Pakistani moslems with Type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycaemic control

Aims To study factors such as sex, educational status and place of care, which might influence knowledge and self-management of diabetes, and glycaemic control in a Pakistani moslem diabetic population attending primary care general practices (GP) and secondary care clinics at the Manchester Diabetes Centre (MDC). Methods Patients with Type 2 diabetes mellitus took part in a one-to-one semi-structured interview and gave blood for haemoglobin A(1c) levels. Results Two hundred and one patients entered the study. Knowledge about diabetic diets was good (average scores 72%), and patients claimed to perform regular glucose measurements (66%), but they were not good at applying their knowledge to problems in daily life. Only 24% knew how to manage persistent hyperglycaemia. Women were worse than men at this (19 vs. 31% (chi(2) = 3.8, P = 0.05)), were less likely to understand why glucose levels should be monitored, and had poorer glycaemic control overall (HbA(1c) 8.8 vs. 8.1%, P = 0.04). Fifty-four patients were completely illiterate. They had similar knowledge scores to readers but were less able to handle problem scenarios. Forty-five of these patients were women, and multiple regression analysis showed they were more likely to have the poorest glycaemic control. No major differences were found between general practioner and hospital attenders, or between patients with and without known complications, except that hospital attenders were more likely to have complications and poorer control. Conclusions Women who cannot read in this population are likely to have poorer glycaemic control and map be finding it more difficult to learn how to apply their knowledge to daily life. This subgroup may need more intensive, culturally appropriate, health education and support.