Diabetes care scale: a first line screening of self care and treatment behaviour in diabetics seeking treatment at a tertiary care setting in Bhubaneswar, Odisha
Quality in diabetic management is the need of the hour, in eye of the menacing increase in the disease in India. What is crucial is the long term consistent care which is needed to prevent setting in of complications, that further enhance the cost of treatment and compromise the disease outcome in terms of rising morbidity and mortality.
Hence, a sensitive qualitative handling of outpatient visits is warranted and an inbuilt mechanism of Quality of life scales (which are proxy of the patient’s response to disease) and Diabetic care scales (proxy for patient’s satisfaction to the care extended), would offer supportive evidence to physicians, of areas where they will have to be more careful. These scales are scientifically validated and are not only tools of assessment but also reinforce to the patients, the essential tips, that they need to adhere to in the course of diabetic management.
An ongoing exercise was planned in the state of art Diabetic clinic in Bhubaneswar, Odisha in a tertiary medical college in conjunction with Department of Community Medicine, where early diagnosed Diabetes 1 and 2 were made to answer to Quality of Life in Diabetics(QOLID) and Diabetic Care Scale(DCS), validated and pretested for Indian populations; and factors affecting patient’s responses were ascertained, to improve care. Date from December 2019 to August 2020 was considered and final sample of 599 interviews were assessed. The QOLID domains were inversely correlated (Pearson’s correlation) with DCS , all of which were strongly significant( treatment satisfaction, general health,symptom botherness, financial worries, emotional health and physical endurance). Only diet satisfaction was positively correlated and not significant, which hints that diet plays a big role in patient satisfaction and in the current sample, diet restrictions caused higher dissatisfaction i.e. higher DCS score, though this was not significant. Role limitations to physical health were also positively related to DCS (-0.422; p<0.001), which indicated that this domain affected DCS positively and significantly. Overall QOLID and DCS scores were negatively correlated and significant (-0.650;p<0.005).
A two step logistic regression showed Education( UOR 0.76; SD 0.64 - 0.90, p=0.002), treatment, medical adherence in diabetics about being careless with medications (AOR=2.38 SD 1.50 - 3.77, <0.001) , morbidity, recovery and complications of eye, kidney and depression . The individual needs high diabetic care (DCS more than median score of 35 and above) 1.57 (1.11 – 2.22) times more likely they had insulin in comparison to those who had low DCS score, though it did not come significant in the adjusted ratios. The study strongly brings out need of quality assessment tools in assessing DCS as a prelim screening to evaluate the quality of care in diabetic management in early stages so as to rectify any gaps and improve through specialized counselling in subsequent visits.
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