Garima Bhutani describes for SIIC his article published in Indian Journal of Endocrinology and Metabolism 19(3):383-386, May 2015

Haryana, India (special for SIIC)
Hypoglycemia is one of the most common complications of diabetes management. Many a times, this problem is increased by over enthusiastic approach of health care professionals to tightly control blood glucose levels along with deficiencies on the part of patients to follow the accompanying instructions of the doctors. According to the American Diabetes Association, blood glucose levels < 70 mg% should be considered as hypoglycaemia.¹ Hypoglycaemia can produce short term complications like morning headaches, nightmares, night sweats, light headedness, shakiness or weakness along with long-term complications like neurologic damage, trauma, cardiovascular events and death.² Hence it is very important to avoid hypoglycaemia in the patients. This study had been planned to assess how successful can diabetic education prove to be in improving the awareness of hypoglycemia in diabetics and the practices adopted by those patients for its prevention.

The study was a longitudinal study conducted in diabetic patients taking oral hypoglycemics. After obtaining written informed consent, the patients were given a predesigned and pretested performa to fill the questionnaire. The questionnaire had 20 questions to assess the knowledge (7), attitude (7) and practices (6) of the diabetic patients toward prevention of hypoglycemia. The knowledge part of the questionaire was to assess the patients’ knowledge of the possibility of hypoglycaemia in diabetes, its dangerous nature, its causes (skipping of meals or excessive exercises) and common symptoms (morning headache, shakiness, weakness, passing out, intense hunger) of hypoglycaemia. Attitude part evaluated the patients’ beliefs regarding simple preventive measures for avoiding hypoglycemia. Patients were asked whether they knew the importance of knowing hypoglycaemic symptoms, timely meal and medicine intake, avoiding excessive exercises, self monitoring of blood glucose, keeping toffees for emergency and educating the family members of the patients. The practice part of the questionnaire was to judge how the knowledge and attitudes of the patients are practically put into action. The patients were asked whether they really take timely meals and medicines, avoid heavy exercises, keep toffees for emergency, self monitor blood sugar levels and pay attention to the warning symptoms of hypoglycaemia. Each correct response was scored as “one” and each wrong answer or unsure response was scored as “zero”. The incidence of hypoglycemic symptoms in the patients in the past 1-week was assessed by 7 questions from Stanford questionnaire. The enquired symptoms were morning headaches, nightmares, night sweats, light headedness, shakiness or weakness, intense hunger and passing out episodes. After filling the performa, patients were educated regarding symptoms, consequences, treatment and prevention of hypoglycaemia. They were also advised to go for self monitoring of blood glucose. The patients were again made to fill the same questionnaire after 1 month of diabetic education. The baseline scores and follow up scores were compared by paired t test to assess the effect of diabetic education on knowledge, attitude and practices of diabetic patients and on incidence of hypoglycaemic episodes in them.

The knowledge scores of the diabetic patients increased significantly from 1.24 ± 0.20 to 5.14 ± 0.18 after diabetic education. Attitude scores improved from 2.11 ± 0.11to 5.01 ± 0.09. Diabetic education significantly increased self reported practices scores from 1.57 ± 0.09 to 2.96 ± 0.10. Overall hypoglycaemic symptom score decreased significantly from 1.11 ± 0.09 to 1.01 ± 0.08. The most commonly reported hypoglycaemic symptoms were night sweats and light headedness.

The knowledge of causes and symptoms of hypoglycaemia was grossly deficient in diabetic patients but after diabetic education, awareness of possibility of hypoglycemia and the dangerous nature of hypoglycemic episodes is known to many. The knowledge of the symptoms of hypoglycemia also increased. Although many patients initially knew about the importance of timely intake of meals and medicines but realisation of importance of self-monitoring of blood glucose, keeping toffees or candies for an emergency situation and avoiding excessive exercises was not there. But diabetic education was seen to improve these attitudes of the patients also. With regard to practices, the situation was even worse. With diabetic education, the practices of the patient also improved but it was not equivalent to knowledge and attitude improvement. Unfortunately, the practice of self-monitoring of blood glucose and keeping toffees and candies as an emergency measure was least commonly followed. The reason for this may be lack of awareness, education and resources along with forgetfulness and busy job schedule of the patients. Many patients experienced hypoglycaemic symptoms in past 1 week, most common of which were weakness, shakiness, and intense hunger. Although overall hypoglycaemic symptom score was decreased after proper education, but problems like night sweats and light headedness continued to bother the patients. Thus this study points towards the fact that inspite of many obstacles like busy and hectic schedule of doctors, low literacy level and forgetfulness of the patients, busy jobs of some of the patients and their low socio-economic levels; repeated health education and motivation by doctors can improve the knowledge and attitude of the patients and decrease the hypoglycemic episodes in them.