Introduction

Diabetes mellitus is believed to be the commonest and most devastating chronic disease in human history. It has afflicted mankind for thousands of years and continues to do so at an exponential rate ¹. It is now a global epidemic with devastating humanitarian, social and economical consequences. In International Journal of Health Sciences,,Dr Tabish in his editorial labeled it as an epidemic of 21st century ².

During the past three decades, the population of the Kingdom of Saudi Arabia has undergone tremendous changes in lifestyle, primarily leading to decreased physical activity and unhealthy eating habits. These changes have had a considerable negative impact on the health of the society. Indeed, this lifestyle transformation is thought to be responsible for the epidemic of non communicable diseases and their complications in the country^{3, 4, 5}

In addition, type 2 diabetes mellitus and obesity are becoming increasingly more prevalent among Saudi females^3,6 . The serious spread of disease can cripple the nation’s fiscal and human resources; therefore, it’s the time to act now and do as much as possible to cover almost all aspects of the disease. The overwhelming burden of the disease threatens to stunt economic growth and undermine the benefits of improved standards of living and education. Proper education and awareness programmes developed according to the need of the society can improve the knowledge of patients and change their attitude. A study from Pakistan highlighted the fact that proper education and awareness programme can improve the knowledge of patients and change their attitude as a large gap was found between knowledge and attitude⁷ . A study from Malaysia shows good knowledge attitude and practice (KAP) of diabetic patients in this region⁸ . These differences may be due to differences of literacy rate and information about diabetes⁹ .

Obtaining information about the level of awareness is the first step in formulating a preventive programme for the disease. There is need to investigate KAP among diabetic patients to aid in future development of programmes and techniques for effective health education. KAP surveys are effective in providing baseline for evaluating intervention programmes¹⁰ .

Patients if given proper education and guidance towards diabetes care would be able to make a significant improvement in life style which is helpful for good glycemic control. Education to diabetic patients would be more effective if we know the level of knowledge attitude and practice of our patients. This study was conducted to assess the general characteristics of diabetic patients and their baseline knowledge, attitude and practice towards Diabetes.

Methodology

Results

Altogether 570 patients were enrolled in the study. The largest number of patients were in the age group of 31-40years (table-1).The overall KAP Score had a Mean ± SD of 16.70±6.06. Knowledge score was 12.42±3.034; attitude 1.46±1.79 and Practice 2.79±2.28, with maximum possible scores for knowledge, attitude and practice patient being 14, 5 and 6 respectively-(Table-5).

Characteristics of the Subjects:

Most of the respondents (42.1 %) were aged 31-40 years, followed by those aged 20-30 years. Most of them 71.9% were educated up till graduate level (table-1). Source of information on diabetes Respondents were asked to identify the one main source of information on diabetes. The major source of knowledge was medical staff (68% ) by brouhiers provided by the hospital followed by television (12%) and newspaper (10%). However 10% received information from friends and relatives

Questions on knowledge regarding symptoms of diabetes The respondents were assessed on their knowledge regarding symptoms of diabetes cause and treatment. Table 2 shows the percentage distribution of respondents by knowledge on different aspects of diabetes. Majority were aware about the causes, symptoms and complications of the disease (Figure- 2)

Questions on Attitude

Figure-3 reveals poor score in attitude part of the questionnaire only 35%had positive attitude towards exercise (Table-3)

Questions on Practice

All patients who had their investigations done with in one month were given a score of one and if more than one month they were given zero score Table-4 shows the percentage distribution of answers to the questions on practices. Figure -4 displays the frequency distribution of respondents’ total practice score. Only 68% of patients had their blood sugar checked with in one month. Only 16% had eye examination done in last month. Only 17% of patients were able to answer 50% of practice questions correctly.

Figure 1

Figure 1: Frequency distribution of overall score 152x122mm (72 x 72 DPI)

Figure 2

Figure 2: Frequency distribution of knowledge score 138x111mm (72 x 72 DPI)

Figure 3

Figure 3: Frequency distribution of Attitude score 142x114mm (72 x 72 DPI)

Figure 4

Figure 4: Frequency distribution of Practice score 154x123mm (72 x 72 DPI)

Figure 5

Table-1 Demographic details of the patients

Figure 6

Table2- Response to Knowledge Questions

Figure 7

Table-3 Response to Attitude Questions

Figure 8

Table-4 Response to Practice Questions

Discussion

The management of Diabetes Mellitus not only requires the prescription of appropriate nutritional and pharmacological regimen by the physician but also intensive education and counseling of the patient¹¹ .

Almost 90% of patients answered 50% of the knowledge questions correctly (Figure-1) Still a large proportion of population that is almost 40.3% were not able to score above 10.This is comparable to the results of a study done in Malaysia by Ranjini Subashini et al who reported 87% respondents able to answer 50%knowledge questions correctly ⁸. . The lack of proper knowledge of each patient should be given individual attention with clear view of its purpose, so that they understand and follow it in practice and fill the gap of this 10% to 100% as studies report that there is a positive correlation between knowledge and good attitude ⁸ . Improving the Knowledge of the diabetics in our society will not be an easy task. Great efforts would be needed by health teams to enhance education of the diabetic patient in order to promote compliance.

Regarding Attitude 17.5% scored above 50% in this study however reports from Malaysia revealed good attitude with 98% scoring above 50% ⁸ . Attitude towards Exercise was also found to be poor. Only a few 35% had habit of exercise. Many studies have confirmed the beneficial role of physical activity in improving glycemic control. Given the importance of physical activity to diabetes management, the low physical activity in this and similar studies should raise concerns among clinicians and it is necessary that all patients should be encouraged to increase their physical activity ¹² .

In Saudi Arabia, the prevalence of physical inactivity is extremely high, especially in women, and may be considered among the highest in the world ¹³ . Al Raeffa S report in his study that strong associations do exist between the high prevalence of physical inactivity in the Saudi population and the epidemic of modern chronic diseases and risk factors in Saudi Arabia. Therefore, reducing the proportion of inactive Saudis would have a tremendous impact on lowering these lifestyle-related diseases and risk factors, and thus reduce future health care costs in the Kingdom ¹⁴ .

This study also highlights the need of having dieticians and educators alongside ^{consultant diabetologists in our diabetes care centers to educate the patients about diet a as 16% were not at all following the dietry plan and also the large population of respondents was missing their drug doses revealing a casual attitude towards the disease (Ref-Table3). Beneficial effects of diet and exercise are out of question 15 .}

Over all 49% answered the 50% of Practice questions and only 15.74% Scored 100% revealing poor score for practice Whereas Malaysian study revealed 99 % answering 50% questions correctly ⁸ . A study from Nepal found the KAP scores of the patients to be low with Knowledge score 4.90 ± 3.34

Attitude 2.03 ± 0.95, Practice 0.84 ± 0.76 and Overall 7.78 ± 3.8 ¹⁶ . Monitoring of blood glucose is a simple and practical procedure acceptable for those patients who can afford it and facilitates the attainment of good glycemic control but unfortunately in our local population the practice was not good as 32% responded that their blood sugar level has not been checked in last week (Table-4).

Education and counseling about all the aspects of diabetes is needed. Group education as well as individualized education programmes should be planned which can lead to better preventive and management techniques in diabetes. Thus there is need for arranging large scale awareness programs for the general public and also to identify and use media to spread the message which could change the attitude of our public in the future.

Conclusion

We conclude that, although the knowledge levels among our study participants are high, the levels of attitudes and practice are lower than desirable. Therefore there is a need for structured programmes to improve attitude and practices of patients. This can be achieved by increasing quality and scope of health education at MOH level Studies with wider scope and much large sample size is recommended to confirm findings and explore relevant features

Limitations of the study

Because the study was based on hospital population, study population may not be the exact MCH is a major facility in the Qassim region catering majority of female population we believe that our results are very near to the prevailing condition in the general population