INS and diabetes mellitus: These gaps may be attributed to the following reasons: (1) ketoacidosis, a life-threatening condition, is often admitted to a comprehensive hospital for treatment, limiting exposure of PHC nurses (31); (2) insulin may not always be accessible in PHC facilities, reducing the knowledge and competencies of primary care professionals in insulin use (32); and (3) nurses may not be directly responsible for treating diabetes, leading to limited practical knowledge.