ArticleDiabetes, metabolic syndrome and obesity : targets and therapy2026
Knowledge Gaps, Primary Care Provider Counselling, and Barriers to Diabetic Retinopathy Screening Among Adults with Diabetes in Syria: A Multicenter Cross-Sectional Study.
Article in Diabetes, metabolic syndrome and obesity : targets and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Diabetic retinopathy (DR) is a leading cause of preventable vision loss, yet retinal screening remains suboptimal in low-resource settings. This study assessed DR-related knowledge, risk perception, screening practices, and barriers among adults with diabetes attending selected healthcare facilities across multiple Syrian regions. Methods: A multicenter cross-sectional study was conducted from December 2025 to February 2026 in public hospitals in Damascus, Latakia, Homs, and Aleppo. Adults aged ≥18 years with self-reported diabetes were recruited predominantly from diabetes/endocrinology clinics using non-probability sampling. An adapted Arabic questionnaire assessed knowledge (10-item score; adequate ≥6/10), screening, barriers, and provider communication. Bivariate analyses and hierarchical binary logistic regression identified factors associated with adequate knowledge and never screening. Results: Among 375 participants, the mean knowledge score was 5.97 ± 2.40 and 60.0% had adequate knowledge. Only 57.6% recognized the need for screening despite controlled blood glucose. Although 62.9% reported ophthalmology advice, only 40.0% reported formal referral. Overall, 36.3% had never undergone diabetes-related eye screening; leading barriers were lack of clinician recommendation (47.1%) and absence of visual symptoms (39.0%). PCP counselling/advice was associated with higher odds of adequate knowledge (aOR 1.914, 95% CI 1.113-3.292) and lower odds of never screening (aOR 0.267, 95% CI 0.145-0.492). Adequate knowledge was also associated with lower odds of never screening (aOR 0.432, 95% CI 0.259-0.721), with substantial regional differences after adjustment. Conclusions: Among adults with diabetes attending selected public hospital clinics in Syria, moderate overall knowledge coexisted with actionable misconceptions and screening gaps. The findings support evaluating interventions to strengthen patient education, clinician counselling, referral pathways, and equitable access to retinal assessment. Hospital-based non-probability sampling limits generalizability.
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