RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

PRAVEEN J

1st YEAR MSc NURSING

MEDICAL SURGICAL NURSING

YEAR 2011-2012

B.M.S HOSPITAL NURSING COLLEGE

NO.618, SRI MALLIKARJUNA TEMPLE STREET

N.R.COLONY

BANGALORE-560019

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,

BENGALURU, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

NAME OF THE CANDIDATE AND ADDRESS

Mr. PRAVEEN J

THEERTHAM , GANDHIMUKKU

KADAKAVOOR P O, KERALA-695306

2.

NAME OF THE INSTITUTION BMS HOSPITAL COLLEGE OF NURSING,

BANGALORE

3.

COURSE OF STUDY AND SUBJECT M.SC NURSING

MEDICAL SURGICAL NURSING.

4.

DATE OF ADMISSION

17-06-2011

5.

TITLE OF THE STUDY:

“A STUDY TO ASSESS THE KNOWLEDGE

REGARDING PREVENTION OF MAJOR

COMPLICATIONS OF DIABETIC MELLITUS

AMONG DIABETIC PATIENTS IN A SELECTED

HOSPITAL BANGALORE WITH A VIEW TO

DEVELOP AN INFORMATION BOOKLET TO

CREATE AWARENESS.”

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“Life is not over because you have diabetes. Make the most of what you have, be grateful.

2

Dale Evans Rogers

The star of life. Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general

condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain .[1] The World Health Organization

(WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence

of disease or infirmity."[2]

The endocrine system place a vital role in our body. It is made up of glands that produce and secrete hormones. Hormones are chemical

messengers created by the body. They transfer information from one set of cells to another to coordinate the functions of different parts of

the body. These hormones regulate the body's growth, metabolism (the physical and chemical processes of the body), and sexual

development and function. The hormones are released into the bloodstream and may affect one or several organs throughout the body [3].

The pancreas is a part of endocrine system. The pancreas is a dual-function gland, having features of both endocrine and exocrine glands.

The part of the pancreas with endocrine function is made up of approximately a million [3] cell clusters called islets of Langerhans. Four

main cell types exist in the islets.they can be classified by their secretion as α cells secrete glucagon (increase glucose in blood), β cells

secrete insulin (decrease glucose in blood), δ cells secrete somatisation (regulates/stops α and β cells).The islet of Langerhans plays an

imperative role in glucose metabolism and regulation of blood glucose concentration[4].

Insulin is a hormone produced by the pancreas. Its function is to regulate carbohydrate and fat metabolism in the body. Insulin causes cells in

the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. Insulin stops the use of fat as

an energy source by inhibiting the release of glucagon. Insulin is provided within the body in a constant proportion to remove excess glucose

from the blood. When blood glucose levels fall below a certain level, the body begins to use stored sugar as an energy source through

glycogenolysis, which breaks down the glycogen stored in the liver and muscles into glucose, which can then be utilized as an energy source.

When control of insulin levels fails, diabetes mellitus will result. [5]

Diabetes is from the Greek word meaning "siphon," and "mellitus" comes from melliferous, meaning "of or relating to honey." Diabetes has

been recognized for centuries and was originally diagnosed by tasting the urine and finding it sweet (melliferous). The high sugar also causes

the kidneys to excrete (or siphon) large amounts of water. In 1815, French chemist Michel Eugene Chevreul discovered that the sweetness

came from grape sugar or glucose. Later discoveries showed how the body makes, stores, and uses glucose. Injury to the pancreas was linked

to diabetes beginning in the seventeenth century and confirmed by animal experiments, particularly those of the German physiologist Joseph

von Mehring (1849-1908) and a Russian pathologist, Oscar Minkowski (1858-1931). The acinus cells were found in the seventeenth century

by the Dutch anatomist Regnier de Graaf and the islet cells in 1869 by a German pathologist Paul Langerhans (1847-1888)[6]

According to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the

population. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be

found by 2030.[7]

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Diabetes mellitus, is a metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin,

or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent

urination), polydipsia (increased thirst) and polyphagia (increased hunger).

There are three main types of diabetes:Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to

inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)Type 2 diabetes: results from

insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly

referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.)Gestational diabetes: is when pregnant

women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2

diabetes mellitus .

.The risk factors are Genetic or Hereditary ,No or low physical activity, Improper food habits ,Obesity ,Gestational diabetes during

pregnancy & Given birth a baby weighing more than 9 pounds , HDL or good cholesterol level less than 35 mg/dl ,Triglycerides level more

than 250 mg/dl, Blood pressure at or greater than 140/90 mmHg ,Previously diagnosed as pre-diabetes or Impaired glucose tolerance ,Ethnic

– Asian particularly Indian (world's largest diabetes population), Middle East, Oceania and the Caribbean, African American, Hispanic

Americans, and Native[8]

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications.[8]

Diabetes without proper treatments can cause many complications..The late complications of diabetes can be broadly classified as.

Microangiopathy includes Retinopathy, Nephropathy and Macroangiopathy includes Coronary Heart Disease ,Peripheral Vascular Disease,

Cerebrovascular Disease

Studies have shown that better control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of

kidney disease, eye disease, nervous system disease, heart attack, and stroke.[9] Basic principles of prevention of complications of diabetes

are take medications (pills and/or insulin) as prescribed by your doctor, Monitor your blood sugars closely, follow a sensible diet. Do not

skip meals.,Exercise regularly,See your doctor regularly to monitor for complications.[10]

Rising prevalence of Diabetes Mellitus especially Type-2 DM in Urban population is a serious concern. The countries with the largest

number of people with diabetes are and will also be in the year 2025, India, China and the U.S.1 With the increasing prevalence of diabetes

especially in the middle age group populations who are commonly affected in India,2 the chances of developing micro & macro vascular

complications are very high & it is going to bring enormous burden on the family, society & the health care providers involved in the

management of diabetes due to high morbidity & mortality. [11]

During the last decades, developing countries have experienced an epidemiologic transition characterized by a reduction of infectious

diseases and an increase of chronic degenerative diseases. This situation is generating tormenting public health, financial, and social

consequences. Of particular relevance is type 2 diabetes mellitus and its chronic complications, particularly cardiovascular disease and

diabetic nephropathy, because mortality of the patient with diabetes is, in most instances, related to these complications.

4

There is a clear need to implement diagnostic and treatment strategies to reduce risk factors for development of diabetes (primary

prevention), to detect risk factors of chronic complications in early stages of diabetes (secondary prevention), and to prevent further

progression of those that already have renal injury (tertiary prevention). Microalbuminuria is an early marker of renal injury in diabetes, and

its early detection can help the timely use of renal preventive measures, which would avoid the extremely high costs of renal replacement

treatment for end-stage renal disease as well as that of other cardiovascular complications.

Preventive strategies are of very little or no impact, if the primary physician has limited knowledge about the natural history of diabetic

nephropathy, the beneficial effect of early preventive manoeuvres for delaying its progression, and the social and economic impact of end-

stage renal disease. It is therefore imperative to assure in our health systems that general practitioners have the ability and commitment to

detect early diabetes complications, in order to promote actions that support regression or retard highly morbid cardiovascular and renal

conditions.[13]

6.1 NEED FOR STUDY

PREVENTION IS BETTER THAN CURE”

The prevalence of diabetes in India is very rapidly rising and it is estimated that by the year 2010A.D, 20% of all Type 2

patients in the world would be contributed from India. This form of diabetes till recently was considered as a mild diabetes or "a touch of

diabetes" and obviously the management strategies were less vigorous. Recently published studies.have proved beyond doubt, that tight

control of diabetes definitely prevents or slows down the progression of late complications of diabetes. Diabetes mellitus basically produces

changes in the blood vessels and hence can affect almost every part of the body. It is known that diabetes mellitus is a leading cause of

acquired blindness in the developed countries. It carries 2-3 times higher risk of heart attacks and an even higher risk for stroke. Diabetics are

at 5 times higher risk to develop nephropathy and an estimated 25% of all new cases of end stage renal diseases are the result of diabetes.

Diabetic patients are five times more prone to gangrene and diabetes accounts for 50% of all non traumatic complications. The onset Type 2

diabetes is usually insidious and the patient may remain asymptomatic until late stages of the diseases. Hence one should aim to make an

early diagnosis in order to reduce the morbidity and prevent the progression to end-stage complications. Thus, it is necessary to screen for all

complications at the time of diagnosis of diabetes.[14,15]

Type 2 diabetes mellitus is the commonest form of diabetes constituting 90% of the diabetes population. The acute and chronic

complications of diabetes mellitus are major causes of hospital admissions. Studies identified that the prevalence of micro vascular and

macro vascular complications were more in Asians when compared to Europeans. Common risk factors like greater duration of diabetes,

hypertension, poor metabolic control, smoking, obesity and dyslipidemia were more prone to develop diabetic complications. Micro vascular

diseases were common amongst patients at diagnosis In India. The morbidity and mortality caused by diabetes mellitus can be reduced by

secondary prevention through regular screening, early detection, and appropriate treatment of chronic complications.[16]

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It is no exaggeration to describe diabetes as one of the major contributors to ill health and premature mortality worldwide. Globally,

across all ages, it is estimated that at least 1 in 20 deaths are attributable to diabetes, and in adults aged 35 to 64 the proportion is at least 1 in

10 deaths. If the current trend continues it is estimated that by 2030 the number of people with diabetes will more than double. Most of this

increase will be due to a 150% increase in developing countries, where the greatest burden will fall on men and women in their economically

productive years. Because of its long term complications, diabetes is an extremely costly disease..

The first step in preventing or delaying the onset of diabetes complications is raising patients’ awareness of risk of complications

such as cardiovascular disease (CVD), nephropathy, retinopathy, and neuropathy in different populations. Other common complications of

diabetes include periodontal disease, birth defects or spontaneous abortions of babies in mothers with uncontrolled diabetes, and biochemical

imbalances that can cause life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma. There is also a greater

risk of contracting and dying from other illnesses, such as pneumonia or influenza.[18]

Clinical studies demonstrate that the complications of diabetes can be prevented or delayed by controlling risk factors such as

hyperglycemia, hypertension and hyperlipidemia.Despite knowledge gained through these studies, adherence to established evidence-based

treatment guidelines aimed at controlling these risk factors and utilization of preventive care services by both providers and patients are low.

This ultimately may result in patient outcomes that are less than optimal. The solution to the lack of adherence by both providers and patients

is not to lay blame, but rather to investigate the factors or barriers underlying non-adherence.

For primary prevention of diabetes complications to be effective, patients must have access to quality medical care and the

knowledge and skills to manage their diabetes on a day-to-day basis. Because access and self-care are critical contributors to outcomes in

patients with diabetes, socioeconomic mediators (education and/or income) may play a significant role in these processes.

Preventive health care is the cornerstone of primary and secondary prevention of diabetes complications. Practice guidelines

established by the American Diabetes Association and the Diabetes Quality Improvement Project are evidence-based and, if followed, are

likely to improve patient outcomes. However, perceived and real barriers to preventive service utilization can result in patients not seeking

care, nonadherence to treatment recommendations, and poorer health outcomes.[17]

6.2 REVIEW OF LITERATURE

Review of literature refers to an extensive ,exhaustive, and systematic examination of

publications relevant to the study. It is the an essential part of every research ,which helps to support the

hypothesis under the study and to analyze the structure and content of the research report .

6

Literature review is a standard requisition of scientific research . .It also supports and explains

why the proposed topics taken for research and avoid unnecessary duplication, explore the feasibility and

illuminate way to new research.

Review of literature consists of following section:

- Reviews on prevention and knowledge regarding complications of diabetes mellitus

Reviews on prevention and knowledge regarding complications of diabetes mellitus

A cross-sectional study was conducted in 816 type 2 diabetic patients from 5 rural Arkansas counties who

attended a diabetes education program from 2005 to 2009. The data was collected through a survey questionnaire and

from medical records. Univariate and multivariate analyses were conducted. Of the 816 patients studied, 9.6% had a

DPN diagnosis, and 43% reported peripheral neuropathy symptoms (PNS). Among the patients with PNS, 79% had

not been diagnosed with DPN. Multivariate analyses found that being female, being white, having less than a college

education, having a longer duration of diabetes, having a history of smoking, having a professional foot examination,

and performing self foot examinations are associated with a higher risk for having DPN or PNS. The study found that

the prevalence of patients with PNS was high, and that DPN was alarmingly underdiagnosed in these underserved

rural communities. The high prevalence of PNS and underdiagnosis of DPN could influence the development of

severe foot complications like diabetic foot ulcer, and even possibly increase the risk of lower extremity amputation in

these underserved communities. The at risk population identified by this study would be a resource to help diabetes

educators develop targeted education and intervention programs in underserved rural communities23.

A study was conducted in Catalonia on 427 Type 1 diabetic patients diagnosed between 1987 and 1988 in 15

hospitals in Catalonia on the prevalence of microvascular (retinopathy, nephropathy and neuropathy) and acute

diabetic complications, and the metabolic control status.The study showed that neuropathy was present in 4.3% and

microvascular complications such as retinopathy,nephropathy, clinical polyneuropathy as a whole and hypertension

was observed. There were no differences in diabetic complications regarding sex or age at presentation

Another study was conducted on Level of knowledge of 148 patients with type II diabetes mellitus in Urban

Health Center in Santander by personal interview method to know the level of information of type II diabetic patients

regarding the handling of complications and to their diet. The result of the study was worse and the study suggested

that due to the differences in knowledge within this group, the establishment of groups and subgroups when educating

diabetic patients and also highly recommended.

A study was conducted on Functional food and diabetes: A natural way in diabetes prevention .As per the

study Diabetes shows a wide range of variation in prevalence around the world and it is expected to affect 300 million

7

by the year 2025. In a prevention framework where banning policies and educational strategies lead the interventions,

functional foods (FFs) with their specific health effects could, in the future, indicate a new mode of thinking about the

relationships between food and health in everyday life. Functional ingredients, such as stevioside, cinnamon, bitter

melon, garlic and onion, ginseng, Gymnema sylvestre and fenugreek, have been addressed for their specific actions

towards different reactions involved in diabetes development. New strategies involving the use of FF should be

validated through large-scale population trials, considering validated surrogate end points to evaluate the effect of FF

in prevention of chronic diseases such as type 2 diabetes mellitus.

A study was conducted knowledge of diabetes and associated ocular complications among personnel

comprising the eye care team in Oman A closed ended questionnaire was administered during November

2008 and November 2009 to eye care team members in six regions of Oman, where trainings were held. All

participants of these trainings were included in our study. The questionnaire comprised 15 questions that

tested the knowledge of the diagnosis and treatment of diabetes and its ocular complications. They circled

the most suitable reply for a list of choices. The replies were compared with the gold standard (answers from

a medical retina specialist, a diabetologist's and general ophthalmologists answers). The participants were

divided into two groups; acceptable (more than 50% score compared to gold standard) and less than desired

(less than 50% score compared to gold standard.) We estimated the areas of acceptable level of knowledge

in different subgroups. Result showed that all 87 (100%) of eye care team members participated. Of the 42

general ophthalmologists, 30 (71.4%) had an acceptable level of knowledge about primary prevention, ideal

blood sugar and blood pressure levels and complication of diabetes. The acceptable level of knowledge

among mid level eye care providers and general physicians was found in 15 (54.5%) and 4 (33.3%)

respondents respectively.19

A study was to identify factors influencing diabetic patients' awareness of the risk of foot problems.

We performed a prospective study of diabetic patients hospitalized or seen in consultation. Various factors

were analyzed in order to identify those related to the patients' level of awareness of risk factors in diabetic

foot. Ninety-one patients were included (mean age: 48; male/female gender ratio: 0.63). Over 50% of the

study population was not aware of the risks of diabetic foot. Educational level and socioeconomic status had

an impact on awareness of good foot health and care. Poor knowledge of the degenerative complications of

diabetes was associated with age, a low educational level and low socioeconomic status. In diabetes, there is

still a need for easily assimilated, locally provided patient education.20

6.3 STATEMENT OF THE PROBLEM

8

“A study to assess the knowledge regarding prevention of major complications of diabetes mellitus among diabetic patients in

a selected hospital Bangalore with a view to develop an information booklet to create awareness.”

6.4 OBJECTIVES OF STUDY

1 .To assess the knowledge regarding prevention of major complications of diabetic mellitus among clients

with diabetes mellitus

2. To develop an information booklet on prevention of major complications of diabetes mellitus for clients

with diabetes mellitus.

3.. To find out the knowledge score of diabetic clients on prevention of major complication of diabetes with

their demographic variables

6.5 OPERATIONAL DEFINITIONS

Knowledge —is an ability of diabetic clients to respond to the structured knowledge questionnaire

prevention. Of major complication of diabetic mellitus

Diabetic mellitus – is a metabolic diseases in which the person has high blood sugar

Prevention –is avoiding the chance of acquiring complications of diabetic mellitus through behavioral

modification. In this study it refers to the expected behavioral modification, after providing information

booklet, so as to prevent major complications of diabetes mellitus

Diabetic clients-early diagnosed diabetic clients between the age of 40 to 70 .

Information booklet-refers to small book containing fact which, motivates diabetic clients to get awareness

regarding prevention of major complication of diabetes mellitus..

.6.6 ASSUMPTIONS

It is assumed that,

1 .The diabetic clients may have some knowledge regarding prevention of major complications.

2. .Diabetic clients may express their knowledge regarding prevention of major complications

3. Information booklet on prevention of major complications of diabetes mellitus is an expected strategy for to create awareness.

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6.7 HYPOTHESIS

H1 .There is a significant association between the knowledge of clients having diabetes mellitus regarding its

prevention of major complications with selected demographic variables

6.8 DELIMITATION

The study delimited to:

Clients with diabetes mellitus at selected hospital Bangalore

Those who are willing to participate in this study.

Clients who are available during the period of data collection at selected hospitals Bangalore.

6.9 PROJECTED OUTCOME:

Information booklet will make significant influence to improve the knowledge among diabetic clients

regarding prevention of complications about diabetes mellitus.

Diabetic clients can use the educational material prepared by the investigator on prevention of

complications about diabetes mellitus.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Data collected from diabetic clients in selected hospital Bangalore.

7.2 METHOD OF DATA COLLECTION

7.2.1 TYPE OF RESEARCH APPROACH

Non experimental descriptive survey approach

7.2.2 RESEARCH DESIGN

Descriptive research design

7.2.3 VARIABLES

A variable is any phenomenon or characteristics are attitudes under study. These are the measurable characteristics of concepts and consist of logical group of attitude.

a) Dependent variables:

10

These response behaviour are outcome that researcher wishes to predict or explain. In the proposed study dependent variables are:

Knowledge of diabetic clients regarding prevention of major complication of diabetes mellitus..

b) Independent variables-The information booklet or non experimental variable that is manipulated or

varied by the researcher to create an effect on dependent variables. In this study the booklet prepared by the

invigilator is the independent variable.

c) Attribute variable-age, sex, gender, knowledge, occupation, socio-economic status,

7.2.4 SAMPLING TECHNIQUE

Non probability purposive sampling technique

7.2.5 SAMPLE AND SAMPLE SIZE

40 diabetic clients in selected hospital Bangalore.

7.2.6 SAMPLING CRITERIA

Inclusive criteria

clients with diabetes mellitus

Clients who are willing to participate in the study

Early diagnosed diabetic clients between the age group of 40-70

clients who can understand English and kannada

Exclusive criteria

Clients who are not willing to participate in the study.

Clients who cannot read kannada

7.2.7 DURATION OF STUDY

1 month of data collection (4 weeks)

7.2.8 TOOL OR INSTRUMENTS

A Structured self administered knowledge questionnaire is used to collect data from diabetic clients.

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SECTION A; socio demographic profile-age, sex, gender, religion, economic status, occupation, education,

family history.

SECTION B; structured knowledge questionnaire

7.2.9 DATA COLLECTION PROCEDURE

The data collection procedure will be carried out for a period of one month .The study

will be initiated only after obtaining permission from concerned authorities. The data will be collected from

diabetic clients, by using structured knowledge questionnaire regarding prevention of major complications

of diabetes mellitus

7.2.10 PLAN OF STATISTICAL ANALYSIS

The data obtained will be tabulated and analyzed in terms of the objectives of the study

by using descriptive and inferential statistics .The plan for data analysis as follows;

Descriptive statistics Frequency, percentage distribution will be used to analyze the socio-demographic

variables of the clients.

Mean, means percentage and standard deviation will be used to assess the knowledge of diabetic clients

regarding prevention of major complications of diabetes mellitus

Inferential statistic

chi square test will be used to analyze the association between socio demographic variables and knowledge

of diabetic clients regarding prevention of major complications of diabetes mellitus..

7.3 Does the study require any investigation or intervention on patient tor human or animal, if so

describe briefly

Yes, with prior consent study will be conducted on diabetic clients to assess their

knowledge regarding prevention of major complications of diabetes mellitus by using structured knowledge

questionnaire.

7.4 Has ethical clearance been obtained from the institution

12

Yes. ethical clearance from the institution will be obtained from concerned authorities

and written consent will be taken from subject .Confidentiality and anonymity of the subject will be

maintained

8. LIST OF REFERENCES (VANCOUVER FORMAT)

13

1. Merriam-Webster. Dictionary - "Health", accessed 21 April 2011.

2. World Health Organization. 1946. [www.who.int/bulletin/archives/80 (12)981.pdf WHO definition of Health],

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference,

New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World

Health Organization, no. 2, p. 100) and entered into force on 7 April 1948

3. http://www.emedicinehealth.com/anatomy_of_the_endocrine_system/article_em.

4. http://en.wikipedia.org/wiki/Pancreas

5. http://en.wikipedia.org/wiki/Insulin

6. http://www.discoveriesinmedicine.com/Hu-Mor/Insulin.html

7. Resphttp://www.greenlife-herbal.com/GlucoTranz/Diabetes.

8. Zimmet P. Type II (non insulin dependent diabetes)– an epidemiological overview. Diabetologia.

1982; 22: 399-411.

9. http://en.wikipedia.org/wiki/Diabetes_control_and_complications_trial

10. http://healthy-ojas.com/diabetes/diabetes-risk-factors.html

11.http://my.clevelandclinic.org/disorders/diabetes_mellitus/hic_preventing_the_complicatns_of_diabetes.aspx

12.http://www.natboard.edu.in/notice_for_dnb_candidates/Prevention%20of%20Diabetic%20Complications.htm

13. http://www.nat14. Rema M, Ponnaiya M, Mohan V. Prevalence of retinopathy in non insulin dependent

diabetes Mellitus at a diabetes centre in southern India. Diabetes Research and Clinical Practice. 196; 34: 29- 36.

15. Kohner EM, Mcleod D and Marshall J. Diabetic eye disease. In : Keen H, Jarrett RJ (eds), Complications

16. King H, Auburt RE, Herman WH. Diabetes Care. 1998; 21:1414- 31.of diabetes. Edward Arnold, London. 1983, 91-

108

17. http://spectrum.diabetesjournals.org/content/14/1/23.full

18. American Diabetes Association. National diabetes fact sheet. Available at:

http://www.diabetes.org/utils/printthispage.jsp?PageID=STATISTICS_233193. Accessed March 14, 2005.

14

19. Middle East Afr J Ophthalmol. 2011 Jul;18(3):204-8. Khandekar R, Deshmukh R, Vora U, Al Harby S Knowledge of

Primary Prevention of Diabetic Retinopathy among General Ophthalmologists, Mid Level Eye Care Personnel and

General Physicians in Oman.

ure.com/ki/journal/v68/n98s/full/4496442a.html

20. Lamchahab FZ, El Kihal N, Khoudri I, Chraibi A, Hassam B, Ait Ourhroui M Ann Phys Rehabil Med. 2011

Sep;54(6):359-65. Epub 2011 Aug 2.Factors influencing the awareness of diabetic foot risks.[Article in English,

French]

21.Indian J Med Res. 2011 Apr;133(4):369-80. Anjana RM, Ali MK, Pradeepa R, Deepa M, Datta M, Unnikrishnan R,

Rema M, Mohan V. The need for obtaining accurate nationwide estimates of diabetes prevalence in India - rationale

for a national study on diabetes.

22. Ezenwaka C, Eckel J. The Diabetes & Metabolism Research Group, Faculty of Medical Sciences, The

University of the West Indies , Trinidad and Tobago. Harefuah.

2010 Dec;149(12):782-3, 811.

23. Department of Physical Therapy, University of Central Arkansas, Physical Therapy Centre, Conway, AR

72035, USA. wwang@uca.edu

24. Anne Waugh, Allisons Grant Text book of Anatomy and Physiology Ninth edition

Page number 235-237.

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE This study is feasible as it creates awareness regarding prevention of major complications of diabetes mellitus in diabetic patients thereby reduce the complications .

15

11.

11.1.

11.2.

11.3.

11.4.

11.5.

11.6.

NAME AND DESIGNATION

(in block letters)

GUIDE

SIGNATURE

CO- GUIDE (IF ANY)

SIGNATURE

HEAD OF THE DEPARTMENT

SIGNATURE

Mr. SIBI ALEXANDER

ASST. PROFESSOR

MEDICAL SURGICAL NURSING

Mr. SIBI ALEXANDER

12.1.

12.2

REMARKS OF THE CHAIRMAN AND PRINCIPAL

SIGNATURE

This study is feasible as it creates awareness regarding prevention of major complications of diabetes mellitus in diabetic patients thereby reduce the complications.

16