Development of KAP questionnaire and data collection
The questionnaire used for the survey related to KAP were recognized after review of similar questionnaires used in other studies6,10and was modified by the authors and underwent content validation by a peer group comprising two senior clinical pharmacists and one endocrinologist. It was pre-tested on a group of 30 diabetic outpatients to ensure that the questionnaire was unambiguous. The final questionnaire had a total of 16 questions related to knowledge, 8 questions pertained to attitude, and 10-step checklists of practice steps.
Knowledge was measured using 16 questions related to hypoglycemia and insulin use. Example of questions covering knowledge was “What are causes of hypoglycemia?” Answers were provided with multiple choices and “Don’t know” followed by correct and incorrect responses to further evaluate the responses. One point was offered for each correct response and the total score was calculated. Score ranges of 0–8, 9-16 were considered as poor and good knowledge, respectively.
An attitude was assessed using eight 5-point Likert scale related to patient’s opinion on insulin role. For example, “Insulin use helps to prevent complications of diabetes.” Responses to above questions were assessed with 5 categorical responses:  (1) Strongly disagree, (2) Disagree, (3) Neither agree nor disagree, (4) Agree, (5) Strongly agree. The average scores of the attitude of each patient ranged above 3 point were categorized as having positive attitudes.
Practice was assessed by using a 10-step checklist when demanding patients to demonstrate how to inject with similar sample pens. Pharmacists observed patients and each step was assessed in order to evaluate the correct and incorrect practice. One point was offered for each correct step and the total score was calculated. Score ranges of 0–5, 6-10 were considered as poor and good practice, respectively.
According to American Diabetes Association Guidelines 201918, FPG target belongs to 80 - 130 mg/dL (4.4 – 7.2 mmol/L) and a HbA1C is <7% (53 mmol/mol) for nonpregnant adult patients. Less stringent HbA1C (<8%) and FPG (90 - 150 mg/dL) are appropriate for patients with more complicated disease features or the elderly.