The dietary knowledge measurement instruments in diabetes: A systematic psychometric review

Translation and Validation of the Diabetes Knowledge Questionnaire in Indonesian Patients With Type 2 Diabetes

PURPOSE

The purpose of the study was to translate and cross-culturally adapt the 24-item Diabetes Knowledge Questionnaire (DKQ) for Indonesian patients with type 2 diabetes (T2D) and evaluate its psychometric properties.

METHODS

Forward-backward translation, adaptation involving 7 experts, and pretesting to develop the Indonesian version of DKQ were conducted. Psychometric analysis was carried out among T2D patients from 40 primary health care centers in Indonesia. Known-group, convergent and discriminant validity, internal consistency and test-retest reliability were assessed. Additionally, a descriptive item analysis was conducted.

RESULTS

In total, 39 patients participated in the pretesting and 304 patients in the validation process and descriptive analysis. Of the 24 items, 2 were adjusted during the adaptation process, and 1 item was deleted because it did not adequately reflect the original item. Known-group validity was demonstrated because patients with younger ages, higher educational levels, and longer diabetes duration had significantly higher DKQ scores. Convergent validity was demonstrated by a significant positive correlation of the DKQ scores with overall treatment satisfaction. The 23-item DKQ Bahasa Indonesia showed satisfactory internal consistency (Cronbach's α = 0.73; omega total = 0.72) and good test-retest reliability (intraclass correlation coefficient = 0.87 in a sample of 27 patients). No floor and ceiling effects were found in the item analysis.

CONCLUSION

The study demonstrates adequate validity and reliability of the 23-item DKQ Bahasa Indonesia for assessing diabetes knowledge in Indonesian primary care patients with T2D. This instrument can be used to identify room for improvement and develop diabetes education programs.

Influence of Disease Knowledge on the Metabolic Control of Diabetes Mellitus: A Cross-Sectional Study

AIM

 Diabetes mellitus is a prevalent disease in the Portuguese population and is associated with significant morbidity and mortality. Its proper therapeutic management is multifactorial, with lifestyle habits having a major impact. Studies show that poorer metabolic control is associated with deficient knowledge related to diabetes, lower self-efficacy, and limited patient empowerment. The aim of this study was to characterize diabetic patients' knowledge about their disease using the Diabetes Knowledge Test (DKT) and to assess the potential correlation between disease knowledge and metabolic control.

DESIGN

 A cross-sectional study was conducted involving a convenience sample of diabetics followed in four primary care units in Braga, Portugal. The sample was divided into two groups: insulin-treated (IT) and non-insulin-treated (NT).

METHODS

 Each participant was given the DKT. Frequency measures were used to describe the sociodemographic characteristics and clinical parameters. For association between categorical variables, the Fisher's test and chi-square test were used. To compare the distribution of the response variable (metabolic control represented by glycated hemoglobin (HbA1C) values) between IT and NT, the Mann-Whitney test was used. For association between nominal qualitative variables, the chi-square test was employed. The statistical significance level used in the tests was 5% (p<0.05).

RESULTS

A total of 99 responses were obtained, with an average age of 65.5 years. Most of the respondents were male, had a low education level, were overweight, and had type 2 diabetes diagnosed 10 or more years ago, with an average HbA1C value of 6.83%. The average performance obtained by the DKT scale revealed medium levels of knowledge (IT and NT). Both groups displayed a medium level of knowledge (59% for NT and 62.5% for IT), without statistically significant difference. There was a statistical difference in metabolic control between IT and NT (Mann-Whitney test, p<0.05). Regarding the degree of knowledge of the disease (by DKT results), there was no statistically significant association, using the Fisher's test (p=0.20), between the two groups. In NT, there was no statistically significant association between metabolic control and the degree of knowledge (Fisher's test, p=0.69). There was an association between metabolic control and the duration of the disease (Fisher's test, p=0.029, odds ratio 3.83) in NT, as in IT (p=0.025). However, there was not a proven association between metabolic control and the degree of knowledge in IT (Fisher's test, p=0.62).

CONCLUSIONS

This study provides a comprehensive analysis of the characteristics of patients with diabetes and the factors affecting both metabolic control and disease knowledge. Although general knowledge of diabetes was "medium" for most patients, this level of knowledge may not be sufficient to ensure good self-care, especially in IT and those with a longer duration of disease. A longer duration of diagnosis was associated with poorer metabolic control, which may be related to the natural progression of diabetes and the challenges in maintaining adequate control over time. This finding highlights the need for continuous and personalized strategies for managing the disease as it progresses. Furthermore, these results emphasize the need for public health policies that promote enhanced diabetes education, aiming to empower patients to manage their condition more effectively.

Knowledge, Attitudes, and Behaviors around Dietary Fats among People with Type 2 Diabetes: A Systematic Review

This systematic review assesses the knowledge, attitudes, and behaviors (KAB) surrounding dietary fat intake among people with type 2 diabetes mellitus (T2DM) and healthcare professionals. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four databases were searched to identify studies published between 1995 and 2023 reporting people with T2DM or healthcare professionals that measured KAB towards dietary fat. This work was registered at PROSPERO (CRD42020140247). Twenty-four studies were included. Studies assessed knowledge of people with T2DM and reported poor nutrition knowledge regarding the health effect of fat consumption. Two opposing attitudes towards dietary fat was reported: (1) dietary fat should be limited, (2) promoted dietary fat intake through a low-carbohydrate diet. Participants reported behaviors of limiting fat intake, including trimming visible fat or choosing lower-fat alternatives. Total fat intake ranged between 10 and 66% of participants' total energy intake, while saturated fat intake ranged between 10 and 17%. People with T2DM reported poor knowledge of dietary fats in particular, and they were frequently unable to identify high-fat food. Attitudes towards dietary fat were heterogenous, and regarding behaviors, saturated fat intake was higher than recommended. Future studies should assess the KAB of people with T2DM based on dietary fat subtypes.

Diabetes knowledge among Malaysian adults: A scoping review and meta-analysis

Introduction

Optimal self-care promotes glycaemic control and prevents diabetes complications. Its performance is facilitated by an adequate level of diabetes knowledge. This review aimed to evaluate diabetes knowledge among Malaysians by assessing diabetes knowledge scores and their associated factors.

Methods

A comprehensive bibliographic search for Malaysian studies on diabetes knowledge was conducted in PubMed, Scopus and Google Scholar. Relevant literature was systematically selected and described; pertinent data were extracted; and data on diabetes knowledge levels and their associated factors were synthesised. The quality of the identified studies was assessed using a Joanna Briggs Institute critical appraisal tool.

Results

Thirty Malaysian cross-sectional studies that measured diabetes knowledge levels were retrieved. Nineteen of them used a named diabetes knowledge measurement tool, with 14 using the 14-item Michigan Diabetes Knowledge Test. A low knowledge level was prevalent among patients with diabetes mellitus (pooled mean knowledge score=6.92, proportion of patients with a low knowledge level=47.97%). The knowledge score was associated with some sociodemographic variables, health literacy, self-care and glycaemic control.

Conclusion

The association of diabetes knowledge with diabetes outcomes (e.g. self-care and glycaemic control) reflects the potential of the former as a target of intervention. Periodic measurement of diabetes knowledge in healthcare settings and among populations can help in assessing the effectiveness of diabetes educational interventions. Concerted efforts to improve diabetes knowledge among Malaysians have the potential to fill knowledge-practice gaps.

Effect of Group Patient Education on Glycemic Control Among People Living with Type 2 Diabetes in Vietnam: A Randomized Controlled Single-Center Trial

INTRODUCTION

In low- to middle-income countries such as Vietnam, urgent measures are required to prevent and control type 2 diabetes and its complications. This study measured the effect of a 3-month patient education and self-management intervention in a low-resource setting on diabetes knowledge and levels of blood glucose control.

METHODS

This was a single-center randomized controlled study among adult outpatients with type 2 diabetes. Patients were randomly assigned to 3-month community intervention consisting of group education for type 2 diabetes knowledge, diet, exercise in combination with usual diabetes care, or to usual diabetes care alone (control). Diabetes knowledge was measured with a modified Michigan University Diabetes Knowledge Test (MDKT). Other study outcomes included change in mean HbA1c, fasting blood glucose (FBG), and systolic blood pressure (SBP).

RESULTS

A total of 364 patients were randomized, 182 to the intervention group and 182 to control. The two groups were similar regarding main baseline characteristics. The male/female ratio was 45.1%/54.9% and mean age was 62.2 ± 9.3 years. Approximately half the patients (48.1%) were overweight and 15.7% were obese, mean baseline HbA1c was 8.21 ± 1.92%, and only 29.9% of participants had a baseline HbA1c < 7.0%. At baseline, diabetes knowledge was "very poor" or "poor" in 63.7% of patients. After a 3-month follow-up, the proportion achieving the target MDKT score increased from 37.4% to 81.3% in the intervention group and from 35.2% to 51.7% in the control (between-group difference P < 0.001). The estimate (SD) of the difference between intervention and control groups was - 1.63 (2.16), 95% CI - 2.07 to - 1.18. Mean changes from baseline HbA1c were - 0.54 ± 1.41% and - 0.18 ± 1.33% in the intervention and control groups, respectively (P = 0.012). Among those with poor glycemic control (HbA1c ≥ 7%) at baseline, mean changes at 3 months were - 0.80 ± 1.52% vs 0.41 ± 1.47%, respectively, (P = 0.013). Statistically significant decreases in FBG and SBP were also observed in the intervention group at 3 months, but not in the control group. Multivariate analysis revealed the variables with the strongest influence on blood glucose control at 3 months were study group, baseline MDKT score, diabetes duration, and baseline HbA1c (all P ≤ 0.05).

CONCLUSION

Provision of a structured educational program to Vietnamese people living with type 2 diabetes is effective at improving disease knowledge and is associated with better glycemic control. Larger and longer-term studies are now warranted to confirm these findings.

TRIAL REGISTRATION

This trial was retrospectively registered on 27 May 2020 through the https://clinicaltrials.gov site with the following identifier: NCT04403841.