international diabetic federation estimated that in india there are 66.8 million patients in 2013 , with nearly 50% undiagnosed .
diabetes was related to one million deaths and mortality was higher under age of 60 years . by 2030 there will more than 79 million diabetics , making it one of the major public health challenge to the country .
observed retinopathy in 28.9% , nephropathy in 32.5% , neuropathy in 30.1% , cardio - atherosclerotic diseases in 19.2% and peripheral vascular diseases in 18.1% diabetic patients .
the investigators of a1 cheive study observed high prevalence of macrovascular and microvascular complications among the indian diabetic patients .
different studies conducted in countries like united states have observed the positive association of patient 's knowledge regarding the disease and self care to the treatment compliance .
hence , this study was planned to assess knowledge about diabetes and its correlation with pharmacological and non - pharmacological compliance , among the diabetics attending a rural health center from sangli district , maharashtra ( india ) .
this was a cross - sectional study conducted in a rural health center attached to a medical college from sangli district of maharashtra , india .
the study population was adult type-2 diabetes patients on oral hypoglycemic drugs for at least 6 months attending the rural health centre .
the patients attending for routine check up or drug re - prescription and consenting to participate were included in the study .
minors , patients on insulin , hospitalized patients , patients who had undertook any sensitization program other than routine counseling by physician and those who can not read in the local language were excluded from the study .
prevalence of knowledge regarding diabetes in the pilot study was 52.71% ; considering level of significance as 5% and error 15% ;
study instrument was a pretested , prevalidated , self - administered questionnaire with good test - retest reliability ( spearman correlation coefficient , r = 0.81 ) and internal consistency ( cronbach 's  , r = 0.78 ) .
it was developed in marathi language with the help of subject experts and published literature and finalized after the pilot study .
it consists of initial section with general information of patient like age , gender etc .
, the occupations reported by patients were classified as sedentary work , moderate work and heavy work .
the second section consisted of questions regarding knowledge of patients about diabetes and its complications and the answers were scored .
those scoring under 50% , 5075% and more than 75% were considered to be having poor , moderate and good knowledge , respectively .
pharmacological compliance was self - reported , with participants reporting to have missed more than two doses in last 15 days were considered as non - compliant .
due to lack of exact definition of compliance to the non - pharmacological management , a scale was developed with equal importance to diet modifications and physical exercises .
the maximum possible score was 12 and the participants scoring above 9 ( 75% ) were considered as compliant to non - pharmacological management .
mean , standard deviation , percentage , chi - square and binary logistic regression were applied .
data from the pilot study and incomplete questionnaires were not included in the final analysis .
out of 329 questionnaires collected , 307 were complete and hence used in the final analysis .
two hundred twenty - three ( 72.6% ) participants were male while 84 ( 27.4% ) were female [ table 1 ] . the mean age of study participants was 55.6 years ( range 3585 years and standard deviation  12.22 years ) .
two hundred ninety - two ( 95.1% ) participants were married . while considering the educational status , 106 ( 34.5% )
had studied up to secondary school and 201 ( 65.5% ) had attended college . among the participants : 208 ( 67.8% ) , 56 ( 18.2% ) and 43 ( 14% ) were sedentary , moderate and heavy workers , respectively .
the mean morbidity with diabetes was 10.7 years ( range : 1 to 44 years and ; standard deviation : 10.02 years ) .
age group and gender distribution of the participants the pharmacological compliance was reported by 234 ( 76.2% ) participants .
the mean score for the non - pharmacological compliance was 8.35 ( standard deviation : 2.8 ) . based on preset criteria of score , 156 ( 50.8% ) participants were considered to compliant to the non - pharmacological management .
the mean score for knowledge regarding diabetes was 14.82 ( standard deviation : 3.5 ) . only 29 ( 9.4% ) participants had good knowledge , whereas 219 ( 71.3% ) had moderate and 59 ( 19.2% ) participants had poor knowledge .
age was not associated with the knowledge ( chi - square 5.47 , p = 0.49 ) , however , higher percentage of older age group ( 75 yrs ) participants had poor knowledge .
gender was associated with knowledge ( chi - square 10.78 , p = 0.005 ) ; higher percentage of male participants ( 81.6% ) had moderate to good knowledge as compared to females ( 78.6% ) . marital status and occupation
education was not associated with the knowledge ( chi - square 2.23 , p = 0.33 ) , however higher percentage of participants who had attended college had moderate to good knowledge .
pharmacological compliance was associated with knowledge . among the participants with good compliance , 88.5% had moderate to good knowledge as compared to only 56.2% participants with poor compliance .
the moderate to good knowledge was present in 87.8% participants with good compliance as compared to only 73.5% with poor compliance [ table 2 ] .
association between knowledge regarding diabetes with pharmacological compliance and non - pharmacological management compliance binary logistic regression was applied with knowledge regarding diabetes as dependent variable , while age , gender , education , occupation , pharmacological compliance and non - pharmacological management compliance as independent variables .
the chance accuracy rate for the model is 83.6% , which was greater than calculated chance accuracy rate ( 67.3% ) .
pharmacological and non - pharmacological management compliance were the highly significant predictors , while education and age were also significant predictors for knowledge regarding diabetes [ table 3 ] .
binary logistic regression model - association of age , gender , education occupation , pharmacological compliance and non - pharmacological management compliance with knowledge regarding to diabetes
in the current study , we observed that the patients compliant with pharmacological and non - pharmacological management had good knowledge regarding diabetes .
al - qazaz hkh et al . , ( 2010 ) , observed significant correlations between the knowledge about diabetes and adherence to the treatment in subjects from penang .
when carried out a study at al - makhfia governmental diabetes primary healthcare clinic in nablus , palestine in 2012 , observed that diabetic patients with high knowledge were less likely to be non - adherent .
chaudhary et al . , from multan ( pakistan ) in 2010 , observed that male gender , higher education and older age ( > 40 years ) were associated with the knowledge regarding diabetes mellitus .
however , age groups used by them were only two : < 40 years and > 40 years , while in the current study four age groups were considered with lowest being 3550 years .
abdella and mohammad studied awareness of diabetic patients about their illness and associated complications in ethiopia ( 2012 ) ; majority of patients ( 67% ) had good knowledge on actions to be taken on the occurrence of acute complications and reasons for developing acute complications . while we observed that less than 10% participants had good knowledge .
however , there is difference in the questionnaire used in both the studies and most of the participants from abdella study had undergone sensitization unlike the current study subjects .
( bangladesh ) 2013 , observed that 19% respondents had poor knowledge , while 68% had average and 13% had good knowledge .
they also deduced that male gender and higher educated people are likely to have better knowledge regarding diabetes .
conducted a study on adults in tamaka village , kolar ( india ) in 2009 .
observed that male gender , higher education and younger age of respondents was significantly associated with level of knowledge , while type of occupation is not associated with it .
bansal et al . observed compliance to medication in 82.5% patients from rural area of ludhiana district , india .
rao et al . observed that 83.6% patients from southern karnataka were on regular medication .
santhanakrishnan et al . observed compliance to oral hypoglycemic agents in 76% subjects , dietary modifications in 81.4% and physical activity in 37% subjects from puducherry , india . while in the current study , pharmacological compliance
was reported by 76.2% participants and compliance to the non - pharmacological management was reported by 50.8% participants .
being a self - administered questionnaire reporting bias can not be totally eliminated ; there may be over - estimation of compliance .
confounders like economical state , availability of medications , counseling by health professionals , exposure to information through media , additional use of ayurvedic / homeopathic / other indigenous systems of medicines etc .
, may be present and are not considered in the current study . only self - reported compliance was considered without confirming .
. however , many of the patients have poor knowledge regarding the disease , the situation is worse among the females .
lower level of literacy and old age hinder the presence of knowledge regarding the diabetes .
seminars , counseling sessions and workshop should be arranged periodically for diabetic patients to increase their awareness regarding diabetes disease in total per say .
 introduction : diabetes is an important public health problem of india . 
 studies have shown that increase in patients knowledge regarding the disease results in better compliance to treatment and decrease in complications . 
 this study was planned to assess the knowledge about diabetes and its correlation with pharmacological and non - pharmacological compliance , among the diabetic patients attending rural health center from sangli district , maharashtra ( india).materials and methods : the study was conducted during september to november 2014 . 
 the study subjects were all willing adult patients with type ii diabetes mellitus attending a selected rural hospital . 
 the study tool was pretested and self - administered questionnaire . 
 analysis was done using microsoft excel and spss-22.results:total study participants were 307 in number , with the mean age of 55.6 years . 
 the mean morbidity with diabetes was 10.7 years . 
 only 23.8% had good knowledge regarding diabetes , while 19.2% participants had poor knowledge . 
 knowledge was significantly associated with the compliance to the pharmacological and non - pharmacological management.conclusion:although most of the patients were suffering with diabetes for many years there is lack of knowledge regarding the disease and self care . 
 the compliance to the management of diabetes was better in patients with good knowledge . 
 seminars , counseling sessions and workshop should be arranged periodically for diabetic patients to increase their awareness . 
Introduction
Material and Methods
Results
Discussion
Conclusion