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Abstract
This research paper focuses on the prevalence, knowledge, and attitudes concerning diabetes in the United Arab Emirates. Diabetes is one of the diseases with high prevalence in the United Arab Emirates according to Al-Maskari et al. (2013). The United Arab Emirates ranks high globally in the number of people suffering from the disease (El-Sharkawy, 2010). Recent studies show that most people have negative attitudes towards their diabetic conditions. Al-Maskari et al. (2013) indicate that about 72% of the survey participants had negative attitudes towards diabetes as a disease. The United Arab Emirates diabetic patients lack essential knowledge about the disease. As such, performing self-care is almost impossible. This worsens the situation since self-care forms an integral component of diabetes management. Several research findings suggest that people in the United Arab Emirates should be educated about this disease in order to enhance its management. This research also revealed that 10% of the respondents were diabetic.
Introduction
Diabetes refers to a life-long disease that develops when the sugar levels (glucose) in a person’s blood reach the levels that the body systems can no longer use well. When this disease is not properly managed or treated well, it may result in several severe complications. Two types of diabetes exist. They include type 1 and type 2. These are different conditions with different causes. However, they both have severe health consequences when left untreated. The United Arab Emirates is one of the countries that has a significant number of people suffering from this disease. This paper focuses on the prevalence, knowledge, and attitudes concerning diabetes in the United Arab
A significant number of people live with diabetes mellitus in the UAE. As such, it has evolved to be one of the growing problems in the United Arab Emirates, which causes concern to the authorities. Despite these facts, people of the United Arab Emirates do not have adequate knowledge concerning the disease according to Al-Maskari et al. (2013). Most patients have negative attitudes towards diabetes. Due to the lack of adequate knowledge about diabetes, the life styles adopted by most patients do not help in disease management. This is why they need education.
This research will disclose the extent of the problem caused by diabetes in the country. Since actions need to be taken to prevent further loss caused by the disease, the government needs information that will form the basis of its actions and inform the decisions taken by the authorities. The information obtained from this research will also educate the general public on the best lifestyle that would keep the prevalence of diabetes down. It will also highlight the types of foods that need to be significantly reduced in the diet so as to prevent obesity, which is one of the predisposing factors for diabetes. The research seeks to investigate whether the people are aware of their diabetic conditions. Such information will be vital to the UAE authorities when it will be strategizing to sensitize the public concerning the disease. The data will also guide further research on diabetes in UAE since important findings such as disease prevalence will be available for future investigators.
By 2013, there was a single survey that evaluated diabetes knowledge conducted in a primary health care environment in the United Arab Emirates (Al-Maskari et al., 2013). The survey demonstrated a substantial lack of knowledge among the members of the public concerning the disease. These facts show the necessity to have more research on diabetes conducted in UAE so that the population may have the requisite information. Such knowledge will enable the people to adapt to the ways of life that enhance good health and keep the disease at a manageable level.
People who experience type 1 diabetes require insulin treatments because their systems produce insufficient insulin. As such, they need additional injection of insulin to fight the disease. Type 2 diabetes is common among the individuals who are obese. In this type of diabetes, insulin is not required. Oral medications and dietary adjustment may be sufficient to deal with the situation. This type of diabetes does not occur among children and youth, but becomes rampant when one reaches the age 40. However, research indicates that 2-5% of the affected individuals get the disease before reaching 25 (El-Sharkawy, 2010).
People living in the United Arab Emirates mostly suffer from type 2 diabetes. It is the most prevalent of all types of diabetes. The country ranks high globally, as Sulaiman et al. (2010) assert. The risk factors for this disease in UAE include diet changes, sedentary lifestyles practiced by the locals, and the increase in cases of obesity in the country. The United Arab Emirates continues to face problems occasioned by diabetes since the country is at the period when the economy is rapidly growing, hence enhancing the factors. Suleiman et al. (2010) believe that the stage of economic development largely contributes to the situation, as it facilitates the determinants that act as the risk factors of the disease. The United Arab Emirates have several risk factors that have contributed to the current diabetes situation in the country. Apart from the factors mentioned above, other factors that are out of the human control include genetic susceptibility, age, sex, and socioeconomic status. Smoking, dyslipidemia, hypertension, and obesity constitute the controllable factors that have significantly contributed to the rampant diabetes prevalence in UAE.
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A study by Al-Maskari et al. (2013) presented data collected from 575 randomly selected patients at Al-Ain and Tawam Hospital. Data collection tools included questionnaires. Their research revealed that 31% of persons suffering from diabetes had insufficient information about the disease, whereas 72% of the patients had negative attitudes towards their condition. The research also indicated that population in the United Arab Emirates substantially suffered from Diabetes Mellitus (Al-Maskari et al., 2013). The management of the type of diabetes rampant in the UAE relies on the capability of the people who experience the problem to perform successful self-care daily. Given this fact, education is critical to the management of diabetes mellitus. Any attempt to improve the glycemic control results in the reduction of the proportions of disease’s complications. According to Al-Maskari et al. (2013), diabetic patients who have the skills and the expertise to conduct diabetes mellitus self-care have improved the long-term control of glycemic (blood sugar) levels. As such, it is almost obligatory to ensure sufficient understanding, attitudes, and practices among the affected people.
Even when records indicate that the United Arab Emirates have a significant portion of people with diabetes, individuals are not well versed and acquainted with the knowledge concerning the disease. They do not have the expertise and knowledge to ensure self-care on a daily basis. Hence, managing condition at F personal level becomes difficult. This fact complicates matters, since diabetes management depends on self-care. Al-Maskari et al. (2013) claim that in 2011, United Arab Emirates ranked 10th globally in diabetes mellitus type 2 as documented by the International Diabetes Federation. However, United Arab Emirates citizens do not have adequate knowledge concerning the disease. There is scanty information concerning the patients’ practices and attitudes when it comes to the matters related to diabetes. Past studies have shown that the UAE nationals who suffered from diabetes had unsatisfactory knowledge and compliance levels. The research revealed a worrying trend in the disease understanding. Only 25% of the patients said that they increased physical activities after they were diagnosed. The study found that 76% of the affected individuals did not have the ability to differentiate between high and low starch glycemic index food types (Al-Maskari et al., 2013).
The United Arab Emirates citizens run a risk of developing other secondary diseases caused by diabetes mellitus, such as a stroke (Benamer & Grosset, 2009). It is known that, when diabetes mellitus is not treated properly, it leads to other multiple diseases and severe complications such as limb loss, stroke, heart diseases, blindness, kidney diseases, and reduced life expectancy (El-Sharkawy, 2010). Following these facts, diabetes is certainly one of the biggest public health concerns that affect a significant part of the population in countries, such as the UAE, and globally. The disease poses substantial personal challenges and influences both the society and the economy of the country. It forces the government to incur substantive indirect and direct costs which could be otherwise put in other speres of development that would improve the lives of the locals and lead to upward social mobility. According to El-Sharkawy (2010), the world has a population of 194 million people living with diabetes. These people are mainly adults, and the figures reflect an increase from 1995 when there were 135 million people with the disease globally. Population projections indicate that by 2015, the global population will reach 8 billion. Out of this population, 300 million will be diabetic (El-Sharkawy, 2010). It is likely that the UAE and other Arab countries will substantially contribute to this. Therefore, there is a need to find a solution that can lower the current prevalence of diabetes.
Various lifestyle measures and pharmacological means can be adopted by the high-risk community to ensure that they remain safe and significantly reduce the prevalence of diabetes. Such strategies include the ABC control techniques applied in diabetes management. Here, the “A” symbolizes the A1c, while “B” is Blood Pressure (BP), and finally “C” stands for LDL-Cholesterol. These measures involve lifelong lifestyle adjustments in addition to other medical treatments. The patients must embrace suitable dietary practices that can reduce the rate of diabetes mellitus development through improvement of risk factor profiles. The individuals must understand that right dietary practices are an integral component of diabetes treatment. The objectives of controlling the diet by diabetic persons include improvement of life quality, prevention of chronic complications brought by diabetes, enhancement of the status of nutrition, and risk factors control (Al-Kaabi et al., 2008). Appropriate dietary control can substantially improve glycemic control. Exercise can lower glycosylated hemoglobin by one to 2 percent. When diet control is combined with other integral components of diabetes treatment, it can have a positive impact on the outcome of clinical and metabolic results (Al-Kaabi et al., 2008). Glycemic control improvement, achieved through dietary measures and other care, is associated with weight decrease and the extent of caloric restriction. However, patients must be careful when practicing diet control.
Al-Kaabi et al. (2008) believe this method of diabetes management improves several aspects of type II diabetes, such as the release of insulin, hypertension, responsiveness, and obesity. However, failure to comply with the dietary modification guidelines is one of the significant limiting factors for glycemic control achievement. Despite the significance of dietary control to the type 2 diabetes patients, the individuals do not have the requisite knowledge of the technique’s role in guaranteeing glycemic control. Research has indicated that even the most enlightened communities fail to follow the recommendations for the diet adjustment most of the time. As such, they sometimes do not get the expected results of the treatment plans. Success in glycemic control in most patients globally has been a real challenge. This happens in both developed and less developed nations. Several surveys show that there is a lot to be done to realize optimal glycemic control. Studies indicate that 34% diabetes mellitus patients have recorded good control of metabolism. In the United Arab Emirates, the average HBA1c of the citizens with diabetes mellitus in primary healthcare is 8.3%. Other parts of the world demonstrate similar findings. For example, 39% of the United Kingdom diabetic patients eat within 20% of the recommended carbohydrates consumption. Studies in Thailand and Mexico reveal non-compliance to diet modification of 45.7% and 62% respectively (Al-Kaabi et al., 2008).
Saadi et al. (2007) collected a random sample of UAE nationals in Al-Ain, UAE. Fasting blood sugar levels were assessed using a glucose meter and OGTT known as oral glucose tolerance test. Objectives included determining if blood glucose was above 7mm/l. World health organization’s criteria were used to define Diabetes mellitus. The results of the study conducted in the Al-Ain area by Saadi et al. (2007) showed that the prevalence of diabetes mellitus in the United Arab Emirates was 10.2%. The new rate, determined by the research, reflected a similar figure obtained by another survey six years before which indicated a prevalence of 10.4%. Saadi et al. (2007) found that 1 out of three parous women had experienced gestational diabetes mellitus. These findings were not unique as they confirmed figures obtained by the surveys conducted before in the country. The study indicated that the age-standardized rate for undiagnosed and diagnosed diabetes mellitus was 29.0%, while that of pre-diabetes was 24.2% (Saadi et al., 2007). These findings confirmed the claims of high diabetes prevalence in the United Arab Emirates. Out of 2360 UAE adult citizens, the study found 24.5% of the participants suffering from diabetes mellitus. The figure consisted of 10% undiagnosed and 14.5% diagnosed cases (Saadi et al., 2007). 18.5% of the sample population suffered from impaired glucose tolerance. Although the situation in the United Arab Emirates has been bad concerning diabetes prevalence and other secondary diseases, the population lacks apparent causes for the disease. Among the explanations used to explain the high disease rate are increased cases of obesity among people. Obesity seems to be the most consistent reason for diabetes prevalence in the country. Researchers believe that the rates of obesity increased in the last few decades. For instance, statistics indicated an obesity rate of 27% 11 years earlier. This rate now stands at 35% (Saadi et al., 2007). These figures suggest that obesity increases at a steady rate and is likely to increase in future if dietary education is not conducted. With the growth of this factor, diabetes is also likely going to surpass the current rate.
Al-Maskari, El-Sadig, and Obineche (2008) conducted a study in Al-Ain, the UAE, using a cross-sectional study to evaluate diabetes mellitus complications prevalence in the district. This was the first study in the field. They sampled 513 people, whose mean age was around 53 years, using random selection in 2004. The patients answered a series of questions in questionnaires, after which a medical evaluation was performed on each of them. Their urines were tested for the possibility of clinical proteinuria. The dipsticks and single Micral-Test II strips were utilized to test MA. The results revealed that 61% of the participants had MA with higher rates in males than in females. This was positively associated with BMI and the presence of other complications of diabetes mellitus, such as neuropathy and diabetic retinopathy. They concluded that the prevalence of MA in the United Arab Emirates among individuals suffering from diabetes mellitus was 61% (Al-Maskari, El-Sadig, & Obineche, 2008).
In a population-based study conducted in Al-Ain, United Arab Emirates, the diabetes prevalence and complications brought by this disease were investigated. The target population was 400, but the study finally sampled 100 participants with diabetes mellitus to estimate complication prevalence (Saadi et al., 2010). 600 houses were randomly selected. The excess members covered for non-response. Blood samples were collected for serum glucose determination and blood chemistry, lipid profiles, and HbA1c. The participants drank 75 grams of anhydrous glucose within 5 minutes. The sample underwent processing within half an hour. Laboratory tests were done on a Beckman Coulter DXC800. SPSS was used to do the analysis. The results showed that 61.1% had normoglycemia; 24.7% suffered from prediabetes; while 14.2% experienced undiagnosed diabetes mellitus. These results were based on FBS/OGTT. On HBA1c, those who had low risk constituted for 55.8%, 34.1% had pre-diabetes, and 10.1% experienced undiagnosed diabetes mellitus (Saadi et al., 2010).
Our Benefits
Since Emiratis have experienced the highest prevalence of diabetes mellitus in the world, there is a need for developing a screening strategy (Saadi et al., 2010). The United Arab Emirates’ economic stabilization has come with a mixture of merits and demerits. It remains clear that one of the reasons for the highest diabetes mellitus prevalence is the strengthening economy and food abundance. Lack of physical activity on the part of the locals has compounded the problem, since these factors act on genetically vulnerable people in the country. Researchers believe that the latest guidelines developed by the United Arab Emirates National Diabetes Mellitus should require urgent screening of adults that have reached 45 years of age (Saadi et al., 2010). Overweight individuals with an extra risk factor, such as belonging to a high-risk ethnic group, should also get involved in exercising.
In a study conducted in Al-Ain in the United Arab Emirates, people aged 30 and above were sampled and their diabetes prevalence estimated. The rate of prevalence was approximately 20% with the highest prevalence in urban areas. Family history plays a significant role in getting diabetes. Both type one and type two diabetes run in families. Therefore, genetic factors influence the prevalence of the disease. In addition to the genetic factors, environmental risks also significantly contribute to the development of diabetic conditions in an individual. There is a significant interaction between environmental and generic factors as far as diabetes is concerned. According to El-Sharkawy (2010), the combination of several genes may raise the probability of developing the disease in an adult. In the recent past, scientists revealed the genetic relationships to type II diabetes. Other Arab countries and the United Arab Emirates lack substantive epidemiological studies concerning the disease’s prevalence. Recent unpublished surveys indicate that the prevalence of diabetes in the United Arab Emirates is only second to Narau (El-Sharkawy, 2010). The rates of diabetes in the United Arab Emirates are significant in urban centers. The rates in cities are high, given the kind of lifestyle led by urban dwellers. The proportions are slightly lower in the rural areas of the country. The low statistics are attributed to the low obesity rates in rural areas as compared to urban centers.
A study conducted by Al-Maskari et al. (2013) used a cross-sectional survey to evaluate knowledge, attitudes, and practices of individuals suffering from diabetes mellitus. The study was based in Al-Ain District, UAE. The study assessed diabetes knowledge among the patients, using questionnaires that had 23 questions related to diabetes mellitus complications, symptoms, and causes. The results showed a negative attitude towards diabetes among the patients. 6% showed negative attitudes towards the significance of diabetes mellitus care. These included medication compliance, control of body weight, and levels of glucose in the body.
Qualitative research is the most appropriate type of research for this study. Due to its exploratory nature, the method was adopted because more insights were required into the reality of diabetes mellitus. The method was utilized to comprehend the underlying motivations, attitudes, arguments, and opinions about several aspects of diabetes in the United Arab Emirates. Qualitative techniques help in providing more insights into the issue under investigation or the problem and assist in the development of hypotheses or ideas for probable conduct of quantitative research. Qualitative research was also useful in this study, since it discloses trends that exist both in opinions and thoughts and tend to dive deep into the issue. As such, the study stood to benefit from such qualities as more information would be obtained concerning the spread of the disease in the country. The data collection under this qualitative research varies and can either be semi-structured or unstructured. Both of these techniques can help obtain objective data from the sampled population. Common applicable methods in this procedure include observations/participation, individual interviews, and focus groups. Selection of the participants is always made to satisfy a particular quota or set criterion. Qualitative techniques are also not complex methods, and are achievable easily with high levels of accuracy. However, disadvantages of qualitative methods include overdependence on the researcher’s skills, which makes them vulnerable to personal idiosyncrasies and biasness. The volume of data may also complicate analysis.
Quantitative research tends to quantify the problem and produces statistics. Hence, it uses measurable data to develop facts. Since this study was an initial one, this method was not the most suitable. Nonetheless, quantitative techniques help to reveal patterns in research. Positivist is a scientific process that utilizes organized and measurable research behaviors. The primary method to obtain information is by observation. As such, it could not be employed in this study. Interpretative methods include unstructured interviews to collect data from the respondents. It also relies on observations. The central idea of this type is activity interpretation. The method can help in qualitative data collection, but lacks specificity and tends to be more general.
The research utilized structured surveys to obtain insights into the problem. Data collection tools in this study included closed-ended questionnaires with yes/no questions. The study employed convincing and snowball sampling techniques. In the snowball procedure, the first subject referred the researchers to other individuals with the characteristics desired by the survey. The respondents kept referring the investigators until the sample size was satisfied. This sampling method was suitable for this type of study, since the emphasis was placed on diabetes. As such, the collected data represented the realities of the country and could be inferred to the entire population of UAE with degrees of certainty. A total of 61 individuals were interviewed.
The table indicates the percentages of people who have diabetes and those who don’t. The respondents were answering the question of whether they had diabetes.
Are you diabetic? Of the 61 individuals, almost 10% had suffered from diabetes (9.84%), while those who had no diabetes constituted 85.25%
The respondents were required to indicate whether consumption of too much sugar and other sweet foods cause diabetes. The table summarizes the responses.
66.67% of the respondent said yes, sugary foods cause diabetes, while 21.67% did not believe that consumption of sugar and sugary foods was a cause of diabetes.
Individuals responded to the question of whether the lack of effective insulin in the body is a usual cause of diabetes. The results are shown here.
81.67% of the population agreed that the lack of insulin caused diabetes. Only 5% thought that it was not a cause of diabetes.
When asked whether, in diabetes control, medication was more important than exercise and diet, the respondents gave the following responses.
Only 4.92% believed that medication was more significant than dietary modification and exercise. 65.57% said that medication was not more important than exercise and diet to control diabetes.
Participants were asked if sweating and shaking were signs of high blood pressure. The table provides the responses.
48.33% believed that sweating and shaking indicated symptoms of high blood pressure. 15% said that shaking and sweating are not signs of HBP, while 36.67% had no knowledge.
The individuals were asked whether the blood sugar levels increase when diabetes is untreated. The results are in the table.
The majority 68.85% agreed that the blood sugar levels increase in the body if diabetes remains untreated. Only 3.28% believed that untreated diabetes does not lead to an increase in sugar levels, while 27.87 had no idea.
People were required to indicate whether their children would have high chances of being diabetic if the parents had diabetes. The responses are contained in the table below.
70.49% of the people said yes, there was a high chance of their children being diabetic if the parents had diabetes. 9.84% did not believe that if the parents had diabetes, the children had increased chances of being diabetic, while 19.67% did not know.
The participants of the survey were asked if diabetes was curable. The summary of the results is in the table below.
45% of the participants said diabetes could be cured. 30% believed that the disease cannot be cured while 25% did not know.
The individuals responded to the question of whether regular exercise increased the need for diabetic medication or insulin.
18.03% of the people said regular activities increased the need for diabetic medication or insulin, 47.54% did not believe that exercises increased insulin and medication for diabetes, while 34.43% were not aware.
The study participants responded to the question of whether people have sufficient awareness concerning diabetes and how to manage it. The table below provides a summary.
39.34% of the respondents indicated that people are aware of diabetes and how to manage it. 45.90% said that people did not have sufficient knowledge about diabetes and its management, while 14.75% did not know anything.
Almost 5% of the individuals in the United Arab Emirates do not know their diabetic status, according to the findings of this survey. The findings echo the results of Al-Maskari et al. (2013) that determined that a significant number of Emiratis lack knowledge about diabetes. The study found 10% of respomdents had diabetes. The proportion is high and confirms the claims by Saadi et al. (2010). Almost 12% of people interviewed did not know that consumption of sugar and other sugary foods was a cause of diabetes. This finding shows that the population lacks vital information about diabetes. Similar assertions were made by Sulaiman et al. (2010) in their study, when they concluded that individuals lack knowledge and fail to observe lifelong practices that help in the management of diabetes. According to the results, a significant number of people do not know the symptoms of diabetes. In this study, 36.67% did not know whether sweating and shaking are symptoms of diabetes. The findings add to the past findings that individuals lack sufficient knowledge concerning the disease (Al-Maskari et al., 2013). Almost 10% of people think that genetic factors have no role in diabetes, while 19.67% don’t know whether genetic factors contribute to diabetes. Serious education concerning risk factors for diabetes should be conducted among UAE citizens. More than half of the respondents either do not know that diabetes is curable or believe that it is not curable. Such findings indicate a degree of ignorance among the citizens, which limits any strategy to deal with the diabetes menace in the country.
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The sampling technique adopted by the study presented some challenges during the survey. First, sometimes the referred people were not the kind of individuals from whom the study wished to collect data. Snowball is a non-random technique (El-Nasr, Drachen, & Canossa, 2013). As such, calculating the sampling error during analysis was not possible. This implies that the inferences the study makes about the entire UAE population may not represent the truth, since it lacks an element of demographic representation. Due to the kinds of responses and the structure of questions, it was not possible to obtain other statistical outputs such as standard deviation and modes. The analysis output was restricted to a yes/no table and bar graphs. It is recommended that in future researchers should select random sampling methods as sample size and errors can be calculated mathematically. Future studies should adopt both qualitative and quantitative methods, so that the questions should be designed to accommodate both quantitative and qualitative variables for rigorous analysis. Such s technique will also facilitate production of varied statistical data.
In conclusion, diabetes is still a problem in the United Arab Emirates. Type 2 diabetes is the most prevalent in the UAE. The disease needs special attention, so that the high prevalence can be lowered. The population needs to be enlightened concerning diabetes and change their attitudes, since most of them have a negative attitude towards their positive diabetic status. The most important aspect of diabetes management is that the patients must know that self-care is an integral part of disease management. Given this, authorities must conduct civic education so that appropriate lifestyles may be adopted. This research reveals similar trends of diabetes prevalence to those obtained by previous studies. Therefore, efforts must be put to contain the disease and reduce its threat.
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