INTRODUCTION:

Diabetes mellitus (DM) is a chronic disease caused by inherited or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves. Type 1 diabetes (also known as insulin dependent) in which the pancreas fails to produce the insulin hormone necessary for regulation for blood glucose level. Type 2 diabetes (also known as non-insulin dependent) results from the body’s inability to respond properly to the action of insulin produced by pancreas.

This is termed as insulin resistance. The signs and symptoms of both types of diabetes include increased urine output and decreased appetite as well as fatigue. DM is diagnosed by blood glucose testing, the glucose tolerance test, and testing of the level of glycosylated haemoglobin. The mode of treatment depends on the type of the diabetes. The major complications of DM include dangerously elevated blood sugar, abnormally low blood sugar due to diabetes medications, and disease of the blood vessels which can damage the eyes, kidneys, nerves, and heart. Public and professional awareness of the risk factors and symptoms of DM are the important steps towards its prevention and control [1].

The rationale for carrying out this research is to know the level of knowledge, attitude and practices (KAP) regarding DM among medical and non-medical students. This could help to increase the awareness about DM and its complication in person with DM. Thus, improve the lives of people with DM, promote better attitude and practices in order to reduce an individual risk of getting DM.

Globally, an estimated 422 million adults are living with DM, according to the latest 2016 data from the World Health Organization (WHO) [2]. Diabetes prevalence is increasing rapidly; previous 2013 estimates from the International Diabetes Federation (IDF) put the number at 381 million people having diabetes [3]. Type 2 diabetes makes up about 85-90% of all cases. Increases in the overall DM prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese.

DM occurs throughout the world, but is more common (especially type 2) in the more developed countries. The greatest increase in prevalence is, however, occurring in low- and middle-income countries including in Asia and Africa, where most patients will probably be found by 2030. The increase in incidence in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the Western pattern diet). The risk of getting type 2 diabetes has been widely found to be associated with lower socio-economic position across countries [4].

In Malaysia, the First National Health and Morbidity Survey (NHMS 1) conducted in 1986 reported a prevalence of DM to 6.3% and in the Second National Health and Morbidity Survey (NHMS 2) in 1996, the prevalence had risen to 8.2%. The WHO has estimated that in 2030, Malaysia would have a total number of 2.48 million diabetics compared to 0.94 million in 2000. DM is strongly associated with obesity. In a study in East coast peninsular Malaysia (Kelantan), 38.4% of diabetics were either obese or overweight compared to 24.1% in those with normal glucose tolerance 3. As for DM management, a study in major government hospitals in Malaysia in 1997 showed that the majority of patients had not been given adequate care. Only 10% had HbA1c measured, 22% had blood lipids measured and 30% had urine albumin checked. As for lifestyle, 66.5% of the patients were either overweight or obese, and only 54.8 % admitted to adhering to diabetic diet regularly or 38.9% exercised regularly. These factors could explain the poor control of DM in this study [5].

The present cross sectional questionnaire based study aimed to study KAP of DM between medical and non-medical students; to understand the difference in action taken in DM prevention; to determine the associated factors for preventive practices; and to make recommendations based on the study as regards the interventions required to impart knowledge, and foster good practices in the prevention of DM.

METHODOLOGY:

Subjects and setting:

This study has been conducted as non-experimental research design, regarding the awareness of DM between medical and non-medical students. The data obtained from the respondents using the questionnaire. Each respondent has been given a questionnaire and every outcome data was collected. The research has been conducted among medical students from Kota Campus of Universiti Zainal Abidin (UniSZA) and non-medical students from Gong Badak Campus of the same university. Sampling method adopted was simple random sampling.

Sample size and data collection:

Subjects were chosen randomly 100 students from UniSZA ranging from 19 years old to 24 years old as the respondents. Fifty respondents were students from medical course; another 50 students were from non-medical courses. After identifying the respondents, questionnaire was distributed in order to collect the data for analysis and obtaining the results. The data that has been collected was analysed quantitatively. The results were displayed in charts, percentage and simplified form.

Questionnaire Design:

A structured questionnaire was used which was constructed from previous studies and consisted of two parts. Part 1 was regarding socio-demographic details while part 2 was about KAP. There were 13 questions pertaining to knowledge, 9 questions for attitude and 20 questions regarding practice. The respondents required to response ‘Yes’ or ‘No’ for the knowledge section, ‘Strongly agree’, ‘Agree’, ‘Don’t know’, ‘Disagree’ or ‘Strongly disagree’ for the attitude section and ‘Never’, ‘Once in a while’, ‘2-3 times a week’ or ‘Daily’ for the practice section. The questionnaire was translated into Bahasa Malaysia. The suitability and clarity of the questionnaire was assessed by a small pilot study. A pilot study was done among 36 participants, before the actual study was initiated among UniSZA medical and non-medical students to pre-test/validate the set of questions in the questionnaire. All participants of the study gave their informed consent to participate in the study.

RESULTS AND DISCUSSION:

Table 1: Distribution of the respondents among UniSZA medical and non-medical students (n=100).

Frequency

Percentage (%)

Medical

Non-medical

50.0

Table 2: Gender distribution of the respondents among UniSZA medical and non-medical students (n=100).

Gender	Count	Percentage (%)
Male	50	50.0
Female	50	50.0

Table 3. Ethnic distributions of the respondents among UniSZA medical and non-medical students.

Race		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	malay	64	64.0	64.0	64.0
	indian	24	24.0	24.0	88.0
	chinese	8	8.0	8.0	96.0
	others	4	4.0	4.0	100.0
	Total	100	100.0	100.0

Table 4: Family history of the respondents among UniSZA medical and non-medical students of DM (n=100).

DM		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	yes	31	31.0	31.0	31.0
	no	69	69.0	69.0	100.0
	Total	100	100.0	100.0

Table 5: Knowledge of respondents among UniSZA medical and non-medical students on DM (n=100).

DM			Knowledge		Total
DM			yes	No	Total
Respondents	medical students	Count	50	0	50
		Expected Count	39.0	11.0	50.0
		% Within correspondent	100.0%	0.0%	100.0%
	non-medical students	Count	28	22	50
		Expected Count	39.0	11.0	50.0
		% Within correspondent	56.0%	44.0%	100.0%
Total		Count	78	22	100
		Expected Count	78.0	22.0	100.0
		% Within correspondent	78.0%	22.0%	100.0%

Table 6. Attitude of respondents among UniSZA medical and non-medical students towards DM (n=100).

DM			Attitude		Total
DM			High	Low	Total
Respondent	medical students	Count	40	10	50
		Expected Count	29.0	21.0	50.0
		% Within respondent	80.0%	20.0%	100.0%
	non-medical students	Count	18	32	50
		Expected Count	29.0	21.0	50.0
		% Within respondent	36.0%	64.0%	100.0%
Total		Count	58	42	100
		Expected Count	58.0	42.0	100.0
		% within respondent	58.0%	42.0%	100.0%

Table 7. Practice of prevention of DM by the respondents among UniSZA medical and non-medical students (n= 100).

DM			Practice		Total
DM			High level of practice	Low level of practice	Total
Respondent	medical students	Count	47	3	50
		Expected Count	34.0	16.0	50.0
		% Within correspondent	94.0%	6.0%	100.0%
	non-medical students	Count	21	29	50
		Expected Count	34.0	16.0	50.0
		% within correspondent	42.0%	58.0%	100.0%
Total		Count	68	32	100
		Expected Count	68.0	32.0	100.0
		% Within respondent	68.0%	32.0%	100.0%

Very recent studies conducted among diabetics and the general population in India found meagre levels of knowledge and awareness related to DM and poor self-care practices [6]. Similar community and hospital surveys in developing countries also unfolded unsatisfactory KAP of the diabetic patients. Thus, the high prevalence of undiagnosed cases, and consequently poor KAP, has directly increased premature deaths, costly complications, and financial burdens. The high cost of DM management and treatment indirectly provoke patients to choose complementary and alternative medicine therapies [7]. Evidence has showed that increasing knowledge regarding diabetes and its complications has significant benefits in management and treatment.

Despite various scientific studies carried out, there are still controversies about research on the social science perspective especially on DM in Malaysia. Social factors play an important role in managing DM. One of the most important social factors is the stigma within the society towards diabetic patients. In addition, the low level of awareness among the public regarding diabetes has also become a factor leading to the increase of diabetic patients. It is therefore very important to know the level of public awareness of diabetes disease. The level of awareness may vary according to the demographic factors such as employment, education, economy, area of residence and age. Based on these factors, this study discussed the level of awareness among students about DM in Malaysia using the approach of KAP.

The present survey based research aimed to study the KAP of DM among students studying at faculty of medicine, UniSZA, and to compare it with the non-medical students in the same university. Based on the study, medical and non-medical students were selected using simple random sampling method. Equal number of medical and non-medical students as well as equal ratio of both genders were the study samples (Tab. 1 and 2). Among all the races that have participated in the study, Malay students (64.0%) made up most of the total students, followed up by Chinese (8.0%), Indian (24.0%) and other races (4.0%) (Tab. 3). In overall, 31 participants did not have any family history of DM while 69 of them have it (Tab. 4).

The knowledge based questions that were asked to the participants are about signs and symptoms, organism, complications, treatment and preventive measures of DM. As expected, the null hypothesis is rejected as significant p-value (<0.05) shows substantial association that the medical students had absolutely higher percentage in having high knowledge regarding DM which is 100.0%. Only 56.0% of the non-medical students had knowledge about this. This could be reasoned by the teaching curriculum of medical students that includes DM. Overall; the majority of our respondents had general knowledge about DM as well as the symptoms, complications, prevention and treatment of the disease (Tab. 5).

Furthermore, from the attitude assessment, significant p-value (<0.05) exposed majority 80.0% of the medical students agreed to support the interventions that need to be taken to control and prevent the disease while only 36.0% of non-medical students had positive attitude. This could relate that medical students had better knowledge about DM which contributed them to have better attitudes as well (Tab. 6).

On further study about the practice of prevention of DM disease among the participants and as expected significant p-value (<0.05) exhibited medical students (94.0%) had higher level of practice towards prevention compared to non-medical students (42.0%). Example of the practices that needed to be done is by exercising, eating a balanced diet, having regular check-ups (Tab. 7).

The study showed that non-medical students have average overall KAP towards DM. However, medical students have better overall KAP as compared to non-medical students due to their higher education on DM. Recent studies done in Pakistan, Kuwait, UAE, Nepal, Bangladesh and Saudi Arabia reported that the majority of respondents had a poor KAP score towards DM. [8-14]. In contrary, a study done in a primary care centre in Malaysia reported that most of the respondents had good knowledge and a better attitude towards the care of their own disease [15].

Knowledge is the greatest weapon in the fight against DM. In this group of people, knowledge of the disease was significantly associated with educational background. Medical students had significantly higher knowledge than non-medical students in this matter. This research proved that knowledge is the contributing factor for one to have good attitude and proper practise to prevent DM. This is proven as medical students in the research had a better attitude and practice regarding DM. Therefore, medical students tend to commit more towards a healthy lifestyle to prevent DM. The study of DM among selected Malaysian population by Universiti Teknologi Mara showed that the respondents with good overall knowledge had better attitude and practice towards DM. The current of work is also in consistent with it too [16].

The study had some limitations which the researcher had to keep in mind. To begin with, the sample size was not large enough and thus, it was not representative of the entire population and would have tilted results. There was also limitation in generalisation and inference making about the entire population. Some recommendations were suggested to improvise the results. In research aspect, greater study sample is needed so that one can infer back the research outcome to the target population. It is also recommended to have the better representation of the group being studied. Regarding research outcome, it is recommended that all forces including authorities and educational sectors should adopt strategies to enhance the society on KAP of DM.

CONCLUSION:

In deduction, the knowledge of DM among non-medical students is average, with the evidence of only about half of them have high knowledge regarding the disease. In contrast, most of the participants having medical background have high knowledge regarding DM as expected. Higher number of medical students show positive attitude towards the prevention of the disease because they are more aware and have higher knowledge about the disease whereas less than half of the non-medical students also show some positive attitude. Finally, considering the fact that medical students have higher knowledge and awareness regarding DM, their tendency on practicing the appropriate action to prevent the disease is higher than non-medical students.

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Received on 29.08.2018 Modified on 11.09.2018

Research J. Pharm. and Tech 2018; 11(11): 4837-4841.

DOI: 10.5958/0974-360X.2018.00879.X