21

6. Available on URL: http://nethealthsite.com/general-diabetes-info/102-global-

scenario-of-diabetes.html

7. Thomas Harder ,  Elke Rodekamp, Karen Schellong, Joachim W.

Dudenhausen,Andreas Plagemann. Birth Weight and Subsequent Risk of Type

2 Diabetes: A Meta-Analysis. 2006 165 (8) 849-857.

8. Rajeev Chawla. “Vascular Complications in Diabetes – Its clinical evaluation

& screening”. Available from URL:

http://www.natboard.edu.in/notice_for_dnb_candidates/Vascular.htm

9. Maji D . Prevention of microvascular and macrovascular complications in

diabetes mellitus. Journal of Indian Medical Association. 2004 102 (8) 426,

428, 430.

10. Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the

Kumamoto Study on optimal diabetes control in type 2 diabetic patients.

Diabetes Care 2000 2 (23) B21-9.

11. Association of systolic blood pressure with macrovascular and microvascular

complications of type 2 diabetes (UKPDS 36): prospective observational study

editorial). BMJ 2000 321:41

12. Klein R, Klein B E, Moss S E. Relation of glycemic control to diabetic

Microvascular complications of Diabetes Mellitus. Annals of Internal

Medicine 1996 124 (1) 90-96

13. Available from URL:

http://www.sciencedirect.com/science/article/pii/S0140673608607667

14. Glycemic control and prevention of microvascular and macrovascular disease

in the Steno 2 study (editorial). Journal of the American College of

Endocrinology 2006; 89-92

15.  Stearne M R,  Palmer S L,  Hammersley M S , Franklin S L,Spivey R S .

Tight blood pressure control and risk of macrovascular and microvascular

complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317 (1760) 703-713

16. Turner Robert, Cull Carole, Holman Rury. United Kingdom Prospective

Diabetes Study 17: A 9-Year Update of a Randomized, Controlled Trial on the

Effect of Improved Metabolic Control on Complications in Non-Insulin-

dependent Diabetes Mellitus. Annals of Internal Medicine 1996,124 (1) 136-

145.

17. Shafiqur Rahman, Irfan Zia. Prevalence of microvascular complications

among diabetic patients. Pakistan J. Med. Res 2004 43 (4)

18. Ghani Abdul Muhammad, Nawaf  Gamal, Nawaf  Fawaz, Itzhak Baruch,

Minuchin Oscar, Vardi Pnina. Increased prevalence of microvascular

complications in type 2 diabetes patients with the metabolic syndrome. The

Israel Medical Association journal IMAJ 2006 8 ( 6) ,  378-382

19. Rosolová H, Petrlová B,  Simon J, Sifalda P, Sípová I , Sefrna F.

Macrovascular and microvascular complications in type 2 diabetes patients.

Vnitrni lekarstvi  2008 54 (3) 229-237.

20. Happich M , Breitscheidel L, Meisinger C , Ulbig M, Falkenstein P, Benter U

et.al. Microvascular complications from a German retrospective observational

study. Current Medical Research And Opinion  2007 23 (6) 1367-1374.

21.  Bleyer A J,  Reddy S V,  Sujata L,  Russell G B, D Akinnifes D. Sickle cell

trait and development of microvascular complications in diabetes mellitus.

Clinical Journal of the American Society of Nephrology  2010  5 (6)  1015-

1020

22. Hemmingsen Christina, Lund S Soren, Bianca Hemmingsen, Allan Vaag,

Thomas Almdal. Intensive glycaemic control for patients with type 2 diabetes:

systematic review with meta-analysis and trial sequential analysis of

randomised clinical trials. BMJ 2011 343 

23. Pradeepa R , Anjana RM, Unnikrishnan R, Ganesan A, Mohan V, Rema M.

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subjects with type 2 diabetes--the Chennai Urban Rural Epidemiology Study

(CURES) Eye Study-5. Diabetes Technol Ther 2010 12(10):755-61.

24. Basanth M. Effectiveness of planned teaching programme on rehabilitation,

of cancer breast patients after mastectomy in terms of knowledge and

expressed practices of nursing personnel. The nursing journal of India, 2007

XCVIII (12): 12-15

25. Gisha. Effectiveness of structured teaching programme on knowledge

regarding specific self care activities among primi gravid women at selected

hospital, Tumkur. The nursing journal of India, 2006 XXIII (10),23-25

26. Bharathi R. Effectiveness of planned teaching programme on selected aspects

of adolescent reproductive health among female students, Times of India,

2005 XXIII (11), 26-29

27. Shaini GS, Venkateshan L. Effectiveness of structured teaching programme

on home care management of DM. The nursing journal of India 2007 XXVIII

(12)

9. SIGNATURE OF THE STUDENT:

10. REMARKS OF THE GUIDE : The topic which is selected by the student

researcher is appropriate and feasible to the

current existing scenario of increasing

number of complications among Diabetic

patients. It helps the diabetic patients to

modify the risk factors to prevent its

complications.

11. NAME AND DESIGNATION

OF GUIDE : Mrs. Semmalar. S.

Asst.Professor,

Medical Surgical Nursing

The Oxford College of Nursing.

11.1 GUIDE’S NAME AND

ADDRESS : Mrs. Semmalar. S.

The oxford college of nursing

No. 6/9 & 6/11, 1st cross, Begur Road

Hongasandra, Bengaluru-560068

11.2 SIGNATURE OF THE GUIDE:

11.3 HEAD OF THE DEPARTMENT

NAME AND ADDRESS : Prof. Babu R.

The Oxford College Of Nursing

No. 6/9 & 6/11, 1st cross, Begur Road

Hongasandra, Bengaluru- 560068

11.4 SIGNATURE OF HOD :

12. REMARKS OF PRINCIPAL : The topic selected is relevant as it helps

the Diabetic patients to improve their

knowledge regarding prevention of

complications of diabetes mellitus.

12.1 SIGNATURE OF PRINCIPAL:

Dr. G. KASTHURI

The Principal

The Oxford College of Nursing

No.6/9 & /11, 1st Cross, Begur Road,

Hongasandra, Bengaluru- 560068