Awareness Level of Diabetic Neuropathy and Its Complications Among Taif City Population in Saudi Arabia

Introduction

Diabetes mellitus (DM) is one of the most common medical conditions in the world, affecting more than 400 million people of different age groups around the globe.¹ In Saudi Arabia, diabetes has been reported to affect 25% of the population over the age of 30 years.² In addition, it is associated with a plethora of medical, personal, and social problems. There are two types of DM: type 1 DM is characterized by a lack of insulin production by the pancreas, while type 2 DM (T2DM) is a long-term metabolic condition characterized by high blood sugar, insulin resistance, and insulin insufficiency.³ Furthermore, diabetic complications are traditionally divided into two major categories: macrovascular complications such as cardiovascular disease, cerebral stroke, and peripheral arterial disease, and microvascular complications such as diabetic retinopathy, nephropathy, and neuropathy.⁴ Diabetic Neuropathy is the most common complication of diabetes, which can result in weakness due to muscle atrophy.⁵ Globally, approximately 10%-20% of diabetic patients are diagnosed with peripheral neuropathy at the time of their primary diagnosis. According to some studies, the development of diabetic neuropathy is directly proportional to the chronicity of the disease, which means that after five years of developing diabetes, approximately 26% of the patients develop diabetic neuropathy, with this percentage rising to 41% after another five years, and eventually reaching approximately 66% after further progression over the years.⁶ In a previous study, 19.9% of diabetic patients were diagnosed with diabetic peripheral neuropathy (DPN) and these patients were older, had diabetes for a longer period, and had a higher incidence of abdominal obesity and hypertension compared to their counterparts without DPN.⁷

A study conducted in Alkobar City of Saudi Arabia found that the prevalence of peripheral neuropathy in patients with T2DM was 37.4%, and approximately 60% of these patients were unaware of the importance of daily foot care.⁸ Another study conducted in Riyadh discovered that 35.5% of diabetic patients included in the study had paresthesia, which could lead to more severe complications over time.⁹ A lack of awareness about DPN was also noted in diabetic patients from Al-Ahsa City.¹⁰ Furthermore, in a study conducted in Jeddah, it was noted that 23% of patients with diabetes did not know about foot ulcers being a complication of diabetic neuropathy and that poor diabetic control affects the health of blood vessels and nerves, resulting in foot ulcers, gangrene, and possibly lower-extremity amputation.^11–13 This indicates a lack of knowledge regarding the dangers posed by diabetic complications among diabetic patients in Saudi Arabia.

Objectives of the Study

This study aimed to determine the level of awareness of diabetic neuropathy and its complications among the population of Taif City in Saudi Arabia.

Subjects and Methods

Study design: Cross-sectional.

Study duration: December 2021 to February 2022.

Study settings: A cross-sectional study was conducted to evaluate the level of awareness of diabetic neuropathy among the population of Taif.

Sampling and population (including inclusion and exclusion criteria): All residents aged 20 years and above and accepted to participate by clicking (Yes) in the given questionnaire, were included in this study.

Exclusion criteria: all residents under the age of 20 years or who refused to participate by clicking (No) in the given questionnaire, were excluded from the analysis.

Tools and data collection procedure: All study participants were requested to consent to their approval prior to completing an online pre-designed self-administered questionnaire. An explanatory statement on how the data is used in this study before their participation was provided.

Statistical design: Data was entered through Excel version 16.0.6742.2048 and all statistical analysis was done using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 23.0, Armonk, NY). P value <0.05 is considered significant.

Administrative Considerations

1. The research proposal and a request letter were submitted to the dean of the College of Medicine and vice dean of scientific research for approval before study commencement.
2. A letter was issued to the Chairman of the Research Ethics Committee to seek permission to conduct the study.
3. All the required documents were completed and submitted to the Research Ethics Committee for ethical approval.

Expected outcomes of the study: Low level of awareness about diabetic peripheral neuropathy and its complications among the population (including healthy people and diabetic patients) of Taif City.

Results

Characteristics of the Participants

A total of 486 participants were included in this analysis, of which 57.2% were females and 42.8% were males. More than 75% of participants were below the age of 39; specifically, 94.9% were in the age group of 15–39. Saudis accounted for 88.1% of the participants, and 87.9% were single. A large proportion of participants were students (73.9%), with 61.3% having a college degree or higher (Table 1).

Table 1 Demographic Data of Participants (n=486)

Awareness of Diabetic Neuropathy and Its Complications

Only 4.9% of participants had diabetes, while 82.9% of non-diabetics knew someone who had diabetes (Figure 1). While 83.1% of participants had never heard of diabetic neuropathy, 16.9% were aware of it (Figure 2a). These 16.9% of participants were asked about the most commonly affected body parts by DPN, and their responses were as follows: feet (14.4%), hands (1.4%), face (0.6%), chest (0.2%), and back (0.2%).

Figure 1 Diabetic status of the participants (n=486).

Figure 2 (a) Number of participants who had heard about diabetic neuropathy (n=486). (b) Awareness regarding symptoms of diabetic neuropathy (n=82). (c) Awareness regarding complications of diabetic neuropathy (n=82).

Numbness was the most identified (75.6%) symptom of diabetic neuropathy, followed by weakness or loss of sensation (73.2%), pain (34.1%), muscle weakness or atrophy, unsteadiness while standing or walking (32.9%), and stiff extremities (23.2%) (Figure 2b).

Out of the 82 participants who had heard about diabetic neuropathy, 77 (93.9%) thought that the regular dietary intake of a diabetic patient and perseverance in treatment contributed to reducing the incidence of diabetic neuropathy, 80 (97.6%) said that diabetic neuropathy can lead to serious complications, and 75 (91.5%) strongly agreed that it is important to take care and protect the feet from injuries and wounds to avoid complications. Among those who had heard of diabetic neuropathy, 66% were aware that amputation is a possible complication of diabetic neuropathy, followed by gangrene (17%), and ulcers of the feet (5%) (Figure 2c).

As shown in Table 2, the mean (±SD) diabetes knowledge score of participants who heard about diabetic neuropathy was 7.65 ± 1.01 out of a total score of 18. Therefore, the performance of participants was not good in terms of general knowledge regarding DM. Furthermore, the data showed that the knowledge of symptoms and complications of diabetes was 42% and 32%, respectively (Table 2).

Table 2 Level of Awareness of Diabetes and Its Complications Among Who Heard About Diabetic Neuropathy

Discussion

The current study revealed that awareness of diabetic neuropathy and its complications among the population of Taif City is poor, since 83.9% of the study participants had never heard of diabetic neuropathy in their lives and only about 16.1% were aware of this condition. The level of awareness of this disorder was low, even though the educational level of the participants in this study was excellent, with 61.3% of participants having a university education or above. One of the traditionally accepted reasons for a community’s lack of health awareness is the lack of education. However, despite the spread of education in Taif, awareness of diabetes was low, and one of the reasons may be that people did not acquire awareness and knowledge about the disease through television, news, and media platforms to protect themselves and their families, as their focus was on health education provided by competent authorities and health awareness campaigns. This is consistent with the results of several previous studies, which have indicated that DM patients in Saudi Arabia have poor knowledge of the disease. Al-Aboudi and his colleagues found that 15% of DM patients had insufficient knowledge of diabetes, while 72% had average knowledge. In a study conducted by Binhemd, 10 patients with DM in Dammam received low scores for knowledge and attitude toward DM. In another survey of DM patients by Al-Maliki et al 11, 49% of the participants gave correct answers to DM-related questions, highlighting a gap in the knowledge of DM in this population.^14–16 On the other hand, our results contradict previous studies from other parts of the world, which have shown an association between higher education levels and increased knowledge of diabetic neuropathy.^17–19

In the present study, 42% and 32% of those who had heard of diabetic neuropathy knew its symptoms and complications, respectively. Complications related to diabetic neuropathy can negatively impact the quality of life.²⁰ This finding is similar to that of the study by Aljoudi and Taha (2009), who reported a “lack of knowledge of diabetic neuropathy complications in eastern Saudi Arabia”. This observation could be attributed to the use of open-ended questions in the aforementioned study. Furthermore, the current study revealed that, although the majority of participants had a university education or higher, there was a serious level of ignorance regarding diabetic neuropathy, with 32% of Taif’s population unaware of its complications.²¹ Likewise, awareness of the complications of diabetic neuropathy is low in Pakistan. Ulvi et al (2009) stated that nearly 88% of respondents in their study had no idea of diabetic complications.²² The longer a person has diabetes, the more likely they are to experience psychological complications, such as depression.²³ Moreover, the demand for efforts to educate the general population about the complications of diabetic neuropathy has also been reported in India and Malaysia.²⁴ Increasing caregivers’ knowledge about these complications is important in decreasing their incidence.²⁵

Conclusions

This is the first study to evaluate the knowledge of diabetic neuropathy among residents of Taif, a city in southwest Saudi Arabia. Irrespective of educational level, the general knowledge of diabetic neuropathy among participants was poor, necessitating enhanced efforts through widespread campaigns and health awareness programs to increase diabetic neuropathy awareness among residents of Taif. This will help in the early detection of such complications and impact the response to different treatment modalities.