Diabetes self-care practice and disease knowledge in patients with type 2 diabetes mellitus: A cross-sectional analysis with respect to age, educational attainment, income class and ongoing anti-diabetic treatments

Objective: To evaluate diabetes self-care practice and disease knowledge in type 2 diabetes mellitus (T2D) patients with respect to age, educational attainment, income class and antidiabetic treatments. 

Methods: A total of 583 patients with T2D (mean (SD) age: 57.3 (9.5) years, 55.9% females) were included in this cross-sectional study. Data on sociodemographic characteristics, diabetes characteristics (duration, current treatment), diabetes self-care practice [forgetting to take anti-diabetic medication, discontinuation of treatment due to side effects, self-monitoring of blood glucose (SMBG), diabetes education and regular exercise] and disease knowledge (definition and target levels of HbA1c, hypoglycemia symptoms and diabetes-related complications) were recorded.

Results: Overall, HbA1c levels were >8% in 53.2% of patients, 38.3% of patients reported that they had no diabetes education, while at least twice daily SMBG and regular exercise was reported by 27.4% and 19.7% of patients, respectively. Lack of knowledge on definition and target levels of HbA1c was noted in up to 65.5% of patients, while majority of patients reported that they know hypoglycemia symptoms (89.2%) and diabetes-related complications (86.4%). Illiteracy was associated with higher likelihood of treatment discontinuation (p<0.001) and with lesser likelihood of performing regular exercise (10.3 vs. 32.8%, p<0.001). Older patient age, lower educational attainment and lower income level were associated with lesser likelihood of knowing the definition or target levels of HbA1c (p<0.001 for each) and sexual complications of diabetes (p<0.001, p<0.001 and p=0.028, respectively). Knowing diabetes-related complications were less common in those with lower educational attainment (p<0.001) and lower income level (p=0.010), while insulin-naïve patients were less likely to know hypoglycemia symptoms (p=0.010).

Conclusion: In conclusion, our findings revealed poor glycemic control, low level of knowledge on definition and targets of HbA1c and lack of diabetes education with suboptimal adherence to self-care practice in a considerable percentage of patients. Disease knowledge but not SMBG practice significantly differed with respect to patient age, educational attainment, income class and treatment. Our findings seem to indicate lower disease-related insight among older patients and those with lower educational and income levels, emphasizing the potential role of individualized diabetes education interventions tailored to needs of patients to improve disease knowledge and thus the adherence to self-care practice in T2D patients.