K'A'P STUDY ON HT

1
TOTAL PATIENTS - 175
120
100
80
No of patients
60
40
20
0
YES
NO
67
108
Series1
FAMILY HISTORY
2
HYPERTENSION DIABETES
160
140
120
100
No of patients
80
60
40
20
0
Railway hospital
Private
Regular treatment
Irregular treatm
149
26
127
48
Series1
TREATMENT
3
Classification of patient
100
91
90
80
70
60
50
40
33
33
30
20
15
10
2
1
0
CLASS-1
CLASS-2
CLASS-4
RTD.EMPLOYEE
CLASS-3
DEPENTANTS
category
4
20
19
COMPLICATION
18
16
14
12
10
8
7
6
6
4
3
2
1
1
0
1
AMPUTATION
RETINOPATHY
NEPHROPATHY
HEART ATTACK
STOKE
NON-HEALING ULCER
5
BODY MASS INDEX
115
120
100
80
49
60
40
6
5
20
0
lt 17
gt 17-lt 27
gt 27- lt 32
gt 32
5
115
49
6
Series1
6
WAIST-HIP RATIO

• How to Calculate Waist-Hip Ratio 
• Waist Hip Ratio is calculated by dividing your
  waist measurement by your hip measurement. Using
  a tape measure, measure your waist below your
  rib-cage but above your belly button. Then
  measure your hips - the widest part of your butt.
  Finally, divide your waist measurement by your
  hip measurement.
• Ideally, women should have a waist-to-hip ratio
  of 0.8 or less.
• Ideally, men should have a waist-to-hip
  ratio of 0.95 or less

7
SMOKING
8
DIET PATTERN
9
EYE CHECK UP
10
ALCOHOL
11
LIPID PROFILE
12
FIBER DIET
13
REGULAR CHECK UP
AT RH/PER
NO
33
YES
67
YES
NO
14
EXERCISE
15
REGULAR TREATMENT
16
SOURCE OF INFORMATION
SOURCE OF INFORMATION
3
5
4
88
RADIO/TV
NEWSPAPER
MEDICAL STAFF
FRIENDS
17
KNOWLEDGE
KNOWLEDGE
160
YES-136
140
120
YES-102
NO-101
YES-96
100
NO-93
NO-91
YES-84
YES-82
NO-79
YES-74
80
NO-73
60
NO-39
40
20
0
WHAT IS HT?
SYMPTOMS OF DM
COMPLICA-TION OF DM
SYMPTOMS OF HT
COMPLICA-TION OF HT
WHAT IS DM?
18
ATTITUDE
19
PRACTICE
160
NO-141
140
NO-125
120
NO-113
NO-105
100
NO-91
YES-84
80
YES-70
YES-62
60
YES-50
YES-35
40
20
HEALTHY/ BALANCED DIET
0
REGUL WEIGHT CHECK UP
REGULAR EXECISE
REGULAR BP CHECK UP
BLOOD, URINE SUGAR CHECK UP
20
DISCUSSION

• This study was conducted to gauge the effects of
  knowledge on the attitude-followed by practice
  among diabetic and HT patients, attending Railway
  health unit, Tondiarpet Marshaling Yard. 
• Total patients for K.A.P study were 175. 68
  of them were suffering from HT, followed by 66
  with DM alone and 41 patients with DM and HT. 114
  male patients and 61 female patients were
  included in this study. Most of the patients age
  ranged from 51-60 years (78), followed by 41- 50
  years (73), gt 60 years (16), and 30 40 years
  (8).

21
The most common source of information on diabetes
was from medical staffs (80 T0 85). This could
be due to the fact that all newly diagnosed
diabetic and HT patients are thoroughly briefed
on diabetes by the doctors and the medical
assistants. The respondents were tested on 6
aspects of knowledge on diabetes - what they
understand by the disease, symptoms,
complications, prevention, diet and exercise. 50
to 60 of the total 175 patients are having the
adequate knowledge about HT and DM. 30 to 40 of
the patients are having the attitude to control
DM and HT.
22
80 to 85 of the patients collected the source
of information about DM and HT from the Medical
Department. Random blood sugar of 60 to 65 of
diabetic patients was above 200 mgms. Only 3
Diabetic patients were periodically monitored by
Hba1c level in blood from private laboratory. 95
of the total patients are Non-Vegetarian. 58 of
the male patients are alcoholic, and 26 Male
patients are smokers. 49/175 patients are over
weight and 6/175 patients are Obese. Only 85 of
the patients were not done lipid profile and 45
of the patients were monitored by eye check-up.
48 of the patients preferred private lab for
their routine investigation for follow-up as
their residence far away.
23
Conclusion

• In many cases, we can prevent or treat these
  diseases, but in order to do so, we need to
  persuade people to make changes in diet, physical
  activity, and their own awareness and monitoring
  of the diseases progression changes that are
  psychologically difficult and that present
  formidable barriers for individuals and health
  systems alike. While genetic predisposition may
  play a role in type II diabetes, its onset and
  severity can be modified by diet and activity.
  Complications can be reduced by addressing these
  risk factors and achieving blood pressure control
  and avoiding tobacco use.

24
To improve health in the next century, we will
have to do a better job of applying the knowledge
we already have and ensuring access to effective
and economically affordable diabetes and HT care
to the population that is essential for
preventing, reducing diabetes and HT related
complications. Certain measures are recommended
to improve peoples perception and practice
towards Diabetes and HT. A better-structured
education programme is recommended to every
individual especially those with diabetes and HT.
The programme should cover topics such as
symptoms, complications, preventive measures,
diet and exercise. This should be done at all
levels including through school, working centres
and to the railway colony people.
25
A tailored programme with gradual introduction of
exercise is encouraged with consideration of the
individuals age. A weight reduction programme
incorporating diet modification is also
recommended for those who are over weight, where
as a weight maintenance programme is encouraged
for those with normal body weight. A continuous
self-monitoring system should be introduced for
diabetic patients. This enables them to
continuously monitor their blood glucose level as
well as control their diet accordingly. studies
on similar context but with wider scope and much
larger sample size is recommended to confirm
findings of this study and to further explore
other relevant factors especially factors
influencing practice and perception.
26
SUGGESTION AND RECOMMENDATION

• GOALS OF DIETARY THERAPY
•  
• 1) Restoration of optimal blood glucose and
  S.lipid levels.
• 2) Provision of adequate calories to maintain
  normal weight and
• Improvement of overall health in diabetes.

27
Three strategies in preventing coronary heart
diseases in DM and HT Patients
1. Substituting unsaturated fats (poly
unsaturated fats) for saturated fats and trans
fats. 2. Increasing use of Omega-3 fatty acids
from fish oil. 3. Diet rich in fruits,
vegetables, nuts, and whole grains but low in
refined grains.
28
CALORIES PRESCRIPTION Calorie
prescription is an important element in
nutritional management. Calorie needs vary with
age, sex and activity level. Recommended calorie
level is based on individuals desired weight. 
IDEAL BODY WEIGHT (IBW) KG (HT IN CM - 100) X
0.9 CALORIE INTAKE BASED ON ACTIVITY IS AS
FOLLOWS   SEDENTARY 20 - 25 CAL/KG
(IBW) MODERATE 26 - 30 CAL/KG
(IBW) STRENUOUR 31 - 35 CAL/KG (IBW)
29
(No Transcript)
30
An energy deficit of 500 k.cal/day will help to
reduce 500 gms of weight every week. Dietary
therapy for people with diabetes should be
individualized with consideration given to usual
eating habits and other lifestyle factors.
Nutrition recommendations are implemented to
attain the goals. Micronutrients such as
vitamins and minerals are supplemented as
required, sodium restriction in those with
hypertension and cardiac failure. Diet with low
glycaemic index is preferred to high glycaemic
index. Complex carbohydrates are ideal as they
are slowly digested and absorbed with lesser
steep in raise of Post Prandial glucose and
insulin response.
31
HEALTHY DIET/ BALANCED DIET   Protein
- 15 of total
energy Carbohydrates - 50 to 60
of total energy Total fats
- 25 to 35 of total energy Saturated fat
- lt 7 total energy Poly
unsaturated fat - up to 10 total
energy Mono unsaturated fat - up to 20
total energy Fiber diet -
20 to 30 grams per day Vitamins and
minerals Water Salt
- 2400 milligrams per day
(One teaspoon of
salt) Cholesterol - lt 300
mgm/day
32
EXERCISE Brisk
walking, healthy diet will be helpful for
longevity for people with Type2diabetes, and
plays an important role in the prevention of over
weight and obesity. TV watching is significantly
associated with the risk of obesity and type 2
diabetes. Obesity can indirectly do some changes
in the body which include the following  

• Raising the levels of LDL (Bad cholesterol)
• Lowering the levels of HDL (Good Cholesterol)
• Raising the levels of Triglycerides
• Increasing the Blood Pressure
• Increasing the risk of Type 2 Diabetes

33
Exercise is known to  

• Increase insulin sensitivity,
• Improve glucose tolerance,
• Promote weight loss,
• Reduce triglyceride levels
• Increasing the levels of HDL cholesterol
• Decreasing the levels of LDL cholesterol
• Reduces the risk of hardening of arteries
  (atheroscelerosis)
• Improving blood flow, which reduces the risk of
  infection in the lower legs and foot. People
  with diabetes are encouraged to exercise for at
  least 30 minutes, at least three or four times
  per week.

34
Exercise precautions  

• Starting slowly and building up to longer/ harder
  workouts.
• Keeping track of ones heart rate.
• Warming up slowly before exercise and cooling
  down slowly afterwards.
• To calculate the maximum target heart rate (220
  Ones age), and maintain the 70 to 80 ones
  maximum heart rate during exercise.
• After exercise, the goal is to decrease the heart
  rate and relax the muscles by doing slow
  stretches.
• To consult physician before beginning any
  exercise program.
• To wear appropriate shoes and socks.
• To have an exercise partner, snacks, and medical
  I.D card.
• Testing glucose levels both before and after
  exercise.

35
YOGA FOR DIABETES   Types of yoga
recommended for diabetes  

• Pranayama
• Dhanurasana
• Ardha-Matsendrasana
• Pachi motanasana
• Halasana
• And Vajarasana 
• Dhanurasana is most effective. These are
  practiced on an empty stomach for 30 minutes
  followed by shavasana for 10 15 mts.

36
Effect of yoga

• Fall in FBS level
• Fall in PPBS level
• Reduction in systolic B.P
• Reduction in Diastolic B.P
• Reduction in dosage requirement of anti
  hypertensives
• Increase in HDL cholesterol
• Decrease in LDL cholesterol
• Decrease in free fatty acids
• Decrease in VLDL cholesterol
• Reduction in fasting insulin levels
• Increase in insulin receptors
• And Insulin sensitivity increases.