1.ABSTRACT Diabetes damages and disables many parts of the body. All components of the cardiovascular system are susceptible to harm from high blood sugar levels. Diabetes and cardiovascular issues are closely related because of this. Blood flow is impeded by the narrowing and loss of flexibility of blood vessels brought on by high blood sugar levels. Due to the decreased blood and oxygen delivery, there is an increased risk of high blood pressure and injury to both large and tiny blood vessels. Among the complications of macro vascular disease are: cardiac arrest stroke, disease of the peripheral arteries. Microvascular disease may also result in issues with the following: eyes, kidneys, nervous system. When there is a wound or infection, poor circulation hinders the body’s capacity to heal. This is brought on by a lack of nutrition, oxygen, and blood. A diabetic patient should constantly examine their skin for wounds and visit their doctor if they exhibit any symptoms of an infection, such as redness, swelling, or fever. Diabetic complications are frequently accompanied by neuropathy, or nerve damage. Nerve damage affects 10 to 20 percent of persons with diabetes at first diagnosis. A person has a greater risk of developing neuropathy the longer they have diabetes. Small wounds may be harder to detect due to the neuropathy-related lack of sensation. This might cause serious issues when coupled with poor circulation. For instance, an infection can swiftly worsen if a person ignores a blister on their foot. It’s a result of poor circulation. Amputation might be required in some instances due to the possibility of tissue death and ulceration. 2.INTRODUCTION Type 2 diabetes mellitus (DMII) is the most common type of diabetes, accounting for approximately 90-95% of all diabetics. It is linked to changes in glucose, lipid, and protein metabolism. Chronic hyperglycaemia can cause organ malfunction and failure, particularly in the eyes, kidneys, nerves, heart, and blood vessels. Retinopathy, nephropathy, neuropathy, myocardial infarction, and stroke are among the long-term micro- and macro vascular consequences of DMII [1,2]. According to the American Diabetes Association, cardiovascular disease (CVD) accounts for 75-80% of DMII mortality [3]. DMII anomalies are caused by a lack of insulin effect on target tissues as a result of impaired insulin production, errors in insulin action, or both. Insulin resistance, defined as a diminished physiological response of peripheral tissues to the action of normal levels of insulin, is a common finding in a variety of metabolic illnesses, including DMII and MetaS [4,5,6]. Insulin resistance is initially compensated for by increased insulin secretion, however later on, insulin secretion is impaired. Insulin production declines quicker than insulin sensitivity in the development from normal to impaired glucose tolerance and diabetes [7]. Insulin resistance has a role in the pathogenesis of diabetic dyslipidaemia and is frequent in MetS [8]. According to the Adult Treatment Panel III (NCEP ATPIII) criteria of the national Cholesterol Education Program, MetS is a combination of modifiable risk factors such as hyperglycaemia, insulin resistance, hypertension, hypertriglyceridemia, decreased high-density lipoprotein cholesterol (HDL-C) and abdominal obesity [9]. The implications of MetS may be to blame for the cardiovascular complications and death found in the DMII population [10]. Several investigations have suggested that the Na+/K+-ATPase enzyme may be structurally and functionally altered in DMII. A variety of mechanisms have been proposed, including glycosylation and impairment of the Na+/K+-ATPase Enzyme, down regulation of the Na+/K+-ATPase enzyme due to low insulin secretion or defects in insulin action, which results in a reduced number of Na+/K+-ATPase enzyme in the cell membrane, a low level of ATP in cells, an abnormal Ionic distribution between the extracellular and intracellular environment, and abnormal sodium metabolism [11]. As a result, understanding the probable links between lower Na+/K+-ATPase activity and CVD risk variables in DMII may help us better understand the pathophysiology of diabetic complications [12]. Diabetes mellitus is a metabolic condition caused by a disturbance in carbohydrate metabolism. The key feature is hyperglycaemia, which is caused by an insulin secretory deficit or tissue resistance to the action of this hormone. The World Health Organization (WHO) recently revealed statistical statistics that indicate crucial features of the disease’s incidence and prevalence, as well as its prognosis: – Diabetes was diagnosed in 9% of adults over the age of 18 in 2014, with the figure expected to double by 2030. Diabetes complications (particularly type II diabetes) are the seventh greatest cause of mortality worldwide; for example, in 2012, 1.5 million people died as a result of diabetes micro- and macro vascular complications. Approximately half of these were caused by stroke, one of the most prevalent Consequences of diabetes; The disease’s frequency varies by ethnic group and age, being more common in developed countries and after the age of 60. The incidence is lower in poorer nations and predominates between the ages of 35 and 64 [13]. The entire world is facing a type 2 diabetes pandemic (diabetes mellitus) as a result of the westernization of lifestyle, the aging population, and urbanization, all of which result in dietary changes, the adoption of a sedentary lifestyle, and the development of obesity. Diabetes prevalence varies greatly depending on the population investigated, age, gender, socioeconomic level, and lifestyle. The projections for 2025 are concerning, with the IDF / WHO projecting a9% prevalence of diabetes. Closer monitoring of the population and the advancement of diagnostic technologies have been major factors in recent years, leading to an increase in the incidence of the disease [14]. However, at least 30% of people have undetected type 2 diabetes. Type 2 diabetes accounts for 80-90% of all diabetes occurrences and is more common in those who are overweight or obese. He frequently has an extended time of asymptomatic patients who are not diagnosed. According to research, more than half of the patients had one or more chronic diabetic problems at the time of diagnosis. Diabetes is linked to a slew of chronic problems, the end result of which is reduced quality of life and premature death. The proposed technique for limiting these impacts is early detection and treatment. Diabetes is an Etiologically complex and multifaceted disorder. Insulin insufficiency caused by auto immune death of Langerhans cells and/or the body’s resistance to the action of this hormone are widely accepted etiological processes [15]. Additional etiological mechanisms of diabetes include a biochemical defect in incretion secretion (intestinal hormones secreted Postprandially to stimulate insulin secretion), genetic predisposition, increased stress-induced epinephrine secretion, obesity-induced lip toxicity, and consequent insulin deficiency [16 3.OBJECTIVES OF REASEARCH
To assess the prevalence of diabetes and its complications within the community.
To explore the impact of diabetes and its complications on the physical, emotional, and social well-being of individuals.
To identify barriers to effective diabetes management and complication prevention within the community.
To investigate the availability and utilization of support services and resources for individuals affected by diabetes.
To provide recommendations for community interventions and support programs to improve diabetes management and complication prevention strategies.
DIABETES
4.RESEARCH METHODOLOGY Approach with a convergent design20 to capture what was important to people living with diabetes and caregivers regarding research on diabetes-related complications.21,22 According to the convergent mixed-methods design, quantitative and qualitative methods are complementary during data collection, data analysis or both. In our case, we combined21 the quantitative and qualitative data after we completed both sets of data collection. In other words, while research often uses quantitative and qualitative methods to collect different types of data from the same population to inform a research question, we used different methods to collect data from groups both more and less likely to participate in different types of research, in an attempt to capture more representative results. Therefore, we carried out quantitative and qualitative analyses separately before bringing both parts together. Our first step was to conduct descriptive statistics using SPSS version 22 (Armonk, NY, USA: IBM Corp.) to measure central tendency and examine the range of variation in responses to our questions about the importance of 10 important diabetes research areas. We recorded focus group discussions and transcribed them verbatim. We performed a six-stage thematic analysis35,36using NVivo qualitative analysis software (QSR International Pty Ltd. Version 10, 2012). We started by generating initial codes and themes, and inductively refining these themes based on the data. MTD analysed focus group data under the guidance of MJD. The codes were labelled with short phrases using the words of participants. Then, MTD sorted codes into potential themes and collated all relevant coded data extracts within the identified themes and subthemes. During this analysis, the codes, themes and subthemes were revised and refined. We used field notes37 to validate and complete the information gathered during the focus groups. After separate analyses were completed, we combined the findings from each study to analyse how complementary or contradictory they were. We additionally examined how focus group findings could improve our interpretation of the statistical analysis. Discussion The reported prevalence of complications among type 2 DM patients in current study was 14.3% in which Foot Problem (12.2%) was the most common.Other complications reported was coronary heart disease (6.7%), Kidney Disease (4.1%), Eye Problem (4.1%). This is high compared to studies done in rural areas of other part of India.9-15 .On other hand, overall health seeking behavior was poor in 45% patients seeking care from govt. facility and 60% patients seeking care from Pvt. Facility. Among them 38.3% patients seeking care from govt. facility and 60% patients seeking care from Pvt. facility had changed their treatment provider more than once. Most quoted reason for this was cost of treatment, which makes them to switch from Pvt. facility to Govt. facility. This is very important for economically disadvantaged community, such as rural community. Choice‑Making Model for health seeking developed by Young describes some factors responsible for preferential utilization of a particular health service. In that he mentioned illness gravity, knowledge of a home treatment, faith in the remedy, and the accessibility of treatment could be the possible determinants.18 The reasons quoted by the study participants were almost like this. On comparing poor health seeking behavior with respect to facility from which health care is seeking and complications of type 2 DM, it was found that significantly higher number of patients seeking health care from Pvt. facility (77.8%) having poor health seeking behaviour had more complications than patients seeking health care from govt. facility (33.3%). Odds of having complications was 7 times higher for patients seeking health care from pvt. Facility than for patients approaching government facility. This study aimed to explore the importance of diabetes-related complication research topics relevant to those living with or caring for someone living with diabetes. Additionally, we wished to explore the reasons why these topics are important from the perspective of under-represented populations. Findings from both the quantitative and qualitative components of the study complement each other and can be summarized in three main points. First the alignment of what is important for patients in diabetes research. Both survey and focus group participants indicated the importance of preventing and treating well-known complications of diabetes such as kidney, eye and nerve problems. This finding confirms that research on such complications matters to patients and caregivers. Second, the need for more research about the bidirectional influence of the “life context” on diabetes. Our participants also pointed out that there are a number of individual and contextual factors, such as individual circumstances (eg, life conditions, previous experiences). Result The present study included 150 known diabetes mellitus patients among which 120 (81.6%) were males and 30 (18.4%) were females. Most of the patients belonged to 40 to 60 years (60%) with a mean age of 57 years and the mean duration of diabetes was six years. Most of the participants belonged to poor socio-economic class and were availing the treatment from government facility at present. Out of 150 diabetes patients, majorly 8 patients had fatigue (16.3), followed by 2 (4.1%) patients had Frequently urinate, 6 patients had foot problems (12.2%),2 patients had cataract (4.1%), 2 patients had kidney disease (4.1%). In total around 6 (12.2%) patients had any one of the complications related to diabetes mellitus (Figure 1). Out of 60 patients currently seeking treatment from government facility, 23 (38.3%) patients were shifted from one facility to another for seeking health care and remaining 37 (61.7%) patients were seeking treatment from the same facility from the beginning. Among these 23 patients, changing of facility or practitioner happens two or more times in 8 (34.8%) patients and in remaining 15 (65.2%) patients happen only once. Among 15 patients currently seeking treatment from private practitioners, 9 (60%) patients were shifted from one facility to another. In which 6 (66.7%) patients change their provider two or more times. The reasons for changing their providers were listed in table 2. The most common reason for changing the treatment facility was cost in both types of patients seeking care from govt. and pvt. Facility (34.8% and 33.3% respectively).Among the total 150 patients studied, 15 (20%) patients missed one or more consultation in the past 6 months, as they reported. Around 33.3% (25/60) patients seeking care from govt. facility and 46.7% (7/15) patients seeking care from Pvt. facility were missing doses occasionally. In those 32 patients, 31.3% (10/32) patients missing due to not stocking-up of medicines on time, 25% (8/32) patients missing due to repeated travel for work, 18.8% (6/32) patients due to adverse effects of drugs, 12.5% (4/32) patients due to money issues and another 12.5% (4/32) patients due to sickness.
5.CONCLUSION Good health-seeking behaviour is needed for long term disease like diabetes mellitus. If it is poor, it will increase the chance of having complications by 7 folds. So, it is the responsibility of both patients and treatment provider to have regular follow-up visits and following all the suggested advices to limit or delaying the complications. So, that the quality of life of diabetes mellitus patients will be improved, even though the chronic nature disease. This study confirmed the importance of research topics regarding diabetes-related complications within a population of people living with diabetes or caring for someone with diabetes, and further explored reasons why these topics might be important for certain groups of under-represented people. The results of this study about what matters most to people living with, and caring for those living with diabetes, including people from under-represented populations, informed the research program of a 5-year pan-Canadian Strategy for Patient-Oriented Research Network on Diabetes and its related complications (2016-2021).39 A broad range of people living with diabetes are now involved as patient partners in this network, collaborating on research projects, research planning and supporting network governance. We anticipate that our results and on-going work will contribute to the development of targeted interventions better aligned with improving the health and well-being of people whose lives are touched by diabetes. This study aimed to explore the importance of diabetes-related complication research topics relevant to those living with or caring for someone living with diabetes. Additionally, we wished to explore the reasons why these topics are important from the perspective of under-represented populations. Findings from both the quantitative and qualitative components of the study complement each other and can be summarized in three main points.First, the alignment of what is important for patients in diabetes research. Both survey and focus group participants indicated the importance of preventing and treating well-known complications of diabetes such as kidney, eye and nerve problems. This finding confirms that research on such complications matters to patients and caregivers. Second, the need for more research about the bidirectional influence of the “life context “on diabetes. Our participants also pointed out that there are a number of individual and contextual factors, such as individual circumstances (eg, life conditions, previous experiences).
