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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 4  |  Page : 404-409

Perception of ocular complications among patients with diabetes mellitus attending tertiary hospitals in Enugu, Nigeria


1 Department of Ophthalmology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
2 Department of Internal Medicine, College of Medicine, University of Nigeria, Enugu Campus, Nigeria

Date of Submission27-Feb-2022
Date of Decision25-Jun-2022
Date of Acceptance11-Jul-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Ifeoma N Asimadu
Department of Ophthalmology, College of Medicine, Enugu State University of Science and Technology, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.ijmh_44_22

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  Abstract 

Background: Diabetes mellitus can lead to sight and life-threatening complications. It affects people in both developed and developing countries. Many diabetics present to the eye clinics with undetected advanced eye complications. Aim: The study aimed at evaluating the perception of the ocular complications of diabetes and how it influences the attitude and practice of the diabetics attending the eye clinics. Materials and Methods: A cross-sectional study was conducted in two tertiary hospitals in Enugu over a 3-month period. An interviewer-administered questionnaire was used to assess their perception, and hence their attitude and practice toward diabetic eye complications after obtaining their informed consents. Results: A total of 884 diabetics participated. There were 337 (38.1%) males and 547 (61.9%) females. A majority, 523 (59.2%), were in the age range of 51–70 years. Only 40.7% knew that diabetes affects the eyes; 60.2% did not know that good blood sugar control will help prevent eye complications; 41.1% knew they needed to see the eye specialist from time to time but not necessarily for routine check-up. Only 9.1% saw the eye specialists routinely; the remaining 90.9% never went for routine eye check as only 40.72 knew it affects the eyes. Conclusion: There was poor perception of the disease and its complications, which led to poor practice such as no regular, periodic eye examinations. There is a dire need for education of the diabetics, building of multidisciplinary effective strategies and policies with the view to decreasing the burden of the disease especially in the developing countries.

Keywords: Developing country, diabetes, knowledge, ocular complications, practice


How to cite this article:
Asimadu IN, Okeke S, Kizor-Akaraiwe NN, Mbadiwe NC, Mbakigwe CF. Perception of ocular complications among patients with diabetes mellitus attending tertiary hospitals in Enugu, Nigeria. Int J Med Health Dev 2022;27:404-9

How to cite this URL:
Asimadu IN, Okeke S, Kizor-Akaraiwe NN, Mbadiwe NC, Mbakigwe CF. Perception of ocular complications among patients with diabetes mellitus attending tertiary hospitals in Enugu, Nigeria. Int J Med Health Dev [serial online] 2022 [cited 2022 Oct 1];27:404-9. Available from: https://www.ijmhdev.com/text.asp?2022/27/4/404/356635




  Introduction Top


Diabetes mellitus is a chronic, multisystemic disease of humans with multisystemic manifestations, the eye inclusive. There is a derangement in the metabolism of glucose resulting in complications in these systems, which sometimes might be life-threatening or sight-threatening when the eyes are affected.

It was initially thought to be a disease of the developed countries; however recent studies have shown that it affects people both in the developed and developing countries.[1] These findings in the developing countries have been linked to changes in the diet of people in these countries who gradually became westernized in their dietary practices.[2] Globally, in 2021, approximately 537 million adults (20–79 years) were living with diabetes. It was estimated that there were about 415 million people with diabetes worldwide in 2015 and expected to rise to 643 million in 2030 and 783 million by 2045.[3] In Sub-Saharan Africa, Nigeria tops the list with about 1.2 million people followed by South Africa with 841,000 sufferers.[4] Diabetes mellitus can lead to several ocular complications such as diabetic retinopathy (DR), diabetic papillopathy, glaucoma, cataract, and ocular surface diseases.[5] Some of these ocular morbidities are mild, whereas some if left untreated will become sight-threatening and can progress to blindness.[6] In patients with type 1 and type 2 diabetes, which has lasted for over 20 years, the prevalence of DR, a blinding complication, is 95% and 60%, respectively.[7] Many diabetics have a poor knowledge of these ocular complications and poor attitude and practice regarding eye care[8] and therefore present late to the ophthalmologists leading to severe visual loss.

In order to forestall this danger of blindness from diabetes, the patients need to be aware of the possible ocular complications and thereby seek the multidisciplinary treatment approach available for optimal ocular health. Good knowledge of the disease will lead to good attitude and consequent good practice pattern.[9]

The aim of this study therefore was to evaluate the perception of the ocular complications of diabetes mellitus and how it influences the attitude and practices of patients presenting to diabetic clinics of two tertiary hospitals in south-east Nigeria.


  Materials and Methods Top


This was a cross-sectional study conducted in two teaching hospitals, Enugu State University of Science and Technology, ESUT, Teaching Hospital, Parklane and University of Nigeria Teaching Hospital, Ituku Ozalla, located in Enugu State, south east Nigeria, from the beginning of August 2016 to the end of October 2016 (3 months). The patients who presented to the diabetic clinics of the two hospitals during the study period formed the sampling frame.

The participants were consecutively recruited as they presented themselves in the clinics during the study period. All confirmed diabetics, 18 years and above, who attended the diabetic clinics in the two hospitals during the study period and consented to participate were recruited (inclusion criteria). Diabetics less than 18 years, those critically ill, and those who declined to give consent were excluded from the study (exclusion criteria).

A knowledge, attitude, and practice (KAP) questionnaire was prepared by the researchers and pretested among a sample group of representative population (patients attending ophthalmology retinal clinic, which caters for patients with diabetes, hypertension, and other systemic diseases) before the actual study. This was to assess if the questions were understood by the respondents or not and to make necessary corrections. Six trained assistants administered the questionnaire via the interviewer-administered method. The eligible participants in the two clinics of the hospitals were interviewed during the study period.

The questionnaire covered the following:

  • (a) sociodemographic information,


  • (b) knowledge of diabetes, its risk factors, and ocular complications,


  • (c) the participant’s general attitude toward the disease and treatment options available,


  • (d) the practice of participants toward the disease and its management.


Ethical consideration

The study was approved by the hospital Health Research and Ethics Committee (HREC) in accordance with the Helsinki Declaration of 1975 as revised in 2008.

Data analysis

Data were coded and entered into a computer and analyzed. Statistical analysis was done using Statistical Package for the Social Sciences (IBM-SPSS), version 20. Descriptive statistics (frequencies, proportions, means, and standard deviation) was used to summarize and analyze variables.


  Results Top


Eight hundred and eighty-four subjects participated in the study. Out of these, 337 (38.1%) were males, whereas 547 (61.9%) were females.

In [Table 1], a majority of the subjects, 523 (59.2%), were in the age range of 51–70 years; 485 (54.9%) had at least a secondary education. Among them, 566 (64.03%) had had diabetes for 1–15 years, whereas 269 (30.4%) had had it for more than 15 years. Only 40.72% knew that the disease affects the eyes, but a greater number, 524 (59.28%), were ignorant; 363 (41.06%) knew they needed to see the eye doctor from time to time [see [Table 2]]. When asked if blood sugar control is important in preventing eye complications, only 38.80% said yes, whereas 61.20% said no.
Table 1: Sociodemographic profile of the participants

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Table 2: Knowledge and attitude of participants

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A total of 348 (39.4%) did not know that it was important for a diabetic to see an eye doctor and how often; 536 (60.6%) participants said it was important but with varied timings and reasons. In [Table 3], 521 (58.94%) of the participants did not have information about diabetes, and 198 (22.39%) obtained information from doctors and nurses. The rest heard from the media, public enlightenment programs, church, community meetings, relatives, and friends. Concerning available treatment modalities for diabetic eye disease, 453 (51.24%) were ignorant of any treatment modality available. The modality that was mostly known was drugs and injections with 42.53% answering in the affirmative. Only eight (0.90%) knew about laser therapy [see [Table 4]]. In [Table 5], when asked when a diabetic should see an eye specialist, 348 (39.37%) were not sure. Those who had an answer said when referred, 268 (30.32%), or when there is an eye complaint, 260 (29.41%). A large number of them, 804 (90.95%), had seen the eye specialist only on the account of eye complaints rather than for routine check-up. Only 80 (9.05%) went for regular eye check-ups as shown in [Table 6].
Table 3: Source of information about diabetes

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Table 4: Knowledge of different treatment modalities for diabetic eye disease

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Table 5: When should a diabetic see an eye specialist?

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Table 6: How often do you see an eye specialist?

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  Discussion Top


The perception of a disease and its complications can affect the health-seeking behavior of the sufferers positively or otherwise. Diabetes is largely a disease of the middle aged; it is therefore not surprising that a majority of our participants were in the age range of 51–70 years. This is similar to findings in other studies.[10],[11] Although 54.9% had at least a secondary education, it did not translate to a better knowledge of the disease as only 40.7% knew diabetes affects the eyes and even much less, 27.7%, knew it could cause blindness. This is a pointer to the low level of awareness of the disease by the respondents probably because of poor health information-seeking behavior or mere ignorance by the participants. This is unlike findings in another study in Nigeria where a majority of the participants also had at least a secondary education, but 77.7% knew it affects the eyes.[12] These ones likely had better information-seeking behavior.

Furthermore, 51.7% of the respondents had had diabetes for more than 5 years, but only 40.7% knew it could cause eye disease. This is similar to findings in a study where only half of the participants knew diabetes could lead to visual problems, and another in Sawihal, Pakistan, where 30.6% knew that diabetes affects the eyes.[13],[14] Studies carried out in Nigeria and Ghana, respectively, also reported a low knowledge of diabetic eye diseases among the participants.[8],[15]

One would wonder whether this poor knowledge is because the studies were carried out in developing countries where health education is not adequate. However, studies conducted in India, also a developing country, showed that 71.9% were aware that diabetes affects the eyes, though much lower proportion, 27.71%, knew it could cause blindness; also, in the second study, 71.67% had a good knowledge of diabetic ocular complications.[9],[16] The study carried out in Saudi Arabia also showed a good knowledge.[17] These places with a good knowledge might have better health systems than the Sub-Saharan Africa.

When asked whether good blood sugar control can aid in preventing eye complications, only 38.80% were aware that good blood sugar control can aid in maintaining good vision. This poor perception could be due to the level of information given by the physicians on the risk factors and their complications. It is similar to the study in Bin Qasim town of Karachi, in which 56.6% did not know if diabetes was related to diet, whereas 63.7% did not know the impact of disease on the eyes.[18]

As regards available treatment modalities for diabetic eye diseases, especially DR, 51.24% of the participants were completely ignorant of any modality, 42.53% said drugs and injectables, 4.64% said surgery, whereas only 0.09% knew about laser. This is similar to the study in Pakistan where 72.2% were ignorant, 18.1% said injections, 1.4% said surgery, whereas 8.3% said laser.[14] This is not surprising seeing that in these two studies, a majority of the participants did not know that diabetes affects the eyes. In a study in Ethiopia, knowledge on the treatment option of DR was also very low as only 9.3% knew laser as a treatment option for DR.[19] This was also the case in an Indian study where only 4.7% knew laser as a treatment option.[20] This knowledge of treatment of DR was most likely acquired from eye clinic visits rather than medical follow-up clinic. The knowledge of laser being a treatment option was least in our study being 0.09%. This is a clear pointer that there is a huge knowledge gap about DR treatment among our respondents, probably because of the variation of the level of information given them by their physicians during their medical clinic visits.

On whether diabetics should have regular eye examinations 41.06% answered in the affirmative. This fairly good answer could be related to the fact that a couple of them have had to see the eye specialist on the account of poor vision. It, however, did not translate into good practice as was seen in their attendance to eye clinics for regular eye check-up.

Regarding the practice of regular periodic eye check-up, 90.95% of the participants in this current study did not have regular periodic eye checks. This is similar to the studies in Tamil Nadu, India, where 61.1% did not have periodic eye examinations, Mexico with only 12.4%, South Africa with 37%, Bangladesh with 37%, being those that went for preventive eye examinations.[9],[21],[22],[23] A majority of them in our study go for eye examination when they have eye problem. This trend is not surprising when one considers the fact that only 27.71% knew that diabetes can lead to blindness. On the contrary, findings in the study in other places such as Jammu, India, had 90% of the participants going for regular eye examination, either monthly, 6 monthly, or yearly.[16] Others were Australia, 71%; Malaysia, 50%; and Ghana, 65.4% of the study cohort attending regular periodic eye check-up.[15],[24],[25]

Diabetes-related ocular complications have remained a major public health concern globally but more importantly in the developing world with poorly functioning health systems. Early detection via routine eye examination can decrease or delay diabetes-related visual loss. Timely management of diabetics and routine examination for complications can decrease the challenges resulting from the disease by as much as 50%.[26]

In Nigeria, a developing country, the emphasis on health care has been largely clinical with very little on prevention, via health education, health promotion, and enlightenment programs. It is not surprising, therefore, that there is poor perception of the disease.

Early detection following regular screening, appropriate knowledge, positive attitude, and right practice leading to effective treatment will go a long way in preventing blindness from the ocular morbidities.

It is therefore imperative that the diabetics and indeed the general public have a good knowledge of the disease as well as the ocular complications. This can be achieved by deliberate efforts at educating the patients and the populace on the multidisciplinary nature of the disease via all available avenues of public enlightenment, including the clinics, with the view to improving the overall knowledge and attitude and hence the practice of diabetic care.

This will need good infrastructure, properly trained personnel, properly established referral system, and willingness and determination of the diabetics to utilize the available facility. Achieving this will, however, be difficult in the developing countries with poor and unstable economy, paucity in the number of trained personnel, poor referral chain, and a high level of superstitious beliefs about the cause of diseases.


  Conclusion Top


Good knowledge about diabetes and its ocular complications will help patients to develop good practice patterns, which can prevent sight-threatening complications. The practice of multidisciplinary approach to the management of diabetes is very important. Strategies to do this, which involves adequate health education, among other things, should be developed. There was a poor knowledge of the disease and its complications, which led to poor practice such as no regular periodic eye examinations. There is a dire need for education of the diabetics, building of effective strategies and policies with the view to decreasing the burden of the disease especially in the developing countries.

Financial support and Sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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