Knowledge and practice of diet among outpatients with type 2 diabetes at Lang Son General Hospital in 2020

Nội dung text: Knowledge and practice of diet among outpatients with type 2 diabetes at Lang Son General Hospital in 2020

1. RESEARCH ARTICLE KNOWLEDGE AND PRACTICE OF DIET AMONG OUTPATIENTS WITH TYPE 2 DIABETES AT LANG SON GENERAL HOSPITAL IN 2020 Vu Van Thanh1, Than Thi Binh2 1Nam Dinh University of Nursing 2Lang Son Medical college ABSTRACT Objectives: To describe the knowledge 4 to 6 meals. 57.9% of patients achieved and practice on diet of outpatients with type dietary practice; patients eating more than 2 diabetes at Lang Son General Hospital in 3 meals per day and using animal fat for 2020; To determine some factors related food were accounted 19.1% and 49.1%. to knowledge and practice on diet of Conclusion: Knowledge and practice on outpatients with type 2 diabetes at Lang diet of outpatients with type 2 diabetes at Son General Hospital. Method: The cross- Lang Son General Hospital was limited; sectional descriptive study was conducted age, accommodation and education level to collect data using self-determination are related to the knowledge on diet of questionnairesfrom 340 outpatients with type 2 diabetic patients (p<0,05). Research type 2 diabetes at Lang Son General results showed that it is necessary to Hospital from March to August in 2020 . enhence health education to improve Results: 76.2% of patients had correct knowledge and practice on diet for patients. knowledge on diet; 30.6% of patients had Keywords: Patients with type 2 diabetes; correctly answering about the number knowledge on the diet; practice on diet. of meals / day of a diabetic patient from 1. INTRODUCTION Diabetes is now recognized as the about 578 million people living with this “pandemic” of the 21st century. Every year, disease, and this number could rise to 700 the world has to spend thousands of billions million by 2045. However, 50.1% of people dollars in direct costs for treatment and do not know they had diabetes, about prevention of complications, but still unable 374 million people have impaired glucose to fill the dire losses and consequences tolerance, which is a high risk group for of diabetes. According to International developing the disease [1]. Diabetes Federation (IDF) in 2019, there In Viet Nam, in 2002, 2.7% of the are about 463 million people in the world population were suffering from diabetes, with aged from 20 to 79 facing with diabetes. but by 2012 this rate had increased by Patients with type 2 diabetes accounts for 5.7% of the population. Thus, after 10 about 90%. By 2030, worldwide there are years, the prevalence of diabetes in our country increased by 211.1% [2]. According to IDF, in 2019, Viet Nam had about 3.78 million people (6% of the population) living Cor. author: Vu Van Thanh with diabetes, predicting that by 2045, it Email: vuthanhdhdd@gmail.com may reach 6.4 million people (7.1% of the Received: Feb 08, 2021 population) have this disease [1]. Revised: Feb 15, 2021 Accepted: Mar 05, 2021 The prevalence of diabetes tends to Journal of Nursing Science - Vol. 04 - No. 01 57
2. RESEARCH ARTICLE increase worldwide; especially, type 2 2.1.1. Inclusion criteria diabetes. The increase of type 2 diabetes - Patients were 18 years old and above. is related to some risk factors such as increased obesity rate, unhealthy diet, - Patients were diagnosed with type 2 sluggish movement. Studies showed diabetes who were at outpatient department that patients who do not comply with the in Lang Son General Hospital from March diet is increasing. Failure to comply with to August 2020. the diet will have consequences such as - The patient can read and understand decreased blood sugar control, leading to VietNamese and respond to the interview. serious complications such as eye, kidney, nervervous, foot the cost of medical services - Patients had no history of psychosis or has also increased; This not only affects psychiatric disorders. directly to the patients but also becomes a 2.1.2. Exclusion criteria burden for families and society [1]. - The patient did not agree to participate In 2019, Lang Son General Hospital in the study. examined and managed 5204 outpatients with diabetes; including 3619 patients - Patients had severe disease progress with type 2 diabetes. This is the hospital must go to inpatient treatment. with the highest number of patients with 2.2. Setting and research period diabetes in Lang Son province. There are many researches on diabetes but most - Research period: The study was of them focus on diagnosis, treatment of conducted from January 2020 to November complications, management and treatment 2020. of diseases. There are few studies on - Period of data collection: From March adherence to the diet of outpatients with to August 2020. type 2 diabetes. Therefore, the research was conducted on the topic: “Knowledge - Research setting: Outpatient and practice on diet of outpatients with type department - Lang Son General Hospital. 2 diabetes at Lang Son General Hospital in 2.3. Research design 2020” with 2 objectives: Cross-sectional descriptive study 1. To describe the knowledge and practice on diet of outpatients with type 2 2.4. Sample size and sampling method diabetes at Lang Son General Hospital in - Sample size: 2020. 2. To determine some factors related Apply the sample size formula for to knowledge and practice on diet of descriptive study outpatients with type 2 diabetes at Lang 2 Son General Hospital in 2020 n = Z (1 - ) 𝛼𝛼 𝑝𝑝𝑝𝑝 2. RESEARCH METHOD 2 n: Sample size required2 𝑑𝑑 2.1. Research subjects p = 0.67: Percentage of patients with The patient was diagnosed with type 2 correct knowledge (According to research diabetes by Nguyen Trong Nhan in 2019) [2]. 58 Journal of Nursing Science - Vol. 04 - No. 01
3. RESEARCH ARTICLE q = 1 - p = 1 - 0.67 = 0.33 type 2 diabetes including 15 questions d: Permissible error, choose d = 0.05 One correct answer got 1 point, Incorrect answer or do not know/practice got 0 point α: Significance level, choose α = 0.05 then Patients had correct knowledge on diet: Z (1 - ) = 1,96 When they got scores ≥ 70% of the total 𝛼𝛼 score (equivalent to 7 points or more). 2 2 Patients had correct practice on diet: => n= 1,96 = 340 When they got scores ≥ 70% of the total 0,67 𝑥𝑥 0,33 score (equivalent to 10 points or more). 𝑥𝑥 2 - Sampling method:0,05 Using convenient sampling method 2.7. Data analysis During the period from March to August After collecting, the data was checked 2020, there were 340 patients who met and cleaned. The data were synthesized by the criteria and agreed to participate in the using SPSS 18.0 software study. Descriptive statistical including mean, 2.5. Data collection percentage, standard deviation were used to describe the general information, All data were collected by directly knowledge and practice on diet. The OR interview. ratio test and 95% confidence interval Patients meet the criteria were selected was used to determine factors related to and explained about the study, ethical knowledge and practice on diet of patients issues, data collection procedures and with type 2 diabetics. invited them to participate in the research. 3. RESULTS Patients were interviewed while patients were finished examination and testing and 3.1. General characteristics of awaiting the test result research subjects 2.6. Research instruments and The average age of subjects was 67.0 ± evaluation criteria 10.3 years; 82.9% of patients lived in urban areas; 51.2% of patients were men. The The research instruments which were majority of the subjects were retire (52.6%); used in this study were based on the 30.3% of patients had family member facing “Guidelines for diagnosis and treatment of with diabetes. type 2 diabetes” of the Minister of Health in 2017 [3]. 32.6% of patients had no complications. The questionnaire consists of 40 Among patients had complications, questions and is divided into 3 parts: hypertension complication is the most common complication, accounting for - Part A: General information of the 63.2%. patient including 15 questions - Part B: Knowledge on diet of patients with type 2 diabetes including10 questions - Part C: Practice on diet of patients with Journal of Nursing Science - Vol. 04 - No. 01 59
4. RESEARCH ARTICLE 3.2. Knowledge and practice on diet of the subjects Table 1. Knowledge on diet of the subjects (n = 340) Correct answer Contents Number % The right diet helps to stabilize blood sugar and lipids 282 82.9 Use green vegetables with meals 340 100 Do not eat a lot of sweet fruits 261 76.8 Do not eat foods from animal viscera 254 74.7 Use animal fats 187 55.0 Limited carbonated soft drinks 288 84.7 Limited drinking sugar and cane juice 293 86.2 Limited drinking alcohol 279 82.1 Limited fruit juices 153 45.0 Do not skip breakfast 340 100 Prepare food in the form of boiling, cooked 248 72.9 Choose foods that raise blood sugar quickly 178 52.4 Number of meals / day from 4 to 6 meals 104 30.6 The results of Table 1 showed that Patients had the correct answers diffirences between contents: use animal fatsf (55.0%), limited fruit juices (45.0%), choose foods that raise blood sugar quickly (52.4%), number of meals / day from 4 to 6 meals (30.6%) 23.8% Correct knowledge Incorrect knowledge 76.2% Figure 1. Classify knowledge on diet of patients with type 2 diabetes (n = 340) The results of figure 1 showed that 76.2% of patients with type 2 diabetes have correct knowledge on diet. 60 Journal of Nursing Science - Vol. 04 - No. 01
5. RESEARCH ARTICLE Table 2. Practice of using green vegetables, number of meals and using fats and oils for cooking of the subjects (n = 340) Patients’ anwers Contents Number % Use green vegetables in daily meals Every day 324 95.2 2-3 times / week 8 2.4 More than 3 times / week 8 2.4 Number of meals / day 3 meals / day 275 80.9 More than 3 meals / day 65 19.1 Selection and use of oils and fats for cooking Oil / margarine 268 78.8 Animal fats 167 49.1 Combine 2 types of oil and fats 127 37.3 The results of Table 2 showed that only 19.1% of patients ate more than 3 meals / day; 49.1% of patients use Combine 2 types of oil and fats for cooking. Table 3. Practice of eating ripen fruits and drinking alcohol per day of the subjects (n = 340) Patients’ anwers Contents Number Number Ripen fruit is often eaten Dragon fruit, guava 193 56.8 Jackfruit 8 2.4 Bananas 91 26.8 Durian 7 2.0 Mango 41 12.0 The amount of alcohol and beer drinking per day (men: from 3 cups/day, women: 2 cups/day or more; 340 ml of beer or 140 ml of wine / week or more) Yes 43 12.6 No or less than the above amount 297 87.4 The table 3 showed that the majority of ripen fruits which patients usually eat were dragon fruit, guava (56.8%). 12.6% of patients drunk alcohol/beer as recommended by the Ministry of Health. Journal of Nursing Science - Vol. 04 - No. 01 61
6. RESEARCH ARTICLE 42.1% Pass 57.9% Not pass Figure 2. Classify practice on diet of of patients with type 2 diabetes (n = 340) 57.9% of patients had achieved practice on the diet of diabetic patients. 3.3. Factors related with knowledge and practice on diet of patients with type 2 diabetics Table 4. Relationship between general characteristics of the subjects with knowledge on diet (n = 340) Knowledge on diet Correct Incorrect OR Contents p n % n % (95% CI) Age group Under 60 years old 79 85.9 13 14.1 2.3 p = 0.016 From 60 years old and up 180 72.6 68 27.4 (1.2 – 4.4) Gender Female 133 80.1 33 19.9 1.53 p = 0.124 male 126 72.4 48 27.6 (0.92 – 2.54) Accommodation Urban 225 79.8 57 20.2 2.79 p = 0.001 Rural 35 55.6 28 44.4 (1.5 – 5.07) Education level High school and above 181 81.2 42 18.8 2.16 p = 0.004 Secondary school and below 78 66.7 39 33.3 (1.3 – 3.6) Occupation Officer 170 79.4 44 20.6 1.6 p = 0.088 Other 89 70.6 37 29.4 (0.97 – 2.67) The results of this table showed that there were relationships between age group, ac- commodation and education level and knowledge on diet of patients. Compared with the age group under 60 years old, the correct knowledge rate was 2.3 times higher among those over 60 years old; Patients lived in urban areas had the correct knowledge was 2.79 62 Journal of Nursing Science - Vol. 04 - No. 01
7. RESEARCH ARTICLE times higher than rural areas; Patients with education from High school and above had the correct knowledge was 2.16 times higher than Secondary school and below (p <0.05) Table 5. Relationship between knowledge and practice on diet (n = 340) Practice Pass Not pass OR Knowledge p n % n % (95% CI) Correct 171 66.0 88 34.0 4.11 p < 0.001 Incorrect 26 32.1 55 67.9 (2.41 – 7.0) The results of the table 5 showed that patients with correct knowledge had pass practice 4.11 times higher than patients with incorrect knowledge (p <0.05). 4. DISCUSSION answer about “using animal fat in cooking”. 4.1. General characteristics of It have been explained that the diabetic subjects patients think they only had a disorder of sugar metabolism in the body, not related The average age of subjects was 67.0 ± to lipids or blood fats. Thus, study subjects 10.3 years. Our result is higher than study have not paid enough attention to diet, while of Pham Lan Anh with the average age of diet is an important part of the treatment 59.5 ± 2.5 years [4]. In this study, almost strategy to control blood sugar, as well as of patients lived in urban areas (82.9%). prevent complications of the disease. In This finding is higher than study of Nguyen our study, only 30.6% of patients had the Trong Nhan (57.1%) [2]. Differece settings correct answer about “the number of meals/ of studies can be the reason for these. day of diabetic patients from 4 to 6 meals”. 30.3% of patients had family member This result is similar to study of Nguyen facing with diabetes. Our finding is similar Trong Nhan (33.7%) [2]. to study of Doan Thi Hong Thuy (37.0%) [5]. The results of figure 1 showed that Family factors are one of the risk factors for 76.2% of patients had correct knowledge on diabetes. Therefore, the individual lifestyle diet of diabetic patients. This result is higher of the patient greatly affects the prevalence than the research of Ha Thi Huyen in 2016 of diabetes. (59.4%) [7]. The difference may be due to 4.2. Knowledge and practice on diet the period that the study was conducted. of the subjects. In recent years, the promotion and The results of Table 1 showed that 82.9% education of diabetes on health has been of patients had correct knowledge on diet promoted and diversified in various forms of to help stabilize blood sugar and lipids; communication. Therefore, the percentage 100% of patients had correct knowledge of patients with correct knowledge on diet about using green vegetables in meals. Our also increases. findings are similar to Vu Thi Tuyet Mai with Only 19.1% of patients ate more 100% of patients know how to use green than 3 meals/day; 95.2% of patients ate vegetables in meals [6]. vegetables every day. Our research results 74.7% of patients had correct answer are similar to study of Vu Thi Tuyet Mai with about “do not eat foods from animal viscera”, the rate of patients eating vegetables every “should not use animal fat” (55.0%). day, accounting for 97.7%, the number However, 45.0% of patients had incorrect of patients eating the correct number of Journal of Nursing Science - Vol. 04 - No. 01 63
8. RESEARCH ARTICLE meals per day is 15.3% [6]. Healthcare had a clear understanding of the diet for workers should to enhence counseling and diabetics, they will have correct practice on health education for patients to improve diet [2]. effectiveness treatment. Only 12.6% of patients drunk alcohol/ 5. CONCLUSION beer as recommended by the Ministry of - The percentage of patients with correct Health. The result is lower than study of knowledge on diet for type 2 diabetes was Nguyen The Hung (19.2%) [8]. This can be 76.2%. 30.6%. of patients had correct explained by the average age of the patient answer about the number of meals/day of a is 66 years old, the patient also accompanied diabetic patient from 4 to 6 meals by some other diseases or complications of diabetes, so that the majority of patients do - 57.9% of patients had achieved not use alcohol or beer. practice on the diet of diabetic patients; 19.1% of patients eating more than 3 meals Through the figure 2, the percentage of / day; 49.1% of patients use animal fat for patients who achivied practice on diet was cooking. 57.9%. This study result is similar to study of Doan Thi Hong Thuy (58.0%) [5]. - Age, accommodation, education level related to knowledge on diet of type 2 4.3. Factors related with knowledge diabetes patients with p <0.05 and practice on diet of patients with type 2 diabetics - There is a positive relationship between knowledge and practice on diet of type 2 The results of Table 4 showed that there diabetes patients with p <0.05.. were relationships between age group, accommodation and education level and knowledge on diet of patients. Compared REFERENCES with the age group under 60 years old, the correct knowledge rate was 2.3 times 1. International Diabetes Federation higher among those over 60 years old; (2019). IDF Diabetes Atlas 9th ed, Edition, Patients lived in urban areas had the p.12-50. correct knowledge was 2.79 times higher than rural areas; Patients with education 2. Nhan Nguyen Trong (2019). from High school and above had the correct Effectiveness of health education knowledge was 2.16 times higher than intervention on knowledge and practice of Secondary school and below (p <0.05). Our diet in outpatient with type 2 diabetes at Bac research results are similar to study of Bui Giang Endocrine Hospital in 2019. Master’s Thi Huong with the relationship between thesis in Nursing, Nam Dinh University of age and knowledge on diet. The age group Nursing. [in Vietnamese] under 60 years old had correct knowledge 3. Ministry of Heath (2017). Decision was 1.62 times higher than age group over 60 years old (p <0.05) [9]. No. 3319 / QD-BYT on promulgating the Professional Document “Guidelines Knowledge is an important factor for Diagnosis and Treatment of Type that positive affecting on practice of the patients. Table 5 showed that patients with 2 Diabetes”, dated July 19, 2017. [in correct knowledge had pass practice 4.11 Vietnamese] times higher than patients with incorrect 4. Anh Pham Lan (2017). Effect of the knowledge (p <0.05). When the patient herbal extracted from the leaves of Robusta 64 Journal of Nursing Science - Vol. 04 - No. 01
9. RESEARCH ARTICLE - Guava - Lotus (VOSCAP) on controlling blood glucose and improving biochemical indicators in patients with diabetes type 2 in Hanoi. Master’s thesis in Nutrition, National Institute of Nutrition. [in Vietnamese] 5. Thuy Doan Thi Hong (2019). Changing knowledge and practice of treatment compliance in outpatients with type 2 diabetes at Son La Endocrine Hospital in 2019. Master thesis of Nursing, Nam Dinh University of Nursing. [in Vietnamese] 6. Mai Vu Thi Tuyet (2014). Knowledge, attitude and practice of diet in patients with type 2 diabetes. Hochiminh Journal of Medicine, 18(5), p. 18- 20. [in Vietnamese] 7. Huyen Ha Thi (2016). Knowledge, attitude, behavior and health care needs of type 2 diabetic patients at the General Internal Medicine Clinic, Kon Tum General Hospital in July 2016, Master thesis in Nursing, Ho Chi Minh University of Medicine and Pharmacy. [in Vietnamese] 8. Hung Nguyen The (2019). Factors related to treatment adherence in outpatients with type 2 diabetes at the Medical Center in Hoa Lu district, Ninh Binh province in 2019. Master Thesis in Public Health, University of Public Health. [in Vietnamese] 9. Huong Bui Thi (2017). Factors related to diet adherence in outpatients with type 2 diabetes at the Endocrinology Department in the People’s Hospital 115 in 2017. Master thesis of Public Health, University of Public Health. [in Vietnamese] 10. National Endocine Hospital (2012). The 7th National Conference on Endocrine - Metabolism on October 3, 2012, Hanoi. [in Vietnamese] Journal of Nursing Science - Vol. 04 - No. 01 65