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1. A PROSPECTIVE STUDY ON EFFECT OF
PANDEMIC RESTRICTION ON QUALITY OF
LIFE AND MEDICATION ADHERENCE OF
DIABETES PATIENTS
UNDER THE GUIDANCE OF:
DR. G PARTHASARTHY
Professor and HOD of Pharmacy Practice Department
The Oxford College Of Pharmacy, Bangalore 560068
Co Guide:
DR TEJASWI C N
Professor and HOD of general medicine
The Oxford Medical College Hospital And Research Centre
Bangalore 562107
Name of the participants
1. ASHMITA MODAK
2. BINDU B N
3. CHANDANA K S
4. DEEKSHITHA L

2. INTRODUCTION ON DIABETES MELLITUS
• It is defined as a group of metabolic disorder characterized by chronic hyper Glycemic condition
along with disturbance of carbohydrate, fat and protein metabolism resulting in defects of insulin
secretion and action or both1.
CLASSIFICATION OF DIABETES MELLITUS
• Type 1 diabetes mellitus: it is characterized by the destruction of insulin producing beta cells of
pancreas.
• Type 2 diabetes mellitus: it’s a heterogenous group of disorders characterized by insulin resistance,
impaired insulin secretion and in increased blood glucose level.
RISK FACTORS :Family history, Genetics , Obesity, Western lifestyle, Tobaco use
,Lack of physical activity , Stress ,Injury to pancreas4
SIGNS AND SYMPTOMS : Increased thrist ,fatigue , blurred vision , numbness of hands and
feet , slow healing of wounds ,unplanned weight loss and weight gain , frequent urination , dry mouth
, hunger4

3. IMPACT OF COVID 19 PANDEMIC ON QUALITY
OF LIFE OF DIABETES PATIENTS
• COVID-19 pandemic has led to health service
modification and temporary disruption of the
routine care provided to patients with diabetes
mellitus (DM) in primary care. This was done to
minimize outpatient visits, permit physical
distancing, and ensure patients’ and healthcare
providers safety(10).
• After the occurrence of the covid pandemic the
number of patients being hospitalized to the
hospital with other disease condition has been
drastically changed and reduced which also reduced
the health care and pharmaceutical care and
drastically affected their quality of life and disease
management

4. QUALITY OF LIFE
Quality of life is an important health outcome on its
own right, representing the ultimate goal of all health
interventions. Quality of life is measured as physical
and social functioning, and perceived physical and
mental well-being. People with diabetes have a worse
quality of life than people with no chronic illness, but
a better quality of life than people with most other
serious chronic diseases. Duration and type of
diabetes are not consistently associated with quality of
life. Complication of diabetes are most important
disease-specific determinant of quality of life. Studies
of clinical and educational intervention suggest that
improving patients health status and perceived ability
to control their disease results in improved quality of
life8.

5. LITERATURE REVIEW
YASUHIRO TANJI et al
June 2021 (9)
IMPACT OF COVID 19 PANDEMIC ON
GLYCEMIC CONTROLAMONG
OUTPATEINTS WITH TYPE 2
DIABETES IN JAPAN
A hospital based survey from a country without lockdown. They
conducted a historical cohort study, using electronic medical
records of patients with type 2 diabetes mellitus who visited the
clinic between January 2019-august 2020. Differences Hba1c
values before and after the outbreak of covid 19 where the
primary outcome examined using liner mixed model. Hba1c
value significantly increased from 7.45% to 7.53%, glycemic
control deteriorated in patients with diabetes mellitus type 2
during the pandemic even in a country without a national
lockdown.
RITA FORDE , SEYDA
OZCAN
November 2020(10)
IMPACT OF COVID 19 PANDEMIC ON
PEOPLE WITH DIABETES AND
DIABETIC SERVICES ACROSS
EUROPE
To describe diabetes nurses perspectives on impact of the covid
19 pandemic on people with diabetes and diabetes services across
Europe. An online survey developed using a rapid Delphi
method. The survey translated into 17 different languages and
disseminated electronically in 27 countries. Survey included
1829 diabetic nurses. The responses indicated that 28-48% of the
nurses felt covid pandemic impacted a lot on physical and
physiological risks of people with diabetes respectively
.82%anxiety, 65% diabetes distress, 49% depression , 39 % acute
hypo glycemic and 18% foot complications was increased. 47%
identified that the level of care provided to people had declined
severely .

6. LITERATURE REVIEW
NAME OF THE AUTHOR TITLE OF THE STUDY CONCLUSION
EMILIA BIAMONTTE ,
ISABELLA
APRIL 2021 13
WEIGHT CHANGE AND
GLYCEMIC CONTROL IN
TYPE 2 DM PATIENTS
DURING COVID 19
PANDEMIC : LOCKDOWN
EFFECT
A retrospective study to evaluate the impact of covid 19
lockdown based on the glycaemic control with type 2 patient
. The study involved 128 patients with type 2 dm and data on
the metabolic control was collected over different time like
within 3 months before and 6 weeks after lockdown
Result : During the lockdown , a significant increase in body
weight , BMI , Waist circumference , FPG ,glycated
haemoglobin . The lockdown had a negative impact on body
weight and glucose control in type 2 dm patients
DAYANIDHI MEHER ,
SONALI KAR
December 2020(7)
QOL OF DIABETIC
PATIENTS IN TERTIARY
CARE HOSPITAL IN
BHUBANESHWAR, ODHISA
INDIA
A prospective study for assessing QOL include 34
questionnaires during a period of dec 2019-may 2020 among
400 subjects with type 1 diabetes mellitus with age group
greater than 18 years. The questions were answered yes/no,
every yes adds up to one score
Result :there is better quality of life in males compared to
females, males also score better in terms of emotional and
mental health

7. NEED OF THE STUDY
• The need of the study is to assess the effect of pandemic
restriction on quality of life of diabetes patients
• To assess the medication adherence of diabetes patients
• The study helps in enhancing patient care by improving
patient education , medication adherence and quality of life .

8. AIMS AND OBJECTIVE OF THE STUDY
AIM: TO STUDY THE EFFECT OF PANDEMIC RESTRICTION ON QUALITY
OF LIFE AND MEDICATION ADHERENCE IN DIABETES PATIENTS .
PRIMARY OBJECTIVE:
• To study impact of covid 19 pandemic restriction on quality of life of
diabetes patient and to enhance patient care .
SECONDARY OBJECTIVE:
• To assess the medication adherence in diabetes patients

9. METHODOLOGY
• STUDY SITE: The oxford medical college hospital and Research
Centre, Attibele, Bangalore.
• STUDY DESIGN: Prospective cross sectional study .
• STUDY PERIOD: 6months
• ETHICAL APPROVAL FOR THE STUDY:
Ethical approval was be obtained from the
institutional ethics committee of the oxford medical college hospital and
research centre , Attibele , Bangalore

10. SAMPLE SIZE DETERMINATION
The following calculation was used for calculating sample size (12)
Desired sample size
X = Z2 P (1-P )
e2
X = ( 1.96 )2 × 0.2 ×0.8
(0.05 ) 2
= 245
Required sample size
n = NX
X +(N-1)
n = 250 × 245
245 +( 250-1 )
= 124
Z= confidence interval 95% = 1.96
P = Expected prevalence(12) = 0.2
N= Desired sample = 250
Q= (1-p)
e= desired margin of error
n = required sample size

11. SAMPLE SIZE
• Case admitted to hospital during the study period.
• Step1:we obtained consent from 110 patient through informed consent form in
both English and Kannada language.
• Step 2: we collected the diabetic cases from outpatient and inpatient general
medicine department during study period.
• Step 3: Collection of demographics details, patient medical history and
patient diabetic condition through diagnostic criteria from case records.
• Step 4 : To assess the effect of pandemic restriction on quality of life by
asking WHOQOL SCALE BREIF 26 and Covid questionnaries .
• Step 5 : To assess the medication adherence through morisky 8 item
questionaries . And follow up was conducted .
• Step 6: The obtained data is subjected for suitable statistical method like Z test
and the results are expressed in the form of suitable graphs.

12. STUDY CRITERIA
INCLUSION CRITERIA:
• All the patients with diabetes mellitus irrespective of gender.
• Both inpatient and outpatient.
• All the patients who are willing to participate in the study.
EXCLUSION CRITERIA:
• Uncooperative patients
• Pregnant women

13. SOURCES OF DATA
• Patient case notes and medication profile
• Patient prescription
• Personal interview with patient/ patient's attendant.
• Responses provided in questionnaires.
OPERATIONAL MODALITY
• Identification of the patient: Diabetes mellitus cases from general medicine
department of the oxford medical college, hospital and research centre Attibele
Bangalore.

14. • Collection of data: The medical records of diabetes mellitus patients
who are visiting during our study period was collected from the
general medicine department . Demographic details like ( name , age ,
gender , occupation ) , medication history , family history , socio
economic status and treatment plan will be recorded .
• Outcome analysis: The outcome of the study is to measure the effect
of pandemic on quality of life , medication adherence through
responses provided by patients in respective questionnaires .

15. RESULTS

16. 23.5
24
24.5
25
25.5
26
26.5
27
27.5
28
28.5
URBAN RURAL
COUNT
RESIDENCY
RESIDENCY
RESIDENCY COUNT
URBAN 25
RURAL 28
0
2
4
6
8
10
12
14
16
18
30-39 40-49 50-59 60-69 70-79 80-90
NUMBER
OF
PEOPLE
AGE INTERVAL
NUMBER OF
PEOPLE
AGE INTERVAL NUMBER OF PEOPLE
30-39 4
40-49 15
50-59 17
60-69 11
70-79 5
80-90 1

17. 0
1
2
3
4
5
6
7
8
9
10
100-129 130-159 160-189 190-219 220-249 250-279 280-309 340-369 370-399
NUMBER FBS DISTRIBUTION
FASTING BLOOD
SUGAR COUNT
100-129 3
130-159 5
160-189 7
190-219 9
220-249 9
250-279 7
280-309 3
340-369 7
370-399 3
HBAIC COUNT
5.7-7.2 4
7.2-8.7 16
8.7-10.2 20
10.2-11.7 3
11.7-13.2 2
13.2-14.7 4
14.7-16.2 3
17.7-19.2 1
4
16
20
3 2
4
3 1
0
5
10
15
20
25
5.7-7.2 7.2-8.7 8.7-10.2 10.2-11.7 11.7-13.2 13.2-14.7 14.7-16.2 17.7-19.2
HBA1C VALUES
HBA1C DISTRIBUTION

18. GENDER COUNT OF GENDER
FEMALE 13
MALE 40
13
40
0
5
10
15
20
25
30
35
40
45
FEMALE MALE
COUNT
COUNT OF GENDER
COUNT OF GENDER
MEDICATION
ADHERENCE COUNT
ADHERENT 17
NON ADHERENT 27
0
5
10
15
20
25
30
COUNT
ADHERENCE
ADHERENCE
ADHERENT NON ADHERENT

19. 21
32
YES NO
ALCOHOL
ALCOHOL CONSUMPTION
ALCOHOL CONSUMPTION COUNT
YES 21
NO 32
13
40
YES NO
SMOKING
NUMBER
SMOKING
SMOKIN STATUS COUNT
YES 13
NO 40

20. COMPLICATION COUNT
DIABETIC FOOT ULCER 11
DIABETIC RETINOPATHY 8
DAIBETIC NEUROPATHY 16
DIABETIC NEPHROPATHY 4
DIABETIC KETO ACIDOSIS 4
HYPERLIPIDEMIA 1
CARDIOVASCULAR DISORDER 4
23%
17%
34%
8%
8%
2%
8%
COUNT
DIABETIC FOOT ULCER DIABETIC RETINOPATHY DAIBETIC NEUROPATHY
DIABETIC NEPHROPATHY DIABETIC KETO ACIDOSIS HYPERLIPIDEMIA
CARDIOVASCULAR DISORDER

22. CONCLUSION
• 110 Cases are collected up to date based on the collected cases
revealed that the quality of life of most of the patients has changed
due to pandemic restrictions.
• Medication adherence was reduced due to financial burden due to
pandemic restrictions and was increased after patient counselling.
• Many newly diagnosed diabetes cases was recorded due to reduced
physical activity, increased BMI, waist circumference
• The patients who were already diagnosed with diabetes have
developed diabetes complications
• Overall prevalence of diabetes has been increased due to pandemic
restrictions .

23. REFERENCES
1. Roger W, CateW. Diabetes mellitus:epidemiology and types . 5th edition 2012: 361-63
2. Mohanty S. Lada and Mody [Internet]. SlideShare. 2014 . Available from: https://www.slideshare.net/sriloy/lada-and-mody
3. Pietrangelo A. Types of diabetes: Causes, identification, and more [Internet]. Healthline. Healthline Media; 2018 .Available from: https://www.healthline.com/health/diabetes/types-
of-diabetes
4. LA S. National Diabetes Statistics Report 2020. estimates of ... Ii [Internet]. National diabetes statistics report. 2020 . Available from:
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
5. EW Gregg. What is diabetes. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2021 Available from:
https://www.cdc.gov/diabetes/basics/diabetes.html
6. SS; MEARBHMES. Evolving Concepts and Treatment [Internet]. Cleveland Clinic journal of medicine. U.S. National Library of Medicine; 2019 . Available from:
https://pubmed.ncbi.nlm.nih.gov/31291183/
7. M; RRRP. Quality of life and diabetes [Internet]. Diabetes/metabolism research and reviews. U.S. National Library ofMedicine;1999.Availablefrom:
https://pubmed.ncbi.nlm.nih.gov/10441043/?from_term=%22Quality%2Bof%2BLife%22%5BMesh%5D&from_no_cache=yes&from_pos=4
8. Banerjee M, Chakraborty S, Pal R. Teleconsultation and diabetes care amid covid-19 pandemic in India: Scopes and challenges. Journal of Diabetes Science and Technology.
2020;14(4):714–5.
9. Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, et al. Glycemic characteristics and clinical outcomes of COVID-19 patients hospitalized in the United States
[Internet]. Journal of diabetes science and technology. SAGE Publications; 2020 .Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673150/
10. Renzo D. Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey [Internet]. Journal of translational medicine. U.S. National Library of Medicine; 2020.
Available from: https://pubmed.ncbi.nlm.nih.gov/32513197/
11. Hussain A, Bhowmik B, do Vale Moreira NC. Covid-19 and diabetes: Knowledge in progress. [Internet]. Diabetes Res Clin Pract. 1970 . Available from:
https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/en/covidwho-47474
12. Ranasinghe P, Jayawardena R, Gamage N, Sivanandam N, Misra A. Prevalence and trends of the diabetes epidemic in urban and Rural India: A pooled systematic review and meta-
analysis of 1.7 million adults. Annals of Epidemiology. 2021;58:128–48
13. Biamonte E, Pegoraro F, Carrone F, Facchi I, Favacchio G, Lania AG, et al. Weight change and glycemic control in type 2 diabetes patients during COVID-19 pandemic: The
lockdown effect. Endocrine. 2021;72(3):604–10.

24. ANNEXURE 1

25. QUESTIONS Patient answer
(yes/no)
Score
Yes=1
No= 0
Do you sometimes forget to take your medicines?
People sometimes miss taking their medicines for reasons other than forgetting. Thinking over the
past two weeks, were there any days when you did not take your medicine?
Have you ever cut back or stopped taking your medicine without telling your doctor because you
felt worse when you took it?
When you travel or leave home, do you sometimes forget to bring along your medicine?
Did you take all your medicines yesterday?
When you feel like your symptoms are under control, do you sometimes stop taking your
medicines?
Taking medicine every day is a real inconvenience for some people. Do you ever feel hassled
about sticking to your treatment plan?
How often do you have difficulty remembering to take all your medicine?
A – never /rarely
B – once in a while
C - sometimes
D – usually
E – all the time
A=0
B-E =1
Scores > 2 = low adherence
1 or 2 = medium adherence
0 = high adherence
ANNEXURE 2

26. ANNEXURE 3

29. COUNSELLING LEAFLETS

31. THANK YOU …………………………….