DIABETES KNOWLEDGE AMONG SELF REPORTED DIABETIC FEMALE TEACHERS: AL-KHOBAR, SAUDI ARABIA Diabetes mellitus (DM) is a complex disease that has an impact on a large …
DIABETES KNOWLEDGE AMONG SELF REPORTED DIABETIC FEMALE TEACHERS: AL-KHOBAR,
SAUDI ARABIA
Nada A Abahussain, PhD, Ahmed G El-Zubier, FRCPI
School Health Services, Al-Khobar, Ministry of Education, College of
Medicine, King Faisal University, Dammam, Saudi Arabia
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Objective: The objective of this study was to determine the general
knowledge of diabetes among female diabetic school teachers in Al-Khobar,
Eastern Province of Saudi Arabia
Methods: A total of 91 female diabetic school teachers were interviewed
in the School Health Clinic in Al-Khobar using a structured
questionnaire Their weight and height were measured and BMI was
calculated
Results: The results showed that understanding of diabetes was
inadequate Knowledge about symptoms of hypoglycemia was low One-fourth
25 of the sample of this study was using certain herbs for the
treatment or management of diabetes mellitus About three- fourths were
overweight and obese The results showed a deficiency of knowledge on the
general aspects of diabetes mellitus An appropriate educational material
was prepared in the form leaflets, lectures and workshops
Conclusion: This paper concludes that awareness and education about
diabetes are needed urgently among the studied sample
Key Words:
Diabetes Mellitus, School teachers, knowledge, herbs
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INTRODUCTION
Diabetes mellitus DM is a complex disease that has an impact on a large
portion of the society It is a growing public health concern in both
developed and developing countries1,2 High prevalence rates of diabetes
mellitus have been demonstrated in the populations of the Arabian
Peninsula Type 2 diabetes mellitus in particular, is a major public health
problem in Saudi Arabia3-5 Rapid urbanization and social and economic
transformation of the country have been accompanied by changes in lifestyle
and by an increase in the incidence of the disease While studies in the
1980s had shown a low prevalence of DM,6,7 higher estimates of 12-15 have
been shown in recent studies8
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Correspondence to:
Dr Nada A Abahussain, PO Box 2211, Al-Khobar 31952, Saudi Arabia E-
mail: n_abahussain@yahoocom
The manifestations of diabetes cause considerable human
suffering and enormous economic costs Both acute
and late diabetic
complications are commonly encountered The long-term complications
represented by cardiovascular and cerebro-vascular diseases, nephropathy,
retinopathy, and neuropathies are already major causes of morbidity,
disability, and premature death in countries of the Eastern Mediterranean
region9-11 Recent clinical outcome studies have made diabetics a target
for primary care initiatives to improve the quality of care12
Education of the health care team on the management of diabetes
and on how to educate people with diabetes is one major area that requires
strengthening13 Traditionally, the care of patients with diabetes has been
provided by a range of health service professionals, including doctors,
practice nurses, diabetes-nurse specialists, dieticians, chiropodists,
opticians and consultant specialists Of late, collaboration throughout
primary, secondary and community care sectors has been encouraged
The pharmacists role in this area is underlined by the
observation that diabetic subjects have a higher overall use of drugs
compared with the general population Education is
another area in which
the pharmacist can become involved People with diabetes must be made aware
of the implications of having diabetes and the need to take control of
their condition14
The objective of this paper is to assess the knowledge of
female diabetic school teachers about the disease
METHODOLOGY
The study population was the female diabetic school teachers working in the
girls education sector in Al-Khobar, Eastern Province of Saudi Arabia An
announcement was made to all schools in the region for all diabetic female
teachers to register The total number of female teachers in Al-Khobar was
1848 A total of 111 diabetic cases were registered Those registered were
contacted, and 91 82 of them agreed to participate in the study They
were personally interviewed in the School Health Clinic in Al-Khobar using
a structured questionnaire15 A teacher is considered diabetic if she has
been diagnosed by blood glucose testing and has been on treatment diet,
insulin or oral hypoglycemic drug OHD for 3 months or more
The body mass index BMI was used as an index of obesity It
was calculated as the weight in kilograms divided
by the height in meters
squared kg/ m2 16 Obesity was graded to indicate the degree of risk to
health17 The grading was set as in Table 1
Table 1: Grading system for adults
| | | |
|Ungraded |BMI 20 |Underweight|
|Grade 0 |BMI |Desirable |
| |20-249 |weight |
|Grade 1 |BMI |Overweight |
| |25-299 | |
|Grade 2 |BMI 30-40 |Obese |
|Grade 3 |BMI 40 |Severely |
| | |Obese |
| | | |
The questionnaire consisted of items on personal and medical
characteristics besides those pertaining to the level of knowledge about
the disease, those testing patients level of self-care in the ability to
follow dietary prescription, and level of compliance to medication The
questionnaire consisted of a number of statements that evaluated certain
attitudes and conceptions that are common among the public
Coded data were entered into personal computer and analyzed
using the Statistical Package for the Social Sciences version 100
RESULTS
A total of 91 female diabetic teachers working in
the educational sector in
Al-Khobar Eastern Province of Saudi Arabia were included in this study The
mean age was 4063528 Table 2 illustrates some general characteristics
of the participants The mean duration of diabetes was 616473 years
Family history of diabetes was positive in 86 of the cases
On the knowledge about the type of diabetes mellitus and
symptoms of hypoglycemia, 6 of the sample 66 stated that they had Type
1 diabetes mellitus, while only 9 cases 106 out of total 85 stated that
they had Type 2
The knowledge about symptoms of hypoglycemia was as follows:
73 answered positively that they knew about the symptoms of hypoglycemia
in general, yet unsatisfactory answers were given when asked about each
symptom separately For example, more than half of the sample answered
positively on Dizziness, impairment of vision, sweating, less than half
of them answered positively on palpitations, lack of concentration, loss
of consciousness, and sweating
Table 2: General characteristics of the participants
| | |
|Characteristics |No |
| |
|
|Age groups in years: | |
|26-35 |13 151|
|36-45 |61 709|
|46-55 |12 140|
|Nationality: | |
|Saudi |88 967|
|Non-Saudi |3 33 |
|Kind of work: | |
|Governmental employee |88 966|
|Private |3 33 |
|Educational level: | |
|Low elementary |5 55 |
|Average intermediate |52 572|
|secondary | |
|High graduate |34 373|
|postgraduate | |
|Family history: | |
|Positive |79 868|
|Negative |12 132|
|Body mass index: | |
|Normal |13 143|
|Overweight |34 373|
|Obese |37 407|
|Severely obese |7 77 |
| | |
Forty-one point seven percent 417 used only oral
hypoglycemic medication OHD, 264 were on diet only and 55 were on
insulin The rest used both OHD and diet or insulin and diet
It seemed that many patients had the wrong answer or had
no
idea about the difference between oral and parenteral medications used for
diabetes, whether they cause habituation, what the cost of drug is or
whether to stop medications during an illness The knowledge of medications
among diabetics is summarized in Table 3
Patient compliance with medications, diet and exercise was also
assessed It seems that patients were more compliant with medication
527 and the least compliant with exercise 55 Half of the sample
sometimes followed diet restrictions given to them
It was found that herbs were being used either individually or
in a mixture of selected herbs for the management of DM though there is no
documentation of their efficacy These herbs varied in their use as shown:
319 used Lupinus albus, Papilionaceae Termis and Allium sativum,
Liliaceae Fresh garlic, 253 Aloe
Table 3: Knowledge about antidiabetic medications
| | | | |
|Medication knowledge |Yes |No |No idea |
| |No |No |No |
| |
| | |
|Tablets are same as insulin |25 275 |35 385 |31 341 |
|Complications are caused by insulin and |18 198 |22 242 |50 549 |
|tablets if used for long time | | | |
|Tablets use is more effective than |23 253 |33 363 |32 352 |
|insulin | | | |
|Vitamins are essential for diabetes |47 516 |15 165 |22 242 |
|Medication should be stopped during |1 11 |62 680 |28 308 |
|inter-current illness | | | |
|Medications can cause habituation |18 198 |31 341 |41 451 |
|Efficacy of medications depend on the |5 55 |45 495 |40 440 |
|cost of drug | | | |
| | | | |
Table 4: Use of herbs for management of diabetes mellitus
| | | | |
|Herbal knowledge |Yes - |No |No idea |
| |No |No |No |
| |
| | |
|Herbal therapy is more effective and |7 77 |54 593|30 33 |
|safe than modern medications | | | |
|Healer management is good for control |8 88 |44 484|39 429|
|Diabetes | | | |
|Nigella Sativa |21 231|33 363|37 407|
|Punica granatum |20 22 |17 187|51 56 |
|Aloe vera |23 253|19 209|48 52 |
|Ferula foetid |12 132|29 319|49 538|
|Pistacia terpinthus |15 165|31 341|43 473|
|Securigera secridaca |9 99 |61 67 |21 231|
|Lupinus albus |29 319|24 264|38 418|
|Commiphora molmol |21 231|24 264|46 505|
|Artemisia inculta |15 165|23 253|52 571|
|Allium cepa |40 44 |11 121|39 429|
|Allium sativum |29 319|18 198|43 47 |
|Mordeum vulgarel |17 187|22 244 |50 549|
| | | | |
|Prescription of Raess Mahakem Tabook |5
55 |70 769|16 176|
| | | | |
vera, Liliaceae Saber, 231 Nigella Sativa, Ranunculaceae Habba
Sawda, 231 Commiphora molmol, Burseraceae Morrah, 22 Punica granatum,
Punicaceae Roman qesher and 187 Mordeum vulgarel, Gramineae Shaeer
A higher proportion of the sample used other plants such as
fresh onion 44 Table 4 illustrates the pattern of herb use among the
sample Certain herbal prescriptions were found to be used among 27 of
the population of this study These prescriptions were mainly mixtures of
two or more of the common herbs
The results showed that only 143 had normal weight, 78 were
overweight and obese, and 77 were severely obese
DISCUSSION
The sample examined in this study was Saudi female diabetic patients
working mainly in governmental teaching sector About three-quarters of
them were middle-aged, very productive and at their peak of their
professional careers Their education varied from average to high They
were expected to be knowledgeable about their main health problem
diabetes The results of this study showed
that their understanding of
diabetes was inadequate Their knowledge of the symptoms of hypoglycemia
was deficient This seems to be a universal finding18-21
This study also showed that half of the sample claimed to be
very compliant with the medication regimen This result seems better than
that found in other studies where the adherence to oral hypoglycemic
treatment was reported to be low, and about two-thirds of patients with
Type 2 diabetes did not regularly take their oral hypoglycemic treatment22
However, this result has to be taken with caution since it depended on
patient recall
Knowledge on medication was low Only about one-third of the
sample were aware that different antidiabetic medications had the same
purpose; that tablets were as equally effective as insulin Some believed
that antidiabetic medication could cause complications and habituation on
long use In support of the pharmacists role, the British Diabetic
Association is aware that many patients with diabetes do not cope
adequately with their disease because of the lack of knowledge This is
especially true of elderly
patients Although all patients with diabetes
can benefit from education and regular updating, it is important for them
to have some knowledge about their medication and, in particular,
understand the causes of hypoglycemia and how to prevent them14 Other
reports stated that improving patient knowledge could improve diabetes
control13,23
As shown in the results, family history of diabetes was
positive in 86 of the cases, so providing education to this sample will
certainly be beneficial to all family members suffering from the same
disease
The past 30 years have seen a revival in use of natural
medicines in developed countries, and the use of medicinal herbs is still
an important area of medical treatment in many developing and third world
countries One of the major reasons cited for the increase in the use of
natural medicines is the growing awareness of the side effects of synthetic
chemical drugs24
Though belief does not always agree with practice, less than
one-tenth of the study sample agreed that herbal therapy was more effective
and safer than conventional medication
Twenty-seven percent of the sample
of this study actually used some kind of herb for treatment or management
of diabetes mellitus either individually or in a mixed selection of
herbs
The use of herbs amongst the sample of this study reflects a
trend observed in adult Saudis In a study performed in the Northern
Province of Saudi Arabia, it was revealed that 24 of primary health care
consumers used herbs despite the availability and easy access to modern
pharmaceutical medicine25 Our study shows a basic lack of awareness among
female diabetics of the possible problems with the use of herbal remedies
The pharmacist can advise on drug-herb interaction and the dangers
associated with the use of some herbal medicines26 Consumers need, more
than ever, the pharmacists expertise and counseling on how to self-select
safe and effective herbal remedies and the sensible use of herbs as
alternative therapies27
It was evident from the study that though about 87 of the
sample responded that obesity was not a sign of good health, about 78 were
overweight and obese This finding is similar to Kings
study,1 which
stated that more that 80 of the cases of Type 2 diabetes were associated
with obesity Studies reported that obesity might be the precipitating
factor in the development of DM3 The high prevalence of Type 2 diabetes is
consistently associated with a high prevalence of obesity in Arab
societies2
The World Health Organization trials and population studies
have shown that prevention was possible Certain studies estimate that up
to 90 of Type 2 diabetes could be avoided through lifestyle changes such
as healthy eating, maintenance of normal weight, and regular exercise28
Only one-fourth of the patients complied with the diet and only
about 5 of them did regular exercise The socio-cultural tradition in
Saudi Arabia is that of a conservative community, in which women are over-
protected and their permitted outdoor activities precludes exercise In
addition, the hot climate also interferes with outdoor activities29
Diabetes mellitus has been cited as a model disease in which
health education could make a significant difference30 As has been shown
in this study, health education is needed to give
this sample a certain
understanding of the disease, an awareness of the importance of compliance
with medication, diet and exercise, weight control and the use of herbal
preparations This group comprised mainly school teachers in a community
where diabetes mellitus is prevalent Their thorough knowledge of this
disease would be beneficial to themselves and qualify them as health
educators Education of the person with diabetes is the cornerstone of
management Without appropriate education, the desired therapy targets are
difficult or even impossible to achieve People with diabetes should be
encouraged and empowered to participate actively in managing and monitoring
their condition
CONCLUSION
This study highlighted important deficiencies in the knowledge of diabetes
mellitus Health education is one of the areas which need to be addressed
immediately An awareness program to include lectures, workshops, and home
blood glucose monitoring are essential skills needed for long-term glycemic
control
ACKNOWLEDGMENT
The authors wish to thank Dr Mohammed Al-Saeedi for agreeing to the use of
his questionnaire in this paper We also thank all the diabetic patients
who participated
in the study for their cooperation
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