Diabetes in Saudi Arabia: Educational Interventions

Diabetes mellitus is a disease that affects and threatens the life of persons in all the parts of the world. Statistics indicate that the disease prevalence is rising and estimate that type2 diabetes might be the leading cause of death worldwide. The disease was previously known to affect people of advanced age but has lately increasingly affecting younger population. The rising cases of diabetes mellitus in younger population have been associated with the high cases of obesity and poor dieting among the adolescents and children. However, most of the factors that lead to diabetes mellitus are preventable (Moura et al, 2015).

TheArab countries have a high prevalence of classification type 2 diabetes. Statistics indicate a sharp rise in the cases of type2 diabetes in industrialized countries (Moura et al, 2015). This is attributed to changes in lifestyle and cultural effects like dieting and poor exercise. Several strategies have been adopted to help reduce the effects of the disease. These measures include educational strategies that aim to educate patients on ways to reduce glucose levels, taking medication and dieting among others that were effective in reducing the disease effects.

The advantage of educational approach in reducing diabetes mellitus is because they are more cost effective, safe and accepted culturally (Deakin et al., 2006). With the rising prevalence signifying a health threat from diabetes mellitus, this research project evaluates and analyzes the use of these education strategies in Saudi Arabia to reduce the effects of the disease.

Classification of diabetes

Several groups of metabolic diseases form the diabetes mellitus. These groups are classified as types and subtypes and are characterized by the defects of the insulin secretion and action resulting in chronic hyperglycemia (Craig, & Donaghue, 2009). The classification of each type of diabetes also depends on the level of glucose present in blood or urine and the presence of symptoms.

The main classifications of diabetes are type 1, 2 and monogenic diabetics. These classifications are significant because each has a different implication relating to educational approach and therapeutic decisions. In addition to hyperglycemia levels, metabolic derangements and Ketonaemia are also crucial factors considered while classifying various types of diabetes (Ludvigsson et al, 2011).

Type1 and type 2 diabetes are polygenic. However, type1 that is the most common in youth and the children. It is clinically described as acute diabetes. This type of diabetes results from insulin deficiency because of beta cells destruction in the body. Type1 diabetes is immune-mediated and idiopathic. For a diagnosis of this type of diabetics, the glucose concentration must be above (200mg/dl) when measured at any time of the day without considering the previous meal.

Type 2diabetes results from insulin resistance. The disease is diagnosed when the glucose concentration of the plasma is above or equal to 126mg/dl (Stone, 2009). A patient must have taken noncaloric meal within the last 8 hours. For monogenic diabetics, the classification is based on the genetic defect of the beta cell that results to insulin action. Other classifications of diabetes include drug-induced diabetics that result from neurosurgery due to the effects of large doses of Dexamethasone. There are also rare types of diabetes like stress-induced diabetes, neonatal diabetes in childbirth and mitochondrial diabetes (Craig, Hattersley & Donaghue, 2009).

Prevalence of diabetes

The risk of development of diabetes is relatively high in individuals with impaired glucose tolerance (IGT). In addition, patients with also impaired tolerance fasting glycemia are also at a high risk of developing diabetes and are eferred to as referred to as pre-diabetes. Type1 diabetes is common in the young adolescent population with more than half of the total population diagnosed with diabetes less than 15 years. Although type 2 diabetes is themost common, those at the highest risk are the older population. The prevalenceof type1 of diabetes is different in various countries and in varied populations(Parving, 2006). This type of diabetes is higher inEurope as compared to Asia when comparing the children between the ages of 0-14years (Craig, 2014).

 Type2 diabetes has a higher prevalence in older people and the number is significantly rising due to urbanization, obesity and physical inactivity. The presence of diabetes type 2 is rapidly rising in Middle East, Africa and India. With the largest factor for the sharp increase in diabetes considered obesity, statistics estimate 336 million people are at the risk of suffering from the disease in the next decade. (Geopp, 2010).Globally, the mean age for type2 of diabetes is 61 years where the Africa, Hispanic and Asian populations have the fastest rising prevalence for this type of diabetes.

Diabetes Prevalence in Saudi Arabia

The Middle-East countries are facing a deadly threat from the rising prevalence had in the world. The population of Saudi Arabia has a significantly high incidence of the disease, which is posing a major problem to the health systems in the country. Statistics indicate that prevalence of type is estimated between 5% and 10% of the population. Factors associated with this increase include industrialization in the country from the 1980s (Al-Daghri, 2011). Other high-treatment associated with changes in lifestyle especially in cultural and religion-related events like Ramadan (Bakhotmah, 2011), as the country is predominantly Muslim and lack of physical activity. Type1 diabetes is also higher in Saudi children where most diagnosis is done late.

Problems associated with diabetes in Saudi Arabia

Saudi is ranked as the second highest Middle East country had with the highest cases of diabetes. The country has a total population of 18 million and it is estimated that over 7 million Saudi’s are diabetic and 3 million pre-diabetic (Robert ET al.2016). This has put a lot of pressure in the country health system through high treatment cost and educational awareness campaigns. In addition, the higher high of drugs is increasing other risk factors and drug-related problems (Zhang& Shrestha, 2015).

Economic burden

The economic burden is significantly high in diabetes-related costs in Saudi Arabia than the other country in the Middle East. Associated from long-term hospital admissions, visits, drug-related costs are putting an immense strain, which is significant economic burden to the population and the government (Rashid et al, 2012). Statistics from the world Health Organization indicate that medical-related costs for Saudi population rose by over 500% in the last 20 years. This translated to 180billion Riyals(Williams, 2015). Of the total budget spent in health systems. Out of this over, 25 billion was spent in diabetic treatment and healthcare expenses (Robert E Tal.2016). The government of the kingdom of Saudi Arabia has focused on preventive programs to reduce the soaring budget it spends on diabetes related costs. In 2014 alone, statistics indicate that the government spent over 7 % of its total budget of health of diabetes related costs (Marwa Tuffaha, 2015).

Mortality

Diabetes mortality rates in Saudi Arabia are among the top with the probability of adult risk factors due to diabetes and obesity estimated to be 33%. Of the total of deaths recorded in the country for the last decade, diabetes contributes to 5%. This number is expected to rise in future is the current prevalence and trend continue. However, the government has realized the threat of diabetes and its effecting measures to control the effects and the costs related to the disease (Gregg, 2007).

Diabetes management and care

The kingdom of Saudi Arabia has developed health system owing to industrialization and oil resources. To manage the diabetic problems, the government requires that every patient diagnosed by the disease register in the nearest hospital for easy following and treatment. The health system maintains specific data for patients with diabetes in the health care system. This information is used in government planning and educational purposes in the management and treatment of diabetes (Sirag, 2009). The government also has special clinics that are concerned with diabetes issue in the country. Statistics indicate that there were over 700000-registered diabetes clinics in the country as of the year 2007.

The ministry of health has set up a national diabetes program (NDP) that is responsible for diabetes control and treatment program. NDP controls the national strategies and awareness campaigns that are carried out by the ministry of health on diabetes control and prevention. Such activities include screening populations with a high risk, supervising diabetes related activities in hospitals and clinics (SheriColberg, 2007). Saudi Arabia adopted the diabetes action plan passed by the GCC countries to boost its efforts in fighting the diabetes problem. Other important national programs that are related to prevention and control of diabetes in Saudi Arabia include the dieting and physicalactivity program. The main role of the program is integrating the physical activity and dieting program in School curriculum, work environments and promoting such activities on the public.

Education Models

Diabetes education models specify the objectives and provide a framework for control and prevention of diabetes. These models are used by the ministry of public health in the country as guidance policies in comparing the performance and one of the education models applicable in diabetes include the Markov model. The model isuseful in type2 because it models the events whose causes are not likely tochange over time and their repeated occurrence is unlikely. Markov model usessimple decision trees and recursive trees to using various stages known as themarkov states and transitions. An example of the markov model is the majordiabetes model used for generating diabetes complications in the long term. itis also useful in estimating life expectancy and diabetics related health costs (Bergemann et al, 2006).

The other model is the probabilistic discrete time model. The model can be implemented through a computer software program and is ideal for type2 diabetes. The main parameters for the models include life expectancy for diabetes patients, first occurrence estimation for various diabetes complication and costs diabetes patients. An example of such model is the UK PDS output model( Holman et al,2011). The other model is the probabilistic discrete event model. This type of model is used in the United Kingdom on the type2 diabetic population. The model is effective for studying long-term projections of life expectancy for diabetic patients and their occurrence of complications related to the disease. Lastly, the other model is the continuous stochastic micro-simulation model. It is effective in studying the predicted complications that are likely to occur from diabetes and their related costs for type 1 and 2 diabetes.

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