Knowledge, Attitudes, and Practices of Family Medicine Residents Regarding Insulin Overbasalization at the Family Medicine Academy of King Saud Medical City.

BACKGROUND

Insulin overbasalization, which refers to the excessive use of basal insulin despite achieving target fasting glucose levels, poses significant clinical risks in managing type 2 diabetes mellitus. This practice can lead to adverse outcomes such as increased hypoglycemia, weight gain, and complications in glycemic control, which ultimately affect the patient's quality of life. Studies indicate that approximately 25-30% of patients on insulin therapy may experience overbasalization, highlighting the urgency of addressing this issue. Given their pivotal role in diabetes management, it is essential to assess family medicine residents (FMRs)' knowledge, attitudes, and practices (KAP) regarding insulin titration to ensure optimal patient outcomes.

OBJECTIVE

This study aims to explore FMRs' KAP to identify gaps and promote evidence-based, patient-centered diabetes care strategies.

MATERIALS AND METHODS

A cross-sectional study using stratified random sampling was conducted among FMRs at King Saud Medical City from June 2024 to April 2025. Data were collected via a validated self-administered questionnaire, which underwent content validation by a panel of experts in family medicine and diabetes management. The questionnaire was then pilot-tested for reliability and clarity before the main study. Data were analyzed using SPSS Statistics version 29.0 (IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp.).

RESULTS

A total of 101 FMRs were assessed. Most were female (n=55, 54.5%) and in their first (n=43, 42.6%) and second (n=37, 36.6%) residency years. The majority had no additional qualifications (n=59, 58.4%). More than half (n=55, 54.5%) had never heard of insulin overbasalization, and only 18 (17.8%) were familiar with the concept. Hypoglycemia (n=78, 77.2%) and weight gain (n=50, 49.5%) were the most commonly recognized consequences. Good knowledge was seen in 53 (52.5%) participants. Only 9 (8.9%) were fully confident in managing overbasalization, and 79 (78.2%) had never educated patients about it. Attitude/practice scores were significantly associated with residency level (p = 0.023), but knowledge scores were not (p = 0.137). Logistic regression confirmed residency year as a significant predictor of good practice (OR = 1.74, p = 0.043). A positive correlation between knowledge and practice was also observed (r = 0.339, p = 0.001).

CONCLUSIONS

This study revealed limited awareness and confidence among FMRs regarding insulin overbasalization. While knowledge alone was not significantly linked to residency level, more training years predicted better practice. A significant correlation between knowledge and practice highlights the need for early, targeted education to enhance insulin management skills in primary care.