Diabetes mellitus, commonly referred to as diabetes, is a chronic metabolic disorder characterized by elevated levels of blood glucose, which can lead to severe health complications if not adequately managed. Globally, diabetes has emerged as a major public health concern, with an alarming increase in its prevalence. In India, the burden of diabetes is particularly pronounced, contributing significantly to morbidity and mortality rates. The northern state of Himachal Pradesh, with its unique demographic and geographic characteristics, is no exception to this trend [1-4].

Shimla, the capital city of Himachal Pradesh, is a district that encapsulates both urban and rural populations, offering a diverse and representative sample for studying community health issues. The increasing incidence of diabetes in this region underscores the urgent need for comprehensive community-based strategies aimed at prevention, early detection, and effective management of the disease. However,   the   success   of     such  initiatives largely depends on the community's awareness and knowledge about diabetes, which influence their health behaviors and attitudes towards the disease.

The present study aims to assess the level of awareness and knowledge about diabetes among the general public in District Shimla. By identifying gaps in knowledge and misconceptions about diabetes, this research seeks to inform and guide public health policies and educational programs tailored to the needs of this community. Understanding the community's perception and knowledge about diabetes is crucial for developing targeted interventions that can mitigate the growing burden of diabetes and improve the overall health outcomes in Shimla.

This study is not only timely but also imperative, given the escalating diabetes epidemic and the critical role of community awareness in combating it. The findings from this research will provide valuable insights into the current state of diabetes knowledge among the residents of Shimla and will serve as a foundation for future public health initiatives aimed at managing and preventing diabetes in this region.

Objectives of the Study

The primary objective is to gauge awareness and knowledge about Diabetes among general public of District Shimla ,Himachal Pradesh.

• Research Approach: Descriptive

• Research Design:  Cross-sectional survey design

• Study Area: District Shimla , Himachal Pradesh

• Study Duration: Between January  2024 to May 2024

• Study Population: The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla Himachal Pradesh for a minimum of 12 months

• Sample Size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Diabetes, a precise 5% absolute error margin, and a conservative 5% non-response rate 

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Diabetes was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents 

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Diabetes. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) = Good,41-59% ( 8-11) = Fair,<40% (< 8) = poor

• Validity of tool - by the experts in this field

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage 

• Ethical Considerations- Participants confidentiality and anonymity was maintained

The study conducted in District Shimla, Himachal Pradesh, aimed to gauge awareness and knowledge about diabetes among the general public. The data was collected from a sample of 400 adults using a structured questionnaire. The results of the study are summarized in three tables: Socio-Demographic Variables, Knowledge Regarding Diabetes, and Overall Knowledge Score Categories.

The socio-demographic profile of the study population is presented in Table 1. The age distribution of the participants was fairly balanced, with 29.8% aged 18-30 years, 25.3% aged 31-40 years, 22.3% aged 41-50 years, and 22.8% over 50 years. The gender distribution showed that 45.3% were male and 54.8% were female. Marital status indicated that 40.3% were single, 54.8% were married, and 5% belonged to other categories. In terms of religion, a significant majority were Hindu (85.3%), followed by Muslims (4.8%), Sikhs (7.3%), and others (2.8%) (Table 1).

Table 1: Socio-Demographic Variables of the Study Population (N = 400)

Employment status revealed that 44.8% of the participants were employed, 25.3% were unemployed, and 30% were students. Educational attainment varied, with 20.3% having education below high school, 29.8% completing high school, 35.3% being graduates, and 14.8% having postgraduate and above qualifications.

Table 2 provides insights into the participants' knowledge about diabetes. The data shows high awareness and understanding of various aspects of diabetes among the participants. Specifically, 79.8% had knowledge of diabetes symptoms, 72.8% were aware of risk factors, and 77.3% understood blood glucose monitoring. Knowledge about diabetes complications was reported by 67.8%, and 69.8% were aware of dietary management (Table 2).

Table 2: Knowledge Regarding Diabetes (N = 400)

Understanding the importance of physical activity was known to 75.3% of the participants, while 64.8% had knowledge about diabetes medication. Awareness of the need for regular health check-ups was reported by 69%, and 59.8% understood insulin use. Knowledge of family history as a risk factor was indicated by 66.5%, and 71% were aware of weight management.

Stress management knowledge was held by 62.3% of respondents, and 57.8% were aware of hypoglycemia symptoms. Knowledge of regular foot care was reported by 61%, and 63.5% were aware of the importance of eye check-ups for diabetes. Understanding the risk of heart disease in diabetes was known to 67.8%, and 65.3% were aware of kidney disease risks. Awareness of diabetes' impact on mental health was noted by 55.3%, and 57.8% had knowledge of diabetic neuropathy. Finally, 79% were aware of lifestyle changes to prevent diabetes.

The overall knowledge scores of the participants are categorized in Table 3. The scoring system classified participants into four categories based on their knowledge scores. 25.3% of the participants fell into the "Very Good" category, scoring between 16-20. The majority, 37.8%, were categorized as having "Good" knowledge with scores between 12-15. 24.5% had "Fair" knowledge, scoring between 8-11, and 12.5% were in the "Poor" category, with scores below 8 (Table 3).

Table 3: Overall Knowledge Score Categories

These results indicate that while a significant portion of the population in Shimla has a good understanding of diabetes, there are still notable gaps in knowledge that need to be addressed. Public health initiatives and educational programs tailored to these gaps could enhance diabetes awareness and management, ultimately improving health outcomes in the region.

The findings from this study provide a comprehensive overview of the current state of knowledge and awareness regarding diabetes among the general public in District Shimla, Himachal Pradesh. The results indicate a generally high level of awareness and understanding of diabetes, yet they also highlight specific areas where knowledge gaps exist, necessitating targeted public health interventions.

The study reveals that a significant portion of the population possesses a good understanding of diabetes symptoms, risk factors, and management strategies. Specifically, 79.8% of participants were knowledgeable about diabetes symptoms, and 72.8% were aware of the risk factors. This level of awareness is encouraging, as it suggests that the majority of the population can recognize early signs of diabetes and understand the underlying risk factors, which is crucial for early detection and management.

Understanding the importance of physical activity and lifestyle management was also high among participants, with 75.3% acknowledging the role of physical activity and 79% being aware of lifestyle changes to prevent diabetes. This reflects a positive trend in the community’s engagement with preventive health measures. However, only 64.8% had knowledge about diabetes medication, indicating a need for more education on pharmacological treatments and their importance in diabetes management.

Despite the high levels of awareness in some areas, the study identified notable gaps in knowledge that need to be addressed. For instance, only 55.3% of participants were aware of the impact of diabetes on mental health, and 57.8% had knowledge of diabetic neuropathy. These findings suggest that while the community may be well-informed about the physical aspects of diabetes, there is less awareness of its psychological and neurological complications. Enhancing education on these aspects could lead to a more holistic understanding and management of diabetes.

The socio-demographic analysis reveals that knowledge levels varied based on educational attainment and employment status. Participants with higher education levels showed better understanding and awareness of diabetes. This underscores the importance of educational interventions and the need to tailor these programs to reach individuals with lower educational backgrounds. Employment status also influenced knowledge levels, with students and employed individuals showing higher awareness compared to the unemployed, indicating that workplace and school-based educational programs could be particularly effective [5-13].

The findings from this study have significant implications for public health policy and educational initiatives in Shimla. The high levels of awareness and understanding among the general public are promising, but the identified gaps highlight the need for continuous education and tailored interventions. Public health initiatives should focus on the less understood aspects of diabetes, such as its mental health impact and the specifics of medical treatment. Additionally, targeted programs aimed at lower educational strata and the unemployed could help bridge the knowledge gap and ensure that all segments of the population are equally informed.

This study underscores the importance of comprehensive diabetes education and the need for community-based strategies to enhance awareness and knowledge. By addressing the identified gaps, public health initiatives can improve diabetes management and prevention, ultimately leading to better health outcomes for the residents of Shimla. Continuous efforts in education, tailored to the unique demographic and socio-economic characteristics of the region, are essential in combating the growing burden of diabetes.

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