Knowledge, Attitude, and Practice of Patients with Diabetes towards Diabetic Nephropathy, Neuropathy and Retinopathy

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Diabetes mellitus, Microvascular complications, Knowledge, Attitude, Practice


Background: Epidemiological and knowledge, attitude and practice (KAP) studies about diabetic microvascular complications are lacking. The goals of this study are: determining 1) the prevalence of diabetes mellitus subtypes and microvascular complications, 2) the KAP towards the complications and 3) health-seeking behavior, barriers to follow-up, stigma and sources of information. Methods: A cross-sectional study was conducted from January to October 2020 enrolling 380 Lebanese patients with diabetes asked about socio-demographic and lifestyle characteristics, medical, therapeutic, supplement, and dietary history, KAP scores, health-seeking behavior, stigma, barriers to compliance, and sources of information. Results: The prevalence of diabetes type II, type I, gestational, and the microvascular complications was 82.23%, 15.65%, 2.12%, and 33.07% respectively. Factors with significant association were: 1) good quality of life (β=-0.03; p=0.005) and presence of microvascular complications (β=3.58; p=0.001) with knowledge score, 2) good quality of life (β=-0.01; p=0.02) and absence of the complications (β=-0.33; p=0.001) with attitude score, 3) advanced age (β=0.01; p=0.01), no metformin (β=-0.39; p=0.005), and low-protein diet (β=0.6; p=0.02) with practice score. Patients visited community pharmacies (41.84%) and clinics (46.32%). Barriers were costs (33.42%) and time (30.53%). Few talked about the complications to the family (19.74%). Sources of information were healthcare workers. Conclusion: Awareness campaigns should be tailored accordingly to retard the microvascular complications.

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1. Kaul K, Tarr JM, Ahmad SI, et al. Introduction to diabetes mellitus. Diabetes: Springer. 2013;1-11.
2. International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation. 2015.
3. Diabetes. 2020 [cited 9 May 2020]. Available from:
4. Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiological reviews. 2013;93(1):137-88.
5. Saaristo T, Moilanen L, Korpi-Hyövälti E, et al. Lifestyle intervention for prevention of type 2 diabetes in primary health care:one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010;33(10):2146-51.
6. Zhou X, Siegel KR, Ng BP, et al. Cost-effectiveness of Diabetes Prevention Interventions Targeting High-risk Individuals and Whole Populations: A Systematic Review. Diabetes Care. 2020;43(7):1593-616.
7. Narayan KMV, Zhang P, Williams D, et al. How should developing countries manage diabetes? Canadian Medical Association Journal. 2006;175(7):733.
8. World Health Organization. Advocacy, communication and social mobilization for TB control: a guide to developing knowledge,attitude and practice surveys Geneva. 2008.
9. Food and Agriculture Organization of the United Nations. Adaptable KAP model questionnaires in MS Word. 2020.
10. Burroughs TE, Desikan R, Waterman BM, et al. Development and validation of the diabetes quality of life brief clinical inventory. Diabetes Spectrum. 2004;17(1):41-9.
11. Memon MS, Shaikh SA, Shaikh AR, et al. An assessment of knowledge, attitude and practices (KAP) towards diabetes and diabetic retinopathy in a suburban town of Karachi. Pakistan journal of medical sciences. 2015;31(1):183.
12. Ng S, Chan K, Lian Z, et al. Reality vs Illusion: Knowledge, Attitude and Practice among Diabetic Patients. International Journal of Collaborative Research on Internal Medicine & Public Health. 2012;4:709.
13. Rani P, Raman R, Subramani S, et al. Knowledge of diabetes and diabetic retinopathy among rural populations in India, and the influence of knowledge of diabetic retinopathy on attitude and practice. Rural & Remote Health. 2008;8(3):838.
14. Centers for Disease Control and Prevention. Epi Info. Epi Info™ V.3.5.1. 2008. 
15. Cummings E, Khan A, Singh J, et al. Knowledge attitude and practices of persons diagnosed with type II diabetes mellitus with regards to nephropathy as a complication. South American Journal of Public Health. 2014;2(2):151-67.
16. SPSS IBM. IBM SPSS statistics version 21 Boston, Mass: International Business Machines Corp. 2012;126.
17. Abro M, Zafar AB, Fawwad A, et al. Prevalence of diabetic micro vascular complications at a tertiary care unit of Karachi, Pakistan. International Journal of Diabetes in Developing Countries. 2019;39(2):325-30.
18. Rahaman KS, Majdzadeh R, Naieni KH, et al. Knowledge, attitude and practices (KAP) regarding chronic complications of diabetes among patients with type 2 diabetes in Dhaka. International journal of endocrinology and metabolism. 2017;15(3):e12555.
19. Hoque MA, Islam MS, Khan MAM, et al. Knowledge of diabetic complications in a diabetic population. Journal of Medicine.2009;10(2):90-3.
20. Desalu O, Salawu F, Jimoh A, et al. Diabetic foot care: self reported knowledge and practice among patients attending three tertiary hospital in Nigeria. Ghana Medical Journal. 2011;45(2):60-5.
21. Li X-F, Xu J, Liu L-J, et al. Efficacy of low-protein diet in diabetic nephropathy: a meta-analysis of randomized controlled trials. Lipids in Health and Disease. 2019;18(1):82.
22. Khongbuh B, Walia I, Kapoor S. Prevalence of diabetes and treatment seeking behaviour among adult populatio at villahe Dhanas, UT, Chandigarh. Nursing and Midwifery Research. 2005;1(3).
23. Pande S, Hiller JE, Nkansah N, et al. The effect of pharmacist‐provided non‐dispensing services on patient outcomes, health service utilisation and costs in low‐and middle‐income countries. Cochrane Database of Systematic Reviews. 2013;28(2):CD010398.
24. Liu NF, Brown AS, Folias AE, et al. Stigma in people with type 1 or type 2 diabetes. Clinical Diabetes. 2017;35(1):27-34.
25. Schabert J, Browne JL, Mosely K, et al. Social stigma in diabetes. The Patient-Patient-Centered Outcomes Research. 2013;6(1):1-10.
26. Sato E, Ohsawa I, Kataoka J, et al. Socio-psychological problems of patients with late adolescent onset type 1 diabetes-analysis by qualitative research. Nagoya journal of medical science. 2003;66(1/2):21-30.
27. Shiu AT-Y, Kwan JJY-M, Wong RY-M. Social stigma as a barrier to diabetes self-management: implications for multi-level interventions. Journal of clinical nursing (Print). 2003;12(1):149-50.
28. Vanderlee L, Ahmed S, Ferdous F, et al. Self-care practices and barriers to compliance among patients with diabetes in a community in rural Bangladesh. International Journal of Diabetes in Developing Countries. 2016;36(3):320-6.
29. Inche Zainal Abidin S, Sutan R, Shamsuddin K. Prevalence and determinants of appropriate health seeking behaviour among known diabetics: results from a community-based survey. Advances in Epidemiology. 2014.
30. Hamed ABA. Knowledge, Attitude and practice of Diabetes Mellitus among Diabetic patient toward their Disease at Gabir Abualiz Diabetic Center, Khartoum State, Sudan (2013): University of Gezira. 2014.

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