Development of Diabetes Knowledge Scale

Main Article Content

Woranuch Saengcharoen
Sanguan Lerkiatbundit
Ruamporn Somprasong
Suriya Khiaoyodkit
Lukkanapa Jitsuwan
Wimwipha Hemtanon


Knowledge assessment of patients with diabetes requires a good knowledge scale. Nonetheless, the existing diabetes knowledge tests had a limited number of questions on how to use oral hypoglycemic medications, initial management when complications arise, restricted response options, including scales tested for validity and reliability, particularly in Thai language measurements. Objective: To develop the Diabetes Knowledge Scale (DIAKS) with a validity and reliability test. Methods: The development of questions for the DIAKS was primarily based on a literature review. The measure was examined for its content validity by five experts. It was then tested, initially in 30 patients with diabetes and subsequently in 120 patients. The Kuder-Richardson (KR-20) reliability, concurrent validity, and construct validity were examined. Results: The DIAKS had 21 items. The reliability based on KR-20 in 120 patients was 0.721. In the concurrent validity analysis using correlation analysis, diabetes knowledge scores from the measure were found to be significantly negatively associated with the most recent FPG (fasting plasma glucose) and HbA1c (glycated hemoglobin) (r = -0.31, P <0.001 and r = -0.30, P = 0.001, respectively). Multiple regression analysis also showed a significant negative relationship between the diabetes knowledge scores from the scale and the most recent FPG and HbA1c (B = -4.08, P = 0.011 and B = -0.16, P = 0.016, respectively) when controlling for gender, education level, and length of diabetes. Regarding to construct validity, the well-controlled group (FPG < 130 mg/dl or HbA1C < 7%) had significantly higher diabetes knowledge scores than the poorly-controlled group (FPG > 130 mg/dl or HbA1C > 7%) (P < 0.001). Conclusion: The DIAKS has an acceptable level of reliability and a good level of validity. As a result, this scale serves as an alternative instrument for evaluating diabetes knowledge among diabetic patients.


Download data is not yet available.

Article Details

Pharmaceutical Practice


Ahn J, Yang Y. Factors associated with poor glycemic control amongst rural residents with diabetes in Korea. Healthcare 2021; 9(4): 391.

American Diabetes Association. Standards of medical care in diabetes-2021. Diabetes Care 2021; 44(suppl 1): S1-179.

Association of Diabetes Care and Education Specialists, Kolb L. An effective model of diabetes care and education: The ADCES7 Self-Care Behaviors™. Sci Diabetes Self Manag Care 2021; 47(1): 30-53.

Bukhsh A, Khan TM, Sarfraz Nawaz M, et al. Association of diabetes knowledge with glycemic control and self-care practices among Pakistani people with type 2 diabetes mellitus. Diabetes Metab Syndr Obes 2019; 12: 1409-1417.

Chanarat P. Outcome comparison after group counseling in diabetic patients with early stage chronic kidney disease, Powaai Primary Care Cluster (PCC), Suratthani Hospital. Reg11med 2019; 33(1): 217-230.

Collins GS, Mughal S, Barnett AH, et al. Modification and validation of the Revised Diabetes Knowledge Scale. Diabet Med 2011; 28(3): 306–310.

Dedefo MG, Abate SK, Ejeta BM, et al. Predictors of poor glycemic control and level of glycemic control among diabetic patients in west Ethiopia. Ann Med Surg 2020; 55: 238-243.

Department of Disease Control, Ministry of Public Health. Campaign for World Diabetes Day 2021, awareness of diabetes care to be treated thoroughly [Online]. 2021 [cited 2022 Mar 26]. Available from:

Diabetes Association of Thailand. Clinical practice guideline for diabetes [Online]. 2017 [cited 2022 Mar 25]. Available from:

Diabetes Association of Thailand. Diabetes situation [Online]. 2021 [cited 2022 Mar 26]. Available from:

Espinosa MM, Almeida V, Nascimento VFD. Poor glycemic control and associated factors in diabetic people attending a reference outpatient clinic in Mato Grosso, Brazil. Invest Educ Enferm 2021; 39(3): e10.

Everitt BS. Multivariate analysis: the need for data, and other problems. Br J Psychiatry 1975; 126: 237-240.

Fekadu G, Bula K, Bayisa G, et al. Challenges and factors associated with poor glycemic control among type 2 diabetes mellitus patients at Nekemte Referral Hospital, Western Ethiopia. J Multidiscip Healthc 2019; 12: 963-974.

Fitzgerald JT, Funnell MM, Anderson RM, et al. Validation of the Revised Brief Diabetes Knowledge Test (DKT2). Diabetes Educ 2016; 42(2): 178-187.

Fitzgerald JT, Funnell MM, Hess GE, et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 1998; 21(5): 706-710.

Garcia AA, Villagomez ET, Brown SA, et al. The Starr County Diabetes Education Study: development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care 2001; 24(1): 16-21.

Ghisi GLM, Aultman C, Konidis R, et al. Development and validation of the DiAbeTes Education Questionnaire (DATE-Q) to measure knowledge among diabetes and prediabetes patients attending cardiac rehabilitation programs. J Cardiopulm Rehabil Prev 2021; 41(4): 224-229.

Hair JE, Anderson RE, Tatham RL, et al. Multivariate data analysis: with readings. Englewood Cliffs (NJ): Prentice-Hall; 1995.

Han CY, Zheng X, Lee LF, et al. Development of a diabetes-related nutrition knowledge questionnaire for individuals with type 2 diabetes mellitus in Singapore. Nutr Diet 2019; 76(5): 567-573.

Kangrang M, Nelson N, Karasa S, et al. Knowledge, attitude and behaviors in diabetics patients at the community hospital in Ubon Ratchathani Province. Proceedings of the 2nd National Conference of Research 4.0 for Developing the Country towards Security, Prosperity and Sustainability, 2017 Jul 26-27; Ratchathani University, Ubonratchathani, Thailand.

Khunkaew S, Fernandez R, Sim J. Linguistic and psychometric validation of the Thai Version of Simplified Diabetes Knowledge Scale: a measure of knowledge of diabetes in a Thai population. SAGE Open Nurs 2018; 4 :1-8

Kline P. Psychometrics and psychology. London: Academic Press; 1979.

Minami T, Shirakawa J, Hiiragi H, et al. Validity and reliability of the Japanese version of the diabetes knowledge test among in-patients with type 2 diabetes. J Diabetes Investig 2022; 13(3): 580-587.

Nazir SUR, Hassali MA, Saleem F, et al. Medication management program: adherence, disease-related knowledge, health-related quality of life, and glycemic control for type 2 diabetes mellitus. Altern Ther Health Med 2020; 26(S2): 4-10.

Plienwong L. Perceived health and behavioral health of patients with diabetes mellitus in the internal medicine ward at Chumphon Khet Udomsak Hospital, Thailand. TJPHS 2022; 5(1): 17-32.

Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health 2006; 29(5): 489-497.

Powers MA, Bardsley JK, Cypress M, et al. Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Educ 2020; 46(4): 350-369.

Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldana V, et al. Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence. BMC Endocr Disord 2020; 20(1): 130.

Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. New York: Oxford University Press, 1989.

Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess 2003; 80(1): 99-103.

Wongwiwatthananukit S. Krittiyanunt S, Wannapinyo A. Development and validation of an instrument to assess the general knowledge of patients with diabetes. Thai J Pharm Sci 2004; 28: 17-29.

Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol 2018; 14(2): 88-98.

Zhu J, Han L. Analysis on the main factors affecting the reliability of test papers. J Lang Teach Res 2011; 2(1): 236-238.