Patient-Reported Outcomes and Impact of Type 2 Diabetes: A Cross-Sectional Study in the Kingdom of Saudi Arabia

Figures & data

Table 1 Demographic Characteristics

	Total (N=310)	Age				Gender
		<40 Years (n=117)	40–50 Years (n=136)	50+ Years (n=57)	p-value^c	Male (n=165)	Female (n=145)	p-value^d
Ethnicity, n (%)
Saudi Arab	305 (98.4%)	117 (100.0%)	133 (97.8%)	55 (96.5%)	0.4384	160 (97.0%)	145 (100.0%)	0.1072
Yemeni	3 (1.0%)	0 (0.0%)	2 (1.5%)	1 (1.8%)		3 (1.8%)	0 (0.0%)
Other^a	2 (0.6%)	0 (0.0%)	1 (0.7%)	1 (1.8%)		2 (1.2%)	0 (0.0%)
Marital status, n (%)
Single	48 (15.5%)	31 (26.5%)	11 (8.1%)	6 (10.5%)	0.0001	46 (27.9%)	2 (1.4%)	<0.0001
Married	256 (82.6%)	84 (71.8%)	124 (91.2%)	48 (84.2%)		118 (71.5%)	138 (95.2%)
Divorced	2 (0.6%)	1 (0.9%)	1 (0.7%)	0 (0.0%)		1 (0.6%)	1 (0.7%)
Widowed	4 (1.3%)	1 (0.9%)	0 (0.0%)	3 (5.3%)		0 (0.0%)	4 (2.8%)
Employment status, n (%)
Full-time work	124 (40.0%)	47 (40.2%)	56 (41.2%)	21 (36.8%)	0.0090	109 (66.1%)	15 (10.3%)	<0.0001
Part-time work	50 (16.1%)	21 (17.9%)	23 (16.9%)	6 (10.5%)		45 (27.3%)	5 (3.4%)
Homemaker/housewife	119 (38.4%)	45 (38.5%)	53 (39.0%)	21 (36.8%)		0 (0.0%)	119 (82.1%)
Student	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)		0 (0.0%)	0 (0.0%)
Unemployed	8 (2.6%)	4 (3.4%)	1 (0.7%)	3 (5.3%)		2 (1.2%)	6 (4.1%)
Retired	9 (2.9%)	0 (0.0%)	3 (2.2%)	6 (10.5%)		9 (5.5%)	0 (0.0%)
Other	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)		0 (0.0%)	0 (0.0%)
Highest level of education, n (%)
Primary School	3 (1.0%)	1 (0.9%)	1 (0.7%)	1 (1.8%)	0.2748	1 (0.6%)	2 (1.4%)	0.1950
Intermediate Education	8 (2.6%)	1 (0.9%)	6 (4.4%)	1 (1.8%)		6 (3.6%)	2 (1.4%)
Secondary Education	137 (44.2%)	48 (41.0%)	57 (41.9%)	32 (56.1%)		66 (40.0%)	71 (49.0%)
University degree (BA, BSc)	150 (48.4%)	63 (53.8%)	65 (47.8%)	22 (38.6%)		88 (53.3%)	62 (42.8%)
Post-graduate degree (MA,  PhD, PGCE)	10 (3.2%)	4 (3.4%)	6 (4.4%)	0 (0.0%)		3 (1.8%)	7 (4.8%)
Other^b	2 (0.6%)	0 (0.0%)	1 (0.7%)	1 (1.8%)		1 (0.6%)	1 (0.7%)
Total household income in last 12 months, n (%)
25,999 SAR or less	12 (3.9%)	7 (6.0%)	3 (2.2%)	2 (3.5%)	0.5170	11 (6.7%)	1 (0.7%)	0.0005
26,000 to 199,999 SAR	87 (28.1%)	31 (26.5%)	37 (27.2%)	19 (33.3%)		56 (33.9%)	31 (21.4%)
200,000 to 399,999 SAR	94 (30.3%)	37 (31.6%)	44 (32.4%)	13 (22.8%)		36 (21.8%)	58 (40.0%)
400,000 to 599,999 SAR	52 (16.8%)	17 (14.5%)	20 (14.7%)	15 (26.3%)		29 (17.6%)	23 (15.9%)
600,000 to 799,999 SAR	26 (8.4%)	10 (8.5%)	12 (8.8%)	4 (7.0%)		17 (10.3%)	9 (6.2%)
800,000 or more SAR	8 (2.6%)	4 (3.4%)	4 (2.9%)	0 (0.0%)		4 (2.4%)	4 (2.8%)
Prefer not to answer	31 (10.0%)	11 (9.4%)	16 (11.8%)	4 (7.0%)		12 (7.3%)	19 (13.1%)

Notes: ^aOther ethnicity reported as: Palestinian (n=1), Somali (n=1). ^bOther highest level of education reported as: Teacher’s diploma (n=1), Technical Institute (n=1). ^cOne way analyses of variance overall F statistic p-value for continuous variables and χ² test p-value for categorical variables by age group. ^dIndependent samples t-test p-value for continuous variables and χ² test p-value for categorical variables by gender.

Table 2 Self-Reported Clinical Data

	Total (N=310)	Age				Gender
		<40 Years (N=117)	40–50 Years (N=136)	50+ Years (N=57)	p-value^b, c	Male (N=165)	Female (N=145)	p-value^d
Time since diagnosis of type 2 diabetes (years)
Mean (SD)	6.3 (5.0)	4.3 (3.5)	6.3 (4.8)	10.7 (5.5)	<0.0001	6.0 (5.2)	6.7 (4.8)	0.2358
Median [Range]	4.7 [0.2–27.1]	3.1 [0.3–17.9]	4.8 [0.2–27.1]	9.7 [1.8–20.8]		4.0 [0.2–27.1]	4.8 [0.3–20.8]
Who diagnosed you with type 2 diabetes? n (%)
General practitioner	97 (31.3%)	39 (33.3%)	47 (34.6%)	11 (19.3%)	0.3283	45 (27.3%)	52 (35.9%)	0.2643
Internal medicine practitioner	153 (49.4%)	54 (46.2%)	64 (47.1%)	35 (61.4%)		84 (50.9%)	69 (47.6%)
Nurse practitioner	2 (0.6%)	2 (1.7%)	0 (0.0%)	0 (0.0%)		0 (0.0%)	2 (1.4%)
Diabetologist	37 (11.9%)	13 (11.1%)	18 (13.2%)	6 (10.5%)		24 (14.5%)	13 (9.0%)
Endocrinologist	19 (6.1%)	8 (6.8%)	7 (5.1%)	4 (7.0%)		11 (6.7%)	8 (5.5%)
Other^a	2 (0.6%)	1 (0.9%)	0 (0.0%)	1 (1.8%)		1 (0.6%)	1 (0.7%)
Last HbA1c level, n (%)
Below 7% (53mmol/mol)	73 (23.5%)	39 (33.3%)	28 (20.6%)	6 (10.5%)	0.0098	53 (32.1%)	20 (13.8%)	<0.0001
Between 7.1% and 8% (54mmol/mol-64mmol/ mol)	139 (44.8%)	53 (45.3%)	57 (41.9%)	29 (50.9%)		59 (35.8%)	80 (55.2%)
Between 8.1% and 9% (65mmol/mol-75mmol/ mol)	60 (19.4%)	14 (12.0%)	35 (25.7%)	11 (19.3%)		41 (24.8%)	19 (13.1%)
Higher than 9% (75mmol/mol)	28 (9.0%)	8 (6.8%)	11 (8.1%)	9 (15.8%)		6 (3.6%)	22 (15.2%)
I do not know	10 (3.2%)	3 (2.6%)	5 (3.7%)	2 (3.5%)		6 (3.6%)	4 (2.8%)
What do you do to treat your type 2 diabetes?^e n (%)
Medication	275 (88.7%)	97 (82.9%)	124 (91.2%)	54 (94.7%)	0.0329	148 (89.7%)	127 (87.6%)	0.5579
Diet	202 (65.2%)	75 (64.1%)	90 (66.2%)	37 (64.9%)	0.9413	112 (67.9%)	90 (62.1%)	0.2841
Exercise	135 (43.5%)	59 (50.4%)	59 (43.4%)	17 (29.8%)	0.0365	83 (50.3%)	52 (35.9%)	0.0105
Nothing	8 (2.6%)	5 (4.3%)	1 (0.7%)	2 (3.5%)	0.1853	0 (0.0%)	8 (5.5%)	0.0022
Which of the following treatments are you currently receiving for your diabetes?^f n (%)
One oral diabetes medication	138 (50.0%)	61 (62.9%)	60 (48.0%)	17 (31.5%)	0.0007	83 (56.1%)	55 (43.0%)	0.0443
Two oral diabetes medications	116 (42.0%)	28 (28.9%)	53 (42.4%)	35 (64.8%)		52 (35.1%)	64 (50.0%)
Three or more diabetes medications	22 (8.0%)	8 (8.2%)	12 (9.6%)	2 (3.7%)		13 (8.8%)	9 (7.0%)
Current or past use of injectables for other conditions, n (%)
No	240 (89.6%)	87 (90.6%)	105 (89.7%)	48 (87.3%)	0.8073	155 (93.9%)	85 (82.5%)	0.0030
Yes^g	28 (10.4%)	9 (9.4%)	12 (10.3%)	7 (12.7%)		10 (6.1%)	18 (17.5%)
How many times per year do you typically see a healthcare provider to help manage your type 2 diabetes?
Mean (SD)	6.8 (3.7)	6.6 (3.6)	6.7 (3.8)	7.7 (3.7)	0.1633	5.5 (3.8)	8.3 (3.1)	<0.0001
Median [Range]	7.0 [1.0–12.0]	7.0 [1.0–12.0]	6.0 [1.0–12.0]	8.0 [1.0–12.0]		4.0 [1.0–12.0]	8.0 [2.0–12.0]

Notes: ^aOther reported as: Chronic Diseases specialist (n=1), Orthopedist (n=1). ^bOne way analyses of variance overall F statistic p-value for continuous variables and χ² test p-value for categorical variables by age group. ^cPairwise post hoc comparisons using Scheffe’s Method for Time since diagnosis of type 2 diabetes were significant where 1***=<40 years vs. 40–50 years, 2***=<40 years vs. 50+ years, and 3***=40–50 years vs. 50+ years. ^dIndependent samples t-test p-value for continuous variables and χ² test p-value for categorical variables by gender. ^eResponses not mutually exclusive. ^fParticipant completed only if indicating they use medication to treat diabetes. ^g42 responses were excluded from this analysis because during QC it was determined that this question was asked incorrectly by 2 of the interviewers. Responses from participants associated with these 2 interviewers have been excluded.

Table 3 Fasting Behaviors During Ramadan

	Total (N=310)	Age				Gender
		<40 Years (N=117)	40–50 Years (N=136)	50+ Years (N=57)	p-value^c	Male (N=165)	Female (N=145)	p-value^d
Were there any days you were not able to fast from dawn to sundown during the last Ramadan (2018)? n, (%)
Yes	62 (20.0%)	15 (12.8%)	29 (21.3%)	18 (31.6%)	0.0129	23 (13.9%)	39 (26.9%)	0.0044
No	248 (80.0%)	102 (87.2%)	107 (78.7%)	39 (68.4%)		142 (86.1%)	106 (73.1%)
Approximately how many days were you unable to fast during the last Ramadan (2018)?^a
Mean (SD)	7.0 (4.4)	7.1 (4.3)	7.2 (4.2)	6.7 (4.9)	0.9244	3.4 (1.6)	9.2 (4.1)	<0.0001
Median [Range]	6.0 [1.0–15.0]	6.0 [1.0–15.0]	7.0 [1.0–15.0]	5.0 [1.0–15.0]		3.0 [1.0–6.0]	10.0 [1.0–15.0]
Does fasting during Ramadan make you worry about your type 2 diabetes? n, (%)^a
Yes	100 (32.3%)	23 (19.7%)	50 (36.8%)	27 (47.4%)	0.0004	62 (37.6%)	38 (26.2%)	0.0326
No	210 (67.7%)	94 (80.3%)	86 (63.2%)	30 (52.6%)		103 (62.4%)	107 (73.8%)
What steps do you take to prepare, if any, for your type 2 diabetes during Ramadan? n, (%)^a, b
I talk to my physician and/or  healthcare team about strategies for  managing diabetes while fasting	115 (37.1%)	41 (35.0%)	52 (38.2%)	22 (38.6%)	0.8428	75 (45.5%)	40 (27.6%)	0.0012
Before starting the fast, I eat more  food than I usually do	47 (15.2%)	13 (11.1%)	25 (18.4%)	9 (15.8%)	0.2716	14 (8.5%)	33 (22.8%)	0.0005
Before starting the fast, I eat different  foods	51 (16.5%)	19 (16.2%)	22 (16.2%)	10 (17.5%)	0.9701	21 (12.7%)	30 (20.7%)	0.0592
I check my blood glucose levels more  often than normal	115 (37.1%)	32 (27.4%)	57 (41.9%)	26 (45.6%)	0.0194	68 (41.2%)	47 (32.4%)	0.1096
I change my medication dose prior to  Ramadan	62 (20.0%)	24 (20.5%)	28 (20.6%)	10 (17.5%)	0.8765	16 (9.7%)	46 (31.7%)	<0.0001
I change my medication dose during  Ramadan	65 (21.0%)	24 (20.5%)	30 (22.1%)	11 (19.3%)	0.9011	33 (20.0%)	32 (22.1%)	0.6552
I take medication at a different time  of day	91 (29.4%)	28 (23.9%)	46 (33.8%)	17 (29.8%)	0.2259	48 (29.1%)	43 (29.7%)	0.9133
I change my medication to prepare  for Ramadan	52 (17.3%)	23 (20.2%)	24 (18.3%)	5 (9.1%)	0.1883	12 (7.6%)	40 (28.2%)	<0.0001
Reduce or limit activity	92 (29.7%)	31 (26.5%)	40 (29.4%)	21 (36.8%)	0.3727	55 (33.3%)	37 (25.5%)	0.1328
I do not take any specific steps	45 (14.5%)	22 (18.8%)	16 (11.8%)	7 (12.3%)	0.2475	30 (18.2%)	15 (10.3%)	0.0506
I do not know	4 (1.3%)	1 (0.9%)	2 (1.5%)	1 (1.8%)	0.8584	3 (1.8%)	1 (0.7%)	0.3797

Notes: ^aParticipants completed only if indicating they were unable to fast during the last Ramadan. ^bResponses not mutually exclusive. ^cOne way analyses of variance overall F statistic p-value for continuous variables and χ² test p-value for categorical variables by age group. ^dIndependent samples t-test p-value for continuous variables and χ² test p-value for categorical variables by gender.

Figure 1 EQ-5D-5L dimension scores (N=310).

Figure 2 Willingness to use injectable diabetes medications.