INTRODUCTION:

Diabetes mellitus (DM) is a long-term metabolic condition marked by dysfunctional metabolism of carbohydrates, proteins, and lipids, caused by insufficient insulin production or insulin resistance.¹ Diabetes, a major worldwide health issue, impacted more than 422 million adults in 2014 and was responsible for over 1.5 million fatalities in 2012. ² The illness may result in serious complications such as retinopathy, nephropathy, neuropathy, and heart-related diseases.³

The onset of diabetes mellitus is affected by environmental as well as genetic influences. Environmental factors encompass inactive lifestyles, overweight, infections, and the administration of specific drugs.⁴ Even though it is mostly preventable, the incidence of diabetes continues to be worryingly elevated, especially in regions such as Johor (14.2%), Kedah (6.5%), and Kelantan (6.5%) (Ministry of Health Malaysia, 2013). In Malaysia, the highest percentage of diabetes cases is among Malays (58.9%), then Chinese (21.4%), and Indians (15.3%).⁵ Precise and current data on the prevalence, awareness, treatment, and management of diabetes is crucial for guiding effective public health initiatives. Despite the increasing incidence of diabetes, there is a significant shortage of research targeting on young adults, an essential group for health education and prevention initiatives. Early adulthood offers an important opportunity to develop healthy habits that may lower the likelihood of chronic diseases in later years.

This study aimed at evaluating the knowledge and awareness of diabetes mellitus amongst nonmedical students at Universiti Malaysia Sarawak (UNIMAS) from four other faculties. By identifying knowledge gaps and examining correlations between demographic factors and awareness, this study seeks to inform targeted interventions to enhance diabetes awareness amongst university students with the objectives of analysing the sample population with their demographic data.

STUDY DESIGN AND RESEARCH METHODS

This cross-sectional research is intended to evaluate the understanding and awareness of diabetes mellitus amongst undergraduate students from nonmedical backgrounds at the University Malaysia Sarawak (UNIMAS).

The survey method is employed to collect data using a structured self-administered questionnaire to gather information, concentrating on demographics, knowledge, and awareness concerning diabetes mellitus and statistically analysed with IBM SPSS.

The Research Tool is the standardised questionnaire consisted of three sections: Sociodemographic Details: gender, ethnicity, academic year, faculty, and family history of diabetes. Understanding Diabetes Mellitus to assess knowledge: Basic information, signs and symptoms, diagnosis, prevention strategies, complications, and associated risk factors.

Understanding Diabetes Mellitus to assess awareness: Individual viewpoints and insights on diabetes.

Response choices comprised Yes, No, and Unsure, with Yes deemed correct, whereas No and Unsure were regarded as incorrect responses.

Study universe: The sample group is chosen from nonmedical disciplines and is selected from the UNIMAS. Study Population: included undergraduate students from nonmedical faculties at UNIMAS: Both male and female students are randomly selected from each faculty. Inclusion Criteria: Undergraduate students from the selected faculties, citizens of Malaysia, students who provided informed consent and could communicate in English. Exclusion Criteria: Students who did not consent to participate. Students from the Science Foundation program or those involved in the pilot study (medical students).

Sample Size: The required sample size was calculated using Open-Epi version 3.01, considering a 63% prevalence rate, ⁶ a 5% margin of error, and a confidence level of 95%. The final sample size, after accounting for a 10% non-response rate, was 391 students. Sampling Method: A simple random sampling method was employed to select participants from the chosen faculties, ensuring equal chances of inclusion for all eligible students. Data Collection Procedure: Data was collected using a self-administered questionnaire and distributed to students after a brief explanation of the study objectives. Sufficient time was given to complete the questionnaire, and responses were collected immediately afterwards. Statistical Analysis: Data was manually checked for completeness and accuracy before being entered into the computer. Descriptive and bi-variate analyses were performed using IBM SPSS version 22.0. Results were presented using tables and a p-value of less than 0.05 was considered statistically significant.

RESULTS:

A cross-sectional survey was carried out for this research, involving 391 students from Universiti Malaysia Sarawak (UNIMAS), who answered a questionnaire aimed at assessing awareness related to the study’s results:

The findings of the research are displayed in the subsequent order:

1. Sociodemographic data

2. Knowledge about diabetes mellitus

3. Awareness of diabetes mellitus

4.The connection between sociodemographic information, diabetes mellitus knowledge and awareness

i. Sociodemographic Data versus Knowledge

ii. Sociodemographic Data versus Awareness

iii. Knowledge versus Awareness

1. Sociodemographic Data

A total of 391 respondents completed the questionnaire, with a mean age of 22.4 years (SD = 1.35), ranging from 20 to 28 years. The most common age group was 23 years (32.2%), while the least common were 27 and 28 years (0.3% each). Most of respondents were female (70.3%) and ethnicity distribution included 42.7% Malay, 30.4% others, 22.8% Chinese, and 4.1% Indian. Most respondents were second year students (35.6%), followed by third year (30.9%), fourth year (23.5%), and first year (10.0%) students. Respondents were from four faculties: Business (25.6%), Social Sciences (25.3%), Cognitive Sciences and Human Development (24.8%), and Engineering (24.3%). Additionally, 39.6% reported a family history of diabetes mellitus.

2. Knowledge about diabetes mellitus

Table 1. Responses of the participants for different items along with the range of possible score, mean (standard deviation), and average correct answer (%) for each knowledge section and the whole knowledge section in general of the questionnaire (n= 391).

Questions

Correct (%)

Wrong (%)

Unsure (%)

Range of possible score

Mean (SD)

Average correct answer (%)

General Knowledge

It involves abnormally high blood glucose level

It is a non-curable disease

It is a long-term disease

It is a non-contagious disease

It can be treated with insulin

It can be treated with oral medication

81.1

29.9

71.6

53.2

65.0

38.9

4.3

43.0

13.0

15.9

6.4

14.8

14.6

27.1

15.3

30.9

28.6

46.3

0-6

3.40 (1.658)

56.67

Sign and Symptoms

Increased thirst

Frequent urination

Extreme hunger

Unexplained weight loss

Fatigue

Irritability

Numbness or tingling in the feet or hands

Slow-healing sores

Blurred vision

52.2

60.9

36.3

51.4

60.1

37.9

58.8

62.1

50.1

8.2

7.7

15.3

14.3

7.9

11.3

6.9

5.4

11.5

39.6

31.5

48.3

34.3

31.7

50.9

34.3

32.5

38.4

0-9

4.70 (2.676)

52.20

Diagnosis

Blood glucose test

Urine glucose test

Haemoglobin A1c (HbA1c) level

87.2

80.6

42.5

3.1

4.6

7.9

9.7

14.8

49.6

0-3

2.10 (0.911)

70.08

Prevention

Reducing body weight

Be physically active

Eat a healthy diet

Avoid smoking

Avoid drinking alcohol

62.9

85.7

94.6

69.1

74.2

14.3

3.6

1.8

10.0

6.1

22.8

10.7

3.6

21.0

19.7

0-5

3.86 (1.285)

77.29

Complication

Heart disease

Coronary arterial disease

High cholesterol level

Eye damage

Nerve damage

Kidney damage

Skin infection

Hearing impairment

Gangrene (Decaying limb)

Alzheimer's disease

64.7

55.5

68.0

45.5

37.1

70.1

46.0

23.5

36.8

17.4

9.7

9.0

6.4

15.6

17.6

5.9

20.5

26.6

10.0

27.1

25.6

35.5

25.6

38.9

45.3

24.0

33.5

49.9

53.2

55.5

0-10

4.65 (2.597)

46.47

Risk Factors

Obesity

Minimal physical activity

Sedentary lifestyle

Eating too much sugar

Unbalanced diet

Age

Ethnicity

Family history of diabetes mellitus

Genetics

Pregnancy

Infection

Pancreatic disease

High blood pressure

High plasma cholesterol level

85.4

75.7

59.3

88.0

84.9

42.7

23.8

78.3

72.1

41.2

26.9

35.0

53.2

48.1

3.6

8.4

6.9

3.8

5.9

33.5

52.2

7.2

9.7

25.3

34.5

17.1

14.6

12.8

11.0

15.9

33.8

8.2

9.2

23.8

24.0

14.6

18.2

33.5

38.6

47.8

32.2

39.1

0-14

8.15 (2.868)

58.18

Total score

0-47

26.85 (8.135)

57.14

Table 1 presents the participants 391 responses to various items in the questionnaire. The lowest correct answer rates were observed in the following areas: general knowledge (“It is a non-curable disease,” 29.9%), signs and symptoms (“Extreme hunger,” 36.3%), diagnosis (“Haemoglobin A1c (HbA1c) level,” 42.5%), prevention (“Reducing body weight,” 62.9%), complications (“Alzheimer’s disease,” 17.4%), and risk factors (“Ethnicity,” 23.8%).

The knowledge scores ranged from 0 to 47, with a mean score of 26.85 (SD = 8.135) and an overall average correct answer rate of 57.14%. Among the sections, the highest average correct answer rate was recorded in the prevention section (77.29%), followed by diagnosis (70.08%), risk factors (58.18%), general knowledge (56.67%), signs and symptoms (52.20%), and complications (46.47%).

Table 2. The assessment of level of knowledge of UNIMAS non-medical students (n= 391).

Range	Level of knowledge	Frequency	Percentage
≤19	Poor	65	16.6
20 - 27	Average	117	29.9
28 - 35	Good	142	36.3
36+	Very Good	67	17.1
Total		391	100.0

Based on table 2, the highest frequency of knowledge level amongst respondents was categorised as good (142 respondents, 36.3%), followed by average (117 respondents, 29.9%), very good (67 respondents, 17.1%), and poor (65 respondents, 16.6%). Overall, nonmedical students demonstrated an average or above level of knowledge.

3. Awareness of Diabetes Mellitus

Table 3. Responses of the participants for their source of knowledge on diabetes mellitus (n= 391).

Source of Knowledge	Frequency	Percentage (%)
Television	237	60.6
Family members who suffer from diabetes mellitus	179	45.8
Health campaign	171	43.7
Educational talk	148	37.9
Newspapers	142	36.3
Books	99	25.3
Friends who suffer from diabetes mellitus	60	15.3
Others	42	10.7

Table 4. Responses of the participants for different items of the awareness section of the questionnaire (n= 391).

Questions	Frequency	Percentage (%)
Awareness of when is “World Diabetes Day”
Yes	31	7.9
No	360	92.1
Awareness of “Malaysian Diabetes Association”
Yes	125	32.0
No	266	68.0

Based on Table 3, most respondents reported gaining knowledge about diabetes mellitus from television (60.6%), while only 15.3% obtained information from friends with diabetes. Similarly, as shown in Table 4, fewer respondents were aware of "World Diabetes Day" (7.9%) compared to awareness of the "Malaysian Diabetes Association" (32.0%)

4. Relationship between Faculties, Sociodemographic Data, Knowledge and Awareness about Diabetes Mellitus

i) Sociodemographic Data vs Knowledge

Table 5. Relationship between sociodemographic profile and level of knowledge (n= 391).

Sociodemographic profiles	Mean (SD^a)	F-statistics (df^b)	p-value^{d, e}
Age	-	-	0.183^g r = 0.068
Gender Male Female	28.0 (9.39) 26.4 (7.51)	1.80^c(389)	0.073^f
Ethnicity Malay Chinese Indian ⁱOthers	27.4 (8.69) 27.7 (8.17) 28.9 (8.66) 25.1 (6.97)	2.75 (3)	0.042
Year of Study 1 2 3 4	22.9 (8.96) 26.5 (7.73) 28.5 (8.44) 26.9 (7.42)	4.98 (3)	0.002
Family History Present Absent	29.1 (8.07) 25.4 (7.84)	4.57^c (389)	<0.001^f
Faculty Faculty of Engineering Faculty of Social Science Faculty of Business Faculty of Cognitive Sciences and Human Development	25.3 (7.21) 27.7 (6.67) 29.4 (10.41) 24.9 (6.84)	7.08 (3)	< 0.001

r = Pearson Correlation Coefficient

a standard deviation b degree of freedom

c t-statistic

d p-value for one-way ANOVA

e p-value of less than 0.05 is taken as significant

f p-value for independent t-test

g p-value for correlation test

i includes Dayak, Iban

Based on Table 5, a significant difference was observed between mean knowledge levels and ethnicity. LSD post hoc analysis revealed that students of "Others" ethnicity had significantly lower knowledge scores compared to Malay (p = 0.019) and Chinese students (p = 0.022). Indian students recorded the highest mean knowledge score, while the lowest was amongst students from the "Others" ethnic group.

A significant difference was also found in mean knowledge levels across years of study. Bonferroni post hoc test indicated a significant difference between Year 1 and Year 3 students (p = 0.001), with Year 3 students scoring significantly higher. Year 3 students had the highest mean knowledge score, while Year 1 students had the lowest.

Additionally, students with a family history of diabetes mellitus had significantly higher knowledge scores than those without such a history.

There was also a significant association between faculty and knowledge level. Bonferroni post hoc analysis showed that students from the Faculty of Business had significantly higher knowledge scores compared to those from the Faculty of Engineering and the Faculty of Cognitive Sciences and Human Development. The Faculty of Business recorded the highest mean knowledge score, while the lowest was amongst students from the Faculty of Cognitive Sciences and Human Development.

ii) Sociodemographic Data vs Awareness

a) Awareness of when is the World Diabetic Day

Table 6. Relationship between sociodemographic profile and awareness of when is the World Diabetic Day (n= 391).

Sociodemographic profiles

Yes

n (%)

Pearson Chi-square (df^a)

p-value^{c. d}

Age

22.4 (1.358) ^f

22.4 (1.355)^f

-0.007^b(389)

0.994^e

Gender

Male

Female

12 (38.7)

19 (61.3)

104 (28.9)

256 (71.1)

1.319 (1)

0.251

Ethnic

Malay

Chinese

Indian

ⁱOthers

13(41.9)

5 (16.1)

2 (6.5)

11 (35.5)

154 (42.8)

84 (23.3)

14 (3.9)

108 (30.0)

1.396 (3)

0.707

Year of Study

2 (6.5)

11(35.5)

15(48.4)

3 (9.7)

37 (10.3)

128 (35.6)

106 (29.4)

89 (24.7)

6.474 (3)

0.091

Family History

Present

Absent

12(38.7)

19 (61.3)

143 (39.7)

217 (60.3)

0.012 (1)

0.383

Faculty

Faculty of Engineering

Faculty of Social Science

Faculty of Business

Faculty of Cognitive Sciences and Human Development

5 (16.1)

12(38.7)

3 (9.7)

11 (35.5)

90 (25.0)

87 (24.2)

97 (26.9)

86 (23.9)

8.183 (3)

0.042

^adegree of freedom

^bt-statistic

^cp-value for Pearson Chi-square

^dp-value of less than 0.05 is taken as significant

^ep-value for independent t-test

^fmean (standard deviation) for independent t-test

ⁱincludes Dayak, Iban

b) Awareness of Malaysian Diabetic Society

Table 7. Relationship between sociodemographic profile and awareness of Malaysian Diabetic Society (n= 391).

Sociodemographic profiles

Yes

n (%)

Pearson Chi-square (df^a)

p-value^{c. d}

Age

22.4 (1.432) ^f

22.4 (1.318)^f

0.193^b(389)

0.847^e

Gender

Male

Female

35 (28.0)

90 (72.0)

81 (30.5)

185 (69.5)

0.245 (1)

0.621

Ethnic

Malay

Chinese

Indian

ⁱOthers

51(40.8)

24(19.2)

5 (4.0)

45 (36.0)

116 (43.6)

65 (24.4)

11 (4.1)

74 (27.8)

3.055 (3)

0.383

Year of Study

13(10.4)

39(31.2)

47(37.6)

26 (20.8)

26 (9.8)

100 (37.6)

74 (27.8)

66 (24.8)

4.222 (3)

0.239

Family History

Present

Absent

47(37.6)

78 (62.4)

108 (40.6)

158 (59.4)

0.320 (1)

0.571

Faculty

Faculty of Engineering

Faculty of Social Science

Faculty of Business

Faculty of Cognitive Sciences and Human Development

31(24.8)

45(36.0)

18(14.4)

31 (24.8)

64 (24.1)

54 (20.3)

82 (30.8)

66 (24.8)

17.269 (3)

0.001

^adegree of freedom

^bt-statistic

^cp-value for Pearson Chi-square

^dp-value of less than 0.05 is taken as significant

^ep-value for independent t-test

^fmean (standard deviation) for independent t-test

ⁱincludes Iban, Melanau and Bidayuh)

Further, Table 8 results establish that there is a significant difference in the knowledge level between those who are aware and those who are unaware of when is the World Diabetic Day is (p-value = 0.028). Those who were aware had a higher mean knowledge level than those who were not aware of when it was World Diabetes Day. However, there is no significant difference in the knowledge level between those who are aware and those who are unaware of the Malaysia Diabetes Association (p-value = 0.131).

DISCUSSION:

This study found that nonmedical students at Universiti Malaysia Sarawak (UNIMAS) had an average level of knowledge about diabetes mellitus (DM), with a mean score of 57.14%. This is consistent with findings from Albaha University, where nonmedical students scored 53.2% in comparison to medical students who scored 85.5%.⁷ The observed gap may be attributed to the absence of health-related content in nonmedical curricula, whereas medical students are formally trained on such topics.

Despite the overall average performance, substantial gaps in knowledge were noted in several key areas. Fewer than 50% of respondents correctly identified that DM is non-curable (29.9%), can be treated with oral medications (38.9%), and presents symptoms such as irritability (37.9%) and extreme hunger (36.3%). Awareness of diagnostic tools was also low; only 42.5% recognised the role of HbA1c in diagnosing DM. Knowledge of complications such as nerve damage (37.1%), gangrene (36.8%), hearing loss (23.0%), and Alzheimer’s disease (17.4%) was also limited. Additionally, awareness of major risk factors for DM was inadequate: high plasma cholesterol (48.1%), advanced age (42.7%), pregnancy (41.2%), pancreatic disease (35.0%), infection (26.9%), and ethnicity (23.8%) were all poorly recognised.

These findings mirror previous research. For example, studies in Lagos and Oman reported that 67.3% and 63.0% of participants, respectively,⁸believed that DM is curable. ^{9, 10} Similarly, only 11.9% of Chinese college students were aware of HbA1c as a monitoring index ¹¹ The low awareness of DM complications aligns with studies from Al-Balqa’ University and among diabetic patients in India.^12,
13 Limited knowledge in these areas is concerning, as early recognition of complications can reduce both morbidity and healthcare costs. ^{14, 15}

Television was reported as the primary source of DM knowledge amongst students. While the mass media play an important role in public health education, reliance on television alone may not provide sufficient depth of understanding. Students should be encouraged to diversify their sources by consulting scientific literature, attending educational talks, and engaging with health campaigns.

Awareness of diabetes-related organisations and observances was notably low demonstrated by 7.9% of respondents recognised World Diabetes Day, and 32.0% showed awareness of the Malaysian Diabetes Association. This low awareness may be due to the relatively young age of the cohort and the lack of personal exposure to DM. A notable link was observed between levels of knowledge and various demographic and academic factors. Students who have a family history of DM showed increased knowledge, aligning with earlier research.^{10, 16}

Increased awareness of the illness amongst these students might arise from their personal experiences and worries regarding genetic predisposition. Knowledge was also positively associated with the year of study, with third-year students scoring higher than first-year students. This trend, reported in other studies, ^{11, 12} likely reflects increased maturity, academic exposure, and cumulative health awareness.

Ethnic differences in knowledge were noted, with Chinese and Malay pupils outperforming those classified as "others," who most likely represented indigenous Sarawakian ethnic groups like the Dayak and Iban. Disparities in access to health information, especially between urban and rural populations, may be the cause of this disparity.

Students from the Faculty of Business and Economics outperformed those from the Faculties of Engineering and Cognitive Sciences in terms of their knowledge ratings. Disparities in academic interests, access to health-related information, or involvement in public health initiatives could be the cause of this.

CONCLUSION:

Non-medical students at UNIMAS exhibited a moderate understanding of diabetes mellitus (DM) but had limited awareness even about general aspect of diabetes such as the Malaysian Diabetes Association and World Diabetes Day. Although, elements like a family background of diabetes mellitus, study year, ethnicity, and faculty were identified as affecting their knowledge.

LIMITATION OF THIS STUDY:

This research concentrated exclusively on UNIMAS non-medical students and might not represent the general knowledge and awareness of young people in Sarawak.

THE PROPOSED RECOMMENDATIONS OF THIS STUDY ENCOMPASS:

To enhance awareness and understanding of diabetes mellitus (DM), additional health campaigns and informational presentations should take place in areas frequented by students, like shopping malls and amusement fairs. Such events ought to feature health assessments such as blood glucose monitoring and BMI evaluations to assist students in understanding their DM risk. Engaging activities like quizzes or poster contests with rewards can be incorporated to enhance student participation. Nonmedical departments can contribute by showcasing informative posters about DM—highlighting its risks, causes, and prevention—and by distributing pamphlets in shared spaces for convenience. These initiatives intend to provide students with the information required to embrace healthier lifestyles in the future and will certainly contribute to decreasing the rising prevalence of DM amongst young people.

ACKNOWLEDGMENTS:

We gratefully acknowledge and express our sincere gratitude to Pyon Sung Cheal, Mira Irisha Binti Iskandar, Nurul Ayummi Binti Zabidi, and Hazziq Diniy Bin Musa for their contributions, which supported the progress of this research work.

ETHICAL CLEARANCE:

Ethical clearance is approved from ethical committee of Faculty of Medicine and Health Sciences.

CONFLICT OF INTEREST:

No conflict of interest exists among the authors.

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Received on 05.02.2025 Revised on 26.04.2025

Accepted on 08.06.2025 Published on 02.08.2025

Available online from August 08, 2025

Research J. Pharmacy and Technology. 2025;18(8):3703-3710.

DOI: 10.52711/0974-360X.2025.00533

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Awareness of:	Mean (SD^a)	t-statistic (df^b)	p-value^c,d
When is the World Diabetes Day? Yes No	29.94 (7.554) 26.59 (8.138)	2.21 (389)	0.028
Malaysia Diabetes Association Yes No	27.76 (6.816) 26.43 (8.665)	1.51 (389)	0.131
^astandard deviation ^bdegree of freedom ^cp-value of less than 0.05 is taken as significant ^dp-value for independent t-test