Sick-Day Knowledge, Recalled Education, and Intended Medication Management Among Adults Prescribed Sodium–Glucose Cotransporter 2 Inhibitors in Jenin, Palestine: A Cross-Sectional Study

Abstract

Sodium–glucose cotransporter 2 (SGLT2) inhibitors can precipitate diabetic ketoacidosis with normal or mildly elevated glucose, particularly during acute illness, fasting, volume depletion, or surgery; safe use therefore depends on patients recognizing when to seek advice and temporarily withhold treatment. This clinic-based cross-sectional survey evaluated sick-day knowledge and intended self-management among 207 adults with type 2 diabetes prescribed an SGLT2 inhibitor in Jenin, Palestine. A structured, interviewer-administered Arabic questionnaire assessed five knowledge domains, attitudes, recalled sick-day education, intended action during acute illness, previous continuation during illness, and information sources. Associations were examined using chi-square testing, logistic regression, and HC3-robust linear regression; a strict knowledge-scoring sensitivity analysis was performed. The mean Knowledge Score was 2.44 out of 5 (SD 1.56). Only 48.8% recalled receiving sick-day education, 77.3% reported an appropriate intended action, and 70.4% reported previously continuing treatment during illness. Recalled education was associated with appropriate intended action both before adjustment (OR 5.71, 95% CI 2.59–12.60) and after adjustment for age, gender, educational attainment, and diabetes duration (adjusted OR 5.39, 95% CI 2.39–12.13). Older age was associated with lower knowledge (b = −0.301, p = 0.003), whereas the positive association with educational attainment was not retained under strict scoring. Recognition of ketoacidosis without marked hyperglycemia and preoperative withholding was limited. These findings support standardized Arabic sick-day counseling, particularly for older adults, using written instructions, teach-back, and involvement of relatives or caregivers, with consent. Prospective studies should assess observed behavior and clinical outcomes rather than relying solely on recalled education and hypothetical intended actions.