The chronic hyperglycemia in diabetes is associated with long-term damage, dysfunction, and failure of different organs. Lack of patient education and knowledge about these complications can worsen the quality of a patient’s life. Hence, more efforts are needed to improve patient’s education especially in rural areas.
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder affecting about 425 million people worldwide in 2017, and, according to the International Diabetes Federation (IDF) report, is expected to affect up to 629 million people by 2045 [
Patients with T2DM were included in the study and given a predesigned questionnaire completed during face-to-face interviews. We randomly selected participants over the age of 18 years (both males and females) at different locations in large primary care centers and private pharmacies in the Tabuk region. We excluded young people (younger than 18 years old) and lately diagnosed diabetic patients (before less than 5 years). Moreover, we excluded patients who had bad handwritings, who intended to hide information, who did not understand the questions even after explanation, who gave irrelevant information, who are mentally handicapped, who are with medical background (all health-related education), who had attended diabetes education programs in the last 6 months, who were on a hurry, and who did not complete the questionnaire. Subjects were consented to participate after they were given full details of the study and its intended aims. Moreover, we clarified their queries before obtaining the consent. Patients fulfilled the inclusion criteria (aged between 51 and 74 years; were classified into (late adulthood: 51 to 64 years old, and young old age: 65 to 74 years old)) and were included for the final analysis. The rationale for choosing the areas is to observe the transition of the disease as a consequence of changing lifestyles and the effect of the presence of both the university and diabetic center related to the ministry of health in Tabuk as well. Besides, these areas were included as 2.77% of the total population of Saudi live in such areas according to the 2019 national statistics [
An observational cross-sectional descriptive study extended for one year from March 2018 to September 2019. We used a previously validated questionnaire for the knowledge, attitude, and practice for diabetes mellitus in both Arabic and English languages as well. The Arabic translation was done by a professional Arabic speaker and expert in both languages with good explaining ability for the meaning to the publics. The Arabic version then went through further revision and then back translated into English by another bilingual translator. This Arabic version of the final form was examined and approved by two diabetologists to assess content and construct validity. The questionnaire did not contain any questions which can reveal the identity of patients or their treating doctors. The first segment of the questionnaire included the socio-demographics of the participants. Data included gender, age, level of education, average income, and occupation. Participants were also asked whether their occupation and education were related to the medical field. Knowledge regarding T2DM was measured using eight main questions related to the risk factors, diagnosis, prevention, and complications of diabetes mellitus. The possible categorical answers were “Yes,” “Do not know,” and “No.” The diabetes attitude was assessed using seven questions related to compliance with the treatment of DM. The possible categorical answers were “Yes,” “Do not know,” and “No.” Patients’ interviews were conducted at the outpatient departments (OPDs) of King Fahd Specialized Hospital in Tabuk and attended twelve different large private community pharmacies in Tabuk region. The sample size was calculated using alpha error 5% and study power 80%, a test value (%) of 11%, and expected sample value (%) of 14% giving a sample size of 100 with adding 10% for nonresponse rate a final sample of 100 was calculated. Participants were well informed about the study and also clarified their queries before obtaining the consent. Out of 325 participants with type 2 diabetes mellitus showed willingness to participate; however, only 100 participants fulfilled the inclusion criteria (aged between 51 and 74 years; we classified them into (late adulthood: 51 to 64 years old, and young old age: 65 to 74 years old)) and were included in the study.
Before administering questionnaires, participants were orally informed about the purpose of the study, emphasizing that participation was voluntary and that their answers would be kept confidential. A structured and pretested data collection form to inquire about such as age, sex, residence, education, occupation, past-medical history, past medication history, and social. A questionnaire used to collect the information from the respondents is consisting four segments including the socio-demographic data, the knowledge of diabetes, self-care practices, and complications [
The study protocol was approved by the Local Research Ethics Committee of the University of Tabuk under the number (UT-64-26-2018), including the use of oral consent for the collection of data. Meanwhile, the Institutional Review Board (IRB) of our institution exempted our study from review. The committee unconditionally approved the project and agreed to verbal consent to be used.
During our study, 3786 males and 3831 females were subjected to the preliminary analysis. The percent of T2DM (4365 patients) from the totally analyzed patients was about 57.3%. 3251 patients, from those showed willingness to participate (74.48% response rate), were included in this study and were given a questionnaire using the purposive sampling method. Only 100 patients fulfilled the inclusion criteria (aged between 51 and 74 years; we classified them into (late adulthood: 51 to 64 years old, and young old age: 65 to 74 years old)) and were included for the final analysis. In addition to KAP, we collected socio-demographic data that include gender, age, occupation, marital status, educational level, income, family history of diabetes, duration of diabetes, and medications. The details of patient demographics mentioned in Table
Demographics of the study population.
Parameter | Number of patients | % of patients |
---|---|---|
Gender | ||
Male | 52 | 52 |
Female | 48 | 48 |
Age | ||
Late adulthood (51 to 64) | 69 | 69 |
Young old age (65 to 74) | 31 | 31 |
Duration of diabetes | ||
5 to 10 years | 46 | 46 |
10 to 15 years | 43 | 43 |
More than 15 years | 11 | 11 |
Education | ||
Illiteracy | 9 | 9 |
Primary | 25 | 25 |
High school | 58 | 58 |
College | 8 | 8 |
Social history | ||
Smokers | 30 | 30 |
Nonsmokers | 70 | 70 |
Occupation | ||
Workers | 39 | 39 |
Nonworkers | 61 | 61 |
Student’s
Association of attitude of respondents towards the knowledge and level of care related to diabetes and its management with age and gender.
Questions | Overall | Age ( | Gender | ||||||
---|---|---|---|---|---|---|---|---|---|
Late adulthood ( | Young old age ( | Male ( | Female ( | ||||||
Knowledge of diabetes | |||||||||
Is diabetes mellitus a lifestyle-related disease? | 1.184 | 0.239 | -2.231 | ||||||
Is it important to do both fasting as well as postprandial blood sugar level for diagnosis and monitoring? | 0.174 | 0.266 | 1.243 | 0.217 | |||||
Apart from blood sugar level, are you aware about HbA1c? | -0.204 | 0.840 | 0.726 | 0.470 | |||||
Self-care practices | |||||||||
Are you aware of self-monitoring of blood glucose level in diabetes? | -0.649 | 0.518 | -2.361 | ||||||
Is it necessary to consume high fiber diet in DM care? | -0.525 | 0.601 | -0.051 | 0.959 | |||||
Is foot care necessary in DM? | 0.271 | 0.787 | -1.595 | 0.114 | |||||
Knowledge regarding complications of DM | |||||||||
Unmanaged DM can cause eye problems or even blindness | 1.356 | 0.178 | 0.024 | 0.981 | |||||
Uncontrolled DM can affect your kidneys | -0.624 | 0.534 | -0.879 | 0.381 | |||||
Uncontrolled DM can cause ischemic heart disease. | -0.528 | 0.599 | -0.904 | 0.368 | |||||
Uncontrolled DM can cause stroke | -0.457 | 0.648 | 2.129 |
Student’s t-test; two-tailed
Association of attitude of respondents towards the knowledge and level of care related to diabetes and its management with education.
Questions | Demographic variables | |||
---|---|---|---|---|
Occupational status ( | ||||
Working ( | Not working ( | |||
Knowledge of diabetes | ||||
Is diabetes mellitus a lifestyle-related disease? | 0.516 | 0.474 | ||
Is it important to do both fasting as well as postprandial blood sugar level for diagnosis and monitoring? | 0.372 | 0.543 | ||
Apart from blood sugar level, are you aware about HbA1c? | 0.030 | 0.863 | ||
Self-care practices | ||||
Are you aware of self-monitoring of blood glucose level in diabetes? | 0.991 | |||
Is it necessary to consume high fiber diet in DM care? | 0.257 | 0.613 | ||
Is foot care necessary in DM? | 0.050 | 0.824 | ||
Knowledge regarding complications of DM | ||||
Unmanaged DM can cause eye problems or even blindness | 0.005 | 0.944 | ||
Uncontrolled DM can affect your kidneys | 0.081 | 0.777 | ||
Uncontrolled DM can cause ischemic heart disease. | 1.378 | 0.243 | ||
Uncontrolled DM can cause stroke | 0.282 | 0.596 |
Student’s
Association of attitude of respondents towards the knowledge and level of care related to diabetes and its management with disease duration.
Questions | Disease duration ( | ||||
---|---|---|---|---|---|
0-5years ( | 6-10 years ( | >10years ( | |||
Knowledge of diabetes | |||||
Is diabetes mellitus a lifestyle-related disease? | 1.066 | 0.348 | |||
Is it important to do both fasting as well as postprandial blood sugar level for diagnosis and monitoring? | 0.745 | 0.478 | |||
Apart from blood sugar level, are you aware about HbA1c? | 0.580 | 0.562 | |||
Self-care practices | |||||
Are you aware of self-monitoring of blood glucose level in diabetes? | 1.335 | 0.268 | |||
Is it necessary to consume high fiber diet in DM care? | 0.319 | 0.728 | |||
Is foot care necessary in DM? | 1.646 | 0.198 | |||
Knowledge regarding complications of DM | |||||
Unmanaged DM can cause eye problems or even blindness | 1.400 | 0.252 | |||
Uncontrolled DM can affect your kidneys | 0.030 | 0.971 | |||
Uncontrolled DM can cause ischemic heart disease. | 0.150 | 0.860 | |||
Uncontrolled DM can cause stroke | 0.174 | 0.840 |
One way ANOVA test; two-tailed
Association of attitude of respondents towards the knowledge and level of care related to diabetes and its management with education.
Questions | Education status ( | |||||
---|---|---|---|---|---|---|
Illiterate ( | Primary ( | High school ( | College ( | |||
Knowledge of diabetes | ||||||
Is diabetes mellitus a lifestyle-related disease? | 7.799 | |||||
Is it important to do both fasting as well as postprandial blood sugar level for diagnosis and monitoring? | 0.281 | 0.839 | ||||
Apart from blood sugar level, are you aware about HbA1c? | 2.913 | |||||
Self-care practices | ||||||
Are you aware of self-monitoring of blood glucose level in diabetes? | 1.315 | 0.274 | ||||
Is it necessary to consume high fiber diet in DM care? | 1.427 | 0.240 | ||||
Is foot care necessary in DM? | 2.447 | 0.69 | ||||
Knowledge regarding complications of DM | ||||||
Unmanaged DM can cause eye problems or even blindness | 1.709 | 0.170 | ||||
Uncontrolled DM can affect your kidneys | 1.840 | 0.145 | ||||
Uncontrolled DM can cause ischemic heart disease. | 1.023 | 0.386 | ||||
Uncontrolled DM can cause stroke | 0.362 | 0.781 |
One way ANOVA test; two-tailed
As shown in Table
Association of respondents’ knowledge with the demographic variables.
Questions | Demographic variables | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Age | Gender | Educational status | Occupation | Disease duration | ||||||
Knowledge of diabetes | ||||||||||
Is diabetes mellitus a lifestyle-related disease? | 0.004 | 0.239 | 0.023 | 0.072 | 0.019 | 0.090 | -0.005 | 0.474 | -0.006 | 0.531 |
Is it important to do both fasting as well as postprandial blood sugar level for diagnosis and monitoring? | 0.009 | 0.174 | 0.005 | 0.217 | -0.022 | 0.362 | -0.006 | 0.543 | -0.005 | 0.498 |
Apart from blood sugar level, are you aware about HbA1c? | -0.010 | 0.893 | -0.003 | 0.414 | -0.002 | 0.384 | -0.010 | 0.964 | -0.010 | 0.845 |
Self-care practices | ||||||||||
Are you aware of self-monitoring of blood glucose level in diabetes? | -0.008 | 0.636 | 0.035 | 0.003 | 0.415 | -0.009 | 0.714 | -0.009 | 0.745 | |
Is it necessary to consume high fiber diet in DM care? | -0.009 | 0.702 | -0.010 | 0.878 | -0.001 | 0.337 | -0.004 | 0.439 | -0.010 | 0.846 |
Is foot care necessary in DM? | -0.008 | 0.642 | 0.008 | 0.178 | 0.034 | -0.010 | 0.901 | -0.009 | 0.769 | |
Knowledge regarding complications of DM | ||||||||||
Unmanaged DM can cause eye problems or even blindness | 0.008 | 0.178 | -0.010 | 0.981 | -0.010 | 0.889 | -0.009 | 0.944 | 0.18 | 0.100 |
Uncontrolled DM can affect your kidneys | -0.006 | 0.534 | -0.002 | 0.381 | -0.010 | 0.839 | 0.013 | 0.777 | -0.010 | 0.963 |
Uncontrolled DM can cause ischemic heart disease. | -0.009 | 0.715 | -0.006 | 0.502 | -0.010 | 0.974 | -0.009 | 0.131 | -0.003 | 0.414 |
Uncontrolled DM can cause stroke | -0.009 | 0.706 | 0.040 | -0.009 | 0.722 | 0.018 | 0.703 | -0.009 | 0.783 |
Saudi Arabia is ranked the second country in the Middle East and the seventh country worldwide for the rate of diabetes [
The studied population in the present study found to have a low to moderate knowledge about the disease factors, which is consistent with the recent systematic review published from Saudi Arabia and they addressed poor knowledge of health care professionals in this regard [
Moderate score on self-care practices observed with no significant influence on the demographic variables including age, gender, disease duration, and occupational status. The influence of socioeconomic factors in self-care practices of diabetes is already established by the previous investigators [
This is a preliminary attempt to investigate the patient perceptions on knowledge, self-care practice, and complications of diabetes among the northwest population in Saudi Arabia. This study was also limited to diabetic patients who were interested to participate. We assessed their knowledge, attitude, and practice on disease, self-care practice, complications, and insulin use. Moreover, we used a well-documented questionnaire for the diabetic knowledge.
The present study recommends the need of patient education to attain medication adherence; thus, it brings better glycemic control in order to protect this population from complications of diabetes mellitus. The pharmacist may play pivotal role in educating the diabetic population. The study showed moderate level of diabetes awareness and good level of positive attitudes towards self-care practice. There is a need to carry out large-scale awareness programs to spread the message to the general population.
The data used to support the findings of this study are available from the corresponding author upon request.
All authors declare no potential conflicts of interest, including any financial, personal, or other relationships with other people or organizations within that could inappropriately influence or be perceived to influence, this work.
Wael A. Al Arawi and Udai S. Al Shaman contributed to the collection of data; Palanisamy A. Siddhachettiar, Reem Diri, and Ahmed Aljabri contributed their intellectual ability to the conception of the project design; Ahmed M. Hamdan worked on the final approval of the version to be published; Sherif M. H. El-kannishy performed the statistical analysis and data interpretation; Alaa Bagalagel performed the data interpretation; Waleed Ahmad Mohsin Albalawi did the paper drafting of the article and revised it critically for important intellectual content. All authors contributed equally to the final version of the manuscript. Wael Ahmed Al Arawi, Udai Salamh Al Shaman, Waleed Ahmad Mohsin Albalawi contributed equally to this work.
We are grateful to all the subjects who participated in the study with all their time constraint.
We are grateful to Dr. Osama Saleh Mohamed and Dr. Amjad Mohamed Ezzat who revised and approved the final Arabic translated questionnaire. The authors would like to acknowledge the financial support for this work from the deanship of scientific research (DSR), University of Tabuk, Tabuk, Saudi Arabia, under the grant number S/1438/0014.