Journal of Diabetes & Metabolism

Survey of Knowledge and Awareness Concerning Different Aspects in Adult Diabetic Patients in Taif City

Niveen M Daoud^1*, Mashael M Al-Otaibi² and Noof M Al-Qethami^{2 *}Correspondence: Niveen M Daoud, Department of Veterinary Division, Animal Reproduction and Animal Institute, ational Research Center, Dokki, Tahrir Street, 12622 Giza, Egypt, Tel: 0096550177836, Email:

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Introduction

Globally, an estimated 422 million adults are living with diabetes mellitus (DM), according to the latest 2016 data from the World Health Organization (WHO) [1]. Diabetes prevalence is increasing rapidly; previous 2013 estimates from the International Diabetes Federation put the number at 381 million people having diabetes. The number is projected to almost double by 2030 [2]. In Saudi Arabia, DM has become more evident in the last two decades as a result of dramatic changes in the life style. Diabetes mellitus is a complex, chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Ongoing patient self-management, education, and support are critical to preventing acute complications and reducing the risk of long-term complications. The self-care practices of individuals are influenced by their knowledge about diabetes; the more they know about their illness, more they would have self-management skills [3]. There are seven essential self-care behaviors in people with diabetes which predict good outcomes. These are healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors [4].

Patient awareness about diabetes, complications, medications adherence, diet plans, and life style modifications can establish patient-specific goals, like the effectiveness of medications and decrease in like the hood of adverse events in all types of diabetes and in all age groups of the diabetic population. Awareness is always helpful to reduce the early onset of DM complications and very helpful to reduce the additional burden of the disease to the nation as KSA. The role of healthcare providers in the care of diabetic patients in KSA has been well recognized. Health care providers actively involve their patients in developing self-care regimens for each individual patient. This regimen should be the best possible combination for every individual patient plus it should sound realistic to the patient so that he or she can follow it [5]. But health care providers should begin by taking the time to evaluate their patients' perceptions and make realistic and specific recommendations for self-care activities.

The objective of this study was to assess the awareness of diabetic patients of how much extent they know about diabetes, the proper use of medications, life style modifications, dietary plans, myths associated concepts and other associated complications, problems and management in Taif city, KSA.

Materials and Methods

Material (questionnaire)

A well-constructed questionnaire was used to collect data from patients. Our questionnaire was divided into two sections. Section I is a socio-demographic profile of our participants covering the following items: age, sex, whether the participant has/had a family history of diabetes or had previously counseled (Diabetes education). Section II expresses 11 basic questions determine the level of awareness regarding diabetic patients like knowledge of what diabetes is, causes, complications, management and prevention measures of DM, life style of Diabetic patients and what about their management during Ramadan. Each basic question has subtitle different number of questions to be sure that the patient completely aware the basic question (The questionnaire is attached in the appendix).

Study design

A cross-sectional study was carried out in Taif city, Kingdom of Saudi Arabia (KSA). The study was carried out on Saudi and non- Saudi nationals from different age groups that were selected by simple random sampling. The data was collected over a period of 3 months, from December 2017 to February 2018. We took random samples from the attendees of 5 randomly chosen hospitals and diabetic clinics, of whom 114 were females and 96 were males with total 210 participates. Data was collected by means of a personal interview with the participants using a pre-designed questionnaire. All questions were asked by to the patients in lay man language instead of using medical terms, the questions were asked directly to patients, and his/her correct response was marked as aware. For example, basic question (BQ) number 2 measures “awareness of monitoring blood sugar” this item has three subtitle questions which are “Do you have knowledge of target FPG levels?”, “Do you have knowledge of target RBS levels?” Why blood glucose monitoring is important? If patient answer 2 of these question correct (60% or more) so it recorded “aware” and if less than that percentage, his/her answer was recorded as "unaware". In case of basic questions that included only 2 subtitle questions, if participant answer one question true we consider he is aware.

Statistical analysis

Filled questionnaires were reviewed for completeness and accuracy before data entry, then the data were coded and analyzed by SPSS version 22 (SPSS Inc., Chicago, Illinois, USA) nonparametric and cross-section Chi-square test was used to investigate the association of awareness of DM. All Frequencies consider significant if p value>0.05.

Ethical considerations

Participants were informed that participation was completely voluntary, no name on the questionnaires and all of the personal information of participants were kept confidential.

Results

Sociodemographic characters of the study population Background characteristics of our study participant are illustrated in Table 1. A total of 210 diabetic patients were interviewed, among them 45.7% (96) were male and 54.3% (114) were females. Regarding Diabetes type, 41.9% (88) had Type I while 58.1% (122) had type II. Ages of our participants were 21.9% (46) ranged from 18 to 30, 31.0% (65) between 30 -50 and most of participates 47.1% (99)>50 years. Most of the participants 84% (176) have previously counseled (Diabetes education) as well as 77.1% (162) have a family history of diabetes.

Table 1: Sociodemographic characteristics of diabetic patients.

General knowledge of diabetic patient about DM and its complication

We asked the participants 6 underline questions to determine if they aware or not about DM and its complication. Table 2 shows that 84.4% of participates with a significant difference were aware when comparing with 15.2% unaware. Among them, 90.35% were female with a significant difference with 78.1% were males. On the other hand, there is no significant difference recorded regarding the type of diabetes as Type I patients are (89.77%) and type II were (81.14%).

Table 2: Responses of participants about DM and its complications.

Awareness of diabetic patients about blood sugar monitoring

We asked the participants 3 subtitle questions to determine if they aware or not about blood sugar monitoring. Table 3 records that. 60.0% of participants with significant difference had awareness when compared with 40% unaware. Among them, 62.3% were female with no significant difference with 57.3% were males. And there was a significant difference recorded regarding the type of diabetes as Type I patients were 70.5% while type II was 52.5%.

Table 3: Responses of participants about blood sugar monitoring.

Awareness of diabetic patients about blood glucose

We asked the participants 3 underline questions to determine if they aware or not about awareness of management abnormal blood glucose. Our results are illustrated in Table 4. 84.3% of our participants recorded high significant awareness level when compared with 15.7% of unaware participants. Among them, 86.8% were female with no significant difference with 81.3% were males. For instance, participants with Type I 90.9% were significantly more aware than those with Type II 79.5%.

Table 4: Responses of participants about management abnormal blood glucose.

Awareness of diabetic patients about balanced diet

Participants were asked 7 subtitle questions to judge on their awareness level regarding balanced diet. Participants answered 4 of these questions true their responses was recorded as aware. Our data was summarized in Table 5. About 77.6% of respondents significantly aware of the balanced diet.

Table 5: Responses of participants about balanced diet.

Among them regarding the effect of gender, high significant awareness difference was recorded between females (87.7%) versus males (65.6%). Our aware participants with type I showed significant difference than those with type II (84.1% vs 73.0%) respectively.

Awareness of diabetic patient’s safe fasting, medications/ insulin use during Ramadan

We asked the participants 2 underline questions to detect their awareness regarding their regimen in Ramadan. Our data is illustrated in Table 6. Nearly two-third of our participants (65.2%) had awareness with their regimen in Ramadan when compared with those who had unawareness (34.8%). Among them, females also recorded significant awareness difference than males (71.0% vs 58.3% respectively). As well as type I diabetics participants registered significant awareness (77.3%) when compared with those with type II (56.6%).

Table 6: Responses of participants’ awareness about Safe fasting, medications/insulin use during Ramadan.

Awareness of diabetic patients about routinely follow up especially during Ramadan

Table 7 illustrate the data that was collected from our diabetic population. By verbal asking participants, 64.3% recorded significant awareness when statistically compared with those unaware (35.7%). Statistical analysis regarding the effect of gender on the awareness level among our population clarified there is no significant between females and males (67.5% vs 60.4% respectively). Contrarily, Type of diabetes had no significant difference on the awareness level (Type I were 78.4% vs type II were 54.1%).

Table 7: Responses of participants about routinely follow up especially during Ramadan.

Awareness of diabetic patient’s awareness about insulin In our study, (69.0%) of target population were aware about insulin medication. Statistically, this percentage was significant when compared with an unaware percentage (31.0%). Although non-significant difference was recorded between females and males percentages (74.6% vs 62.5% respectively), type of diabetes reported high significant difference (Type I was 81.8% vs type II was 59.8%). Our data was clarified in Table 8.

Table 8: Responses of participant’s awareness about insulin.

Awareness of diabetic patients about rational use of insulin

Our data regarding the rational use of insulin is illustrated in Table 9. By asking the participants 4 underline questions we recorded that, a high percentage of our participants were significantly aware regarding the uses of insulin (80.5%) when compared with an unaware population (19.5%). Moreover type of diabetes recorded the significant effect of awareness level which type I recorded 84.1% vs 77.9% to type II. But the effect of gender recorded no significant effect (Females 80.7% vs Males 80.2%).

Table 9: Responses of participants about rational use of insulin.

Awareness of diabetic patients about life style modifications

Table 10 show that the level of awareness about lifestyle modifications was significantly high when compared to unaware (67.6% and 32.4% respectively). Among the aware population, both gender and type of diabetes recorded no significant effects (Females 63.2% vs males 72.9%/type I 71.6% vs type II 64.8%). Awareness of diabetic female’s patients about gestational diabetes

Table 10: Responses of participants about life style modifications.

Table 11 show 61.4% of females have sufficient knowledge concerning GDM while 38.6% unaware associated with statistical significance. In the same time, the general awareness about gestational diabetes was found to be significantly lower with type I 53.3% than type II 66.6%.

Table 11: Responses of participants about general awareness of gestational diabetes.

Awareness of diabetic patients about Importance of insulin/ glycemic control in pregnant

We asked the participants 2 underline questions only for the female to detect if they aware or not about Importance of insulin/ glycemic control during pregnancy. Table 12 show that 56.1% of participants with a non-significant difference were aware when comparing with 43.9% unaware. Among them, 64.4% with type 1 were higher significantly difference when compared with type II 50.7%.

Table 12: Responses of participants about importance of insulin/glycemic control in pregnant.

Discussion

To our knowledge, this is the first research evaluating the level of awareness in the diabetic population at Taif. The specific objectives scoped on how our diabetic patients knew about the definition, causes, complications, management, and prevention of DM. And subsequently, the recommendations outcomes and realistic suggestion display to the health care providers around Taif to evaluate their patient’s perception towards their self-care awareness.

Generally, our findings show that the general awareness of DM is significantly high among diabetic patients in Taif city except those females had awareness about the importance of insulin/ glycemic control in pregnant (56.1 aware vs 43.9 unaware). This high significant awareness level recorded in our study partially agrees with the recent study was conducted on the population in Makkah AL-Mokkaramah. This study concluded that population (diabetic and non-diabetic) had enough general knowledge of diabetes regarding risk factors, symptoms, etc. However, they are not very well aware of diabetes associated secondary complications [6]. Although those author conducts their survey on diabetic and nondiabetic populations, they agree with us. This point of agreement may be due to the great effort of primary health care role in holly place as Makkah. On the other hand a large number of studies disagree with our finding as Al-Dahan, et al. In KSA [7-11] in Tabuk city, KSA. This disagreement is due to the difference in designated participants, as all above-mentioned researchers target diabetic and non-diabetic population. In our study, we target only diabetic patients which are the concerned population for this disease.

Non-significant difference between females awareness regarding the importance of insulin/glycemic control in pregnant women may be due to the fine detail nature of this question as not all female is pregnant and concern with these fine details.

On a specific scale, majority of the DM patients in our study 78.1% male and 90.3% of females had awareness about DM and its complications, with a significant difference between males and females. Female had a high level of the awareness that's unlike a study conducted in Pakistan shows the knowledge about complications of diabetes was not satisfactory in female diabetics, only 32.4% female diabetics were aware of the complications [11].

Regarding awareness about blood sugar monitoring and problemsolving skills, we recorded a significant level of awareness with the non-significant difference between males and females. This result is agreeing with a study conducted by Bani [12]. On another hand in our result, type of diabetes has a significant effect on awareness.

Our results concluded that there is a significant level of awareness with a significant effect of both gender and type. This disagrees with Jingran et al. who conducted that only 54.10% of patients with diabetes mellitus believed that the diet should be balanced and reasonable [13]. The rate of awareness was 80% and there was a misunderstanding about a balanced diet. In other study done by Raj, 80% of the respondents reported that they were strict about their diet but 37.8% were consuming beverages with sugar [14].

Regarding safe fasting medication and insulin use during Ramadan, we reported a high significant awareness level (65.3% vs 34.8 respectively). This finding also disagrees with study Almalki et al. showed relatively poor awareness as 34.7% of participants don’t have enough information's about safe fasting as diabetic patients who attended a specialized clinic at a tertiary health care center lacked information on diabetes during Ramadan [15].

In our study, Type 1 DM participants had significant awareness about routinely follows up especially during Ramadan than type 2 diabetic 78.4% and 54.1% respectively. Female and male participants have the same awareness 67.5% and 60.4%, respectively. A study done by Zainudin et al. revealed deficiencies in DM knowledge and inappropriate practices among Muslim patients with DM who fast during Ramadan. These may have a major impact on the incidence of DM-related complications, which can be magnified when patients fast during Ramadan [16].

Our findings reported that there was a high gap between the level of awareness in participants with type 1 and type 2 DM of Knowledge about Insulin and rational use of insulin (81.8%-84% vs 59.8%- 77.9%) respectively. About gender, there is no significant between females or males (74.6%-80.7% vs 62.5%-80.2%) respectively. It was interesting to find out that the percentage of participants who knew about insulin injection was higher in male and female. This result was also found in the study done in Singapore and Kuwait [17,18].

In our findings, Type 1 (71.6%) and males (72.9%) populations have a relatively high knowledge about importance of exercise and foot care recommendations than type 2 (64.8%) and females (63.2%) populations. A study conducted in Mexico shows that patients with type 2 diabetes served in an outpatient clinic had poor knowledge and practices of foot care [19].

In special awareness assessed female participants about the general idea of gestational diabetes and the importance of glycemic control in pregnant females with both types of DM, no significant effect of diabetes type I or type II (53.3%-64.4% vs 66.6%-50.7%) respectively.

Our finding was supported by Bhavadharini et al. study who conclude that women are still not visiting antenatal clinics until late in pregnancy, providing little opportunity for education about GDM and appropriate lifestyle changes that can be made to help prevent the disease. Another study in Samoa shows that knowledge about GDM is poor amongst pregnant women, especially in rural areas [20], our result support this finding.

Conclusion

This is the first study examining the knowledge and awareness of diabetes among the only diabetic population in KSA. Our data conducted that the diabetic population at Taif city have enough general awareness of DM regarding complication, sugar monitoring, safe fasting, lifestyle modifications, and gestational diabetes which reflect the very well health care services provided at Taif hospitals and clinics to their patients.

References

1. World Health Organization. Global report on diabetes. World Health Organization. ‏ 2016.
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-1053.
3. Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabet Metabol Disord. 2013;12:14.
4. American Association of Diabetes Educators. AADE guidelines for the practice of diabetes self-management education and training (DSME/T). Diabetes Educ. 2009;35:85S-107S.
5. Anderson RM. Patient empowerment and the traditional medical model: a case of irreconcilable differences?. Diabetes Care. 1995;18:412-415.
6. Alwan YMS, Alayed IS, Albarakati MH, Alaryni MA, Kashaba GAA, Alkateeb AS, et al. Assessing awareness about diabetes mellitus among attendees of primary Health Care Centers, Makkah, Saudi Arabia. Egypt J Hosp Med. 2017;66:57-66.
7. Al-Dahan SM, Albaik M, Alomran Y, Aldahan F, Albaik S. Awareness and Knowledge of Diabetes among Al-Wazarat Family Medicine Health Center Attendants. American Journal of Research Communication. 2013; 1(12): 104-130.
8. Deepa M, Bhansali A, Anjana RM, Pradeepa R, Joshi SR, Joshi PP, et al. Knowledge and awareness of diabetes in urban and rural India: the Indian Council of Medical Research India diabetes study (phase I): Indian Council of Medical Research India diabetes 4. Indian J Endocrinol Metab. 2014;18:379.
9. Irshad M, Khan I, Khan FA, Baig A, Gaohar QY. A Survey of awareness regarding diabetes and its management among patients with diabetes in Peshawar, Pakistan. J Postgrad Med Inst. 2015;28.
10. Mirghani HO, Hamdi NH, Almarhapi SA, Hamdi NH, Alshehri RA. Awareness of General Population Regarding Diabetes Mellitus Diseases among Tabuk, KSA. 2017.
11. Alanazi AM, el-Fetoh NMA, Alotaibi HK, Alanazi KA, Alotaibi BK, Alshammari SM, et al. Survey of awareness of diabetes mellitus among the Arar population, Northern Border Region of Saudi Arabia. Electron Physician. 2017;9:5369.
12. Bani IA. Prevalence, knowledge, attitude, and practices of diabetes mellitus among Jazan population, Kingdom of Saudi Arabia (KSA). J Diabetes. 2015;5:115.
13. Cao J, Guo J, Cao F, Guo Y. Investigation of diabetes nutrition knowledge, attitude, and practice in outpatients with type 2 diabetes. Chin J Integr Med. 2015;9:427-430.
14. Raj CP, Angadi MM. Hospital-based KAP study on diabetes in Bijapur, Karnataka. Indian J Med Spec. 2010;1:80-83.
15. Almalki MH, Hussen I, Khan SA, Almaghamsi A, Alshahrani F. Assessment of Ramadan Education and Knowledge Among Diabetic Patients. Clinical Medicine Insights: Endocrinology and Diabetes. 2018;11.
16. Zainudin SB, Ang DY, Soh AWE. Knowledge of diabetes mellitus and safe practices during Ramadan fasting among Muslim patients with diabetes mellitus in Singapore. Singapore Med J. 2017;58:246.
17. Wee HL, Ho HK, Li SC. Public awareness of diabetes mellitus in Singapore. Singapore Med J. 2002;43:128-134.
18. Al-Hussaini M, Mustafa S. Adolescents’ knowledge and awareness of diabetes mellitus in Kuwait. Alexandria Med J. 2016;52:61-66.
19. Robles BR, Ortiz CLG, Quirarte GNH, Berry DC, Pérez AP, Martínez PS. Knowledge and Practices of Diabetes Foot Care and Risk of Developing Foot Ulcers in México May Have Implications for Patients of Méxican Heritage Living in the US. Diabetes Educ. 2017;43:297-303.
20. Bhavadharini B, Deepa M, Nallaperumal S, Anjana RM, Mohan V. Knowledge about gestational diabetes mellitus amongst pregnant women in South Tamil Nadu. J Diabetol. 2017;8:22.