A propósito del artículo “Factores asociados con niveles adecuados de conocimientos sobre diabetes mellitus tipo 2 en pacientes de redes de servicios de salud en Bogotá D.C., Colombia"

On the article “Factors associated with adequate levels of knowledge about type 2 diabetes mellitus among outpatients of health service networks in Bogotá D.C., Colombia”

Dear Editor:

In a recent article published in the Revista de la Facultad de Medicina, Marcell-Vásquez et al.¹ identified the factors associated with an adequate level of knowledge about type 2 diabetes mellitus (T2DM) among patients with this diagnosis receiving outpatient care in Bogotá. Their work makes a significant contribution to current knowledge about the aspects that influence the understanding of the disease in this population. Moreover, the relevance of the topic and its large sample size (n=1 068) further strengthen the impact of this study in the clinical context. However, we would like to highlight some methodological considerations that should be taken into account to accurately interpret the results and guide future research.

Señor editor:
En un reciente artículo publicado en la Revista de la Facultad de Medicina, Marcell-Vásquez et al. ¹ identificaron los factores asociados con un nivel adecuado de conocimientos sobre diabetes mellitus tipo 2 (DMT2) en pacientes con este diagnóstico atendidos en servicios ambulatorios de Bogotá, realizando una importante contribución al conocimiento actual sobre los aspectos que afectan la comprensión de la enfermedad en esta población. De igual forma, la importancia del tema y el amplio tamaño de la muestra (n=1 068) fortalecen aún más
la influencia de este estudio en el contexto clínico. No obstante, queremos resaltar algunas consideraciones metodológicas que deben tenerse en cuenta para interpretar con exactitud los resultados y guiar
futuras investigaciones.

Carta al editor

Miguel Ángel Jesús Huamán-Ascona¹ Jeff David Huarcaya-Victoria¹,²

¹ Universidad Privada San Juan Bautista - Ica Campus - Faculty of Health Sciences - Ica - Peru.

² Hospital Nacional Guillermo Almenara Irigoyen-Essalud - Lima - Peru.

Open access

Received: 11/07/2025

Accepted: 22/10/2025

Corresponding author: Miguel Ángel Jesús Huamán-Ascona. Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista. Ica. Perú. E-mail: miguel.hascona@gmail.com.

Keywords: Diabetes Mellitus, Type 2; Health Knowledge, Attitudes, Practice; Health Education; Cross-Sectional Studies (MeSH).

Palabras clave: Diabetes Mellitus Tipo2; Conocimientos Actitudes y Práctica en Salud; Educación en salud; Estudios Transversales (DeCS).

How to cite: LHuamán-Ascona MAJ, Huarcaya-Victoria JD. On the article “Factors associated with adequate levels of knowledge about type 2 diabetes mellitus among outpatients of health service networks in Bogotá D.C., Colombia”. Rev. Fac. Med. 2025;73:e121533. English. doi: https://doi.org/10.15446/revfacmed.v73.121533.

Cómo citar: Huamán-Ascona MAJ, Huarcaya-Victoria JD. [A propósito del artículo “Factores asociados con niveles adecuados de conocimientos sobre diabetes mellitus tipo 2 en pacientes de redes de servicios de salud en Bogotá D.C., Colombia"]. Rev. Fac. Med. 2025;73:e121533. English. doi:
https://doi.org/10.15446/revfacmed.v73.121533.

Copyright: ©2025 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author and source are credited.

First, it is important to consider that the method used by Marcell-Vásquez et al.1 to measure the levels of knowledge showed a Cronbach’s alpha coefficient of 0.36, which indicates a low level of internal consistency; in fact, it has been established that values ≤7 are not acceptable to ensure the internal consistency of a questionnaire or measurement instrument.2 Such a low level of reliability jeopardizes the internal validity of the instrument and reduces the potential impact of the conclusions derived from the results.

Second, in that study, the threshold for defining “adequate” knowledge was set as correctly answering at least four of the six questions asked (66%). This parameter is a limitation that should have been reported, since the cutoff point for considering knowledge as adequate —when result interpretation is based on two categories (adequate vs. inadequate)— is 70% correct responses.3 Therefore, further research should include more questions that cover the threshold or, alternatively, assign a higher score to some questions.

Third, the study offers multiple explanations suggesting a possible causal relationship between the level of knowledge about T2DM and blood glucose regulation. However, this conclusion is methodologically insufficient given the cross-sectional nature of the study, as the literature suggests that cross-sectional studies can detect associations by jointly assessing variables but cannot establish causality.4-7

Finally, the majority of the sample was composed of patients treated in public health system networks (86.98%), which caused a selection bias that restricts the extrapolation of the results to other communities within the health system. This limitation has been pointed out by Rudolph et al.,8 who state that a study is considered representative when the results obtained in the sample can be applied or generalized to the target population.

The observations presented in this letter to the editor are not intended to detract from the study conducted by Marcell-Vásquez et al.1 or from its contributions to the literature on the subject. Instead, it aims to encourage a critical, and mostly constructive, analysis aimed at enhancing the methodological rigor of future studies in the country and the region on the factors associated with patients’ knowledge of T2DM.

Conflicts of interest

None stated by the authors.

Funding

None stated by the authors.

Acknowledgments

None stated by the authors.

References

1.Marcell-Vásquez S, Villar JC, Torres-López LA, Barrera EC, Balcázar-Muñoz ÁM. Factors associated with adequate levels of knowledge about type 2 diabetes mellitus among outpatients of health service networks in Bogotá D.C., Colombia. Rev. Fac. Med. 2024;72(2):e112118. doi: 10.15446/revfacmed.v72n2.112118.

2.Colorado-Romero JR, Romero-Montoya M, Salazar-Medina M, Cabrera-Zepeda G, Castillo-Intriago VR. Análisis Comparativo de los Coeficientes Alfa de Cronbach, Omega de McDonald y Alfa Ordinal en la Validación de Cuestionarios. Revista Científica y Académica. 2025;4(4):2738-55. doi: 10.61384/r.c.a..v4i4.836.

3. Shi Z, Chen YB. Knowledge, Attitude, and Practice Toward Chronic Pain in Older Adults Among Health Sciences Students: A Cross-Sectional Study. J Pain Res. 2025;18:4611-22. doi: 10.2147/JPR.S532065.
PMID: 40933499; PMCID: PMC12419208.

4.Grimes DA, Schulz KF. Descriptive studies: what they can and cannot do. Lancet. 2002;359(9301):145-9. doi: 10.1016/S0140-6736(02)07373-7. PMID: 11809274.

5.Savitz DA, Wellenius GA. Can cross-sectional studies contribute to causal inference? It depends.
Am J Epidemiol. 2023;192(4):514-6. doi: 10.1093/aje/kwac037. PMID: 35231933.

6.Pérez-Guerrero EE, Guillén-Medina MR, Márquez-Sandoval F, Vera-Cruz JM, Gallegos-Arreola MP, Rico-Méndez MA, et al. Methodological and statistical considerations for cross-sectional, case-control, and cohort studies. J Clin Med. 2024;13(14):4005. doi: 10.3390/jcm13144005. PMID: 39064045;
PMCID: PMC11277135.

7.Maier C, Thatcher JB, Grover V, Dwivedi YK. Cross-sectional research: a critical perspective, use cases, and recommendations for IS research. Int J Inf Manage. 2023;70:102625. doi: 10.1016/j.ijinfomgt.2023.102625.

8.Rudolph JE, Zhong Y, Duggal P, Mehta SH, Lau B. Defining representativeness of study samples in medical and population health research. BMJ Med. 2023;2(1):e000399. doi: 10.1136/bmjmed-2022-000399. PMID: 37215072; PMCID: PMC10193086.