CMPH Journal

Introduction

Diabetes Mellitus (DM) has become a global health crisis, affecting millions of people worldwide. As a chronic metabolic disorder, DM can significantly impact patients’ quality of life and increase their risk of developing other diseases [1]. In 1979, the National Diabetes Data Group produced a consensus document standardizing the nomenclature and definitions for diabetes mellitus. This document was endorsed one year later by WHO. The two major types of diabetes mellitus were given names descriptive of their clinical presentation: “Insulin-Dependent Diabetes Mellitus” (IDDM) and “Non-Insulin-Dependent Diabetes Mellitus” (NIDDM) [2].

The classification system for diabetes mellitus has evolved over time, with the current system identifying three main types: type 1, type 2, and gestational diabetes [3].

Type 2 diabetes mellitus (T2DM) is considered a major public health concern as an epidemic with considerable number of premature deaths, disabilities, high morbidity, and mortality rates [4]. The incidence of T2DM has tremendously increased globally in the last 20-30 years [5]. Diabetes symptoms might appear suddenly. Type 2 diabetes symptoms might be subtle and take years to become apparent. These symptoms of diabetes include feeling very thirsty, needing to urinate more often than usual, blurred vision, feeling tired, losing weight unintentionally. Type 2 diabetes contributes more than 95% of those who have the disease. This kind of diabetes was only diagnosed with adults until recently, but it is now increasingly happening in children as well [6].

Complications associated with T2DM include hypoglycaemia, hyperosmolar hyperglycemic state, diabetic ketoacidosis, retinopathy, nephropathy, neuropathy, and cardiovascular events [4]. The primary aim of management of DM is to delay the macro and microvascular complications by achieving optimal glycaemic control. This involves lifestyle modification, including regular exercise, healthy diet and weight loss, and drug therapy [7]. With almost seven million diabetic patients, Saudi Arabia is regarded as one of the nations with the highest rates of diabetes [6].

Many issues may arise from long-term type 2 diabetes. A microvascular condition known as diabetic retinopathy can impact one or both of the macula and peripheral retina. For diabetics, it is a leading cause of blindness and vision loss. It can be segregated into two kinds “Proliferative Diabetic Retinopathy” (PDR) and “NonProliferative Diabetic Retinopathy”(NPDR) [8]. The retinopathy characterized by blurred vision, sudden shower of black “floaters” (black or grey specks or strings) in vision, fluctuating vision and dark or empty areas of vision [9]. Nephropathy, a chronic consequence of both types of diabetes mellitus, is defined by decreased kidney Glomerular Filtration Rate (GFR) or increased urine albumin excretion (proteinuria) [8].

This study aims to assess the knowledge, attitude and practice toward type II diabetes and its complication among general population in Bisha province. Although the Type 2 DM is a wellknown disease among all the age groups (as per the previous studies) still the prevalence is very high in KSA (>30%) and is projected to be even higher in near future if the same trend of lifestyle among general population, on average, continues. Hence the study intends to find the reason for such higher percentage of prevalence across all age groups. The findings may assist diabetic people live better lives, lessen the stress on their families, and prevent or limit the risk of complications.

Methodology

Study design

This was a cross-sectional questionnaire-based study. Participants were included with informed consent to participate after they were given full details of the study and its intended aims. The questionnaire was designed in English and then translated to the local spoken language Arabic by proficient speakers of both languages and was revised to be suitable to the general population.

Sampling strategy

Non-randomized convenient sampling was adapted.

Calculating sample size

The following formula is used to determine the sample:

n = The minimum sample size = 207

P = is the proportion of people with good awareness = (p = 0.84) [1].

q = (1- P) = Complimentary probability (1-0.84) = 0.16 d = is the degree of accuracy = 0.05

z = the standard normal deviate value corresponding to 95% confidence interval = 1.96

Data collection

A well-structured, vetted and piloted self-administered online questionnaire used in the current study, which was developed to evaluate the participant’s KAP regarding diabetes and its complication. The questionnaire contained four sections. The first section collected demographic information about the participants. The second section contained questions about knowledge of DM and its complications. The third section collected information about their general attitude toward diabetes. The last section collected information about the practices of participants toward disease and its complication.

Study population (inclusion and exclusion)

The participants for the study were included based on following inclusion and exclusion criteria, such as population who were ≥12 years of age and those who reside in Bisha were included as study participants. And those who were less than 12 years old, did not consent to participate and those who don’t reside in Bisha were excluded from the study.

Data analysis

Data were collected on a google form and entered on a Microsoft Office Excel^® (2019) spreadsheet. Statistical data analysis and tables were generated using Microsoft Office Excel^® (2019). A Chi-squared test was used to test for significance with the help of IBM SPSS software version 29, and a priori level of p<0.05 was considered statistically significant.

Ethical approval

Upon submission of full project proposal and consent forms made to the Research Ethics Local Committee at the College of medicine, University of Bisha in the Kingdom of Saudi Arabia. The research has been approved on Wednesday 22^nd May 2024. The reference number: UB-RELOC H-06-BH-087/ (1508.24).

Results

This table shows the sociodemographic factor of our sample. As shown, most age groups participate in this study are from (above 18-30). The number of males less than the female number. It shows that those who have bachelor’s or diploma have the highest rate of all participants. Most of the participants live in Bisha city (urban) while only 15% live in villages. According to those having diabetes, they make up only 10.6% of all participants.

Figure 1: Subjects Levels of knowledge, attitude and practice toward type 2 diabetes and it’s complication.

This figure demonstrates the percentage of good and poor knowledge, attitude and practice. Of them 54% show good knowledge, and only 36.3% have good attitude. Interestingly, most of them have positive practice toward the disease (76%).

Figure 2: Subjects Levels of knowledge of complication of diabetes type 2.

This figure describes the percentage of knowledge of complication. In our sample most of them chose the retinopathy as a complication, while the vascular disease was the least one chosen. This above table explain the relationship between knowledge and sociodemographic factors. It shows that the age and education have significant relation with knowledge. according to gender, living area or having diabetes or not there is no significant relation.

In this table, age only shows association with attitude. The most common age group has good attitude is from above 18-30. The gender, education, living area or whoever has diabetes show no association. This table explain the association of practice with socio-demographic factors. Most of these factors have a significant relation. The highest one is age which have highly significant relation as shown in the table above. The gender or living area show no significant. The education or having diabetes also have a significant.

Discussion

A total of 479 questionnaires were collected in this study. Approximately, 85% of the respondents were from Bisha urban region (407), of whom 248 were females (51.8%) compared to 231 males (48.2%), with many of the respondents in the 18-30 years’ age group (33.6%). Interestingly, the respondents recorded close to 60% for both their educational background, completed high school and above. The characteristics of the studied population are shown in Table 1.

Table 1: Sociodemographic distribution of the study population.

Among our sample, 280 (58.5%) had good knowledge scores, while 199 (41.5%) had poor knowledge scores. In comparison to a study conducted in Pakistan, the knowledge rate was close to 47% in Pakistan [10]. While in another study conducted in Riyadh only 16.9% had good knowledge about type 2 diabetes and its complications [12]. In the attitude, 176 (36.3%) participants had positive scores indicated positive attitudes, while 364 (63.6%) had negative scores indicated negative attitudes. Our sample’s attitude was close to people’s attitude in study conducted in Jordan, where it was 46.4% of good attitude [11]. Interestingly, more than half of the participants, 364 (76%), were practicing adequately, whereas 24% of the participants were carefree, and their practices were inadequate for preventing DM and its complication (Figure 1). There were many variations in knowledge of complication of diabetes, the most common complication was chosen by participants is retinopathy (74.5%), while the least one is vascular disease (34.7%) (Figure 2).

Study participant’s score showed that there is significant relation between knowledge, attitudes and practice with age (p=0.012, p=0.018 and p=0.000). We analyzed the gender-wise comparison of people’s knowledge, attitude and practice toward type 2 diabetes and its complication. It was observed that there is no difference or relation found (p=0.063, p=0.712 and p=0.587). Study participant’s knowledge scores showed that higher education had better knowledge scores and good practice compared to those who had low education (p=0.022, and p=0.031), while no difference was found in attitude scores (p=0.526). Also, the study demonstrates that there is no relation when having diabetes and with knowledge and attitude but shows good practice (p=0.030) (Tables 2-5).

Table 2: Subjects’ socio-demographic characters and knowledge of type 2 diabetes mellitus and it’s complication.

Table 3: Subjects’ socio-demographic characters and attitude of type 2 diabetes mellitus and it’s complication.

Table 4: Subjects’ socio-demographic characters and practice toward type 2 diabetes mellitus and it’s complication.

Table 5: Percentages of response to the items of the questionnaire.