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Obesity Medicine
journal homepage: http://www.journals.elsevier.com/obesity-medicine
Original research
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
Faculty of Nursing, Alexander Technological Educational Institute of Thessaloniki, Greece
c
1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Greece
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 30 October 2015
Accepted 29 December 2015
Aim: To investigate whether people with diabetes mellitus (DM) have different disease-specic
knowledge according to gender, DM type and centre of education and if they have adopted appropriate changes in their lifestyle according to their DM-related knowledge.
Patients and methods: A total of 76 patients with DM (males: 31, females: 45; age 18e82 years; DM type
1: 45, DM type 2: 31) participated in this cross-sectional, multi-center, questionnaire-based study. The
Revised Michigan Diabetes Knowledge Scale questionnaire includes disease-specic questions on DM,
diet and exercise. The Diabetes Care Prole questionnaire of the Michigan Diabetes Research and
Training Center was applied to identify the demographic characteristics of the individuals, the education
in diabetes, nutrition and exercise and the changes in lifestyle according to the given instructions.
Results: The overall score of correct answers was 69%. Gender did not present any difference in
knowledge about DM (p 0.259), diet (p 0.971) and exercise (p 0.262). In contrast, patients with DM
type 1 achieved higher scores in knowledge about DM (p < 0.001) and foot care (p 0.019) compared to
the patients with DM type 2. Patients attending private DM-specic support centers achieved more
correct answers compared to those attending public hospitals' outpatient clinics (p 0.003).
Conclusions: Patients with DM type 1 and patients who attend private DM-educational centers receive
more education on practical aspects of DM management and have superior knowledge related to it.
2016 Elsevier Ltd. All rights reserved.
Keywords:
Diabetes complications
Diabetes diet
Diabetes exercise
Diabetes education
1. Introduction
Glycemic control plays a key role in the outcome of diabetes
mellitus (DM). Diet along with exercise are important factors in
achieving glycemic control, either alone or in combination with
medication. The knowledge of a person with DM about his/her
disease contributes in a positive way to its management (ClarkeFarr et al., 2006; Dunn et al., 1990). This knowledge is related to
general issues on DM (medications, complications, control of
glucose concentrations and factors that affect them), diet (equivalents of carbohydrates, treatment of hypoglycemia, food composition) and exercise (benets).
There is evidence that many people with DM do not know the
complications that are associated with the disease, ignore the
30
The second questionnaire consisted of queries about the demographic characteristics of the individuals, such as gender, age,
educational level and profession, and questions about the duration
of the disease, the control of glucose concentrations, medication,
existing complications, education in diabetes, foot care, nutrition
and exercise and application of the given instructions. This questionnaire was part of the Diabetes Care Prole (DCP) questionnaire (Section IX e Diet Adherence Scale, Section XII e Monitoring
Barriers and Understanding Management Practice Subscales) of the
Michigan Diabetes Research and Training Center (University of
Michigan, 2015).
The individuals were informed about the purpose of this study
and were asked to ll a consent form which was given separately
from the questionnaires, so as to keep anonymity.
Table 1
Baseline characteristics and disease-specic knowledge according to gender.
Age (years)
Duration of DM (years)
BMI (kg/m2)
Education
about DM (%)
about foot care (%)
about diet (%)
about exercise (%)
Knowledge
about DM (%)
about diet (%)
about exercise (%)
General score of knowledge (%)
Changes in lifestyle
related to diet
related to exercise
Men (n 31)
Women (n 45)
p value
47.3 19.3
15.4 10.8
28.6 5.0
49.6 17.0
18.7 12.6
27.7 5.7
0.587
0.257
0.503
61.3
77.4
93.5
67.7
77.8
88.9
93.3
77.8
0.259
0.164
0.971
0.262
56
77
79
67
60
81
80
71
0.377
0.450
0.822
0.134
3.3 0.2
3.0 0.2
3.6 0.2
3.0 0.2
0.378
0.764
Data are expressed as mean standard error of the mean (SEM) or as percentage (%)
of correct answers. BMI: body mass index; DM: diabetes mellitus. Application of the
instructions is expressed on a 1e5 scale, where 1 never, 2 rarely 3 sometimes,
4 often, 5 always.
Age (years)
Duration of DM (years)
BMI (kg/m2)
Education
about DM (%)
about foot care (%)
about diet (%)
about exercise (%)
Knowledge
about DM (%)
about diet (%)
about exercise (%)
General score of knowledge (%)
Changes in lifestyle
related to diet
related to exercise
DM type 1
(n 45)
DM type 2
(n 31)
p value
37.2 13.0
20.1 13.5
25.9 5.1
65.3 8.0
13.4 7.7
31.3 4.2
<0.001
0.460
<0.001
91.1
93.3
97.8
75.6
42.0
71.0
87.1
71.0
<0.001
0.019
0.109
0.834
68
86
84
76
44
71
73
60
<0.001
<0.001
0.040
<0.001
3.6 0.2
3.2 0.2
3.3 0.1
2.7 0.3
0.276
0.172
Data are expressed as mean standard error of the mean (SEM) or as percentage (%) of correct answers. BMI: body mass index; DM: diabetes mellitus.
Application of the instructions is expressed on a 1e5 scale, where 1 never,
2 rarely 3 sometimes, 4 often, 5 always.
4. Discussion
The aim of this study was to investigate whether people with
diabetes mellitus (DM) receive different education and have
different disease-specic knowledge according to gender, DM type
and centre of education and if DM-related knowledge plays a role in
adopting changes in their lifestyle.
For the needs of this study there has been made an extensive
search for questionnaires in the Greek and international literature, so as to nd a questionnaire that included all the relevant
questions but being also easy to comprehend and not requiring a
long completion time. Other questionnaires than the selected
Table 3
Baseline characteristics and disease-specic knowledge according to center of
origin.
Age (years)
Duration of DM (years)
BMI (kg/m2)
Education
about DM (%)
about foot care (%)
about diet (%)
about exercise (%)
Knowledge
about DM (%)
about diet (%)
about exercise (%)
General score of knowledge
Application of the instructions
for the diet
for the exercise
Public hospitals
(n 29)
Private centres
(n 47)
p value
60.0 2.6
15.4 1.9
31.5 0.8
41.7 2.4
18.6 1.9
26.0 0.7
<0.001
0.256
<0.001
51.7
72.4
89.7
72.4
83.0
91.5
95.7
74.5
0.031
0.020
0.305
0.995
49
73
76
62
64
83
82
73
0.001
0.017
0.372
0.003
3.3 0.2
2.9 0.3
3.6 0.2
3.0 0.2
0.264
0.836
Data are expressed as mean standard error of the mean (SEM) or as percentage (%)
of correct answers. BMI: body mass index; DM: diabetes mellitus. Application of the
instructions is expressed on a 1e5 scale, where 1 never, 2 rarely 3 sometimes,
4 often, 5 always.
31
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TRUE/FALSE/DON'T KNOW
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TRUE/FALSE/DON'T KNOW
TRUE/FALSE/DON'T KNOW
Source: Collins GS, Mughal S, Barnett AH, Fitzgerald J, Lloyd CE. Diabet
Med 2011; 28:306e10.
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