Role of Pharmacist in Structured Teaching on Self Care Management of Diabetes Me llitus Abstract: A structured teaching programme (STP) was

designed to educate the diabetic patie nts on disease condition, investigation, foot care, exercise and personal hygien e, which in turn is expected to increase the awareness among diabetic patients a nd prevent further complications. A supportive educative system to help diabetic patients in decision-making, behaviour-control and knowledge acquisition was de finitely felt as essential by the investigators. The educative system can guide, teach and promote an environment for the diabetic patients to practice the prev entive measures like diet control, exercises, self- administration of medication and regular follow up. The pharmacists can play a crucial role in creating the supportive system for the diabetic patients. Present study was conducted to asse ss the existing level of knowledge on home care management of diabetes among dia betic patients through pretest and effectiveness of STP on knowledge of home car e management of diabetic patients through post-test. Finally, association betwee n pre and post-test level of knowledge regarding home care management and select ed demographic variables was evaluated. Keywords: Diabetes mellitus, structured teaching programme, pharmacist, self-car e Introduction: In the last two decades, the worldwide explosion in the prevalence of type 2 dia betes mellitus has become a major societal challenge of the 21st century1. Diabe tes increasingly affects the young or middle-aged, with more than half of diabet ics in developing countries between the ages of 40 and 59. Each year, another 7 million people develop diabetes, while 3.8 million die of diabetes-linked causes 2. India now has the largest number of diabetics (almost 41 million) in the worl d, followed by China (nearly 40 million), the United States (19.2 million) and R ussia (9.6 million). By 2025, the number of people with diabetes is expected to rise to 380 million worldwide, with 80 percent living in the developing world2. Diabetes mellitus (DM) is a metabolic disease characterized by absolute insulin deficiency, or relative insulin deficiency when insulin secretion is inadequate to overcome co-existent resistance to insulin action on carbohydrate, protein or fat metabolism. DM generally develops in genetically susceptible individuals wi th superimposed environmental and behavioural factors mainly sedentary lifestyle and obesity. These two conditions will lead to development of insulin resistance, o ne of the major metabolic impairments involved in the pathophysiology of type 2 diabetes. But it is only when the pancreatic beta cells fail to fully compensate for this insulin resistance that glucose intolerance will appear as impaired gl ucose tolerance (IGT) (postprandial hyperglycemia) and/or impaired fasting gluco se3 (IFG) (mild fasting hyperglycemia). The American Diabetes Association s (ADA) criteria for the diagnosis of DM were rece ntly revised to include a new threshold for the diagnosis of impaired glucose to lerance (IGT) and impaired fasting glucose (IFG). The diagnosis of DM is made on the basis of one of the following criteria4 (i) Symptoms of hyperglycaemia incl uding polyuria, polydipsia, weight loss plus random plasma glucose concentration >200 mg/dl (11mM). (ii) Fasting (> 8 h fast) plasma glucose > 126 mg/dl (7 mM). (iii) 2 h post-prandial glucose >200 mg/dl during an oral glucose tolerance tes t (OGTT). Criteria for diagnosing IGT and IFG are 2 h plasma glucose between 140 -200 mg/dl or a fasting glucose between 100-125 mg/dl respectively4-6. Material And Methods: The present study was conducted at the out patient department of Sri Guru Nanak Dev Hospital, Amritsar, Punjab, India. Purposive sampling technique was used and 100 samples were selected. Tool was prepared on the basis of objectives. The in

struments used in this study were demographic variable proforma and structured q uestionnaire on home care management. The structured questionnaire consisted of 38 multiple choice questions regarding home care management of diabetes mellitus . Each question had 4 options which included one right answer. Every correct ans wer carried one mark and no negative marking was given for wrong answers. The to tal score was 40 which was classified into 3 levels. <50% Inadequate knowledge 50-70% Moderately adequate knowledge >75% Adequate knowledge

Validity of the tool was obtained by getting opinions from 5 experts in Punjab, India. The reliability of the tool was elicited by using test-retest method 7. A nd the reliability was r = 0.89. Null hypotheses were formulated and Pharmaceuti cal Care Model was followed for this study 8. Data were collected by purposive sampling technique. Pretest was conducted on the first day. After pre-test the S TP on home care management of diabetes mellitus was implemented on the same day with the help of audio visual aids. Post-test was conducted on the fifth day usi ng the same questionnaire. Results And Discussion: There was equal percentage of participants (50%) from both sexes. Most of the su bjects were graduates (60%). The subjects comprised of equal number of participa nts from working and non-working groups (50%). The family history of diabetes wa s present in 30% of the subjects. Heredity plays a very important role in the de velopment of diabetes mellitus9. This study revealed that 98% had a family histo ry of diabetes mellitus out of which 30% of subjects had acquired it genetically from their fathers. It was found that 39% were well aware and knowledgeable about diabetes mellitus and its management because of being chronical and because of information acquire d through TV shows, radio programmes, newspapers, pamphlets etc. The patients we re coming regularly for check up every month. In the pre-test, majority of the participants (60%) has inadequate knowledge, 36 % of participants have moderately adequate knowledge and none of them had adequa te knowledge. In the post-test, 70% of the participants gained adequate knowledg e and none of them had inadequate knowledge. The overall mean and standard devia tion of knowledge on home care management was increased in post-test (M=30.00 SD =3.44) when compared with pre-test (M=19.51. SD=4.66). The highest improvement in mean value was observed in the aspect of diet (M=5.0) . There was no significant association between the selected demographic variable s and level of knowledge on home care management of diabetes mellitus in pre-tes t as well in post-test. The finding shows that diabetic patients attending OPD l ack knowledge regarding home care management of diabetes, irrespective of their demographic characteristics. Pharmacist should recognize the need for teaching patients. It has been reported that diabetic patient see their pharmacist 7 times more often than see their ph ysicians10. This puts pharmacist in a key position to identify people at high ri sk to convey the importance of proper self management, to encourage closer follo w up with physicians, & to help screen for problems that may arise with pharmaco therapy. The study stresses the importance of the pharmacists being knowledgeabl e to provide adequate information about diabetes home care management. Pharmacis t should possess skills in counseling person-to-person or group counseling withi n the short time available in the out patient department. The Pharmacy curriculum should be updated to enable pharmacy students to identif y the educative supportive needs of the chronically ill diabetic patients. The s

tudents should cultivate their cine. This study calls for the tem of pharmacy education. The he latest views about diabetes

skills in giving health education along with medi strengthening of patients education as a part of sys course content of the curriculum should include t mellitus.

Conclusions: A major responsibility of the professional pharmacists is helping patients gain self-management skills for any chronic health problem through teaching and couns eling. Self-management skills are probably the major determinant of how well the health problem is controlled and the quality of life maintained, particularly f or persons with diabetes. Research confirms that patient education has a positiv e effect on patient out-comes. The pharmacist is in a unique position to educate and motivate patients with diabetes mellitus to optimize well-being and minimiz e long-term diabetes complications.

Refrences: 1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates fo r the year 2000 and projections for 2030. Diabetes Care. 2004, 27, 1047 1053. 2. Martin Silink, M.D., president, International Diabetes Federation; Alan Moses , M.D., associate vice president, medical affairs, Novo Nordisk, Princeton, N.J. ; March 14, 2007, press briefing with Australian Sen. Guy Barnett, Global Changi ng Diabetes Leadership Forum, New York City. 3. Unwin N, Shaw J, Zimmet P, Alberti K G. Impaired glucose tolerance and impai red fasting glycaemia: the current status on definition and intervention. Diabe t Med, 2002, 19, 708 723. 4. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes C are, 2006, 29 (Suppl 1), S43-8. 5. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care, 2003, 26, 3160-7. 6. Report of the Expert Committee on the Diagnosis and Classification of diabete s mellitus. Diabetes Care, 1997, 20, 1183-97. 7. Wermille J, Bennie M, Brown I, McKnight J. Pharmaceutical care model for pati ent with type 2 diabetes: Integration of the community pharmacist into the diabe tes team-a pilot study. Pharmacy world & science, 2004, 26 (1), 18-25. 8. Robert D. M, David L. R, Arthur J. H, Ronald K. K, Alfred A. R. Obesity and h eredity in the etiology of non-insulin-dependent diabetes mellitus in 32,662 adu lt white women. American Journal of Epidemiology, 1989, 130 (1), 112-121. 9. Robert W. B. J. Note on the relationship between internal consistency and tes t-retest estimates of the reliability of a test. Psychometrika, 1942, 7 (3), 157 -164 10. Cranor C. Outcomes of Ashville project. Pharm Times 1998, (Suppl), 19-25.

Table 1. Mean and standard deviation of pre-test and post-test level of knowledg e on home care management of diabetes mellitus. Knowledge Scores M SD t Pre-test 19.50 4.66 Post-test 30.00 3.44 12.90*** Improvement 12.56 1.22 (N =100).***P<0.001