Socio demographic characteristics
A total of 404 patients were included in the study of which 402 responded, yielding a response rate of 99.5%. Of the total participants, 225 (56%) were females and 243 (60.4%) were urban dwellers. Most of the respondents, 150 (37.3%) were aged 45-70 years. The majority 304 (75.6%) of the participants were orthodox Christians and 348 (86.6%) were from Amhara ethnic group. One hundred and eighteen (29.4%) study participants had a family history of diabetic mellitus. Out of the total respondents, 242 (61.3%) were married, 110(27.4%) are unable to read and write, were urban dwellers, 85 (21%) were farmers, and 156 (38.8%) had a monthly income below 500 Ethiopian birr (Table 1).
Table 1: Socio demographic characteristics of Type 2 adult DM patients at Adiss Zemen District Hospital, Gondar, Ethiopia, 2019(N=402)
Variables
|
Frequency
|
Percent (%)
|
Sex
|
|
Male
|
177
|
44.0
|
Female
|
225
|
56.0
|
Age
|
|
18-30
|
134
|
33.3
|
31-45
|
118
|
29.4
|
45-70
|
150
|
37.3
|
Level of Education
|
|
Cannot read and write
|
110
|
27.4
|
Informal education can read and write
|
124
|
30.8
|
Primary school and can read and write
|
77
|
19.2
|
Secondary school and above
|
91
|
22.6
|
Marital status
|
|
Married
|
202
|
50.2
|
Divorced
|
37
|
9.2
|
Widowed
|
49
|
12.2
|
Single
|
114
|
28.4
|
Occupation
|
|
Farmer
|
85
|
21.1
|
Government worker
|
46
|
11.4
|
Merchant
|
104
|
25.9
|
Housewife
|
77
|
19.2
|
NGO worker
|
90
|
22.4
|
Religion
|
|
Orthodox
|
304
|
75.6
|
Muslim
|
68
|
16.9
|
Protestant
|
30
|
7.5
|
Ethnicity
|
|
Amhara
|
348
|
86.6
|
Kimant
|
35
|
8.7
|
Tigrie
|
19
|
4.7
|
Residence
|
|
Rural
|
159
|
39.6
|
Urban
|
243
|
60.4
|
Duration of DM
|
|
(1-5)
|
270
|
67.2
|
(6-10)
|
93
|
23.1
|
>10
|
39
|
9.7
|
Type of medication they use
|
|
Oral
|
133
|
33.1
|
Injectable
|
218
|
54.2
|
Both
|
51
|
12.7
|
Family history of DM
|
|
Yes
|
118
|
29.4
|
No
|
284
|
70.6
|
Income( ETB)
|
|
<500
|
156
|
38.8
|
500-1500
|
68
|
16.9
|
1501-2500
|
86
|
21.4
|
>2500
|
92
|
22.9
|
Abbreviations: ETB=Ethiopian Birr, DM= Diabetes mellitus, NGO= Non-governmental organizations
Attitude of type 2 diabetic patients towards complications of diabetes
Two-thirds of the study participants 65.2% (95% CI: 60.2, 69.4) possessed good attitude levels. Most (74.1%) of the respondents agreed that diabetic complications could be prevented. Nearly three quarters (74.1%) of respondents thought they could lead a normal life if they take appropriate measures for diabetes. Over two-third of the participants 69(16.9%) believed that diabetic complications can be prevented by having good glycemic control. The majority (79.9%) of participants agreed that regular exercise can prevent complications of diabetes. Dietary modification and weight reduction was considered important to prevent diabetic complications by 91.8% (n=369) and 46.3% (n=186) respondents, respectively. One hundred thirty-five (33.6%) respondents believed that their diabetic diet spoils their social life. Furthermore, 214(53.2%) respondents thought diabetics were the worst thing that ever happened to them (Table 2).
Table 2: Frequency distribution of participant’s response on attitude related questions on DM complications among Type 2 adult DM patients at Adiss Zemen District Hospital, Gondar, Ethiopia, April, 2019(N=402)
Variables
|
Frequencies
|
%
|
I can lead a normal life if I take appropriate measures for diabetes
|
|
Agree
|
298
|
74.1
|
Disagree
|
64
|
15.9
|
Neither nor disagree
|
70
|
10
|
Regular exercise prevents further complication
|
|
Agree
|
321
|
79.9
|
Disagree
|
25
|
6.2
|
Neither nor disagree
|
56
|
13.9
|
Glycemic control has no role in preventing complications
|
|
Agree
|
68
|
16.9
|
Disagree
|
333
|
82.8
|
Neither nor disagree
|
1
|
2
|
Diabetic spoils my social life
|
|
Agree
|
135
|
33.6
|
Disagree
|
232
|
57.7
|
Neither nor disagree
|
35
|
8.7
|
I could prevent diabetic complications
|
|
Agree
|
298
|
74.1
|
Disagree
|
40
|
10
|
Neither nor disagree
|
64
|
15.9
|
Dietary modification is important to prevent diabetic complication
|
|
Agree
|
369
|
91.8
|
Disagree
|
29
|
7.2
|
Neither nor disagree
|
4
|
1
|
Weight reduction is important to prevent diabetic complication
|
|
Agree
|
186
|
46.3
|
Disagree
|
104
|
25.9
|
Neither nor disagree
|
112
|
27.9
|
I don’t tell people as I have diabetics
|
|
Agree
|
38
|
9.5
|
Disagree
|
349
|
86.8
|
Neither nor disagree
|
15
|
3.7
|
Diabetes is the worst thing that have ever happened to me
|
|
Agree
|
214
|
53.2
|
Disagree
|
173
|
43
|
Neither nor disagree
|
15
|
3.7
|
Total attitude level
|
|
Good attitude
|
262
|
65.2
|
|
Poor attitude
|
140
|
34.8
|
Abbreviations: DM= Diabetes Mellitus
Factors associated with attitude towards complications of diabetes
The residence and educational status of the respondents had a significant influence on attitude. Subjects who informal school and can read and write were 2.3 times (AOR=2.32, 95% CI=1.26, 4.27) more likely to have good attitude as compared to those who cannot read and write. Type 2 diabetic patients who attained primary school and can read and write were 4 times (AOR= 4.31, 95% CI= 2.06, 9.02) more likely to have good attitude than those who cannot read and write. Similarly, those who conquered secondary school and above were 2.8 times (AOR=2.79, 95% CI=1.41, 5.50) more likely to have good attitude than those who cannot read and write. Patients from urban area were 1.8 times (AOR=1.80, 95% CI=1.12, 2.91) more likely to have a good attitude than those who live in a rural area (Table 3).
Table 3: Factors affecting good attitude towards DM complication among Type 2 adult DM patients at Adiss Zemen Hospital, Gondar, Ethiopia, April 2019.
Variables
|
Attitude status
|
COR(95%CI)
|
AOR(95%CI)
|
Good attitude
|
Poor attitude
|
Level of Education
|
|
|
|
|
|
Can’t read and write
|
49
|
61
|
1
|
|
Informal school and Can read and write
|
88
|
36
|
3.04(1.77,5.22)**
|
2.32(1.26, 4.27)**
|
Primary school and can read and write
|
60
|
17
|
4.39(2.28,8.47)**
|
4.31(2.06, 9.02)**
|
Secondary school and above
|
65
|
26
|
3.11(1.73,5.62)**
|
2.79(1.41, 5.50)**
|
Marital status
|
|
|
|
|
|
Married
|
144
|
58
|
1
|
1
|
Divorced
|
25
|
12
|
0.84(0.40,1.78)
|
0.96(0.41, 2.22)
|
Widowed
|
22
|
27
|
0.33(0.17,0.62)*
|
0.51(0.24, 1.08)
|
Single
|
71
|
43
|
0.67(0.41,1.08)
|
0.41(0.22, 1.72)
|
Occupation
|
|
|
|
|
|
Farmer
|
48
|
36
|
1
|
1
|
Government employee
|
29
|
17
|
1.25(0.60, 2.62)
|
1.33(0.58, 3.04)
|
Merchant
|
72
|
32
|
1.65(0.91, 3.01)
|
1.56(0.79, 3.06)
|
House wife
|
56
|
21
|
1.96(1.01,3.79)*
|
2.18(0.95, 4.49)
|
NGO worker
|
56
|
34
|
1.21(0.66, 2.22)
|
1.12(0.57, 2.19)
|
Residence
|
|
|
|
|
|
Rural
|
87
|
72
|
1
|
|
Urban
|
175
|
68
|
|
|
Duration of DM
|
|
|
2.13(1.40, 3.24)**
|
1.80(1.12,2.91)**
|
|
1-5
|
186
|
84
|
1
|
|
6-10
|
56
|
37
|
0.68(0.41, 1.11)
|
0.79(0.46, 1.38)
|
>=10
|
20
|
19
|
0.47(0.24, 0.93)*
|
0.55(0.25,1.25)
|
Income(ETB)
|
|
|
|
|
|
<500
|
110
|
46
|
1
|
1
|
500-1500
|
36
|
32
|
0.47(0.26,0.85)*
|
0.55(0.28, 1.08)
|
1501-2500
|
50
|
36
|
0.58(0.34, 1.01)*
|
0.52(0.27, 1.99)
|
>2500
|
66
|
26
|
1.06(0.60, 1.88)
|
0.69(0.35,1.37)
|
*significant at P-value≤0.05, ** significant at P-value≤0.01
Abbreviations: ETB=Ethiopian Birr, DM= Diabetes mellitus, NGO= Non-governmental organizations, COR= Crude Odds Ratio, AOR= Adjusted Odds Ratio
Practice of type 2 diabetic patients towards complications of diabetes
Almost half of the respondents 48.8% (95% CI: 44.0, 53.5) had good practice towards diabetic complications. More than two-third of the patients 280(69.7%) reported that they never forgot to take their medication. One hundred nine (27.1%) and 179(44.5%) respondents said that they stopped their medication when they felt better and felt worse, respectively. Only about 21(5%) respondents performed exercise daily. The majority (86.6%) of them change their diet according to the recommendations of their physician. Most (80.1%) of respondents monitor their blood glucose level in hospital. One hundred fifty-one (37.6%) of respondents monitor their blood glucose level monthly. Greater than 239 (59%) of respondents reported daily feet examination. Only 48(11.9%) of respondents use hot water to wash their foot and 45.5% take care when they cut their nail. Regular kidney and eye checkup was practiced by 29.9% and 7.7% of study participants, respectively. Nearly all, 96.8% of respondents do not smoke and 188(46.8%) of the participants never drink alcohol (Table 4).
Table 4: Response distribution of practice on DM complications related questions among Type 2 adult DM patients at Adiss Zemen District Hospital, Gondar, Ethiopia, April, 2019
Variables
|
Frequencies
|
%
|
Forget to take medicine/ insulin
|
|
Yes
|
122
|
30.3
|
No
|
280
|
69.7
|
Careless at times about taking medicine
|
|
Yes
|
114
|
28.4
|
No
|
288
|
71.6
|
Stop taking medicine when feel better
|
|
Yes
|
109
|
27.1
|
No
|
293
|
72.9
|
Stop taking medicine when feel worse
|
|
Yes
|
179
|
44.5
|
No
|
223
|
55.5
|
Physical work or exercise in the last week
|
|
Never
|
186
|
46.3
|
Once a week
|
43
|
10.7
|
2-3 times per week
|
99
|
24.6
|
Almost daily
|
53
|
13.2
|
Daily
|
21
|
5.2
|
Duration of physical work or exercise
|
|
<10Minutes/day
|
57
|
14.2
|
10-20Minutes/day
|
74
|
18.4
|
20-30Minutes/day
|
36
|
9.0
|
>30Minutes/day
|
49
|
12.2
|
Diet modification according to the recommendations of physician
|
|
Yes
|
348
|
86.6
|
No
|
54
|
13.4
|
Monitoring blood glucose
|
|
Self- monitoring
|
68
|
16.9
|
Local pharmacy
|
12
|
3.0
|
Hospital
|
322
|
80.1
|
Barriers for self-blood glucose monitoring
|
|
Too expensive
|
128
|
31.8
|
Too painful
|
6
|
1.5
|
Don’t know how to test
|
77
|
19.2
|
Other
|
123
|
30.6
|
Frequency of blood glucose monitoring
|
|
Monthly
|
151
|
37.6
|
Every 2 month
|
165
|
41.0
|
Every 3 month
|
86
|
21.4
|
checking feet
|
|
Never
|
41
|
10.2
|
Daily
|
239
|
59.5
|
Once a week
|
6
|
1.5
|
Rarely
|
116
|
28.9
|
Drinking alcohol
|
|
Never
|
188
|
46.8
|
Weekly
|
34
|
8.5
|
2-3 times weekly
|
50
|
12.4
|
Nearly every day
|
29
|
7.2
|
Rarely
|
101
|
25.1
|
Cigarette smoking
|
|
Yes
|
13
|
3.2
|
No
|
389
|
96.8
|
Wearing footwear during exercise as recommended by health professionals
|
|
Yes
|
196
|
48.8
|
No
|
206
|
51.2
|
Type of water used to wash feet
|
|
Cold water
|
354
|
88.1
|
Warm water but not hot
|
48
|
11.9
|
care during cutting toe nails
|
|
Yes
|
183
|
45.5
|
No
|
219
|
54.5
|
Periodic kidney examination
|
|
Yes
|
120
|
29.9
|
No
|
282
|
70.1
|
Regular checkup of eye by eye specialist
|
|
Yes
|
31
|
7.7
|
No
|
371
|
92.3
|
Practice level
|
|
Good practice
|
196
|
48.8
|
|
Poor practice
|
206
|
51.2
|
Abbreviations: DM=Diabetic mellitus
Factors associated with practice towards complications of diabetes
Educational status was the single independent factor associated with patients practice towards diabetic complications. The odds of good practice towards prevention of complications of diabetes were two times (AOR=1.96, 95% CI=1.06, 3.61) more likely among type 2 diabetic patients who were informal school and can read and write, four times (AOR= 4.31, 95% CI= 2.06, 9.02),more likely among participants attains primary school and can read and write and two point six times (AOR=2.57, 95% CI=1.32, 5.02) more likely among who attains secondary school and above than those who cannot read and write (Table 5).
Table 5: Factors affecting good practice towards DM complication among Type 2 adult DM patients at Adiss Zemen Hospital, Gondar, Ethiopia, April, 2019.
Variables
|
Practice level
|
COR(95%CI)
|
AOR(95%CI)
|
Good practice
|
Poor practice
|
|
|
Age
|
N
|
|
|
|
|
18-30
|
81
|
53
|
1
|
1
|
31-45
|
53
|
65
|
0.53(0.32,0.88)*
|
0.69(0.35, 1.40)
|
>=45
|
62
|
88
|
0.46(0.29,0.74)*
|
0.59 (0.30, 1.15)
|
Level of education
|
|
|
|
|
|
Can’t write and read
|
33
|
77
|
1
|
1
|
Informal school and can Read and write
|
67
|
57
|
2.74(1.60, 4.70)**
|
1.96(1.06, 3.61) *
|
Primary school and can read and write
|
38
|
39
|
2.27(1.24, 4.16)*
|
1.53(0.78, 3.01)
|
Secondary school and above
|
58
|
33
|
4.10(2.27, 7.40)**
|
2.57(1.32, 5.02)**
|
Marital status
|
|
|
|
|
|
Married
|
94
|
108
|
1
|
|
Divorced
|
18
|
19
|
1.09(0.54, 2.20)
|
1.13 (0.51, 2.52)
|
Widowed
|
16
|
33
|
0.56(0.29, 1.08)
|
0.99(0.46, 2.12)
|
Single
|
68
|
46
|
1.70(1.07, 2.71)
|
1.11(0.58, 2.13)
|
Occupation
|
|
|
|
|
|
Farmer
|
38
|
47
|
1
|
|
Government employee
|
12
|
34
|
0.44(0.20,.96)
|
0.39(0.17,1.90)
|
Merchant
|
59
|
45
|
1.62(0.91,2.89)
|
1.49(0.79, 2.82)
|
House wife
|
37
|
40
|
1.14(0.62,2.12)
|
1.33(0.68, 2.59)
|
NGO worker
|
50
|
40
|
1.55(0.85,2.81)
|
1.41(0.73, 2.72)
|
Resident
|
|
|
|
|
|
Rural
|
63
|
96
|
1
|
|
Urban
|
133
|
110
|
1.84(1.23,2.77)*
|
1.49(0.94, 2.37)
|
Duration of DM
|
|
|
|
|
|
≤5
|
147
|
123
|
1
|
|
6-10
|
36
|
57
|
0.53(0.33,0.86)*
|
0.65(0.38, 1.13)
|
≥10
|
13
|
26
|
0.42(0.21,0.85)*
|
0.57(0.26, 1.27)
|
Level of income
|
|
|
|
|
|
<500
|
80
|
75
|
1
|
|
500-1500
|
28
|
40
|
0.67(0.37, 1.18)
|
1.07(0.55, 2.08)
|
1501-2500
|
33
|
53
|
0.59(0.35, 1.01)
|
0.82(0.43, 1.55)
|
>2500
|
55
|
37
|
1.41(0.84, 2.38)
|
1.71(0.89, 3.25)
|
*significant at P-value≤0.05, ** significant at P-value ≤0.01
Abbreviations: DM= Diabetes mellitus, NGO= Non-governmental organizations, COR= Crude Odds Ratio, AOR= Adjusted Odds Ratio