Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : August | Volume : 4 | Issue : 4 | Page : 2830 - 2836

Relationship between Initial Psychological Response To Diagnosis Of Diabetes Mellitus And Its Impact On Subsequent Management.

KAUR H Correspondence Address :
Dr Harleen Kaur
213, Master Tara Singh Nagar
Jalandhar
Ph No: 09814651884
Email: vinty_10@hotmail.com

Abstract

Introduction: This study is designed to test the hypothesis that a relationship exists between emotional reaction to diagnosis and the subsequent adherence to diet and exercise regimen, and to correlate the responses of subjects with factors like knowledge about diabetes and education status.

Material and methods: 100 randomly selected established cases of type 2 diabetes patients attending the diabetes clinic at MMIMS Hospital were interviewed with a questionnaire designed to elicit the reaction to diagnosis and adherence to the diet and exercise regimen among them. Responses were analyzed after content analysis to achieve the objectives. Chi‐square test was applied to determine statistical significance.

Results: It was found that the patients with positive feelings at the time of diagnosis were better adherent to exercise regimen than those with negative feelings. The difference in adherence to dietary plan, however, wasn’t found significant. Also, males were adherent to exercise than females. The patients who were fully explained about diabetes by physician showed better adherence to exercise than those who were not.

Conclusions: It can be safely concluded that patients with negative feelings and less knowledge about diabetes at the time of diagnosis show poor adherence to self‐management regimen. The physicians need to understand the emotional state of the patients at the time of diagnosis and provide them sufficient information about the condition for better response to the prescribed self management plans.

Keywords

Diabetes, Emotional response, Diet, Exercise, Adherence

introduction : Diabetes is a life‐long disease and a patient suffering from it, has to combat against it throughout his life.Studies highlight that the receipt of bad news and the diagnosis of a chronic illness is an emotional time for a patient (1). A study also reported that the participants of their study, when told that they had diabetes, all reported feelings of shock, despair and anxiety in varying degrees (2).

A study explains that the attitude of doctors towards the patient at the time of diagnosis played an important role in their subsequent compliance to self‐management (3). Thus, the way a physician dealt with the reaction of the patient at the time of diagnosis is of vital importance in improving the management of diabetes. An insight into the patients’ attitudes can help diabetes educators and patients develop realistic and relevant self‐care plans (4).A prompt and simple, but detailed advice about type 2 DM management would be helpful for newly diagnosed patients (5).
Family support also plays an important role in the patient’s compliance.

This study would help the physicians in deciding how they have to deal with a patient while breaking the news of the diagnosis. A proper counselling and explanation of the salient features of the disease would encourage the patient to manage the condition in a more appropriate way.

Material and Methods

The sample consisted of 100 established cases of type‐2 diabetes mellitus patients (diagnosed more than a year ago), attending the diabetes clinic at the Out Patient’s Department of Medicine, MMIMS, Mullana , Ambala. Random sampling was done to choose the subjects for the study.
The patients were fully informed about the study design and the purpose of the study. Informed consent was taken from the patients before starting the interview.

Detailed history was taken and physical examination was done. The subjects were chosen for the study according to the following inclusion and exclusion criteria:

Inclusion Criteria
• Patients suffering from type 2 diabetes (established)
• Both sexes
• Age group of 30‐60 years
Exclusion Criteria
• Diabetics diagnosed in the last one year
• Physically disabled
• Any disease contraindicating vigorous exercise like proliferative retinopathy,
unstable angina, recent myocardial infarction, severe hypertension, etc.
• Hectic work schedule (>12 hours), irregular working hours (night shift etc.)
• Pregnancy
• Lactating mothers
The data was collected from every subject separately in the form of a questionnairethat focussed mainly on the following themes:

Diagnosis of diabetes and the patient’s emotional reaction to it (as described by the subject)
The patient’s self reported compliance to diet and the exercise regimen.

The questionnaire was derived from a similar qualitative study on compliance/adherence in patients living with type‐2 diabetes (5) and also from the results of a comprehensive review of recent literature on compliance/adherence.

Interpretation of Data
Content analysis of the responses to the questions after interpretation could be structured into a master chart eliciting the following for each subject:

• The emotional reaction to the diagnosis.
• The adherence to the dietary regimen.
• The adherence to the exercise regimen.
• Education status of the patient.
• Annual family income
• Whether or not the patient was made aware of the various aspects of the condition at the time of diagnosis.

The degree of adherence to the diet and exercise regimens among the optimistic and pessimistic emotional response groups was found out separately. Also, the adherence was determined separately among males and females and it was correlated with the patient’s familiarity with diabetes and education status, annual income, etc.

The results were analyzed by statistical means. 2×2 contingency tables were made to analyze the adherence to diet and exercise regimen separately .Chi square test was applied and two‐tailed P‐values were calculated using an online statistics calculation software.

Results
On the basis of the response to questions, 38% patients were found to be optimistic and 62 % had a pessimistic attitude at the time of diagnosis.(Table/Fig1) Not much difference was found between the optimistic and the pessimistic groups who were devoted to a prescribed diet regimen, ie 68.4% and 54.8% (Table/Fig1). But a marked difference was found in the adherence to the exercise regimen ie 63.15% and 29 % respectively (Table/Fig2). For exercise adherence, this difference was statistically significant. On the basis of the familiarity with diabetes, patients who had some knowledge about diabetes were found to have significantly more adherence to the exercise regimen (61.9%) than those who had little or no knowledge about diabetes (27.58%)[Table/Fig2]. However, the adherence to the diet plan between the two groups was not significant (Table/Fig 1). The difference in adherence among different groups on the basis of education levels and annual family income was not significant [Table/Fig1],(Table/Fig 2).

Results

On the basis of the response to questions, 38% patients were found to be optimistic and 62 % had a pessimistic attitude at the time of diagnosis.(Table/Fig 1) Not much difference was found between the optimistic and the pessimistic groups who were devoted to a prescribed diet regimen, ie 68.4% and 54.8% (Table/Fig 1). But a marked difference was found in the adherence to the exercise regimen ie 63.15% and 29 % respectively (Table/Fig2). For exercise adherence, this difference was statistically significant. On the basis of the familiarity with diabetes, patients who had some knowledge about diabetes were found to have significantly more adherence to the exercise regimen (61.9%) than those who had little or no knowledge about diabetes (27.58%)(Table/Fig 2). However, the adherence to the diet plan between the two groups was not significant (Table/Fig 1). The difference in adherence among different groups on the basis of education levels and annual family income was not significant (Table/Fig 1),(Table/Fig 2).

Discussion

Diabetes mellitus refers to a group of metabolic disorders which are characterized by hyperglycaemia.. The disorder has been divided into type 1 and type 2 diabetes mellitus. The number of cases of both type 1 and type 2 diabetes are rising throughout the world, but in future, a greater rise in the prevalence of type 2 is expected, because of obesity and reduced activity levels globally. The estimated prevalence of diabetes among adults was 7.4 % in 1995; this is expected to rise to about 9 % in 2025(6).

In both the types, the active self management of the illness by the maintenance of blood glucose levels in normal limits is the key to a good quality of life. Studies of clinical and educational interventions suggest that improving the patients’ health status and perceived ability to control their disease results in an improved quality of life (7). Diabetes mellitus type 2 is a chronic illness and more than 95% of diabetes care is performed by the patient; so, health professionals have very little control over how their patients manage their illness between office visits (8).

One factor, which is believed to hold importance in the self management, is the reaction of the patient at the time of being diagnosed with diabetes. How the physician counsels the patient at the time of diagnosis plays a crucial role in the perceived seriousness by the patient (3).

A physician has to work out a simple, yet effective advice and information for the patient for better management. The emotional reaction shown by the patient at the time of diagnosis may help the physician in helping the patient in a more effective way. For this, the compliance pattern in relation to the emotions of the patients holds significance (5).

Therapeutic interactions with patients should no longer be viewed simply as opportunities to reinforce instructions around treatment: rather, they should be seen as a space where the expertise of the patients and health professionals can be pooled to arrive at mutually agreed goals (9).In primary care, patients strongly want a patient centered approach, with communication, partnership and health promotion (10).It is increasingly evidence‐based that patients should be considered as the doctor’s partner and should make decisions about the treatment regimen together with the physician (11).
In the field of diabetes management, the concept of empowerment holds utmost importance. Empowerment addresses not just the disease management, but other components including emotional, spiritual, social and cognitive aspects (12),(13). Tailored education forms part of the empowerment pathway, incorporating it into the context of the individual’s life (14).

The patients’ own knowledge, ideas and experiences, as well as those of family members and friends, have also been shown to correlate with compliance (15). In a study, 65% of the spouses felt that diabetics required minimum support. Most men received support from their spouses in adhering to diet and more women depended on their spouses to go for exercise (16).

In this study, I found out the adherence of 100 type 2 diabetes mellitus patients to lifestyle changes (diet control and exercise regimen) and related it with various factors which are believed to affect the same i.e. emotional reaction to diagnosis, knowledge about diabetes when diagnosed, education level and family support .

The main aim of this study was to test the hypothesis that a relationship exists between the reaction to diagnosis and the patient’s subsequent compliance. Patients having an optimistic attitude at the time of diagnosis had a significantly higher degree of adherence to the exercise regimen than those with a pessimistic attitude. For diet control, the difference was not found to be statistically significant.

An explanation for this result is that diet control is comparatively easier to follow than adherence to the exercise regimen. It was found that 30 (60%) patients were compliant to the diet as compared to 40% compliance to the exercise plan. In other works which were reviewed, a similar pattern was seen, the %age of dietary compliance being higher than exercise. A focus group study among type‐2 diabetics found the dietary and exercise compliance to be 81.7% and 57.2%, respectively (17).
focus group study among type‐2 diabetics found the dietary and exercise compliance to be 81.7% and 57.2%, respectively (17).

Male patients were more adherent to the prescribed exercise regimen than females, while both were equally well compliant to the diet control plans. In a study on gender differences in living with diabetes, men were shown to live more effectively than women (18). In India, women have a poorer quality of life and well being (19) and so, must be encouraged to develop a more positive attitude. Compliance to lifestyle changes has also been studied by many researchers. Anderson et al divided the participating patients into two groups: high and low adherence groups. Differences in attitudes between the high‐ and low adherence groups were more prevalent for difficult adherence areas, e.g., diet and exercise, than for easy adherence areas like carrying sweets (4).

The most commonly reported reason for the defiance to exercise among males was the nature of the occupation, followed by body ache and laziness. On the other hand, in females, household work was the most commonly reported barrier, followed by laziness, body aches and the nature of the occupation (Table/Fig 3).The only reason for not adhering to diet plans as reported by most of the patients, was their helplessness in controlling the craving for sweets. Shobhana et al found that non‐adherence was due to the nature of occupation (38%); followed by household work (35.2%), body ache (18.3%) and laziness (8.5%) (17). The most common psychological problems faced by diabetes patients included dietary restrictions, self‐monitoring of blood glucose, taking insulin injections and lack of support from family and health care professionals (20). A Cross National Diabetes Attitudes, Wishes and Needs (DAWN) study found that 41% patients had poor psychological well‐being and only 10% of them reported to be taking psychological The patients who had previous knowledge about diabetes or were made aware of it by the physician showed better self management in terms of adherence to diet and exercise regimen than those who had little knowledge. Thus, these results clearly indicate the need for physicians to make their patients perceive the condition seriously.

The comparison of compliance among the patients with different education levels revealed that well educated patients were better compliant than poorly educated patients.The adherence was also compared among different economic groups, but a marked difference was not observed in the adherence among these groups.

The role of family members also cannot be underestimated. Among the patients who were not supported by their family, only 14.2% were adherent to the exercise regimen. The family members inspire the patient for a better quality of life, because of which better compliance is found in patients with good family support. A hospital‐based cross‐sectional study emphasized the importance of the role played by family members in the self‐management of a diabetic(21). The study was based on the factors influencing the basic knowledge about diabetes and the attitude and behaviour regarding diabetes among the family members of diabetics. Factors such as gender, place of residence (rural or urban) and level of education were quoted to affect the knowledge among the family members. An appreciable behavioural change was observed in the participants as they were ready to restrict oily and fried food and sweets and also to start exercising (22).

There is a need for more research in this field, especially on the emotional reaction to diagnosis. Studies can also involve physicians in order to find out how they respond to the varied reactions of the patients. Also, questionnaire based study, though effective, cannot match the focus group studies, through which the subjects’ inner feelings and perceptions can be explored more candidly and spontaneously.

The data generated by such studies will be helpful in studying the psychosocial problems of the patients and making them mentally prepared to see the life ahead with a positive attitude, when they are diagnosed with diabetes.


Conclusion

Patients with a pessimistic attitude and less knowledge about diabetes at the time of diagnosis show poor adherence to the self‐management regimen. Thus, a physician needs to analyze the emotional response of the patient while breaking the news of diagnosis and should counsel the patient accordingly for better adherence and thus, a better control of diabetes. This would also result in a delay in the appearance of complications among the patients.

The physician should be able to impart simple but sufficient knowledge to the patient, explaining in brief about the various aspects and the possible complications of diabetes, so that the patient is aware of the need for self management for a better quality of life. There is a need for developing mutual understanding between the physician and the patient, so that the patient is not left with any kind of doubts which are related to the treatment.

Further exploration should be done on the topic, especially on the emotional reaction to the diagnosis, as very little literature is available on the subject. Focus group studies involving both physicians and patients should be carried out to explore the feelings and thoughts of both, in a better way.
The outcome of self management has to be improved by combining the efforts of the physician, educator, nutritionist and the psychologist, with the individual and his/her family.

Key Message

• Emotional responses affect diabetes management
• Males adhere more to the exercise regimen than females
• Dietary compliance is higher than exercise compliance
• Physicians must impart sufficient knowledge to the patients

References

1.
Faulkner A. When the news is bad: a guide for health professionals on breaking bad news. Cheltenham, UK: Stanley Thornes; 1998;783-790
2.
Gilibrand W, Flynn M. Forced externalization of control in people qualitative exploratory study. J Adv Nurs 2001; 34:501‐10.
3.
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