Systematic Review and Meta-Analysis on T2D

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Rev Diabet Stud, 2021, 17(2):82-89 DOI 10.1900/RDS.2021.17.82

Systematic Review and Meta-Analysis of Diabetes Knowledge among Type 2 Diabetes Patients in Southeast Asia

Phei Ching Lim1, Retha Rajah1, Chong Yew Lee2, Te Ying Wong1, Sherene Su Ann Tan1, Sarah Abdul Karim1

1Hospital Pulau Pinang, Penang, Malaysia
2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
Address correspondence to: Chong Yew Lee, e-mail: chongyew@usm.my

Manuscript submitted September 23, 2020; resubmitted September 23, 2021; accepted October 20, 2021.

Keywords: type 2 diabetes mellitus, knowledge, Southeast Asia, knowledge factors

Abstract

OBJECTIVES: Recognition of patient baseline knowledge is important in educating patients with type 2 diabetes mellitus (T2D) to manage their disease effectively. The purpose of this study is to review current evidence on the level of diabetes knowledge among T2D patients and determine factors affecting their knowledge. METHODS: A systematic search of English language articles published between 1990 and June 2019 was conducted using six electronic databases. Only quantitative studies that assessed knowledge of T2D patients in Southeast Asian countries were included. Data were extracted and a meta-analysis was conducted. RESULTS: A total of 6210 articles were retrieved; seven articles met the inclusion criteria, comprising 1,749 T2D patients. The calculated mean knowledge score was 55.6% (95% CI: 7.6 to 103.6). Five types of assessment tools were identified ranging from five to 41 questions that focused on disease specifics, treatment, and nutrition. Age, education level, and glycemic control were the most common factors impacting knowledge. CONCLUSIONS: The level of knowledge among T2D patients in Southeast Asia was unsatisfactory, especially in older patients with low education levels and poor glycemic control. Hence, an appropriate educational plan should be prioritized to these groups.

1. Introduction

Type 2 diabetes mellitus (T2D) has emerged as one of the most challenging public health problems of the 21st century. The disease has risen at an alarming rate with a worldwide prevalence of 463 million people in 2019. In developing countries, particularly in Southeast Asia, the incidence rate is much higher following population growth, aging, lifestyle changes, and the increasing prevalence of obesity. Southeast Asia consists of eleven countries, including Vietnam, Thailand, Cambodia, Laos, Myanmar, Malaysia, Singapore, Indonesia, Brunei, the Philippines, and Timor-Leste. According to recent updates in 2019 by the International Diabetes Federation, 29 million people are living with diabetes in these countries. Malaysia has the highest prevalence rate of adults aged more than 20 years that have T2D (16.8%) followed by Singapore (14.2%) and Brunei (13.2%). Indonesia, as the highest populated country in the region, has the highest number of people living with diabetes, 10.7 million. If interventional strategies are not implemented, this number is projected to increase to 46 million by the year 2045 [1].

Besides appropriate usage of antidiabetic medication, effective diabetes management also depends on the patients’ knowledge about their disease, healthy eating options, physical exercise, and self-monitoring of blood glucose levels [2]. Despite various pharmacological modalities available today, T2D prevalence continues to increase. Poor disease knowledge is one of the main reasons for suboptimal self-care behavior and failure to achieve recommended glycemic targets in diabetic patients [3, 4]. Poor glycemic control (HbA1c ≥ 7%) may result in microvascular and macrovascular complications such as kidney failure, retinopathy, neuropathy, myocardial infarction, stroke, and peripheral vascular disease, which in turn lead to increased morbidity and mortality as well as economic challenges [5, 6].

Although knowledge about the disease alone does not bring about the required behavior modifications to achieve optimal treatment outcomes, the assessment of patient knowledge level is crucial in designing personalized educational interventions tailored to the individual needs of each T2D patient. Diabetes education should aim to improve patients’ knowledge about their disease and self-care behavior to achieve optimal glycemic control and reduction in diabetes-related complications [7]. In order to implement effective and individualized diabetes education, the patients’ knowledge level should be determined first and specific knowledge gaps identified. Recent standards of care recommendations provided by the American Diabetes Association (2019) emphasize patient participation or a "patient-centered" approach in charting the course of disease management together with the healthcare providers [8]. A patient-centered communication style that uses person-centered, strength-based language, and active listening to elicit patient preferences and beliefs, assessment of literacy and numeracy, and identification of potential barriers to diabetes care are recommended. When patients participate in creating the treatment plan, adherence to the treatment regimen is increased. It is therefore necessary for a T2D patient to have a minimum level of basic knowledge to be able to participate in the decision-making process. Baseline knowledge about the disease also enables further enhancement of a patient’s knowledge level through education.

Given the high prevalence of T2D in Southeast Asian countries and the importance of diabetes-related knowledge in achieving positive outcomes, a comprehensive review of the knowledge level of T2D patients in this region is highly warranted to inform diabetes educators in formulating educational interventions with an emphasis on patient participation. To date, only a handful of systematic reviews conducted in Southeast Asia countries involved T2D patients, but none of them specifically provided data on diabetes knowledge. Therefore, the present study aims to identify and examine available literature on the knowledge level of T2D patients in the Southeast Asia region. Also, this review provides data on the types of knowledge assessment tools that were used and the factors affecting the knowledge level.

Acknowledgments: The authors thank the General Director of Health Malaysia for the permission to publish this paper.

References

  1. IDF Diabetes Atlas (Ninth Edition) Committee. IDF Diabetes Atlas Ninth Edition 2019. International Diabetes Federation 2019. [DOD] 
  2. Casagrande SS, Burrows NR, Geiss LS, Bainbridge KE, Fradkin JE, Cowie CC. Diabetes knowledge and its relationship with achieving treatment recommendations in a national sample of people with type 2 diabetes. Diabetes Care 2012. 35(7):1556-1565. [DOD] [CrossRef]
  3. Phillips E, Rahman R, Mattfeldt-Beman M. Relationship between diabetes knowledge, glycemic control, and associated health conditions. Diabetes Spectr 2018. 31(2):196-199. [DOD] [CrossRef]
  4. Mamo Y, Bekele F, Nigussie T, Zewudie A. Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study. BMC Endocr Disord 2019. 19(1):91. [DOD] [CrossRef]
  5. Gerstein HC. Diabetes: dysglycaemia as a cause of cardiovascular outcomes. Nat Rev Endocr 2015. 11(9):508-510. [DOD] [CrossRef]
  6. Beckman JA, Creager MA. Vascular complications of diabetes. Circ Res 2016. 118(11):1771-1785. [DOD] [CrossRef]
  7. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns 2016. 99(6):926-943. [DOD] [CrossRef]
  8. American Diabetes Association. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes - 2019. Diabetes Care 2019. 42(Suppl 1):S34-S45. [DOD] [CrossRef]
  9. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009. 151(4):264-269. [DOD] [CrossRef]
  10. Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998. 19(4):170-176. [DOD] 
  11. Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Research Notes 2012. 5:52. [DOD] [CrossRef]
  12. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003. 327(7414):557-560. [DOD] [CrossRef]
  13. Ioannidis JP, Patsopoulos NA, Evangelou E. Heterogeneity in meta-analyses of genome-wide association investigations. PLoS One 2007. 2(9):e841. [DOD] [CrossRef]
  14. Abbasi YF, See OG, Ping NY, Balasubramanian GP, Hoon YC, Paruchuri S. Diabetes knowledge, attitude, and practice among type 2 diabetes mellitus patients in Kuala Muda District, Malaysia–A cross-sectional study. Diabetes Metab Syndr 2018. 12(6):1057-1063. [DOD] [CrossRef]
  15. Al-Qazaz HK, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, Saleem F. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm 2011. 33(6):1028-1035. [DOD] [CrossRef]
  16. Ardena GJ, Paz-Pacheco E, Jimeno CA, Lantion-Ang FL, Paterno E, Juban N. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based Diabetes Self-Management Education (DSME) Program in San Juan, Batangas, Philippines. Diabetes Res Clin Pract 2010. 90(2):160-166. [DOD] [CrossRef]
  17. Ding C, Teng C, Koh C. Knowledge of diabetes mellitus among diabetic and non-diabetic patients in Klinik Kesihatan Seremban. Med J Malaysia 2006. 61(4):399-404. [DOD] 
  18. Eknithiset R, Somrongthong R, Kumar R. Factors associated with knowledge, perception, and practice toward self-care among elderly patients suffering from type 2 diabetes mellitus in rural Thailand. J Ayub Med Coll Abbottabad 2017. 30(1):107-110. [DOD] 
  19. Kueh YC, Morris T, Ismail AA. The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes. Psychol Health Med 2017. 22(2):138-144. [DOD] [CrossRef]
  20. Thewjitcharoen Y, Chotwanvirat P, Jantawan A, Siwasaranond N, Saetung S, Nimitphong H, Himathongkam T, Reutrakul S. Evaluation of dietary intakes and nutritional knowledge in Thai patients with type 2 diabetes mellitus. J Diabetes Res 2018. 2018:9152910. [DOD] [CrossRef]
  21. Collins G, Mughal S, Barnett, Fitzgerald J, Lloyd CE. Modification and validation of the revised diabetes knowledge scale. Diabet Med 2011. 28(3):306-310. [DOD] 
  22. Tham KY, Ong JJ, Tan DK, How KY. How much do diabetic patients know about diabetes mellitus and its complications? Ann Acad Med Singap 2004. 33(4):503-509. [DOD] 
  23. Wee H, Ho H, Li S. Public awareness of diabetes mellitus in Singapore. Singapore Med J 2002. 43(3):128-134. [DOD] 
  24. Verastigue-Custodio M, Jimeno C, Isip-Tan I, Trajano-Acampado. A survey of diabetes knowledge among type 2 diabetes patients at UP-PGH using the Filipino version of American Association of Clinical Endocrinology (AACE) knowledge evaluation form. Phil J Intern Med 2006. 44(5):225-230. [DOD] 
  25. Fitzgerald JT, Funnell MM, Hess GE, Barr PA, Anderson RM, Hiss RG, Davis WK. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 1998. 21(5):706-710. [DOD] [CrossRef]
  26. Feld S. The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-Management - 2002 Update. Endocr Pract 2002. 8(Suppl 1):40-82. [DOD] [CrossRef]
  27. Sommer AE, Golden BP, Peterson J, Knoten CA, O’Hara L, O’Leary KJ. Hospitalized patients’ knowledge of care: a systematic review. J Gen Intern Med 2018. 33(12):2210-2229. [DOD] [CrossRef]
  28. Stroebele N, Müller-Riemenschneider F, Nolte CH, Müller-Nordhorn J, Bockelbrink A, Willich SN. Knowledge of risk factors, and warning signs of stroke: a systematic review from a gender perspective. Int J Stroke 2011. 6(1):60-66. [DOD] [CrossRef]
  29. Shrestha N, Yadav S, Joshi A, Patel BD, Shreshta J, Bharker DL. Diabetes knowledge and associated factors among diabetes patients in Central Nepal. Int J Collab Res Intern Med Publ Health 2015. 7(5):82-91. [DOD] 
  30. Ezenwaka C, Offiah N. Patients’ health education and diabetes control in a developing country. Acta Diabetol 2003. 40:173-175. [DOD] [CrossRef]

 
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