Diabetes mellitus (DM) has emerged as one of the most significant public health challenges of the 21st century, characterized by a growing global burden and profound impacts on quality of life, healthcare systems, and national economies. India, often referred to as the "diabetes capital of the world," is witnessing a sharp rise in the prevalence of both type 1 and, more notably, type 2 diabetes mellitus. This escalation is attributed to a combination of genetic predisposition and rapid lifestyle transitions marked by urbanization, sedentary behavior, unhealthy dietary patterns, and increased stress levels. Alarmingly, a large segment of the population remains either unaware of their diabetic status or lacks a comprehensive understanding of the disease, its risk factors, and preventive strategies [1-4].

Despite significant advances in diagnosis and treatment, diabetes management in India faces critical gaps, particularly in semi-urban and rural settings where healthcare access and health literacy are limited. Awareness about the disease’s early warning signs, risk factors such as obesity, poor  diet,  and  physical  inactivity and the importance of preventive lifestyle modifications remains fragmented. Misconceptions surrounding diabetes — including myths about dietary restrictions, curability, and medication dependency — further complicate effective disease prevention and management. In this context, lifestyle interventions, particularly those promoting balanced nutrition, regular physical activity, and routine health screenings, play a pivotal role in mitigating the growing diabetes epidemic [5-9].

Shimla district of Himachal Pradesh, with its diverse demographic spread across urban, semi-urban, and rural landscapes, presents a compelling backdrop to study diabetes awareness and prevention practices at the grassroots level. Factors such as changing dietary habits, reduced physical activity, and the co-existence of traditional beliefs alongside modern healthcare practices make it critical to assess the community’s knowledge, attitudes, and behaviors toward diabetes. However, there is a dearth of localized data specifically evaluating the awareness, misconceptions, and preventive measures adopted by the residents of Shimla district.

This study seeks to bridge this gap by systematically assessing the level of awareness about diabetes, evaluating lifestyle practices related to its prevention, and identifying prevalent myths and misconceptions among the local population. By uncovering the knowledge gaps and behavioral trends, this research aims to inform targeted educational strategies and community-based interventions that can empower individuals to make informed health choices and reduce the future burden of diabetes in the region.

Study Design

This study adopted a descriptive, cross-sectional survey design to evaluate diabetes awareness, prevention practices, and common misconceptions among residents of Shimla district, Himachal Pradesh. The cross-sectional approach was chosen to capture a real-time snapshot of community knowledge and behaviors related to diabetes mellitus.

Study Area and Population

The study was conducted across urban, semi-urban, and rural areas within Shimla district, encompassing a diverse demographic spread. The target population included adult residents aged 18 years and above, irrespective of prior diabetes diagnosis. Healthcare professionals were excluded to avoid professional bias and maintain the focus on general public awareness.

Study Duration

The data collection phase spanned three months, from January to March 2025, ensuring ample time for reaching a broad cross-section of the district's population through digital platforms.

Sample Size and Sampling Technique

A total sample size of 400 participants was determined based on a 95% confidence interval, a 5% margin of error, and an assumed 50% diabetes awareness rate, reflecting the lack of extensive previous data from the region. Participants were selected through purposive and snowball sampling methods conducted exclusively online. Initial participants were approached through digital outreach, including WhatsApp groups, Facebook communities, local online forums, and email invitations. Participants were encouraged to forward the survey link to others in their network, facilitating wider and diverse participation.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Adults aged 18 years and above residing in Shimla district.

• Ability to read and respond to the survey in Hindi or English.

• Access to an internet-enabled device (smartphone, tablet, or computer).

• Willingness to provide informed online consent.

Exclusion Criteria

• Practicing healthcare professionals (e.g., doctors, pharmacists, nurses)

• Incomplete survey responses

Data Collection Tool

A structured, pre-validated, bilingual (Hindi and English) online questionnaire was developed with expert inputs from diabetologists and public health specialists. The survey consisted of four sections:

• Demographic Information – Age, gender, education, occupation, and residential setting

• Knowledge Assessment – Awareness regarding types of diabetes, symptoms, complications, risk factors, and preventive strategies

• Lifestyle Practices – Inquiry into participants’ diet, exercise habits, smoking, alcohol consumption, and frequency of health screenings.

• Misconceptions and Beliefs – Identification of common myths about diabetes causation, curability, diet, and medication adherence

The questionnaire was administered using Google Forms, designed to be mobile-friendly to ensure easy accessibility across rural and urban populations.

Data Collection Procedure

Participants were invited to participate via an online survey link distributed through WhatsApp, Facebook groups, email, and local community forums. The link included an introductory message explaining the study purpose, assuring confidentiality, and requesting voluntary participation. Only fully completed responses were considered for final analysis to ensure data quality.

Scoring and Data Classification

Each correct response in the knowledge section was awarded one point, with incorrect or "don't know" responses scoring zero. Participants’ cumulative knowledge scores were categorized into four levels:

• Very Good (≥80% correct responses)

• Good (60–79% correct responses)

• Fair (41–59% correct responses)

• Poor (<40% correct responses)

Lifestyle practices were evaluated against recommended diabetes prevention behaviors. Misconceptions were analyzed based on the frequency and types of incorrect beliefs identified.

Data Analysis

Data collected via Google Forms were exported to Microsoft Excel, cleaned, and analyzed using SPSS version 26.0. Descriptive statistics (frequencies, percentages, means) summarized participant demographics, knowledge levels, lifestyle practices, and misconceptions. 

Ethical Considerations

Online informed consent was obtained from all participants before accessing the questionnaire. Confidentiality and anonymity were strictly maintained, and no personal identifiers were collected. Participants were informed that they could exit the survey at any point without providing a reason

The study enrolled a total of 400 participants from Shimla district, with the majority (38.8%) aged between 26–35 years, followed by 25.8% in the 36–45 years range, and 23.8% aged 18–25 years, indicating a predominantly young to middle-aged population. Gender distribution showed a slight female predominance, with females comprising 52.3% and males 47.8% of the sample. Educational attainment varied, with the highest proportion (36.0%) having completed secondary school, followed by 29.3% holding undergraduate degrees, and 18.8% completing primary education; 7.5% of participants reported having no formal education. Regarding occupation, homemakers constituted the largest group (33.8%), followed by self-employed individuals (22.5%) and students or unemployed respondents (21.3%). Government and private sector employees represented 12.3% and 10.3%, respectively. Geographically, rural residents made up a significant majority at 65.5%, compared to 34.5% from urban settings, ensuring comprehensive coverage across different socio-economic backgrounds.

Assessment of diabetes awareness among participants revealed encouraging results, with 79.8% correctly identifying diabetes as a disorder of high blood sugar, and 76.5% acknowledging that type 2 diabetes is preventable. Obesity was recognized as a major risk factor by 73.5% of respondents, while 78.0% were aware that diabetes can lead to complications like blindness. Preventive practices such as regular exercise were affirmed by 82.0%, and 83.5% correctly emphasized the importance of a balanced diet. However, misconceptions persisted, with only 68.3% knowing that diabetes cannot be completely cured and just 62.8% correctly refuting the need to avoid all sugars entirely. Awareness regarding the role of stress (67.3%) and genetic predisposition (70.3%) was moderate, while knowledge about insulin usage (60.5%) and smoking-related diabetes risk (65.8%) was comparatively lower. Importantly, 84.3% correctly identified doctors as the appropriate professionals for diabetes screening. Overall, while a strong foundation of knowledge existed, certain crucial gaps related to symptoms, complications, and lifestyle risks were evident.

Based on the overall knowledge scores, 31.5% of participants demonstrated a "Very Good" understanding of diabetes and its prevention, achieving 80% or more correct responses. A further 42.5% fell into the "Good" category, scoring between 60%–79%, indicating a strong general awareness across a significant portion of the community. However, 18.8% of participants were categorized as having "Fair" knowledge (41%–59%), and 7.3% were found to have "Poor" knowledge (<40%), highlighting the presence of critical knowledge gaps among nearly one-fourth of the surveyed population. These findings emphasize the need for continuous educational efforts to uplift diabetes literacy, especially targeting those with lower awareness levels to ensure better preventive behaviors and early management practices.        

Table 1: socio-demographic characteristics of participants

Table 2: awareness and knowledge of diabetes and prevention among participants

Table 3: knowledge score classification

The present study provides critical insights into the level of diabetes awareness, preventive practices, and common misconceptions among the residents of Shimla district, Himachal Pradesh, highlighting both encouraging trends and areas of concern. Overall, the findings suggest that while a significant proportion of the population demonstrates a sound understanding of diabetes mellitus (DM) and its associated risk factors, substantial gaps remain that could undermine effective prevention and early management efforts, particularly in rural and semi-urban communities.

A notable strength observed in the study is the high baseline awareness of diabetes as a disorder of high blood sugar (79.8%) and the recognition that type 2 diabetes is largely preventable (76.5%). Encouragingly, lifestyle-related prevention strategies such as regular exercise (82.0%) and a balanced diet (83.5%) were well understood by participants, reflecting a promising foundation for building further community health initiatives. Awareness about complications associated with diabetes, including blindness (78.0%) and heart disease (74.5%), was also commendable, underscoring a growing understanding of the serious health consequences associated with poor glycemic control.

Despite these positive findings, the study uncovered critical knowledge gaps that warrant urgent attention. Only 68.3% of participants correctly understood that diabetes cannot be completely cured—a misconception that could lead to complacency in disease management. Similarly, 62.8% mistakenly believed that all forms of sugar must be entirely eliminated from the diet, pointing to widespread dietary myths that could unnecessarily complicate nutritional management for diabetics. The moderate awareness levels regarding stress (67.3%) and genetic predisposition (70.3%) as risk factors, as well as the relatively low knowledge about the use of insulin beyond type 1 diabetes (60.5%), further highlight areas where misconceptions may impair prevention and treatment adherence.

Behaviorally, the study also sheds light on gaps in symptom recognition and early intervention. While classic symptoms like frequent thirst (71.8%) and weight loss (69.5%) were moderately well-recognized, the confusion around non-specific symptoms, such as fatigue, and the incorrect identification of non-symptoms like hair growth (only 64.8% correct), suggest that community members may still overlook early warning signs of diabetes, delaying diagnosis and increasing the risk of complications.

The knowledge score classification reinforces this dual picture. While an impressive 74% of participants scored in the "Very Good" or "Good" categories, a considerable 26% fell into the "Fair" or "Poor" categories. This finding indicates that while general awareness is growing, nearly a quarter of the community remains vulnerable due to insufficient understanding—a critical barrier to achieving effective, community-wide diabetes prevention and control.

Importantly, the demographic profile of the participants provides additional context for interpreting these findings. The rural majority (65.5%) and the substantial proportion with only primary or secondary education highlight structural challenges in health information dissemination. Limited access to healthcare services, reliance on traditional beliefs, and low health literacy levels in these populations could contribute to persistent misconceptions and risky health behaviors, even in the presence of basic awareness. Moreover, the online nature of data collection implies that the surveyed population likely had better access to digital technology and may represent a somewhat more health-aware subset of the district's residents compared to the general population, suggesting that knowledge gaps in the broader community may be even more pronounced.

Overall, the findings emphasize the urgent need for sustained, targeted public health interventions aimed at enhancing diabetes literacy in Shimla district. Community-driven education campaigns must focus not only on reinforcing correct knowledge about diabetes prevention and management but also on dispelling persistent myths and misconceptions. Health communication strategies should be culturally sensitive, leverage digital platforms for wider reach, and involve local healthcare providers, school systems, and community leaders to build trust and relevance. Special attention must be paid to rural populations and individuals with lower educational attainment, who are disproportionately vulnerable to misinformation and its consequences [6-9].

Furthermore, strengthening routine health screenings at the community level, promoting early symptom recognition, and encouraging proactive health-seeking behaviors will be essential in bridging the knowledge-practice gap. Integrating lifestyle counseling into primary healthcare services and ensuring that credible, easy-to-understand educational materials are accessible to all segments of the population could further enhance the impact of preventive efforts.

This study highlights that while the residents of Shimla district exhibit encouraging levels of basic awareness regarding diabetes mellitus, particularly its definition, risk factors, and the importance of preventive lifestyle practices, critical knowledge gaps and misconceptions still persist that could hinder effective prevention and early management. Although a substantial majority recognized the value of exercise, balanced diet, and regular screening in diabetes control, confusion regarding disease curability, sugar consumption, symptom recognition, and the role of insulin indicates areas requiring urgent educational reinforcement. The significant proportion of participants with only "Fair" or "Poor" knowledge underscores the pressing need for sustained, community-focused health education initiatives, particularly targeting rural and less-educated populations. Tailored, culturally sensitive strategies leveraging digital outreach, school-based programs, and community health workers are essential to dismantle prevailing myths, promote early diagnosis, and foster proactive disease management behaviors. Strengthening diabetes literacy at the grassroots level will be pivotal in reducing the future burden of diabetes and building a healthier, more informed society in Shimla district.

1. Muralidharan, S. "Diabetes and Current Indian Scenario: A Narrative Review." Journal of Diabetology, vol. 15, no. 1, Jan.–Mar. 2024, pp. 12–17.

2. Kumar, D.L., et al. "Knowledge and Awareness About Diabetes Mellitus Among Urban and Rural Population Attending a Tertiary Care Hospital in Haryana." Cureus, vol. 15, no. 4, 30 Apr. 2023, Article ID e38359.

3. Nalavadey, S., et al. "Misconceptions About Diabetes Mellitus Among Diabetes Patients: A Cross-Sectional Study." Indian Journal of Health Sciences and Biomedical Research, vol. 15, no. 3, Jan. 2022, p. 230.

4. Al-Wagdi, et al. "Knowledge, Attitude and Practice Toward Diabetes Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study." Frontiers in Public Health, vol. 12, 2024, Article ID 1326675

5. Patil, R., et al. "Popular Misconceptions Regarding the Diabetes Management: Where Should We Focus Our Attention?" Journal of Clinical and Diagnostic Research, vol. 7, no. 2, Feb. 2013, pp. 287–291.

6. Deepa, M., et al. "Knowledge and Awareness of Diabetes in Urban and Rural India: The Indian Council of Medical Research India Diabetes Study (Phase I)." Indian Journal of Endocrinology and Metabolism, vol. 18, no. 3, May 2014, pp. 379–385.

7. Al-Mutawaa, K.A., et al. "Level of Knowledge, Attitude and Practice Towards Diabetes Among Nationals and Long-Term Residents of Qatar: A Cross-Sectional Study." BMJ Open, vol. 12, 2022, Article ID e052607.

8. Bassey, I.E., et al. "Exploring the Perception and Preventive Practices Among Diabetes Patients in Rural Areas of Cross Rivers State." International Journal of Tropical Medicine, vol. 20, 2025, pp. 12–23

9. Baig, M., et al. "Diabetes Mellitus Knowledge, Attitudes, Preventive Practices and Associated Factors Among a Sample of Adult Non-Diabetic Saudi Residents." Diabetes, Metabolic Syndrome and Obesity, vol. 16, 15 May 2023, pp. 1393–1406.