Fig. 1The validity and reliability checking process of study questionnaire. CVI, content validity index; S-CVI, simplicity-CVI; C-CVI, clarity-CVI; R-CVI, relevance-CVI; CVR, content validity ratio.
Table 1Characteristics of physicians
Variable |
Total (n=100) |
Male (n=46) |
Female (n=54) |
P value |
Age, yr |
41.98±9.26 |
46.41±10.52 |
38.2±5.9 |
0.001 |
≤40 |
52 (52.0) |
17 (37.0) |
35 (64.8) |
0.005 |
>40 |
48 (48.0) |
29 (63.0) |
19 (35.2) |
0.005 |
Time since graduation in general medicine, yr |
15.59±8.71 |
19.88±10.66 |
12.25±5.26 |
<0.001 |
Time since graduation in specialty, yr |
8.91±8.18 |
12.59±9.92 |
5.85±4.64 |
<0.001 |
Working at teaching hospital |
27 (27.0) |
9 (19.6) |
18 (33.3) |
0.093 |
CME attendance during past year, time |
2.42±2.56 |
1.75±1.21 |
3.08±3.36 |
0.211 |
Working at diabetes clinic |
20 (20.0) |
8 (17.4) |
12 (22.2) |
0.547 |
No. of diabetic patients visited per week |
33.28±36.2 |
36.14±41.22 |
30.96±31.98 |
0.490 |
Positive family history of diabetes |
44 (44.0) |
14 (30.4) |
30 (55.6) |
0.010 |
Table 2Description of knowledge score in detaila
Knowledge |
Correct choice |
Score (0–1) |
K1. Which one is not in new diabetes diagnostic criteria? |
57 (57.0) |
0.57±0.5 |
K2. Which one is not a risk factor for type 2 diabetes? |
61 (61.0) |
0.61±0.49 |
K3. Which one is the best choice for initiation of treatment in newly diagnosed diabetic patients? |
70 (70.0) |
0.7±0.46 |
K4. Which one is not a sign of hypoglycemia? |
99 (99.0) |
0.99±0.1 |
K5. When we refer a diabetic patient for retinopathy evaluation? |
78 (78.0) |
0.78±0.42 |
K6. Which one is the correct laboratory test and its correct time for nephropathy screening? |
46 (46.0) |
0.46±0.5 |
K7. Which one is the goal of treatment of type 2 diabetes? |
50 (50.0) |
0.5±0.5 |
K8. Which one is the LDL goal for diabetic patients without cardiac problems? |
82 (82.0) |
0.82±0.39 |
K9. Which one is the correct goal of blood pressure in diabetic patients? |
29 (29.0) |
0.29±0.46 |
K10. When the foot of diabetic patients should evaluate by physician? |
36 (36.0) |
0.36±0.48 |
K11. Which one is not pre-diabetes? |
81 (81.0) |
0.81±0.39 |
K12. Which one is the correct choice for physical exercise in patients with diabetic retinopathy? |
80 (80.0) |
0.8±0.4 |
K13. Which one is the best choice for gestational diabetes? |
62 (62.0) |
0.62±0.49 |
K14. Which one is the best choice for diabetic patient with hypertension? |
97 (97.0) |
0.97±0.17 |
Total |
928 (66.29) |
9.28±2.73 |
Knowledge percentage (0–100) |
66.29±19.5 |
Table 3Description of attitude in detail; each item belongs -2 to 2 Likert-like (strongly agree, agree, no idea, disagree, and strongly disagree) scores
Attitude |
Score (−2 to 2) |
A1. |
Early treatment of diabetes could prevent complications. |
1.56±0.795 |
A2. |
In diabetic retinopathy moderate aerobic exercises are forbidden. |
−0.23±1.32 |
A3. |
All diabetic patients should be visited by a diabetologist each 3 months. |
0.87±1.39 |
A4. |
Patients should receive sufficient explanation about diabetes, its complications, and how to prevent complications at each visit. |
0.89±1.28 |
A5. |
Diabetes reduces the patients' quality of life. |
0.65±1.03 |
A6. |
Diabetes reduces the patients' life span. |
1.67±1.14 |
A7. |
Regular exercise helps controlling diabetes. |
1.84±0.37 |
A8. |
Carbohydrates should be omitted from diet of overweight diabetic patients. |
0.89±1.36 |
A9. |
Controlling serum lipids and blood pressure are mandatory for prevention of cardiovascular complications of diabetes. |
1.94±0.24 |
Total attitude score (−18 to 18) |
9.08±3.49 |
Total good attitude percentage (0–100) |
50.44±19.39 |
Table 4Description of practice score in detaila
Practice |
Correct choice |
Score (0–1) |
P1. |
A 78-year male diabetic patient receiving insulin, atorvastatin, aspirin and losartan has attended. He had a brain stroke 6 years ago and his right foot has amputated 1 year ago. What is your suggestion to continue treatment? |
59 (59.0) |
0.59±0.49 |
P2. |
When do you refer a diabetic patient to the ophthalmologist? |
95 (95.0) |
0.95±0.22 |
P3. |
How many times a year do you check HbA1c for diabetic patients? |
91 (91.0) |
0.91±0.29 |
P4. |
How many times a year do you check lipid profile for diabetic patients? |
37 (37.0) |
0.37±0.49 |
P5. |
Which one is the best choice for controlling dyslipidemia in diabetic patient? |
40 (40.0) |
0.4±0.49 |
P6. |
Management of a 44-year female diabetic patient with following characteristics (weight 82 kg, height 154 cm, blood pressure 135/85 mm Hg, HbA1c 7.5%, and FPG 158 mg/dL) |
91 (91.0) |
0.91±0.29 |
P7. |
How many times a year do you examine the foot of diabetic patients? |
33 (33.0) |
0.33±0.47 |
P8. |
Management of a 54-year female with diabetes from 12 years ago, receiving metformin 1 g twice a day, glibenclamide 5 mg twice a day and atorvastatin 40 mg daily and with a 6 kg weight loss within past 5 months. |
93 (93.0) |
0.93±0.26 |
P9. |
Which one is your suggestion for diet of a diabetic patient with BMI of 28 kg/m2? |
35 (35.0) |
0.35±0.48 |
P10 |
. Management of a 59-year male diabetic patient receiving 1 g metformin twice a day, gliclazide 80 mg twice a day, and atorvastatin 20 mg daily. |
71 (71.0) |
0.71±0.46 |
Total |
645 (64.5) |
6.45±1.53 |
Practice percentage (0–100) |
64.5±15.3 |
Table 5Factors affecting knowledge, attitude, and practice
Variable |
Knowledge |
Attitude |
Practice |
Total score, % |
66.29±19.5 |
50.44±19.39 |
64.5±15.3 |
Age |
r=–0.407 |
r=–0.247 |
r=–0.364 |
P<0.001 |
P=0.013 |
P<0.001 |
Age categories, yr |
P=0.001 |
P=0.282 |
P=0.014 |
≤40 |
72.25±16.23 |
52.46±14.11 |
68.08±14.82 |
>40 |
59.82±20.82 |
48.26±23.79 |
60.63±14.93 |
Sex |
P=0.108 |
P=0.016 |
P=0.001 |
Male |
62.89±18.23 |
45.41±19.92 |
58.91±14.18 |
Female |
69.18±20.24 |
54.73±18.01 |
69.26±14.65 |
Time since graduation in general medicine |
r=–0.384 |
r=–0.140 |
r=–0.314 |
P<0.001 |
P=0.219 |
P=0.005 |
Time since graduation in specialty |
r=–0.395 |
r=–0.307 |
r=–0.279 |
P<0.001 |
P=0.004 |
P=0.009 |
Working at teaching hospital |
P=0.307 |
P=0.020 |
P=0.249 |
Yes |
69.58±18.43 |
57.82±15.19 |
67.41±16.55 |
No |
65.07±19.87 |
47.72±20.13 |
63.43±14.74 |
CME attendance during past year |
P=0.241 |
P=0.837 |
P=0.299 |
Yes |
62.2±20.26 |
51.16±21.42 |
61.67±11.29 |
No |
67.58±19.22 |
50.22±18.84 |
65.39±16.28 |
Working at diabetes clinic |
P=0.827 |
P=0.019 |
P=0.018 |
Yes |
67.14±19.3 |
59.44±20.4 |
70.5±10.99 |
No |
66.07±19.67 |
48.19±18.58 |
63.0±15.86 |
No. of diabetic patients visited per week |
r=0.096 |
r=−0.013 |
r=0.055 |
P=.351 |
P=0.899 |
P=0.595 |
Family history of diabetes |
P=0.406 |
P=0.668 |
P=0.917 |
Yes |
64.45±19.33 |
51.39±19.14 |
64.32±15.16 |
No |
67.73±19.69 |
49.7±19.72 |
64.64±15.49 |