European Journal of Cardiovascular Medicine

Type 2 diabetes mellitus (T2DM) is a major global health concern, with an increasing prevalence among young individuals due to sedentary lifestyles, unhealthy dietary habits, and rising obesity rates. The International Diabetes Federation (IDF) Diabetes Atlas estimates that diabetes cases will continue to rise globally, with projections showing a significant increase by 2045 (Saeedi et al., 2019 [1]). Historically considered a disease affecting middle-aged and older adults, T2DM is now being diagnosed in adolescents and young adults at an alarming rate. The transition from insulin resistance to overt diabetes is influenced by modifiable lifestyle factors such as diet and physical activity. Regular exercise and a balanced diet rich in fiber and low in sugar play a crucial role in preventing diabetes and managing its complications (Mtshali & Sookan-Kassie, 2024 [2]).

Understanding young individuals' knowledge, attitudes, and practices (KAP) related to diet and exercise is essential for designing effective preventive strategies. A knowledgeable population is more likely to adopt healthier behaviors, while positive attitudes toward prevention can reinforce long-term adherence to lifestyle modifications. However, gaps between knowledge and actual practice pose a challenge to diabetes prevention, particularly in student populations who may be aware of healthy lifestyle choices but fail to incorporate them into daily routines (Joshi et al., 2013 [3]). Previous research in India has shown that although students are informed about health risks, behavioral changes are not always implemented, leading to an increasing burden of metabolic disorders (Bassi et al., 2021 [4]).

Several studies indicate that demographic factors such as gender, education level, and family history of diabetes significantly influence KAP levels. Male students and those with a family history of diabetes often exhibit higher knowledge and better lifestyle practices, while undergraduate students tend to have lower adherence to preventive measures (Mekonnen et al., 2020 [5]). A study among university students in Saudi Arabia found that awareness levels were relatively high, yet many students failed to translate their knowledge into effective diabetes-preventive behaviors (Gazzaz, 2020 [6]). Similarly, research suggests that structured health education interventions can significantly improve KAP scores and glycemic control in diabetes patients (Chawla et al., 2019 [7]).

Despite these findings, limited research has focused on the KAP of young students in India regarding diabetes prevention. This study aims to assess young students’ knowledge, attitudes, and practices related to diet and exercise for diabetes prevention in Ghaziabad. Additionally, it explores demographic influences on KAP scores and examines the relationships between knowledge, attitudes, and practices. The results will help identify gaps in awareness and behavior and contribute to the development of targeted educational interventions to reduce the risk of diabetes among young individuals.

Study Design

A cross-sectional survey was conducted to evaluate the knowledge, attitude, and practice (KAP) regarding diet and physical activity for diabetes prevention among young students in Ghaziabad. A structured questionnaire was administered to assess participants' demographic details, knowledge of diabetes prevention, attitudes toward lifestyle modifications, and self-reported practices related to diet and exercise.

Study Population and Sampling

The study included 300 students (mean age: 21.3 ± 1.9 years) from various educational institutions in Ghaziabad. Participants were selected using convenience sampling to ensure a diverse representation of students from different academic backgrounds.

Inclusion Criteria:

Students aged 18 to 25 years

Enrolled in a Ghaziabad-based institution

Non-diabetic individuals

Willing to provide informed consent

Exclusion Criteria:

Students diagnosed with diabetes or metabolic disorders

Individuals unwilling or unable to complete the survey

Data Collection

A self-administered questionnaire was used to collect data over six months (January – June 2024). The survey was conducted under the supervision of research assistants who provided clarifications if needed.

The questionnaire comprised three sections:

Demographics – Age, gender, education level, and family history of diabetes.

KAP Assessment – Questions on knowledge, attitudes, and practices related to diet and exercise, scored on a 5-point Likert scale (1 = lowest, 5 = highest).

Data Analysis

Data were analyzed using SPSS software (Version 26.0). The following statistical tests were applied: Descriptive Statistics (mean, standard deviation, percentages) to summarize demographic and KAP data. t-tests & ANOVA to assess differences in KAP scores based on gender, education level, and family history of diabetes. Pearson Correlation Analysis to examine the relationships between knowledge, attitude, and practice scores. Linear Regression Analysis to identify predictors of healthy lifestyle practices, with a p-value < 0.05 considered statistically significant.

Ethical Considerations

The study was conducted in compliance with ethical guidelines for research involving human participants. Informed consent was obtained from all respondents before participation. The data collection process ensured anonymity and confidentiality of participants’ responses.

This section presents the analysis of knowledge, attitude, and practice (KAP) related to diet and exercise for diabetes prevention among young students in Ghaziabad. The findings highlight the relationships between demographic factors and KAP scores, as well as correlations between knowledge, attitudes, and behaviors regarding diabetes prevention.

Descriptive Analysis of KAP Scores

The overall mean scores for knowledge, attitude, and practice among participants are summarized in Table 1. Participants exhibited an intermediate level of knowledge (Mean = 3.6 ± 0.8) and a generally positive attitude (Mean = 4.1 ± 0.6). However, practices related to diabetes prevention were relatively weak (Mean = 3.3 ± 0.7), indicating a gap between knowledge and action.

Table 1: Descriptive Statistics of KAP Scores

Figure No:1. Descriptive Statistics of KAP Scores

Impact of Demographic Factors on KAP Scores

Statistical tests were conducted to assess the influence of gender, family history of diabetes, and education level on KAP scores. The results (Table 2) indicate significant differences in knowledge and practice scores based on gender, family history, and education level (p < 0.05).

Table 2: KAP Scores by Demographic Variables

(*Significant at p < 0.05)

Figure No: 2.KAP Scores by Demographic Variables

Male students and those with a family history of diabetes scored higher on knowledge and practice measures. Postgraduate students exhibited higher KAP scores compared to undergraduates, suggesting an association between educational attainment and diabetes-related awareness and behavior.

Correlation Between KAP Scores

Pearson’s correlation analysis (Table 3) revealed statistically significant positive correlations between knowledge and attitudes (r = 0.42, p < 0.01) and between knowledge and practice (r = 0.39, p < 0.01).

Table 3: Correlation Matrix Between KAP Scores

(Significant at p < 0.01)

A strong positive correlation between knowledge and attitudes suggests that students with higher awareness tend to have more favorable perceptions toward diabetes prevention. The significant relationship between knowledge and practice indicates that higher awareness can lead to better lifestyle behaviors, though gaps remain in implementation.

Regression Analysis: Predictors of Practice Scores

A linear regression analysis was conducted to identify significant predictors of healthy lifestyle practices among students. Knowledge score, family history of diabetes, and gender were found to be significant predictors of practice scores (p < 0.05).

Table 4: Regression Analysis for Predicting Practice Score

(*Significant at p < 0.05; Significant at p < 0.01)

Figure No:3. Regression Analysis for Predicting Practice Score

Knowledge score was the strongest predictor of healthy lifestyle practices (p = 0.002). Students with a family history of diabetes were more likely to engage in positive lifestyle practices (p = 0.027). Male students demonstrated slightly higher practice scores than female students (p = 0.031).

This study assessed the knowledge, attitude, and practice (KAP) of young students in Ghaziabad regarding diet and exercise for diabetes prevention. The findings indicate that while students possess intermediate knowledge and generally positive attitudes, their practices related to diabetes prevention remain weak, highlighting a critical gap between awareness and action. This is consistent with the study by Peter et al. (2022) [8], which found that while individuals diagnosed with type 2 diabetes understood the significance of lifestyle modifications, their actual adherence to such practices was low. Similarly, Mphasha et al. (2024) [12] reported that while families of diabetic patients were aware of the importance of diet and exercise, their practical implementation remained a challenge due to cultural and social influences.

The results revealed that students had a moderate level of knowledge (Mean = 3.6 ± 0.8) and a positive attitude (Mean = 4.1 ± 0.6) toward diabetes prevention. However, their practice scores (Mean = 3.3 ± 0.7) were significantly lower. This gap is well-documented in other studies, where despite increased awareness, translating knowledge into sustainable lifestyle changes is difficult (Dessie et al., 2020 [9]). Many young individuals acknowledge the importance of a healthy diet and regular physical activity but struggle to integrate these habits into daily life due to lifestyle constraints, lack of motivation, and environmental influences. According to Schwarz et al. (2012) [11], non-pharmacological interventions, including dietary adjustments and exercise regimens, are essential in preventing type 2 diabetes, but long-term adherence is often hindered by behavioral and social factors.

The study found that gender, family history of diabetes, and education level significantly influenced KAP scores. Male students demonstrated higher knowledge and practice scores compared to female students (p < 0.05). This aligns with research by Grundlingh et al. (2022) [10], which suggests that men may be more proactive in seeking health-related information or engaging in physical activities due to cultural expectations and personal interest in fitness. Furthermore, students with a family history of diabetes had significantly higher KAP scores, suggesting that personal or familial exposure to diabetes influences preventive behaviors. Phoosuwan et al. (2022) [13] emphasized that individuals with direct family exposure to diabetes were more likely to adopt preventive lifestyle measures due to heightened awareness of the disease’s consequences. Similarly, Mohammadi et al. (2015) [14] observed that patients with type 2 diabetes in Iran showed improved dietary habits and exercise routines when there was a familial predisposition to diabetes, reinforcing the role of genetic risk perception in health behavior.

Postgraduate students had higher knowledge and practice scores compared to undergraduates (p < 0.05), reflecting the role of education in health awareness and decision-making. Higher education levels often correlate with better access to health-related information, critical thinking, and a greater understanding of disease prevention (Dessie et al., 2020 [9]). This trend has also been observed in studies conducted in various regions, including Africa and Asia, where increased educational attainment was associated with improved dietary and exercise behaviors (Mphasha et al., 2024 [12]).

Pearson correlation analysis revealed significant positive correlations between knowledge and attitude (r = 0.42, p < 0.01) and between knowledge and practice (r = 0.39, p < 0.01). These findings suggest that increasing awareness alone is not enough; targeted interventions must address behavioral barriers to bridge the knowledge-practice gap. Similar studies have emphasized that health literacy plays a crucial role in improving lifestyle choices, but sustained efforts are required to translate knowledge into action (Schwarz et al., 2012 [11]). The relationship between knowledge and behavior is well-documented in diabetes prevention research. Peter et al. (2022) [8] found that higher knowledge levels were positively associated with better glycemic control in diabetic patients, further emphasizing the importance of structured education and behavior change strategies.

Regression analysis identified knowledge score, family history of diabetes, and gender as significant predictors of practice scores (p < 0.05). Knowledge was the strongest predictor (p = 0.002), reinforcing the idea that educational interventions can positively impact lifestyle behaviors. Additionally, students with a family history of diabetes (p = 0.027) were more likely to adopt healthy habits, emphasizing the role of personal risk perception in influencing behavior. These results are consistent with international studies that highlight the need for comprehensive health education programs that go beyond theoretical knowledge and focus on behavioral modifications (Mohammadi et al., 2015 [14]).

The findings of this study align with prior research conducted in Bangladesh, Ethiopia, China, and Nepal, where knowledge levels were moderate to high, but practice scores remained low, indicating a widespread gap between awareness and action (Dessie et al., 2020 [9]; Phoosuwan et al., 2022 [13]). Family history of diabetes significantly influenced KAP scores, as observed in Bangladesh and China, where individuals with diabetic family members were more likely to engage in preventive behaviors (Grundlingh et al., 2022 [10]). Education was a key determinant of knowledge and practices, consistent with findings from Ethiopia and Nepal, where individuals with higher educational attainment demonstrated greater adherence to preventive measures (Mphasha et al., 2024 [12]). However, unlike some previous studies where attitude scores were neutral, this study found highly positive attitudes toward diabetes prevention, suggesting that students are receptive to adopting healthier behaviors if properly guided (Schwarz et al., 2012 [11]).

Given the observed knowledge-practice gap, targeted interventions should focus on enhancing health education programs through interactive, practical sessions that emphasize the importance of diet and physical activity in preventing diabetes (Peter et al., 2022 [8]). Additionally, behavioral change strategies must be promoted to address psychological and environmental barriers that prevent students from adopting healthier habits. Mohammadi et al. (2015) [14] suggested that structured counseling and peer engagement significantly improve adherence to lifestyle modifications. Encouraging peer and family involvement is crucial, as family history significantly influences KAP scores. Phoosuwan et al. (2022) [13] highlighted that involving family members in diabetes education programs enhances motivation and adherence to preventive measures. Finally, integrating digital and social media campaigns can effectively engage young individuals through online workshops, gamification, and health challenges, as proposed by Dessie et al. (2020) [9].

Limitations and Future Research Directions

While this study provides valuable insights, certain limitations must be acknowledged: Self-reported Data – The study relied on self-reported responses, which may introduce biases in reporting actual practices. Cross-Sectional Design – This study captures a snapshot of students' KAP at a single point in time and does not assess longitudinal behavioral changes. Sample Representativeness – The study focused on students in Ghaziabad, limiting generalizability to other populations. Future research should expand the sample size and explore cultural and socioeconomic influences on KAP.

This study reveals that while young students in Ghaziabad have moderate knowledge and positive attitudes toward diabetes prevention, their practical implementation of healthy behaviors remains insufficient. Significant demographic influences were observed, with male students, postgraduates, and those with a family history of diabetes demonstrating higher KAP scores. Strong positive correlations between knowledge, attitudes, and practices suggest that improving awareness can enhance preventive behaviors. However, educational interventions must address behavioral barriers to ensure lifestyle modifications. To bridge the knowledge-practice gap, targeted awareness programs, behavioral strategies, and peer-based engagement should be implemented. Encouraging long-term healthy habits is crucial in reducing diabetes risk among young individuals and fostering a health-conscious student population.

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