Background  
Diabetes mellitus is a chronic health condition that can involve individuals of all ages(1). In the last three decades, the number of diabetic patients has risen four times worldwide. Moreover, it is also the ninth major cause of death. Globally, one out of every eleven adult individuals now have diabetes mellitus 90% of whom suffer from type 2 Diabetes mellitus(2). Currently, the prevalence of Type 2 Diabetes mellitus in Pakistan is 11.77% (1.) Throughout the world 352 million adult individuals have impaired glucose tolerance and are at the risk of developing diabetes by 2045(3.)

Type 2 Diabetes mellitus is associated with various risk factors such as obesity, elevated levels of cholesterol, triglycerides and low HDL levels(4. )The beneficial effects of patient education in lowering glycosylated Hemoglobin (HbA1c) were found in patients with type 2 Diabetes mellitus(5).

Aim
* Our goal was to re-establish nutrition service to the diabetic patients of Sugar Hospital which was interrupted temporarily due to financial constrain during the Covid 19 pandemic. 
* We also aimed to analyze the impact of a nutrition education video administered via cellphone to the patients with Type 2 Diabetes.

Method  
We collected and analyzed the data from patients visiting The Sugar Hospital, Peshawar, Pakistan following an informed verbal consent. We surveyed 200 patients over the course of 4 weeks. Their baseline nutrition related knowledge of Type 2 Diabetes using UKDDQ was assessed before giving the educational material, along with their clinical and demographic data by the Nutritionist. Various variables including age, gender, smoking, disease duration, occupation, height, weight, BMI, waist circumference, blood pressure, most recent HbA1C, other co-morbid diseases and dietary habits were initially measured for all the recruited participants.

This was followed by demonstration and delivery of the nutrition education video (2.5 minutes) using cellphone of The Sugar Hospital. The video was made in native language that was easy to understand. It included basic health, diet and exercise advice. The patients were followed up after one week for their feedback on the educational video (sent via WhatsApp). These patients were followed up again after a period of three months to determine the role of nutrition video intervention on the measured variables using the same UKDDQ score.

Results  
Out of the 200 patients recruited, 80 patients were successfully followed up while 120 patients had a loss to follow up. Among these 80 patients, 45 were females and 35 were males. 15% of the patients had a normal BMI, 44% were overweight while 41% were obese. The mean BMI of these obese patients decreased from (32.9 S.D. ±3.2) to (31.6 S.D. ±3.7). Moreover, patients with HbA1c of 7 and above decreased from an average of (10.1 S.D. ±2.1) to (8.6 S.D. ±2.1), with single tail t-test p-value &lt;0.001.

Discussion  
This study confirms a slight decrease in BMI along with a statistically significant decline in HbA1c levels of patients as a result of nutrition education video and dietary advice. 

References  
1. Sultan Ayoub Meo, Inam Zia, Ishfaq A Bukhari, Shoukat Ali Arain (2016) Type 2 diabetes mellitus in Pakistan: Current prevalence and future forecast J Pak Med Assoc 2016 Dec;66(12):1637-1642.  
2. Yan Zheng, Sylvia H. Ley &amp; Frank B. Hu (2017) Global etiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology volume 14, pages88–98 (2018)  
3. Godfrey O. Mauti, and Ritah Kiconco (2020) Prevalence and Risk Factors Associated with Type 2 Diabetes in Elderly Patients Aged 45-80 Years at Kanungu District. Journal of Diabetes Research Volume 2020 |Article ID 5152146. https://doi.org/10.1155/2020/5152146   
4. Mohammed Abdullah Al Mansour (2019) The Prevalence and Risk Factors of Type 2 Diabetes Mellitus (DMT2) in a Semi-Urban Saudi Population. International Journal of Environmental  
5. Iraj Zareban, Mahmood Karimy, Shamsaddin Niknami, Alireza Haidarnia, Fatemeh Rakhshani (2014) The effect of self-care education program on reducing HbA1c levels in patients with type 2 diabetes International Journal of Health Promotion and Education 3(3):123 DOI:10.4103/2277-9531.145935



Impact of diabetes based nutrition educational video on patients' diabetes control in Sugar Hospital Peshawar Pakistan