Journal of Diabetes & Metabolism

Journal of Diabetes & Metabolism
Open Access

ISSN: 2155-6156

+44 1477412632

Research Article - (2019) Volume 10, Issue 11

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

Niveen M Daoud1*, Mashael M Al-Otaibi2 and Noof M Al-Qethami2
 
*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:

Author info »

Abstract

Background: Awareness of various aspects of Diabetes Mellitus (DM) is essential for the prevention, management and control of the disease. Saudi Arabia is one of the most countries have the highest incidence of diabetes. To our knowledge, this was the first research evaluating the level of awareness in a diabetic population of Taif. In this study, we assessed the awareness of DM among diabetic patients attending in the hospitals and diabetes clinics, in Taif city, KSA.

Methods: A cross-sectional study conducted in Taif city from December 2017 to February 2018. An attached questionnaire was filled after a personal interview, having 11 items. The correct answers were marked as aware and incorrect as unaware and made conversions to a percentage. Total 210 diabetic patients were assessed. The data were analyzed using SPSS version 22 software.

Results: The 210 participants interviewed included 114 females and 96 males, 88 with types 1 DM while 122 with type 2. Approximately 84% of participants have previously counseled (Diabetes education), 77.1% of them have a family history of diabetes. Overall sufficient awareness regarding diabetes mellitus was reported among the majority of the participants with a significant effect of gender and type in some specific items.

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, life style modifications, and gestational diabetes which reflect the very well health care services provided at Taif.

Keywords

Perception; Diabetes mellitus; Life style; Insulin use; Taif

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.

  Number  (n=210) Percentage  %
Age distribution
18-30 years 46 21.90%
31-50 years 65 30.90%
>50 years 99 47.10%
Gender distribution
Male 96 45.70%
Female 114 54.30%
Diabetes mellitus type
Type I 88 41.90%
Type II 122 58.10%
Family history of diabetes 162 77.1%
Previously counseled (Diabetes education) 176 83.80%

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%).

BQ(1)-General idea of diabetes mellitus and its complications
Subtitle questions
What do you understand about condition called diabetes?
Do you know types of diabetes mellitus?
Do you know about symptoms of hyper-or hypoglycemia?
Do you have any idea of diabetes associated complications?
Do you know persistent hyperglycemia can affect your eyes, heart and kidneys?
Do you know about diabetic foot and amputation?
Aware Unaware p-value
No Percentage No Percentage 0.001
178 84.40% 32 15.20%  
Effect of gender on awareness
Female Male 0.021
No Percentage No Percentage
Aware 103 90.40% 75 78.10%
unaware 11 9.60% 21 21.90%  
Effect of diabetes type on awareness
Type I Type II 0.071
No Percentage No Percentage
Aware 79 89.70% 99 81.10%
unaware 9 10.20% 23 18.90%

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%.

BQ (2) -Awareness of monitoring blood sugar
Subtitle questions
• Do you have knowledge of target FPG levels?
• Do you have knowledge of target RBS levels?
• Why blood glucose monitoring is important?
Aware Unaware p-value
No Percentage No Percentage 0.004
126 60.00% 84 40.00%  
Effect of gender on awareness
Female   Male   0.71
No Percentage No Percentage  
Aware 71 62.30% 55 57.30%  
Unaware 43 37.70% 41 42.70%  
Effect of diabetes type on awareness
Type I Type II 0.009
No Percentage No Percentage  
Aware 62 70.50% 64 52.50%  
unaware 26 29.50% 58 47.50%  

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%.

BQ (3)-Awareness of management abnormal blood glucose
Subtitle questions
Do you know symptoms of hypoglycemia?
Do you know how to manage it?
What happened if you have persistent high sugar levels?
Aware Unaware p-value
No Percentage No Percentage 0
177 84.30% 33 15.70%
Effect of gender on awareness
Female Male 0.24
No Percentage No Percentage
Aware 99 86.8 78 81.30%
unaware 15 13.20% 18 18.80%
Effect of diabetes type on awareness
Type I Type II 0.019
No Percentage No Percentage
Aware 80 90.90% 97 79.50%
unaware 8 9.10% 25 20.50%

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.

BQ (4) -Awareness of balanced diet
Subtitle questions
Do you know about your diet plan?
Do you know the daily requirements of Carbohydrates in your diet?
Do you know the food sources of Carbohydrates?
Are unsalted nuts and seeds good to be included in your diet?
Do you know much portions of fruits and vegetables should be taken every day?
All Sugar free stuff can be consumed as much as diabetic patient can- it’s a misconception
Diabetics cannot eat fruits- it’s a myth
Aware Unaware p-value
No Percentage No Percentage 0
163 77.60% 47 22.40%
Effect of gender on awareness
Female   Male   0
No Percentage No Percentage
Aware 100 87.70% 63 65.60%
unaware 14 12.20% 33 34.40%
Effect of diabetes type on awareness
Type I Type II 0.058
No Percentage No Percentage
Aware 74 84.10% 89 73.00%
unaware 14 15.90% 33 27.00%

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%).

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BQ(5)-Awareness of Safe fasting, medications/insulin use during Ramadan
Subtitle questions
Do you know how to manage diabetes during Ramadan
Do you know recommendations for safe fasting?
Aware Unaware p-value
No Percentage No Percentage 0
137 65.20% 73 34.80%
Effect of gender on awareness
Female Male 0.055
No Percentage No Percentage
Aware 81 71.00% 56 58.30%
unaware 33 29.00% 40 41.70%
Effect of diabetes type on awareness
Type I Type II 0.002
No Percentage No Percentage
Aware 68 77.30% 69 56.60%
unaware 20 22.70% 53 43.40%

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%).

BQ (6)-Significance of physician follows up–especially during Ramadan
Subtitle questions
Do you know your medication regimen need to be change with time especially during Ramadan?
Do you have any idea that why routine checkup is important?
  Aware Unaware p-value
  No Percentage No Percentage 0
  135 64.30% 75 35.70%
Effect of gender on awareness
  Female Male 0.28
  No Percentage No Percentage
Aware 77 67.50% 58 60.40%
unaware 37 32.50% 38 39.60%
Effect of diabetes type on awareness    
  Type I   Type II 0
  No Percentage No Percentage  
Aware 69 78.40% 66 54.10%  
unaware 19 21.50% 56 45.90%  

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.

BQ (7)-Awareness about insulin
Subtitle questions
Do you know insulin is a lifesaving agent?
Insulin is the last stage- it’s a myth
Insulin can affect kidney – it’s a myth
Aware Unaware p-value
No Percentage No Percentage 0
145 69.00% 65 31
Effect of gender on awareness
Female Male 0.07
No Percentage No Percentage
Aware 85 74.60% 60 62.50%
unaware 15 25.40% 36 37.50%
Effect of diabetes type on awareness
Type I Type II 0.001
No Percentage No Percentage
Aware 72 81.80% 73 59.80%
unaware 16 18.20% 49 40.20%

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%).

BQ (8)-Recommended and rational use of insulin
Subtitle questions
Do you know administration technique?
Do you know proper body sites for injection?
Do you know when to be administered your insulin?
Misconception that no dietary modifications with insulin?
Aware Unaware p-value
No Percentage No Percentage 0
169 80.50% 41 19.50%
Effect of gender on awareness
Female Male 0.85
No Percentage No Percentage
Aware 92 80.70% 77 80.20%
unaware 22 19.30% 19 19.80%
Effect of diabetes type on awareness
Type I Type II 0.043
No Percentage No Percentage
Aware 74 84.10% 95 77.90%
unaware 14 15.90% 27 22.10%

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

BQ (9) -Basics of life style modifications
Subtitle questions
Do you know advantages of daily exercise in diabetes?
Do you follow foot care recommendations?
Aware   Unaware   p-value
No Percentage No Percentage 0
142 67.60% 68 32.40%
Effect of Sex on awareness
  Female Male 0.13
No Percentage No Percentage
Aware 72 63.20% 70 72.90%
unaware 42 36.80% 26 27.10%
Effect of diabetes type on awareness
Type I Type II 0.339
No Percentage No Percentage
Aware 63 71.60% 79 64.80%
unaware 25 28.40% 43 35.20%

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%.

BQ (10)-General idea of gestational diabetes
Subtitle questions
Do you know about gestational diabetes?
Blood sugar usually returns to normal after delivery, do you know if this’s not happen?
Aware Unaware P-value
No Percentage No Percentage 0.015
70 61.40% 44 38.60%
Effect of diabetes type on awareness
Type I in Type II 0.043
No Percentage No Percentage
Aware 24 53.30% 46 66.60%
unaware 21 46.60% 23 33.30%

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%.

BQ (11)-Awareness about Importance of insulin/glycemic control in pregnant
Subtitle questions
Do you know insulin is necessary in pregnancy?
Do you know uncontrolled glycemic levels can harm fetus and mother?
Aware   Unaware   p-value
No Percentage No Percentage 0.19
64 56.10% 50 43.90%
Effect of diabetes type on awareness
Type I Type II 0.063
No Percentage No Percentage
Aware 29 64.40% 35 50.70%
unaware 16 35.50% 34 49.70%

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

Author Info

Niveen M Daoud1*, Mashael M Al-Otaibi2 and Noof M Al-Qethami2
 
1Department of Veterinary Division, Animal Reproduction and Animal Institute, Egypt
2College of Clinical Pharmacy, Taif University, Kingdom of Saudi Arabia
 

Citation: Daoud NM, Al-Otaibi MM, Al-Qethami NM (2019) Survey of knowledge and awareness concerning different aspects in adult diabetic patients in Taif city. J Diabetes Metab 10:837. doi: 10.35248/2155-6156.19.10.837.

Received Date: Oct 07, 2019 / Accepted Date: Nov 18, 2019 / Published Date: Nov 25, 2019

Copyright: © 2019 Daoud NM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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