Diabetes Care Knowledge-Practice Gap Among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Assessment of Competency and Training Needs

Introduction: Primary healthcare nurses deliver most routine diabetes contact, yet regional studies rarely test whether nurses self-rated confidence matches objective knowledge.This study assessed diabetes knowledge, self-efficacy, and satisfaction among primary care nurses, and examined concordance between knowledge and self-rated confidence.Methods: This cross-sectional study was conducted among primary care nurses at 11 primary health centers in Eastern Province, Saudi Arabia.A structured questionnaire combining a 36-item diabetes knowledge test and 17-item self-efficacy scale (5-point Likert) was piloted on 10 respondents (Cronbach's alpha=0.948)before administration to the main analytic sample of 100 nurses.Knowledge and self-efficacy scores were compared using Spearman correlation, Mann-Whitney U, and Kruskal-Wallis tests (p<0.05).Results: Mean knowledge score was 53.7% (SD 18.9); 59% had poor knowledge (<60% correct).Self-efficacy was moderate-to-high overall (mean 3.66/5).Knowledge and self-efficacy scores were only weakly-tomoderately correlated (Spearman's rho=0.38,p<0.001); 33% of nurses showed knowledge-confidence discordance (20% underconfident, 13% overconfident).Prior diabetes-specific training was associated with significantly higher self-efficacy (p=0.005)but not objective knowledge (p=0.47).Qualification level was associated with knowledge scores on univariate analysis (p=0.016) but not after adjusting for training, experience, and chronic-unit exposure (p=0.088).Glucagon injection technique was the lowest-rated competency (mean 2.57/5); satisfaction with training received was low (mean 2.24/5) and uncorrelated with objective knowledge (p=0.48).Conclusion: Primary care nurses show a measurable disconnect between diabetes-related confidence and objective knowledge: existing training is associated with strengthened self-assurance without a proportional association with improved knowledge.Structured, competency-verified training targeting glucagon administration and Ramadan-specific counseling is needed to close this gap and safeguard patient outcomes.