Assessment of Level of Awareness for Management and Treatment of Diabetes Mellitus Among Patients in Bangladesh: A Cross‐Sectional Study

ABSTRACT

Background and Aims

Diabetes mellitus (DM), a non‐communicable disease, is one of the major global causes of mortality and debility, with an increase in prevalence day by day. This study investigated the knowledge and awareness level of the patients on diabetes, risk factors, symptoms, and diabetic associated complications.

Methods

A questionnaire‐based survey was conducted among diabetic patients at Rajbari (Sadar) Upazilla Health Complex, Rajbari, from September 2022 to December 2022. A total of 200 diabetic patients of different ages, sexes, and levels of education participated in the survey, and the data were analyzed thereafter.

Results

This study indicates that two‐thirds of the participants (67.5%) have a general idea of diabetes; however most are highly reluctant to monitor their blood glucose level (61%), follow a diet chart (82.5%), do physical exercise (80%), and maintain social activities (76.5%). Only 37.5% of the respondents understand the necessity of routine check‐ups, and surprisingly, over half of the participants (53.5%) do self‐medication. Moreover, age, sex, and education related disparity were observed among many of these knowledge and awareness covariates studied. Males are more likely to have Type 2 DM, and the highest disease prevalent age range was found to be 41–60 years. Although only 37.5% of the respondents were found to be obese, the majority had a family history (60.5%) of diabetes, and almost half of the participants (48%) had smoking habits.

Conclusions

These findings confirm the lack of awareness regarding diabetes and its associated complications. A national awareness campaign might be launched to increase awareness among patients with diabetes.

1. Introduction

Diabetes mellitus (DM) is one of the leading causes of death and disability worldwide. The prevalence of this non‐communicable disease is steadily increasing, and approximately 537 million people are living with DM currently [1, 2]. Among the three different types of DM (type 1, type 2, and gestational), type 2 diabetes mellitus (T2DM) is the most common type and is characterized by high blood sugar levels [3]. According to the International Diabetes Federation (IDF), approximately 240 million people are living with undiagnosed diabetes globally, meaning nearly one‐in‐two adults with diabetes are unaware that they have the disease. Approximately 90% of people with undiagnosed diabetes live in low‐ and middle‐income countries [4]. DM was responsible for the death of approximately 6.7 million people worldwide in 2021.

Asia and the eastern Pacific region are particularly affected by this life‐threatening disease diabetes [2, 4, 5]. Bangladesh is a densely populated country and is considered to be among the countries with the highest number of people with diabetes worldwide. According to the IDF, Bangladesh was one of the top 10 countries or territories for the number of adults (13.1 million, 20–79 years) with diabetes in 2021 and nearly 5.7 million adults had undiagnosed diabetes, which is almost half of the people suffering from diabetes. Like other lower‐ and middle‐income countries, the existing diabetes situation in Bangladesh is creating an economic burden in our health sector [6, 7]. By 2045, nearly 22.3 million adults will be suffering from diabetes [2], which indicates that the lack of awareness or ignorance about this deadly chronic disease will cause huge public health complications soon if it remains unaddressed.

The level of knowledge and awareness of the treatment of diabetes in Bangladesh is very poor. According to a research based on the Bangladesh Demographic and Health Survey (BDHS) 2017–18, only 30.9% of individuals with diabetes were aware of their condition [8]. Among those who were aware, 28.2% reported receiving treatment. Despite this, treatment outcomes were inadequate, as just 26.5% of those receiving treatment achieved adequate glycemic control [8]. In another study conducted among 2,009 secondary school‐going children in Bangladesh to assess their knowledge, attitude, and practice regarding diabetes, the majority of respondents (79.3%) reported that they had heard of diabetes. However, only 45% were aware that diabetes can cause elevated blood glucose levels [9]. These findings reveal critical gaps in diabetes awareness, treatment coverage, and management in Bangladesh.

Even being diabetic, people usually don't do routine check‐ups to see if the treatment approaches are keeping the blood sugar level controlled [8, 10]. Moreover, a very poor level of education and diabetes management is apparent in both primary or non‐specialist healthcare facilities and urban tertiary care specialist centers [11, 12]. The people are very much uncaring about the severity and consequences of this chronic disease. DM, if not properly managed, can cause fatal consequences affecting multiple organs, such as nephropathy, neuropathy, stroke, and blindness, among others [3, 13, 14]. This is ultimately used as a potential health hazard, causing an elevated health care cost. The level of knowledge and awareness for treatment among patients suffering from diabetes has not been investigated yet. Therefore, the present study aimed to assess the level of awareness regarding the management and treatment of DM among patients in Bangladesh. Specifically, this study sought to determine the extent of patients' knowledge and awareness about their condition, their treatment practices, and the factors associated with diabetes awareness and management. The outcomes of this study could be used to develop strategies for the management of this disease, thereby reducing the burden of public health problems.

2. Materials and Methods

2.1. Study Design, Participants, and Data Collection

This cross‐sectional survey was planned and performed among diabetic patients in Rajbari District, Bangladesh from September 2022 to December 2022 to collect population‐based information. For the collection of data, a structured questionnaire was designed based on the study objectives. The survey questionnaire form was prepared in English and then translated in Bengali for the understanding of the common native population. The WHO diabetes KAP survey tools were translated into Bengali and back‐translated into English to ensure accuracy. The tool was pretested among 20 patients in a nearby clinic, and minor wording adjustments were made. The data used in this study was obtained from outpatients attending Rajbari (Sadar) Upazilla Health Complex, Rajbari, Bangladesh during the study period. A total of 200 respondents participated in this study, and they were of above 30‐year old with known diagnosis of DM. The data were collected through face‐to‐face interviews, and patients with a recent diagnosis (< 1 year) of diabetes and type 1 diabetes were excluded from the study. Informed consent was obtained from each participant before they participated in the study.

The sample size of the study was calculated by Rasoft®.

$$n=\frac{z^2\times p\times q}{d^2}$$

Where Z = 1.96, p = 0.5, q = 0.5, d = 0.07 → n ≈ 196

Where:

n = Minimum required sample size

Z = Z‐score corresponding to the desired confidence level. For a 95% confidence level, $Z=1.96$

p = Estimated proportion of the population with the attribute of interest (prevalence). In the absence of prior data, $p=0.5$is used as it provides the maximum sample size

q = Complement of p, calculated as $q=1-p$. Here, $q=0.5$

d = Margin of error (precision), representing the maximum acceptable difference between the sample estimate and the true population value. Here, $d=0.07$ (7%)

The minimum estimated sample size would be 196.

Since the total number of prescriptions was 200, the sample size was greater than the minimum estimated value, thereby meeting the study requirement [15].

2.2. Study Measures

Sex, age, and level of education were the socio‐demographic features of the participants interrogated in this study. Along with these, their general knowledge and awareness of this disease and its treatment were recorded as well. This study categorized the age variable into the groups 30–40, 41–50, 51–60, and above 60 years. Education level was classified as illiterate, can read only, secondary, higher secondary, and graduation and above. The age groups were selected based on common epidemiological reporting ranges and the distribution of our sample. The education categories reflect the Bangladesh national education classification, where “Can read only” refers to individuals with basic literacy but no formal schooling. The questions were focused on gathering information related to knowledge of diabetes, family history of diabetes, signs and symptoms of diabetes, diabetes‐associated complications, physician intervention, medication, and other associated activities.

2.3. Data Analysis

Microsoft Excel 2019 (Microsoft Corporation, USA) was used for initial data management and analysis. Responses from participants based on the structured questionnaire were transferred to an Excel spreadsheet for data cleaning and sorting. The Excel file was used to analyze the data into frequencies, means, and percentages. Further statistical analyses were also performed using STATA 17, where a p‐value < 0.05 was considered to be statistically significant. All variables were transformed into categorical form prior to analysis. The study first performed univariate analysis and then applied chi‐square tests for the bivariate analysis.

2.4. Ethical Clearance

The study protocol was approved by the Ethics Committee of the Faculty of Pharmacy, University of Dhaka, Bangladesh (Ethics committee reference number: Fa. Ph. E/028/22). Verbal consent was taken from the participants, and the objective of the study was explained to them before the interview.

3. Results

3.1. Socio‐Demographic Characteristics

Out of 200 respondents, 61.5% (123) were male, and 38.5% (77) were female. The respondents were divided into four age groups, where the highest number of respondents (36%) were from the 51–60 years age group and the lowest (13%) were from the over 60 years age group. Besides, the educational level of the respondents was categorized into five groups. The survey identified that a large portion of the patients were just able to read only (34.7%), and 18.6% were illiterate. On the other hand, only 9% of respondents were graduate and above (Table 1). This could be due to the fact that the survey was carried out at the district level hospital, where the majority of patients visiting are usually from peripheral areas with low literacy levels.

Table 1.

Socio‐demographic characteristics of the respondents by sex, age, and education level (n = 200).

Socio‐demographic characteristics		Frequency	Percentage (%)
Sex	Male	123	61.5
	Female	77	38.5
Age (years)	30–40	31	15.5
	41–50	71	35.5
	51–60	72	36
	Above 60	26	13
Educational level	Illiterate	37	18.6
	Can read‐only	70	34.7
	Secondary	50	25.1
	Higher Secondary	25	12.6
	Graduation and above	18	9

3.2. Prevalence of Diabetes Risk Factors

The risk factors associated with the disease were studied. The risk factor analysis shows that more than half of the respondents (60.5%) had a family history of diabetes and only 37.5% had obesity (Table 2). Almost half of the respondents had smoking habits.

Table 2.

Risk factors associated with diabetes.

Variables	Responses (%)
	Yes (n)	No (n)
Family history	60.5% (121)	39.5% (79)
Obesitya	37.5% (75)	62.5% (125)
Smoking habits	48.0% (96)	52.0% (104)

^aObesity was defined according to the WHO BMI criteria (BMI ≥ 29.99 kg/m²)

3.3. Knowledge and Awareness of the Respondents about Diabetes

For identifying the general knowledge and awareness of the respondents about diabetes and also its treatment, several questions were asked and presented in Table 3. Although the respondents were from rural areas, most of them (67.5%) had general knowledge about the disease, like what the diabetes is and how it can affect the body. Among the respondents, only 39% check their blood glucose levels at regular intervals as part of monitoring their disease condition. A total of 64% of respondents took consultation from physicians during their initial diagnosis as a diabetic patient. However, only a little over half of the respondents (53%) consulted with a physician for diabetes‐associated complications. Nearly two‐thirds of the respondents use oral anti‐diabetic medications (77%) and only nearly one‐third (32%) were dependent on insulin. As T2DM is not insulin dependent, and most of the cases in Bangladesh belong to T2DM, using insulin as a treatment modality is not seen in the majority of the patients suffering from diabetes. Analogously, our survey data also suggests the same, where nearly only one‐third of participants were being managed with insulin. Though diabetes is claimed to be a lifestyle disease, a large percentage of patients (82.5%) do not follow the regular diet chart even after knowing that they should. And only 20% of respondents had the habit of regular physical exercise. Social activities like seminars, conferences, and meetings motivate people to lead a healthy life. These are very useful tools to disseminate awareness among diabetic patients and thus motivate them to follow a healthy lifestyle to improve their disease condition. However, only 23.5% of the respondents were found to be socially active. Alarmingly, this study revealed the most awful picture of self‐medication practice in Bangladesh. A total of 53.5% of respondents admitted that they took anti‐diabetic medications by themselves without consultation with a physician (Table 3).

Table 3.

General knowledge and awareness of the respondents about diabetes and its treatment.

Variables	Responses (%)
	Yes (n)	No (n)
General idea of diabetes	67.5% (133)	32.5% (67)
Measuring blood glucose	39.0% (78)	61.0% (122)
Consultation with the physician	64.0% (128)	36.0% (72)
Consultation with the physician for diabetes associated complications	53.0% (106)	47.0% (94)
Using anti‐diabetics	77.0% (154)	23.0% (46)
Insulin dependency	32.0% (64)	68.0% (136)
Diet chart	17.5% (35)	82.5% (165)
Physical exercise	20.0% (40)	80.0% (160)
Social activities	23.5% (47)	76.5% (153)
Medication by self‐prescribing	53.5% (107)	46.5% (93)
Idea on necessity of a routine check‐up	37.5% (75)	62.5% (125)

3.4. Disease Symptoms and Associated Complications Among Respondents

In this cross‐sectional study, a total of 60% of patients complained that they had fatigue, which was found to be the maximum, whereas 13.50% of participants claimed to have no symptoms at all (Figure 1a). Other symptoms were blurred vision (29.5%), increased urination (31%), excessive thirst (28.5%), hunger (24.5%) and nausea/vomiting (15.5%).

Figure 1.

Symptoms (a) and complications (b) of DM.

Alongside the different symptoms of diabetes, the complications associated with diabetes were also studied. It was found that 29% of the respondents have been suffering from kidney disease, and 26% had experienced a stroke (Figure 1b). Other disease‐related complications were cataracts (17%), heart attack (16.5%), diabetic foot (11.5%), and glaucoma (11%).

3.5. Association Between Sex and Knowledge, Attitude and Practice of Diabetes Patients

The variabilities in different covariates with respect to sex were assessed (Table 4). The prevalence of obesity was found to be higher among males (43.90%) compared to females (27.27%). Approximately 68.29% of males smoke, while females are much less smokers (15.58%). Male patients usually seek more consultation with a physician for complications related to diabetes than females. Males exhibited a greater degree of reliance on insulin compared to females as a treatment option for diabetes. All other factors assessed, including family history of diabetes, awareness of routine check‐up, use of anti‐diabetic medications, self‐prescribing practice, physical exercise habit, and social engagement, do not show any significant variation between males and females suffering from diabetes.

Table 4.

Association between sex and knowledge and awareness for diabetes and its treatment.

Variables		Sex		p ‐value
		Male (n = 123) %	Female (n = 77) %
Age (years)	30–40 (n = 31)	12.20	20.78	> 0.05
	41–50 (n = 71)	40.65	27.27
	51–60 (n = 72)	36.59	35.06
	Above 60 (n = 26)	10.57	16.88
Educational status	Illiterate (n = 37)	21.14	14.29	> 0.05
	Can read only (n = 70)	33.33	37.66
	Secondary (n = 50)	22.76	28.57
	Higher secondary (n = 25)	14.63	9.09
	Graduation and above (n = 18)	8.13	10.39
Obesity	Yes (n = 75)	43.90	27.27	0.02
	No (n = 125)	56.10	72.73
Family history of Diabetes	Yes (n = 121)	60.98	40.26	> 0.05
	No (n = 79)	39.02	40.26
General idea of Diabetes Mellitus	Yes (n = 133)	69.11	62.34	> 0.05
	No (n = 67)	30.89	37.66
Smoking Habit	Yes (n = 96)	68.29	15.58	< 0.001
	No (n = 104)	31.71	84.42
Consultation with a physician regarding diabetes	Yes (n = 128)	62.60	66.23	> 0.05
	No (n = 72)	37.40	33.77
Consultation with a physician for diabetes associated complications	Yes (n = 106)	59.35	42.86	0.02
	No (n = 94)	40.65	57.14
Idea on the necessity of a routine check‐up	Yes (n = 75)	36.59	38.96	> 0.05
	No (n = 125)	63.41	61.04
Monitoring blood glucose level	Yes (n = 78)	43.09	32.47	> 0.05
	No (n = 122)	56.91	67.53
Insulin dependency	Yes (n = 64)	38.21	22.08	0.02
	No (n = 136)	61.79	77.92
Using anti‐diabetic medicines	Yes (n = 154)	79.67	72.73	> 0.05
	No (n = 46)	20.33	27.27
Medication by self‐prescribing	Yes (n = 107)	56.10	49.35	> 0.05
	No (n = 93)	43.90	50.65
Physical exercise	Yes (n = 40)	21.14	18.18	> 0.05
	No (n = 160)	78.86	81.82
Social activities	Yes (n = 47)	26.83	18.18	> 0.05
	No (n = 153)	73.17	81.82

3.6. Association Between Age and Knowledge, Attitude and Practice of Diabetes Patients

The variabilities in different covariates reflecting knowledge, attitude, and practice of diabetic treatment with respect to age were assessed (Table 5). The level of education varies significantly among different age groups. For example, people at the age of 60 and older, who made up 53.85% of the total, had more people who could only read. Family inheritance causes significant variation in diabetes occurrence among different age groups. People between the ages of 30 and 40 are more likely to get diabetes due to their family background. There is a significant variation in the general idea about diabetes mellitus with the age of the patients, where the patients over 60 years of age were found to be the least aware. On the contrary, the comparatively younger patients (30–40 years age group) are least aware of taking consultation with physician for complications related to diabetes mellitus. Interestingly, we found significant differences in the awareness of diabetic patients for routine check‐up. Patients between 30 and 40 years of age are more aware of the importance of regular check‐ups, whereas the older patients with ages over 60 are more reluctant to check‐up their health conditions routinely. There is a strong link between age and the use of anti‐diabetic medications. Patients between the ages of 51 and 60 were more inclined than people in other age groups to be taking drugs to treat diabetes. The older patients with over 60 years age were less likely to take medicine on their own, whereas both the 41–50 and 51–60 age groups have high tendency of self‐medication. All age groups of patients over 40 are physically less active, and among them, patients with 60 and over are the least active physically compared to other age groups. All other factors examined, including smoking habit, blood glucose level monitoring, and use of insulin, do not vary significantly with the age of the diabetic patients.

Table 5.

Association between age and knowledge and awareness for diabetes and its treatment.

Variables		Age (years)				p‐value
		30–40 (n = 31) %	41–50 (n = 71) %	51–60 (n = 72) %	Above 60 (n = 26) %
Educational status	Illiterate (n = 37)	25.81	18.31	13.89	23.08	0.02
	Can read‐only (n = 70)	16.13	30.99	40.28	53.85
	Secondary (n = 50)	25.81	28.17	29.17	3.85
	Higher Secondary (n = 25)	19.35	16.90	9.72	0.00
	Graduation and above (n = 18)	12.90	5.63	6.94	19.22
Obesity	Yes (n = 75)	41.94	43.66	36.11	19.23	> 0.05
	No (n = 125)	58.06	56.34	63.89	80.77
Family history of Diabetes	Yes (n = 121)	80.65	57.75	51.39	69.23	0.03
	No (n = 79)	19.35	42.25	48.61	30.77
General idea of Diabetes Mellitus	Yes (n = 133)	74.19	74.65	65.28	38.46	0.01
	No (n = 67)	25.81	25.35	34.72	61.54
Smoking habit	Yes (n = 96)	48.39	52.11	47.22	38.46	> 0.05
	No (n = 104)	51.61	47.89	52.78	61.54
Consultation with physician regarding diabetes	Yes (n = 128)	64.52	57.75	73.61	53.85	> 0.05
	No (n = 72)	35.48	42.25	26.39	46.15
Consultation with physician for diabetes associated complications	Yes (n = 106)	25.81	54.93	62.50	53.85	0.01
	No (n = 94)	74.19	45.07	37.50	46.15
Idea on necessity of routine check‐up	Yes (n = 75)	61.29	40.85	30.56	19.23	0.01
	No (n = 125)	38.71	59.15	69.44	80.77
Monitoring blood glucose level	Yes (n = 78)	45.16	42.25	33.33	38.46	> 0.05
	No (n = 122)	54.84	57.75	66.67	61.54
Insulin dependency	Yes (n = 64)	25.81	28.17	36.11	38.46	> 0.05
	No (n = 136)	74.19	71.83	63.89	61.54
Using anti‐diabetic medicines	Yes (n = 154)	70.97	80.28	84.72	53.85	0.01
	No (n = 46)	29.03	19.72	15.28	46.15
Medication by self‐prescribing	Yes (n = 107)	45.16	61.97	62.50	15.38	< 0.001
	No (n = 93)	54.84	38.03	37.50	84.62
Physical exercise	Yes (n = 40)	48.39	15.49	16.67	7.69	< 0.001
	No (n = 160)	51.61	84.51	83.33	92.31
Social activities	Yes (n = 47)	38.71	21.13	23.61	11.54	0.01
	No (n = 153)	61.29	78.87	76.39	88.46

3.7. Association Between Educational Status and Knowledge, Attitude and Practice of Diabetes Patients

The roles of educational status on different awareness parameters for diabetes mellitus were assessed (Table 6). Data show that patients with a better level of education are more likely to have a family history of diabetes. Although this never means being illiterate or being able to read, only put someone in an advantageous position of not having a family history of diabetes. As expected, people's educational status determines their level of awareness about the disease. People with secondary education and higher mostly possess the general idea of diabetes mellitus. However, those who are either illiterate or can only read do not have much idea about the disease. Similarly, the education level of the people is also a significant contributor to the treatment adherence. People with a secondary education and higher are more likely to seek consultation with a physician about their disease, to an extent of over 75% cases. Likewise, the illiterate and people who can only read are reluctant at higher extents to visit doctors for their problems. The awareness about the importance of routine check‐up is correlated well with the education status of the patients. The educated patients tend to understand the necessity of routine check‐up more as their level of education gets higher. A very low level of awareness about routine check‐up importance is observed among illiterate and can read only patient's groups. People with progressively more education are more likely to monitor their blood glucose levels. The illiterate patients are the least aware of blood sugar monitoring, whereas graduates are the most aware of their blood glucose status. Although there are significant variations among different education levels patient groups in terms of using anti‐diabetic medications as their treatment option, the extent of use is very high in each patient's cohort. Interestingly, people with graduate and higher levels of education do not self‐prescribe. People with a tertiary education are more likely to work out and engage in social activities than people with less schooling.

Table 6.

Association between educational status and knowledge and awareness for diabetes and its treatment.

Variables		Educational status					p‐value
		Illiterate (n = 37) %	Can read only (n = 70) %	Secondary (n = 50) %	Higher secondary (n = 25) %	Graduation and above (n = 18) %
Obesity	Yes (n = 75)	48.65	37.14	34.00	40.00	22.22	> 0.05
	No (n = 125)	51.35	62.86	66.00	60.00	77.78
Family history of Diabetes	Yes (n = 121)	51.35	50.00	70.00	72.00	77.78	0.04
	No (n = 79)	48.65	50.00	30.00	28.00	22.22
General idea of Diabetes Mellitus	Yes (n = 133)	35.14	45.71	98.00	96.00	83.33	< 0.001
	No (n = 67)	64.86	54.29	2.00	4.00	16.67
Smoking Habit	Yes (n = 96)	59.46	47.14	44.00	60.00	22.22	> 0.05
	No (n = 104)	40.54	52.86	56.00	40.00	77.78
Consultation with physician regarding diabetes	Yes (n = 128)	43.24	54.29	76.00	88.00	77.78	< 0.001
	No (n = 72)	56.76	45.71	24.00	12.00	22.22
Consultation with physician for diabetes associated complications	Yes (n = 106)	48.65	44.29	64.00	64.00	50.00	> 0.05
	No (n = 94)	51.35	55.71	36.00	36.00	50.00
Idea on necessity of routine check‐up	Yes (n = 75)	21.62	14.29	46.00	76.00	83.33	< 0.001
	No (n = 125)	78.38	85.71	54.00	24.00	16.67
Monitoring blood glucose level	Yes (n = 78)	16.22	24.29	46.00	68.00	83.33	< 0.001
	No (n = 122)	83.78	75.71	54.00	32.00	16.67
Insulin dependency	Yes (n = 64)	40.54	25.71	28.00	40.00	38.89	> 0.05
	No (n = 136)	59.46	74.29	72.00	60.00	61.11
Using anti‐diabetic medicines	Yes (n = 154)	64.86	71.43	82.00	96.00	83.33	0.03
	No (n = 46)	35.14	28.57	18.00	4.00	16.67
Medication by self‐prescribing	Yes (n = 107)	45.95	60.00	68.00	56.00	0.00	< 0.001
	No (n = 93)	54.05	40.00	32.00	44.00	100.00
Physical exercise	Yes (n = 40)	24.32	1.43	14.00	36.00	77.78	< 0.001
	No (n = 160)	75.68	98.57	86.00	64.00	22.22
Social activities	Yes (n = 47)	21.62	10.00	24.00	28.00	72.22	< 0.001
	No (n = 153)	78.38	90.00	76.00	72.00	27.78

4. Discussion

DM is a growing global public health concern, and the prevalence of this non‐communicable chronic disease is increasing gradually and alarmingly. The trends of diabetes occurrence clearly show that it has increased in developing countries, which might be due to the transition of lifestyle from traditional to more urbanized patterns. However, the people in developing countries are generally less adherent to the treatment systems and reluctant to perceive the consequences of any diseases due to multifaceted factors, including illiteracy, lack of social awareness, economic constraints, etc. Thus, we attempted to identify the level of awareness related to treatment and disease management among a selected sample of Bangladeshi patients suffering from diabetes mellitus. The data were collected from a district‐level hospital, expecting that it would cover every socio‐demographic sphere of Bangladesh, including both rural and urban populations, educational disparity, economic condition, etc. Male participants were more in number than females in this study. Basically, T2DM is more common in males [16, 17, 18]. A significant age range is found to be in 41–60 years, and a similar study in Bangladesh also reported a high prevalence of diabetes among elderly people [19]. So, it is very much eloquent that diabetes occurs mainly in the middle age range, though it may develop at any age. Recently, the disease has also been seen in younger, educated people at a large percentage, which is also very alarming [20, 21]. Moreover, the misconception related to diabetes that this disease only occurs in old people could result in a smaller number of undiagnosed younger people. Hereditary is one of the important risk factors that cause diabetes, and the disease is linked to family history and genetics. Agreeably, this study indicates that the family history of diabetes may be a predisposing factor since the majority (60.50%) of the patients had a family history of diabetes. Obesity is another risk factor that is associated with diabetes. It is suggested that obese people have the highest susceptibility to becoming diabetic. However, interestingly, only 37.5% of participants were found to be obese, albeit higher in male patients. A possible reason might be due to the fact that the survey was conducted in Upazila Health Complex at the district level, where the majority of the people visiting are low to mid‐income level and from rural area. These people are usually hard‐working, as the studies have shown that people living in rural areas are engaged in agricultural activities [22, 23]. Furthermore, another plausible explanation might be that the strong promotion of obesity as linked to diabetes could have increased the awareness of people. Smoking is another key factor associated with the onset of diabetes. Smoking can induce increased insulin resistance, dyslipidemia, and directly damage β‐cell function [24, 25, 26]. Almost half of the participants had the habit of smoking. Knowledge of participants regarding the treatment for the disease is very important for the proper management of this deadly chronic disease. It was very interesting that more than two‐thirds of the participants (67.5%) admitted that they have at least general ideas regarding the disease. This could be the reflection of the education levels of participants, where only 18.6% were illiterate, and the majority of the people were in the categories of at least able to read to graduate. It is apparent from the study that the level of education among participants plays a very important role in obtaining general knowledge of the disease and awareness of the treatment as well. Another possible reason might be the fact that the majority of the participants were the middle age (41–60 years), and people of this age range become very careful about their health, thinking that they might have the disease and become very aware of the disease as well as the treatment.

Consultation with a registered physician for diabetes and its associated complications is a good practice for proper treatment or rational use of drugs, which is properly maintained in developed countries. Unfortunately, people from developing countries like Bangladesh are usually reluctant to consult with a physician, regardless of their condition. It is also apparent from the study results that, although not being illiterate and having general knowledge of the disease, a significant percentage of people are unaware of the treatment for the disease. However, the study indicated that people adhere more to the treatment as their literacy status increases. Moreover, sex and age disparity were also observed in respondents related to their trends of physician consultation for diabetes associated complications. Male patients and highly disease prevalent age groups (41–50 and 51–60) are more likely to seek consultation more for their diabetes related complications. Furthermore, routine check‐up is another important factor for assessing the disease prognosis and if there are any complications, thereby ensuring overall well‐being. Only 37.5% of the respondents understand the importance of routinely checking their health status. This awareness level was progressively decreased with the age of the patient, and the older patients seemed to be the least aware. Conversely, the understanding of the necessity of routine check‐ups is positively correlated with the educational status. Patients with graduation and higher‐level education do perceive the importance most.

Monitoring glycemic condition is very essential for the diabetic management procedure. Only 39% of our participants measure their blood glucose level on a regular interval, and the rest of them measure very rarely. Importantly, education level is an important contributor to people's awareness about blood sugar monitoring. People monitor their blood glucose levels more as their literacy levels go higher. In Bangladesh, both the over‐the‐counter and prescription‐only medications are quite available without a proper prescription. People have a high tendency to self‐medicate irrationally due to ignorance of probable danger. Once people get the name of any medicine, they tend to buy and consume it without the proper directions provided by the physician. In this study, about 77% of participants are used to taking anti‐diabetic medications, and more than half of the participants (53.5%) take medication without consulting the doctors, which is not only life‐threatening to the people but also a public health issue requiring urgent attention. Alarmingly, the highly disease prevalent middle age range patients (41–60 years) are more inclined to self‐prescribing. As expected, people with an education level of graduation and above are completely aware of not doing self‐medication. Although more than half of the participants were consulting with doctor for the treatment and taking anti‐diabetic medications, their callousness to monitor their blood glucose level, follow a diet chart, do physical exercise, and maintain social activities suggest their lack of awareness regarding the disease and its associated complications which is consistent with other studies on the population of the same division [8]. The participants were taking medication‐related treatment only, but were completely uncaring about other important activities, which might be necessary for keeping diabetes in control, such as diet, physical exercise, and social activities.

This study provides valuable insights into the knowledge and awareness of diabetes management among patients in a semi‐urban district of Bangladesh, a population often underrepresented in research. The use of a structured, pre‐tested questionnaire ensured clarity and consistency in data collection, and the inclusion of participants from diverse age and education groups enhances the applicability of findings. Furthermore, the analysis considered multiple socio‐demographic factors, allowing for a more comprehensive understanding of determinants of awareness. However, several limitations should also be noted. The cross‐sectional design limits causal interpretation of associations. The socioeconomic status and duration since diabetes diagnosis are important determinants that may influence patients' knowledge and awareness regarding diabetes management. Unfortunately, these variables were not collected in our present dataset. Data were collected from a single healthcare facility, which may reduce generalizability to all regions of Bangladesh. Socioeconomic and cultural differences across districts could influence awareness levels. Additionally, information on physical activity, dietary habits, and medication use was self‐reported, which may introduce recall or social desirability bias. Despite these limitations, the findings can inform targeted awareness campaigns and intervention strategies.

5. Conclusions

Our findings imply that the government should provide more emphasis on raising awareness for this chronic disease, associated complications, and treatment approaches. Moreover, more emphasis should be placed on rolling out the awareness program not only in urban areas but also at every corner of rural areas so that the public awareness program becomes effective to prevent diabetes and its associated complications. It is apparent from our study that people suffering from diabetes do not have the proper knowledge regarding the disease condition and its associated complications. To overcome this situation, a nationwide awareness program can be initiated to raise the level of awareness among the patients. Healthcare providers, along with other stakeholders, should come forward to make this program more viable. The successful implementation of these programs may reduce the diabetic condition along with its complications to an acceptable extent.

Author Contributions

Monjurul Islam Ripon: conceptualization, methodology, investigation, data curation. Uttom Kumar: data interpretation, writing – original draft, writing – review and editing. K. M. Yasif Kayes Sikdar: funding acquisition, statistical analysis, writing – review and editing. A. S. M. Monjur Al Hossain: data interpretation, writing – review and editing. Md. Momin Islam: data curation, statistical analysis, writing – original draft. Sreedam Chandra Das: conceptualization, funding acquisition, supervision, data interpretation, writing – original draft, writing – review and editing. All authors have read and approved the final version of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest. The funding authority does not have any relation in regards to study design; collection, analysis and interpretation of the data; writing of the report; and the decision to submit the report for publication.

1. Transparency Statement

The lead author, Monjurul Islam Ripon, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

The data on which the statistical analysis was made are available in the relevant tables and figures. The raw data that support these findings of the study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.