Diabetes is becoming a major public health problem of developing countries like India because of rapid urbanization and life style changes. At present diabetes is becoming a fastest growing disease in India having prevalence of 8.8%. In India approximately 72 million cases of diabetes were present in 2017 and this figure is expected to double by 2025. Diabetes is a life-style disease having significant mortality and morbidity associated with its micro-vascular and macro-vascular complications; causing huge financial burden on individual as well as on the healthcare system of the country.

Diabetes is a silent killer and may remain undiagnosed for years. Early diagnosis and management of diabetes is essential to prevent and decrease its morbidity and mortality. The main emphasis in management of Diabetes is centered on achieving target sugar levels. Along with pharmacotherapy, diabetic education is an integral part of treatment of diabetes to achieve target glycemic control. Diabetic patients who are empowered with self-care knowledge and education are less prone for diabetic complications and may have better glycemic control. Various studies have proven the role of educational intervention to improve the knowledge and self-care of diabetes and to further minimizing the healthcare problems associated with it [1].

There are very limited studies on assessment of knowledge, attitude and practice from both urban as well as rural part of India and even those which are available; reflect poor awareness among Indian population [2,3]. One study which was conducted in Chennai in 2005 yielded that awareness and knowledge regarding the diabetes is grossly inadequate in India and concluded the need of starting diabetes education programs at mass level [4]. Studies from our neighboring countries like Bangladesh and Pakistan also revealed the suboptimal education and knowledge about the diabetes and emphasized on the need of effective diabetes education [5,6,7]. UP is classified as one of the ‘lagging states of India’ for its slow growth, low human development indicators and high concentration of the poor. In view of presence of very limited KAP studies on diabetes from India and especially from western U.P region of India, In the present study, data on this subject to understand the level of knowledge of Diabetes among western

All study subjects who fulfilled the inclusion criteria were interviewed.

All the study subjects were explained in detail about the purpose of the study and informed consent was taken for their participation and they were assured about the confidentiality and privacy of their responses. Questionnaire was available in Hindi and English language.

Few of the questions in the questionnaire were taken from studies done by Wee et al [8] and Kaniz et al [9] and some were included by us. A pilot study under the guidance of three of the authors (Dr. Jyoti Goyal, Dr. Navin Kumar and Ms. Seema Raghav) was done to pretest the questionnaire which helped in validating this questionnaire before finalizing it. Internal consistency of this questionnaire was found to be 0.74 using cronbach’s alpha which had a good level of reliability.

Questionnaire was divided into 3 sections – first section contains demographic profile of study subjects, second section had questions about knowledge, risk factors and complications of diabetes of all study subjects and the last section of the questionnaire included health seeking behavior pattern of diabetic subjects only.

Data Analysis: The collected data was initially entered into Microsoft Excel and then transferred to IBM SPSS 21.0 (Armonk, NY, USA). The number and percentage of gender, age group, marital status, education, occupation, total family member, monthly income, place of residence and family history for diabetic and non-diabetic group were determined. Also, knowledge of respondents toward diabetes, its risk factors, health-seeking behavior and complications were assessed with the help of the questionnaire prepared.

Socio-demographic characteristics of all study subjects (Table 1) - A total of 412 study subjects were interviewed, after taking the consents, out of which 206 were diabetics and 206 were non-diabetics. Socio-demographic characteristics of the two study groups are as follows: 50% of the diabetics are in the age group category of 41-60 years. > 50% of non-diabetics are in the age group category 21-40 years. > 30% of diabetics were >60years of age while approx. 10% of non-diabetics were coming in this category. > 60% diabetics and > 85% non-diabetics were male; while rest of the population were female.

The responses of all the questions were grouped into 3 categories: Yes, No & Don’t Know. Approximately 50% of diabetics and 41% non-diabetics believed that diabetes is not caused by eating more sweets; while, approximately 4.6% diabetics and 51.9% non-diabetics believed that it is caused by eating more sweets. Very few (3.4% diabetics and 6.8% non-diabetics) were not aware of any association of diabetes with eating sweets.

>85% of diabetics and 70% of non-diabetics were aware that frequent urination and frequent thirst are the main symptoms of diabetes. >80% of subjects in both the categories were aware that diabetes is not a communicable disease and it doesn’t spread from person to person. >40% of non-diabetics think that diabetes is curable while only 25% in diabetics category think so. > 74.3% non-diabetics and 62.1% of diabetics knew that in diabetes either deficiency of insulin or insulin resistance or both.

Knowledge about risk factors and complication of diabetes (Table 3) - More than 85% of diabetics and >75% of non-diabetics knew that lack of physical activity; obesity and stress are risk factor for diabetes. Approx. 15% of diabetics were either un-aware of these risk factors or they think that these factors do not matter. Similarly, 81.6% of diabetics and 66.5% of non-diabetics knew that this illness is related to our lifestyle.

Healthcare seeking behavior of diabetic patients (Table 4) - Diabetics were asked about their healthcare seeking behavior in form of 7 questions: a question regarding their physical activity was asked in form of the duration of their daily exercises. >50% of the diabetics do not exercise at all. 4% do it for >45 minutes daily. Approx. 20% do it for 30-45 minutes and 28.2% do it for < 30 minutes. A question regarding the awareness of hypoglycemia management was asked and approx.

87% diabetics do not keep any candy or sugar with them before leaving home; which is a disheartening figure and emphasized the need of hypoglycemia education to be made mandatory for all diabetics who are on anti-diabetic drugs. Asking about their frequency of consulting a doctor for their sugar control, >30% visit every month, >30% visit as per doctor’s advice; approx. 20.4% visit every 6 monthly and 12% visit every year. Asking about their foot care practice approx. >70% do not clean their feet with water and do not apply oil or cream before sleeping; only 30% are doing good foot care.

Knowledge of participants towards diabetes was assessed with the help of 8 questions asked from each participant. Approximately 50% of the participant think that diabetes is caused by eating sweets, reflecting poor understanding of pathophysiology of diabetes. This belief was uniformly distributed in diabetics as well as in non-diabetics. Most of the people (more than 80%) knew that diabetes is not a communicable disease; more than 30% of respondents thought that diabetes is curable. Non-diabetics (42%) in comparison to diabetics (25%), had this misconception.

Approximately 80% of respondents are aware of symptomatology of diabetes (frequent urination and thirst) that too is almost uniformly distributed among diabetics and non-diabetics. More than 80% diabetics as well as non-diabetics knew about the need of self-monitoring of blood glucose at home. Approximately 70% of respondents knew regarding the mechanism of development of diabetes which may be either due to lack of insulin or insulin resistance. More than 90% of people are aware that diabetes is increasing in incidence very rapidly.

The most common source of knowledge regarding the diabetes is either relatives or diabetic educator. Television, newspaper, and mass media can play a crucial role in increasing the awareness about these life style diseases and as per the present study its contribution was only 20%, further signifies tremendous scope of improvement and to start education campaigns based on improving the awareness about all lifestyle disorders.

The mass and print media have a huge responsibility of providing evidence base scientific information in a very clear and non-confusing manner.

Hypoglycemia awareness and management is an integral part of diabetic care and it is absolutely essential to impart the knowledge about it to every diabetic who is on pharmacotherapy, be it, oral or Insulin. It is heartening to see that >80% of diabetics were not having any form of addiction. Smoking and alcohol among diabetics are very detrimental for its long-term control and management.

Approximately >60% of the diabetic patients consult their doctor either as per doctor’s advice or every monthly, though nominal amount (12%) of respondents do not come for follow-up for more than a year. Knowledge regarding the foot care is suboptimal in approx. 70% of the diabetics. 65% of the diabetics were checking their blood sugar at home with the help of glucometer while 35% of them were not aware about the need of it. Very encouragingly 85% of patients were either not having sweets or having it occasionally 2-3 times in a week; only approx. 8% people were consuming sweets daily.

As this study was conducted in Internal Medicine OPD of a tertiary care hospital situated in Mathura, it might not truly represent the western UP population. Study is conducted in a hospital-based setting where diabetic educators are available and education with help of leaflets and videos displayed in hospital premises is being provided, may also impact the study conclusion. Therefore, the reliability and applicability of this study conclusion is limited in consideration with general population of Uttar Pradesh.

More than 50 % of diabetics as well as Nondiabetics were poorly informed about the pathophysiology of Diabetes. Knowledge of symptomatology of diabetes and requirement of self-monitoring of blood glucose at home was adequate among most of the study subjects and uniformly distributed among diabetics and Nondiabetics.

More than 80% of diabetics were not aware about hypoglycemia detection and management, raises a big concern and puts health care professional into an obligation to impart knowledge on symptoms and correction of hypoglycemia. Also, there should be some processes or protocol in place to ensure its compliance.