Assessing The Knowledge, Attitude And Practice (KAP) of Prediabetes Management Among Healthcare Providers in Four Tertiary Hospitals In Nigeria: An Observational-Based Cross-Sectional Study

Abstract

Introduction: An estimated 6.3 million Nigerians were reported to have prediabetes in 2015 placing Nigeria in the 9th position in world ranking. This number is projected to become 12.9 million by 2040. One way of reversing this trend is early identification of individuals at risk. This study was carried out to assess the knowledge, attitudes and practice of health care providers toward prediabetes diagnosis and management. Methods: This was an observational-based cross-sectional study involving the use of self administered questionnaire to doctors from the departments of internal medicine, paediatrics, obstetrics and gynaecology, family medicine and others. Results: In all, 358 questionnaires out of 410 were selected. All 10 risk factors for prediabetes were correctly identified by 82/358 (22.9%) participants with 300/358 (83.8%) able to identify at least 5 risk factors. Laboratory reference interval of 5.6 – 6.9 mmol/L for diagnosing prediabetes using fasting plasma glucose were correctly identified by 70/358 (19.6%) (lower value) and 14.5% (upper value) respectively. American Diabetes Association guidelines for prediabetes screening was the most familiar to 272(76.0%) respondents even though 144/358(40.2%) do not consider prediabetes as a condition that requires specific management. Over half 186/358(52%) of respondents agreed that metformin use can reduce the risk of diabetes in individuals with prediabetes but only 6/358(1.7%) have ever discussed starting metformin with their patients. Conclusion: There is need to educate medical doctors about risk factors for prediabetes and its management to curb the rising diabetes epidemic in Nigeria.

Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review

“…Full texts of 45 articles were reviewed, and 22 articles describing 21 unique studies were included ( online supplemental figure S3 ). The studies were conducted in Asia (n=8), 13–17 19 20 34 North America (n=8), 18 21 24–26 29 30 33 South America (n=1), 32 Africa (n=2) 22 31 and Europe (n=2). 27 28 These were cross-sectional studies that examined the KAP toward pre-diabetes among the general public (n=1), 20 patients with pre-diabetes (n=7) 13–19 and HCPs (n=13) ( tables 2 and 3 ).…”

“… 21–23 25–28 34 However, some providers (27%–34.1%) used non-fasting blood glucose to detect pre-diabetes, although the diagnostic criteria are currently non-existent. 22 26 34 Unsurprisingly, 12.3%–76.8% of providers were either unfamiliar with or did not adhere to clinical guidelines in their practice. 21 22 25 26 28 33 Blood screening was repeated at different intervals, ranging from 3-monthly to every 4 years.…”

“…At the HCPs and system level, guidelines and clinical decision support tools were found to be useful, 22 24 26–28 31 although guideline complexity was identified as an area for improvement. 21 28 Healthcare providers identified the time required to advise patients with pre-diabetes as a potential challenge and could hinder effective management.…”