WITHDRAWN: Risk factors of cardiovascular diseases of individuals with type 2 diabetes mellitus, knowledge levels and affecting factors

Abstract

Background

The aim of this study was to determine the cardiovascular disease risk factors knowledge levels of individuals with Type 2 diabetes mellitus and the affecting factors.

Methods

Data were collected from 207 patients (101 men; 106 women) diagnosed with Type 2 Diabetes, who came to the Endocrinology outpatient clinic for control purposes between September 2021 and February 2022.

Results

The mean age of individuals with type 2 diabetes mellitus is 60.99 ± 13.74 years, and they have been diabetic for an average of 12.22 ± 9.86 years. The mean total score of the cardiovascular diseases risk factors knowledge scale was found to be 17.90 ± 3.33. It was determined that there was a statistically significant relationship between the sociodemographic characteristics of the patients and some of the variables related to heart health-protective behaviors and the level of knowledge of cardiovascular risk factors (p < 0.05).

Conclusion

The cardiovascular disease risk factors knowledge level of the patients included in the study was higher than the limit. The level of knowledge of the patients who exercise, have a balanced diet, and have cardiovascular health checks is higher than the others.

Introduction

Type-2 Diabetes mellitus (T2DM) is a chronic disease characterized by high blood glucose level and abnormalities in carbohydrate, fat, and protein metabolism. Chronic hyperlipidemia causes cardiovascular diseases (CVD) by affecting the circulatory physiology in individuals with DM [1, 2]. There are modifiable and non-modifiable risk factors in the development of DM and CVD. Modifiable risk factors such as malnutrition, obesity, and sedentary lifestyle play a role in the development of both DM and CVD [3]. The most effective way to reduce risk is to control modifiable risk factors [4, 5]. Khot et al [6]. emphasized that morbidity and mortality due to CVD can be reduced by 80–90% through controlling modifiable risk factors. For this reason, the level of knowledge about CVD risk factors of individuals with Type-2 DM should be increased and healthy lifestyle behaviors should be established [7, 8]. In the literature, it is seen that reducing alcohol/cigarette use, regular exercise and consumption of plant-based foods reduce the risk of Type-2 DM and CVD [9]. However, there are not enough studies directly addressing this issue in Turkey. Therefore, in this study, it was aimed to investigate the CVD risk factors knowledge levels of individuals with Type-2 DM and the affecting factors in Turkey.

Materials And Methods

Data collection

Data were collected by face-to-face interview technique using the "Individual Descriptive Information Form" and the "Cardiovascular Diseases Risk Factors Knowledge Level (CARRF-KL) Scale".

Individual Descriptive Information Form

Prepared using the relevant literature [1, 10, 11]. There are 33 (thirty-three) questions in the questionnaire form regarding socio-demographic characteristics, cardiovascular risk factors and protective behaviors for heart health.

Cardiovascular Diseases Risk Factors Knowledge Level (CARRF-KL) Scale

It was developed by Arıkan et al. in 2009 and its validity and reliability study was conducted. The scale questions the characteristics of cardiovascular diseases, their preventability, risk factors and the result of changes in risk behaviors. There are 28 items on the scale. The score that can be obtained from the scale is between 0–28. The higher the scores, the higher the level of knowledge. The internal consistency coefficient (Cronbach's alpha) of the scale is 0.768 [12]. In this study, the Cronbach's alpha coefficient of the scale was found to be 0.827.

Results

The mean age of the individuals included in the study was 69.99 ± 13.74, 51.2% were female, 83.6% were married, and 60.4% were primary school graduates. When the family histories of the patients were examined, it was determined that 31.9% had a history of DM and 52.2% had a history of heart disease (Table 1). When the health-protective behaviors of individuals with Type-2 DM are examined, 34.8% of them exercise, 35.3% consume at least one fruit per day, 43.0% consume at least one serving of vegetables per day, and 59.9% preferred to consume healthy foods as snacks, and 65.2% of them had their cardiovascular health checked regularly (Table 2).

The total mean score of the CARRF-KL Scale of the individuals participating in the study was 17.90 ± 3.33 points (Table 1). A statistically significant difference was found between the CVD risk factors knowledge level of individuals with Type-2 DM and exercise (p = 0.029), the amount of fruit consumed per day (p = 0.022), the type of food preferred for snacks (p = 0.025), regular blood glucose monitoring (p = 0.030), blood cholesterol level monitoring (p = 0.000), EKG check (p = 0.006), and cardiovascular health checks (p = 0.007) (Table 3).

The effect size between the variables affecting the CVD risk factors knowledge level of the individuals participating in the study was evaluated by regression analysis and is given in Table 4. The independent variables of "exercising", "blood glucose monitoring", "cholesterol level monitoring", "EKG test" and "having cardiovascular health checked", which are health-protective behaviors, explain 9.1% of the total score of the scale (R = 0.301; R2 = 0.091; F = 4.010; p = 0.02; DW = 1.631). The independent variables of "daily consumed fruit amount", "daily consumed vegetable amount", and "preferred food type in snacks" within the nutritional habits also explain 9% of the total score of the scale (R = 0.300; R2 = 0.090; F = 4.010; p = 0.0001; DW = 1.654). − .412 increase in regular exercise, 0.389 increase in regular blood glucose monitoring, -1,489 increase in blood cholesterol level monitoring, − .346 increase in EKG check, and − .430 increase in cardiovascular health monitoring increases the scale score by 1 point (Table 4).

Discussion

According to the International Diabetes Federation (IDF) 2021 data, it is known that 537 million people in the world have diabetes and 90% of them are diagnosed with Type-2 DM [14]. CVD is an important cause of morbidity/mortality in individuals with diabetes, and it is difficult to examine risk factors separately from DM [11, 15]. According to the American Diabetes Association (ADA) (2019) report and the Turkish Endocrinology and Metabolism Society Guidelines (2020), controlling risk factors in individuals with DM also reduces the risk of CVD [16, 17].

There are many factors such as advanced age, genetic factors, smoking/alcohol use, obesity, malnutrition, and sedentary lifestyle among diabetes and CVD risk factors.^[18] In the national and international literature, it is seen that the majority of individuals with DM consume cigarettes and alcohol, are obese, and have a low level of physical activity [1, 11, 18]. In this study, it is seen that the average age of Type-2 DM individuals is over 60 years old, more than half of them have a family history of DM and CVD, and most of them do not exercise. The results of the research are similar to the literature and it can be said that individuals with Type-2 DM have more than one CVD risk factor. The level of knowledge is important in reducing the risk of CVD in individuals with type-2 DM. In the study of Wanger et al. (2005), it is seen that the CVD risk factor knowledge level of individuals with DM is low [19].

There are different studies in the literature reporting that individuals with DM have medium or high CVD risk factor knowledge levels [5, 20]. In this study, the CVD risk factor knowledge level of individuals with diabetes was found to be higher than the limit. The high level of knowledge of individuals indicates that their awareness of CVD risk factors has improved. This awareness of risk factors can be considered as the strength of the study in gaining healthy life behaviors in individuals with Type-2 DM.

It is stated in the national and international literature that reducing smoking/alcohol use, regular physical exercise, and an herbal diet are healthy lifestyle behaviors, and that these practices reduce CVD risk factors by lowering HbA1C, lipid, and blood pressure [ 9,21,22,23]. In addition, in the systematic review published by Barbareso et al. (2018), healthy living behaviors include sleeping patterns, medical controls, and social activity [24]. In this study, similar to the literature, the exercise status, diet and medical controls of individuals with diabetes were examined.

As a result of the research, it was determined that although very few of the individuals with Type-2 DM exercise regularly, the majority of them consume enough fruit/vegetables daily, prefer healthy foods for snacks, go to their medical controls, have EKGs, and have their blood sugar and cholesterol levels measured. This situation positively affects the cardiovascular disease risk factors knowledge level of individuals with Type-2 DM. In other words, these individuals are more aware of CVD risk factors than other individuals. However, in the regression analysis, it is seen that health-protective behaviors (9.1%) and positive eating habits (9%) explain only a small part of the CVD risk factor knowledge level. This situation can be interpreted as that health behaviors are affected by social and cultural variables other than the level of knowledge.

Strengths And Limitations

We used a convenience sample of Type-2 DM patients who came to the Pamukkale University Hospital endocrinology outpatient clinic for control purposes in westhern in Turkey. Therefore, the results cannot be generalized to all Type-2 DM patients.

Conclusion

In conclusion, this study demonstrated that individuals with diabetes who participated in the study are aware of CVD risk factors. However, the ratio of the healthy lifestyle behaviors they have developed to the general risk factors knowledge level is quite low. For this reason, it may be recommended to include CVD in the diabetes education program to increase the number of individuals who perform these behaviors and to reduce CVD-related morbidity/mortality.

Declarations

Ethics approval and consent to participate

To conduct the research, a written permit was obtained from the Board of Ethics of Pamukkale University Medical Faculty (23/09/2021-E.106847), the hospital where the research was carried out, the authors who developed the scale and individuals participating. The study was conducted in accordance with the principles of the Declaration of Helsinki. All participants gave informed consent for the research, and that their anonymity was preserved.

Consent for publication

Not applicable

Availability of data and materials

Restrictions apply to the availability of some or all data generated or analyzed during this study to preserve patient confidentiality or because they were used under license. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.

Competing interests

The author (s) declare that I have no competing interests.

Funding

The study was not funded by any funding organization and did not receive any funding support

Author contributions

The study was jointly designed by the one author. FG collected the data, performed the statistical analysis and prepared the first draft. Each author made substantial contributions to the conception and design of the study, was involved in drafting the manuscript or revising it critically for important intellectual content and approved the final version to be published.

Acknowledgments

The author (s) would like to thank all patients who participated in this study and all experts and hospital for supporting this study.

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