Effectiveness of a Structured Foot-Care Education Programme on Knowledge and Self-Care Practices among Patients with Diabetes Mellitus: A Study in Madhyapradesh, India

Diabetes mellitus (DM) is a metabolic disorder characterized by persistent high levels of blood glucose with serious micro- and macro-vascular complications. Effective management of DM including lifestyle changes can minimize the levels of diabetes related diseases and deaths. A person affected by DM should learn to accept the new lifestyle modifications because poor glycaemic control puts diabetics at higher risks of developing life threatening complications. This makes adherence to management therapies paramount in achieving good glycaemic control. The study aimed to as Aim: To assess the effectiveness of a structured foot-care education programme on knowledge and self-care practices among patients with diabetes mellitus in Bhopal, India. A cross - sectional study design was used and 300 known diabetics aged 30 years and above attending diabetes clinic in four selected health facilities in Bhopal were recruited using simple random sampling technique. Structured questionnaires comprising both open and close ended questions were used to collect demographic data and data on compliance and barriers. Fasting blood glucose levels were measured with a glucose metre. It included patients with diabetic foot ulcers in the medicine and plastic surgery wards. Samples from deeper portions of ulcers were collected using sterile techniques and cultured in the microbiology department to isolate and identify causative bacteria. Statistical analysis confirmed the importance of effective management strategies to mitigate the high burden of DFUs. The study results revealed that 11.7%, 24.3% and 20.7% of the study participants had fasting blood glucose levels ranging between 4.0 - 6.0mmol/L, 6.1 - 7.9mmol/L and 8.0 - 9.9mmol/L respectively while the majority (43.3%) of the participants had fasting blood glucose levels of 10mmo/L or above. Greater proportions (78%) of the participants have had diabetes self-care management education with only 22% reporting no education. The study showed self-reported compliance of 79%, 18.3% and 6% for medication, diet and exercise respectively. Factors such as forgetfulness, financial constraints, bitterness of drugs, pains from injections; restrictive diets, small portion sizes and lack of support; fatigue, pains in limbs and laziness were identified to be barriers to medication, diet and exercise regimen adherence respectively. Although compliance to medication was found to be higher than diet and physical activity recommendations, there were no significant associations between medication (p = 0.789), dietary regimen (p = 0.341), physical activity (p = 0.547) and fasting blood glucose levels. The research underscores the critical epidemiological burden of DFUs in diabetic patients in India. It highlights the complex interplay of microbial infection and drug resistance that complicates the management of these ulcers. The findings advocate for precise microbial identification and susceptibility testing to guide targeted treatment, aiming to improve patient outcomes and reduce healthcare burdens associated with diabetic foot complications.