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PO034 THE KNOWLEDGE AND BEHAVIOURS TOWARDS DIABETIC FOOT CARE IN DIABETIC PATIENTS IN SINGAPORE
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Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
to investigate the effect of ginger extract on Apolipoprotein A and B levels, cardiac fibrosis, and heart muscle cell proliferation under hyperglycemic conditions, in vivo. Method: Twenty-four male wistar rats were divided three groups namely: Control, Nontreated diabetic, and ginger extract treated diabetic groups. A single intraperitoneal injection of buffered streptozotosin (60 mg/kg) in cold sodium citrate (pH=4.5) was used to induce diabetes. The ginger extract treated diabetic group received 50 mg of ginger extract daily intragastrically for 6 weeks. Apolipoprotein A and B levels, cardiac fibrosis, and heart muscle cells proliferation were measured after 42 days. Result: The Apolipoprotein A level in serum was 141±2, 106±3.7, and 126±3.9 in Control, Nontreated diabetic, and ginger extract treated diabetic groups respectively. In nontreated diabetic group, Apolipoprotein A level was significantly less than control group (p < 0.05). Ginger extract administration increased apolipoprotein A level in serum significantly compared to the nontreated diabetic group (p < 0.05). Apolipoprotein B level in serum of control group was 109±4.49 mg/dl. In nontreated diabetic, apolipoprotein B level showed signinificantly increases (170±5.1) compared control group(112±2.3)(p < 0.05). There was no significant differences between ginger extract treated diabetic and control groups (p < 0.8). Examination of the cardiac section of diabetic rats revealed that the average of PCNA-positive indices (as indicators of proliferation) was dramatically increased in the nontreared diabetic group compared with the indices in the control group (p < 0.05). There was no significant differences between the ginger extract treated diabetic and control groups. The microscopic fibrosis score in heart tissue for the nontreared diabetic group was 2.76, which was significantly higher than the score for the control group (p < 0.005), but there was no significant differences between the ginger extract treated diabetic and control groups. Conclusion: These findings indicate that ginger extract significantly improved heart structural abnormality in diabetic rats and that these effects could be associated with improving serum apolipoproteins levels and antioxidant properties of ginger. Keywords: Diabetes, Heart, Rat, Ginger
PO034 THE KNOWLEDGE AND BEHAVIOURS TOWARDS DIABETIC FOOT CARE IN DIABETIC PATIENTS IN SINGAPORE A.S. Sinnathamby1 , S.Y. Low2 , D. Ong3 . 1 Yong Loo Lin School of Medicine, 2 Department of Emergency Medicine, National University Health System, 3 Department of Family Medicine, National Healthcare Group Polyclinics, Singapore, Singapore Background: Diabetes mellitus is a chronic disease with a disease burden that has increased from 8.2% in 2004 [1] to 11.3% in 2012 [2]. In Singapore, it comprises one of the top 4 conditions of polyclinic attendances [3]. Studies in Morocco showed that > 50% of the study population was not aware of the risks of the diabetic foot. Further studies in Iran and America showed that with education, there was a significant increase in foot self-care leading to improved outcomes. However, there have been no similar studies done in Singapore to date. This study aimed to assess the level of knowledge that patients with diabetes mellitus have towards diabetic foot care (DFC) and analyse the factors influencing their knowledge and behavior towards diabetic foot care. In the long-term, it is hoped that the results of this study can improve the standard of DFC education provided in polyclinics and eventually, reduce complications and improve treatment outcomes in diabetic patients in Singapore. Method: 200 diabetic respondents were randomly surveyed at Jurong Polyclinic from 10th June to 5th July 2013.
The anonymous and voluntary survey comprised questions on demographics, medical history and knowledge of diabetes. The patients were also assessed on their knowledge of DFC via a list of 26 questions based on good DFC as stipulated in the NHGP Foot Care Advice Handout. Result: Out of a score of 26, the mean score of correct answers was 18. This was also taken as the cut-off point when defining whether the participants scored well or poorly in their knowledge of DFC. The results were analysed using SPSS V20.0 and p < 0.05 was taken to be significant. Among those who scored poorly in their knowledge of DFC, 31.6% had never been educated on DFC by a diabetic foot nurse before, whereas only 18.5% of those who scored well had never been educated before (P = 0.035). Furthermore, 64.5% of those who scored poorly in the knowledge section did not know that diabetes may affect their feet, as compared to 46.0% of those who scored well (p = 0.11) In terms of behaviour, it was noted that 80.6% of those who scored well go for diabetic screening yearly vs 63.2 % of those who scored poorly (p = 0.017). At home, 38.2% of those who scored poorly do not carry out DFC, as compared to 21.8% of those who scored well (p = 0.002). The top positive DFC behaviour was washing feet with soap daily, whilst the poorest included failing to moisturize corns, cutting toenails round instead of straight, and checking feet and shoes. It was also noted that those who scored poorly consistently had poorer DFC behaviours than those who scored well. Conclusion: The results suggest that proper education on DFC by a trained professional such as a diabetic foot nurse is associated with better knowledge of DFC among diabetic patients, and better knowledge is associated with an increased practice of DFC among diabetic patients. We further recommend highlighting poor behaviours to patients and emphasizing the importance of good DFC. Further studies could include a larger sample size across polyclinics, and a validated questionnaire be conducted to further evaluate this area of diabetic care. Reference(s) [1] Epidemiology and Disease Control Division. National Health Survey. Singapore: Ministry of Health; 2004. pp. 3–7. [2] Khalik, Salma. “1m diabetics by 2050 as Singaporeans get older, fatter.” The Straits Times [Singapore] 2 Oct. 2012, sec. Home: n. pag. The Straits Times Online . Web. 8 Apr. 2013. [3] Epidemiology and Disease Control Division. Statistics. Singapore Health Facts. Singapore: Ministry of Health. Top 4 Conditions of Polyclinic Attendances 2012. [4] Lamchahab, FZ, M Ait Ourhroui, N El Kihal, I Khoudri, A Chraibi, and B Hassam. “Factors influencing the awareness of diabetic foot risks.” Ann Phys Rehabil Med. 54(6). September (2011): 359–65. PubMed . Web. 4 Apr. 2013. [5] Kafaie P, Noorbala MT, Soheilikhah S, Rashidi M. Evaluation of Patients’ Education on Foot Self-Care Status in Diabetic Patients. Iran Red Cres Med J. 2012; 14(12): 829–32. DOI: 10.5812/ ircmj.1138. [6] De Berardisa, Giorgia et al. “Are Type 2 diabetic patients offered adequate foot care? The role of physician and patient characteristics.” Journal of Diabetes and its Complication 19.6 (2005): 319–327. Pubmed . Web. 4 Apr. 2013. [7] Singapore National Healthcare Group Polyclinics (NHGP) Foot Care Advice Handout.
Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
to investigate the effect of ginger extract on Apolipoprotein A and B levels, cardiac fibrosis, and heart muscle cell proliferation under hyperglycemic conditions, in vivo. Method: Twenty-four male wistar rats were divided three groups namely: Control, Nontreated diabetic, and ginger extract treated diabetic groups. A single intraperitoneal injection of buffered streptozotosin (60 mg/kg) in cold sodium citrate (pH=4.5) was used to induce diabetes. The ginger extract treated diabetic group received 50 mg of ginger extract daily intragastrically for 6 weeks. Apolipoprotein A and B levels, cardiac fibrosis, and heart muscle cells proliferation were measured after 42 days. Result: The Apolipoprotein A level in serum was 141±2, 106±3.7, and 126±3.9 in Control, Nontreated diabetic, and ginger extract treated diabetic groups respectively. In nontreated diabetic group, Apolipoprotein A level was significantly less than control group (p < 0.05). Ginger extract administration increased apolipoprotein A level in serum significantly compared to the nontreated diabetic group (p < 0.05). Apolipoprotein B level in serum of control group was 109±4.49 mg/dl. In nontreated diabetic, apolipoprotein B level showed signinificantly increases (170±5.1) compared control group(112±2.3)(p < 0.05). There was no significant differences between ginger extract treated diabetic and control groups (p < 0.8). Examination of the cardiac section of diabetic rats revealed that the average of PCNA-positive indices (as indicators of proliferation) was dramatically increased in the nontreared diabetic group compared with the indices in the control group (p < 0.05). There was no significant differences between the ginger extract treated diabetic and control groups. The microscopic fibrosis score in heart tissue for the nontreared diabetic group was 2.76, which was significantly higher than the score for the control group (p < 0.005), but there was no significant differences between the ginger extract treated diabetic and control groups. Conclusion: These findings indicate that ginger extract significantly improved heart structural abnormality in diabetic rats and that these effects could be associated with improving serum apolipoproteins levels and antioxidant properties of ginger. Keywords: Diabetes, Heart, Rat, Ginger
PO034 THE KNOWLEDGE AND BEHAVIOURS TOWARDS DIABETIC FOOT CARE IN DIABETIC PATIENTS IN SINGAPORE A.S. Sinnathamby1 , S.Y. Low2 , D. Ong3 . 1 Yong Loo Lin School of Medicine, 2 Department of Emergency Medicine, National University Health System, 3 Department of Family Medicine, National Healthcare Group Polyclinics, Singapore, Singapore Background: Diabetes mellitus is a chronic disease with a disease burden that has increased from 8.2% in 2004 [1] to 11.3% in 2012 [2]. In Singapore, it comprises one of the top 4 conditions of polyclinic attendances [3]. Studies in Morocco showed that > 50% of the study population was not aware of the risks of the diabetic foot. Further studies in Iran and America showed that with education, there was a significant increase in foot self-care leading to improved outcomes. However, there have been no similar studies done in Singapore to date. This study aimed to assess the level of knowledge that patients with diabetes mellitus have towards diabetic foot care (DFC) and analyse the factors influencing their knowledge and behavior towards diabetic foot care. In the long-term, it is hoped that the results of this study can improve the standard of DFC education provided in polyclinics and eventually, reduce complications and improve treatment outcomes in diabetic patients in Singapore. Method: 200 diabetic respondents were randomly surveyed at Jurong Polyclinic from 10th June to 5th July 2013.
The anonymous and voluntary survey comprised questions on demographics, medical history and knowledge of diabetes. The patients were also assessed on their knowledge of DFC via a list of 26 questions based on good DFC as stipulated in the NHGP Foot Care Advice Handout. Result: Out of a score of 26, the mean score of correct answers was 18. This was also taken as the cut-off point when defining whether the participants scored well or poorly in their knowledge of DFC. The results were analysed using SPSS V20.0 and p < 0.05 was taken to be significant. Among those who scored poorly in their knowledge of DFC, 31.6% had never been educated on DFC by a diabetic foot nurse before, whereas only 18.5% of those who scored well had never been educated before (P = 0.035). Furthermore, 64.5% of those who scored poorly in the knowledge section did not know that diabetes may affect their feet, as compared to 46.0% of those who scored well (p = 0.11) In terms of behaviour, it was noted that 80.6% of those who scored well go for diabetic screening yearly vs 63.2 % of those who scored poorly (p = 0.017). At home, 38.2% of those who scored poorly do not carry out DFC, as compared to 21.8% of those who scored well (p = 0.002). The top positive DFC behaviour was washing feet with soap daily, whilst the poorest included failing to moisturize corns, cutting toenails round instead of straight, and checking feet and shoes. It was also noted that those who scored poorly consistently had poorer DFC behaviours than those who scored well. Conclusion: The results suggest that proper education on DFC by a trained professional such as a diabetic foot nurse is associated with better knowledge of DFC among diabetic patients, and better knowledge is associated with an increased practice of DFC among diabetic patients. We further recommend highlighting poor behaviours to patients and emphasizing the importance of good DFC. Further studies could include a larger sample size across polyclinics, and a validated questionnaire be conducted to further evaluate this area of diabetic care. Reference(s) [1] Epidemiology and Disease Control Division. National Health Survey. Singapore: Ministry of Health; 2004. pp. 3–7. [2] Khalik, Salma. “1m diabetics by 2050 as Singaporeans get older, fatter.” The Straits Times [Singapore] 2 Oct. 2012, sec. Home: n. pag. The Straits Times Online . Web. 8 Apr. 2013. [3] Epidemiology and Disease Control Division. Statistics. Singapore Health Facts. Singapore: Ministry of Health. Top 4 Conditions of Polyclinic Attendances 2012. [4] Lamchahab, FZ, M Ait Ourhroui, N El Kihal, I Khoudri, A Chraibi, and B Hassam. “Factors influencing the awareness of diabetic foot risks.” Ann Phys Rehabil Med. 54(6). September (2011): 359–65. PubMed . Web. 4 Apr. 2013. [5] Kafaie P, Noorbala MT, Soheilikhah S, Rashidi M. Evaluation of Patients’ Education on Foot Self-Care Status in Diabetic Patients. Iran Red Cres Med J. 2012; 14(12): 829–32. DOI: 10.5812/ ircmj.1138. [6] De Berardisa, Giorgia et al. “Are Type 2 diabetic patients offered adequate foot care? The role of physician and patient characteristics.” Journal of Diabetes and its Complication 19.6 (2005): 319–327. Pubmed . Web. 4 Apr. 2013. [7] Singapore National Healthcare Group Polyclinics (NHGP) Foot Care Advice Handout.