Elsevier

Diabetes & Metabolism

Volume 35, Issue 2, April 2009, Pages 121-128
Diabetes & Metabolism

Original article
The level and determinants of diabetes knowledge in Kuwaiti adults with type 2 diabetesNiveau et déterminants des connaissances concernant le diabète chez les diabétiques de type 2 koweïtiens adultes

https://doi.org/10.1016/j.diabet.2008.09.005Get rights and content

Abstract

Aim

To investigate the level of diabetes knowledge in a population with type 2 diabetes (T2D) and a high prevalence of illiteracy, to identify the main gaps in the knowledge and to study the determinants of the knowledge score.

Methods

This cross-sectional survey involved 24 diabetes clinics and Kuwaiti adults with T2D (n = 5114), and used the Michigan Diabetes Knowledge Test.

Results

The participants’ mean age (± S.D.) was 55.6 ± 10.4 years; 68.2% were women, 45.0% were illiterate, 52.2% reported a family income equivalent to 1200 to 2400 euros per month and only 28.6% performed glucose monitoring. Mean ± S.D. HbA1c was 8.76 ± 2.3%. Their mean score for the total knowledge test was 58.9%. Knowledge deficits were apparent in the questions related to diet and self-care. Participants who were older, and with lower educational levels, limited family income, negative family history of diabetes or were smokers had significantly lower knowledge scores. The scores were also lower in those who had shorter disease duration and fewer complications, were taking insulin, had less frequent insulin injections, performed less glucose monitoring and had lower HbA1c levels. Education, family income, glucose monitoring and presence of complications were independent determinants of the knowledge score.

Conclusion

Knowledge of diabetes in a T2D population with a high prevalence of illiteracy was poor. Limited family income and lack of self-care are other predictors of knowledge deficits. Efforts need to be focused on educational programmes with strategies to assist T2D patients of limited education and income to manage their disease more effectively.

Résumé

But

Étudier le niveau des connaissances concernant le diabète dans une population de diabétiques de type 2 avec une fréquence élevée d’analphabétisme, identifier les déficits principaux des connaissances et étudier les déterminants du niveau de connaissances.

Méthodes

Une étude transversale a été menée dans 24 cliniques diabétologiques chez des 5114 diabétiques de type 2 adultes, grâce au test d’évaluation des connaissances sur le diabète du Michigan.

Résultats

L’âge moyen (± S.D.) des patients était de 55,6 ± 10,4 ans, 68,2 % des participants étaient des femmes, 45,0 % étaient illettrés, 5,2 % rapportaient un revenu familial équivalent à 1200 à 2400 € par mois et seuls 28,6 % pratiquaient une autosurveillance glycémique. L’HbA1c moyenne était de 8,76 ± 2,3 %. Le niveau moyen global du test de connaissance était de 58,9 %. Les défauts de connaissance relevés concernaient le régime et l’autoprise en charge. Les participants qui étaient plus âgés, qui avaient un degré d’instruction plus faible, des revenus familiaux limités et une absence d’antécédents familiaux de diabète, ainsi que les fumeurs avaient un niveau de connaissance plus faible. Ce niveau était plus faible chez les participants qui avaient une plus courte durée de la maladie, peu de complications, qui étaient insulinotraités, avec des injections moins fréquentes d’insuline, qui réalisaient moins d’autosurveillance glycémique et qui avaient un taux d’HbA1c inférieur. Le niveau d’éducation, le revenu familial, l’autosurveillance glycémique et la présence des complications étaient les déterminants indépendants du niveau de connaissances.

Conclusions

Les connaissances concernant le diabète d’une population de diabétiques de type 2 caractérisée par une fréquence élevée d’analphabétisme étaient limitées. Le revenu familial et le manque d’autoprise en charge étaient des facteurs prédictifs d’un faible niveau de connaissances. Des efforts doivent être concentrés sur des programmes d’éducation avec des stratégies qui aident les diabétiques de type 2 dont l’éducation et les revenus sont limités pour contrôler efficacement leur maladie.

Section snippets

Abbreviations

    DKT

    diabetes knowledge test

    DSME

    diabetes self-management education

    KS

    knowledge score

    SPSS

    Statistical package for social sciences

Sampling procedure

The study involved 24 diabetes clinics at primary-care health centres in the five health regions of Kuwait. A consecutive series of eligible patients from each of the 24 clinics were included until the required number was achieved. The numbers of patients with T2D selected from each clinic was proportional to the number of diabetic patients registered in each clinic.

The estimated sample size was 5100 patients with T2D out of about 100,000 eligible patients registered in the 24 clinics, a number

Patients’ sociodemographic and diabetes-related data

Analyses of the data for the participating 5114 Kuwaiti patients with T2D are shown in Table 1, including the frequency distribution of the patients’ sociodemographic characteristics and diabetes-related data. The mean age (± standard deviation, S.D.) of the participants was 55.6 ± 10.4 years, 68.2% were women (male:female ratio, 1:2.15), 45.0% were illiterate and only 4.4% were university graduates. The majority of participants (52.2%) reported a family income between 500 and 1000 Kuwaiti dinars (1

Discussion

Diabetes education is effective for improving the clinical outcomes and quality of life for patients [1]. The role of education of patients with T2D has been emphasized by several studies [9], [10], [11]. For this reason, it is now generally accepted that diabetic patients need to be knowledgeable about diabetes and its management to achieve good metabolic control. However, studies have shown that there are significant knowledge and skill deficits in 50 to 80% of patients with diabetes [12].

Our

Conflicts of interest

None to declare.

Acknowledgments

This study was supported by a grant from the Executive Board of the Health Ministers’ Council for The Gulf Cooperation Council States. The authors acknowledge the efforts and support of Dr Yousef Al-Nissef, chairman of the National Working Group for Control of Diabetes in Kuwait and member of the Executive Board of the Health Ministers’ Council for The Gulf Cooperation Council States. The authors also thank the Michigan Diabetes Research and Training Center for allowing the use of the Michigan

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