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Childhood Diabetes in Saudi Arabia: The Prevalence of Type 1 Diabetes Among Children

Diabetes is one of the major chronic ailments facing children in Saudi Arabia. This trend has been observed in recent years, in the light of which campaigns have been launched to reverse the trend. The prevalence of diabetes varies from region to region. This necessitates further research into the reasons why certain regions have lower prevalence rates. Findings from such research could provide insights that would help curb diabetes and thus improve the health of Saudi children. This research is important and the government will do well to implement the recommendations of this research for the sake of protecting Saudi children from the disease.

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Research Aims

  • To determine the various factors affecting diabetes among children in Saudi Arabia.
  • To determine the reasons for the discrepancy in the prevalence of diabetes within Saudi Arabia
  • To engage the community at large in addressing the challenges presented by diabetes among children
  • To find ways of curbing diabetes and enhancing the health of Saudi children

Literature review

Research has revealed that Saudi Arabia has some of the highest prevalence rate diabetes in the world. Recently, many children have been diagnosed with diabetes, which has caused a lot of concerns among various stakeholders (Al-Nozha, et al., 2004, pp. 1603-1610). There are several factors which are thought to cause diabetes among Saudi Children. Genetic factors do play a critical role in the development the disease (Salman, Abanamy, Ghassan & Khalil, 1991, pp. 176-178). Nonetheless, environmental aspects and lifestyles also play a key role in the development of the disease. In Saudi Arabia, the prevalence of diabetes among children varies from one region to another (Al-Herbish, et al., 2008, pp. 1285-1288). Studies have indicated that age is a very important factor in the severity of the disease before being admitted to hospital (Al-Fifi, 2010, pp. 87-90). Diabetic treatment regimens strive to maintain a metabolic control to levels that are as near as possible to the normal levels. Metabolism determines the glycosylated hemoglobin assay (HbA1c) – a measure of blood glucose level (O’Donohue, 2009, p. 86; Al-Agha, Ocheltree & Hakeem, 2011, pp. 202-207). Research indicates that there has been an increasing trend of the disease among children in Saudi Arabia (Abduljabbar, et al., 2010, pp. 413-418). Of course diabetes among children affects the parents greatly (Felimban & Salih, 2000, pp. 63-68).

Methodology

Method Chosen

This research study will employ a quantitative methodology. Quantitative research method is logical and focused in its approach to acquire and analyze data concerning any given subject of study. The quantitative research methodology was chosen due to its numerous advantages. They include specificity in the statement of the research problem. It is also clear and precise in the description of the variables being investigated. In addition, this methodology is quite reliable and has limited subjectivity. It is also is good for longitudinal studies thus enabling future studies to be compared with the results of other studies.

Participants

This study intends to target families and adolescents who are capable of speaking and reading Arabic. It will include every 8 year old to 19 year old who has been diagnosed with type 1 diabetes mellitus and is due for a scheduled follow up in Eastern Saudi Arabia during the next eight months.

Sampling frame

The sample for this study will be drawn from Saudi Arabia. The sample will be drawn from records at the medical registry. Family members and parents will be invited through the mail for an interview before the actual scheduled consultation. Notably, the cohort in this current research is characteristic of Saudi children and adolescents diagnosed with diabetes. However, this will be evaluated by assessing demographic and medical characteristics in relation to the Saudi Arabian medical registry. It is assumed that almost 95% of all diagnosed cases of diabetes among children and adolescents are accurately documented and registered in the registry.

The type of data analysis needed

DISABKIDS

DISABKIDS is a chronic generic module (DCGM-37) which is a list of questions that evaluate the general HRQOL and the extent of distress brought about by a chronic illness, and can be complemented with condition-specific components for arthritis, asthma, cystic fibrosis, cerebral palsy, epilepsy, and diabetes (Bullinger, Schmidt & Petersen, 2002). The contraptions include a questionnaire to be filled out by the respondents aged 8 to 18, and a questionnaire to be filled out by their guardians and/or parents. The study will apply a recall system of four weeks for all items apart from item 11. Item 11 concerns symptoms and will be recalled after a duration of one year. This duration is determined by the specific module for diabetes.

The DCGM-37 questionnaire concerns 37 areas, and surveys six aspects of HRQOL (Petersen, Schmidt, Power & Bullinger, 2005). These aspects include mental independence, which evaluates if the child feels self-assured about the future and is capable of living an independent life without deficiencies as a result of the condition. Another aspect is the mental emotion which deals with emotional responses such as concerns, anger, worries and problems, which may result from the child’s condition. In addition, there is social inclusion, which concentrates on positive sociocultural interactions and comprehension of others. And then there is social exclusion which refers to the sense of being left out and slurred. The other aspect is the physical limitation which deals with somatic limitations resulting from the condition. Physical treatment helps evaluate the effect of applying medication and the use of injections to cure the disease. The individual item is scored on a five-point Likert scale showing the frequency of conduct or feelings as 1=never, 2=seldom, 3=quite often, 4=very often, and 5=always (Frøisland et al. 2012). There is a clear indication that the manual has a reverse version of the item scale which has been worded negatively. When computing the total scores of the system, replacement is done for the missing values with the item means (Frøisland et al. 2012). This is applied only if there is just one item missing from the domain. There are no scores on a domain when the items missing exceed one item (Frøisland et al. 2012). The total score is obtained by getting the sum of scores of all single items. The final scores are computed using the raw scores. The raw scores have a range of 0-100. The highest scores show that HRQOL is highly perceived.

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The Diabetic Specific Instrument (DSI) has the component scale of the impact and treatment. The impact scale shows the emotional behavior for the regulation of blood glucose. In addition, it also indicates a reaction to follow diets on a daily basis. The treatment scale shows the emotional response concerning the management of plans, as well as hauling of the equipment. DDM’s 10 items are evaluated on a five-point scale, and a score of 0 to 100 is computed for each sub scale (Schmidt, 2006). DCGM-37 as well as DDM-10 were translated into Arabic (Schmidt, 2006). The translation is aimed at maintaining the meaning of the questionnaires and to help identify the suitable items in Arabic. The DISABKIDS research group authorized the final version of the domain.

Standard guides should be provided to the health centers involved. Recently, presentations on HRQOL outcomes have been condemned for being inconceivable in relation to medical relevance (Leplège & Hunt, 1997). Osobo et al. (2006) imply that the outcomes of HRQOL should have a meaning when using negative domains. This shows that mental emotion exists within the inner strength. Limitations on physical aspects limit physical ability and exclusion to equality in the society (Chaplin et al. 2009).

Child health questionnaire

Form-87 is filled with children and adolescents. On the other hand, their guardians will fill the child health questionnaire parent form-50 (CHQ-PF-50). Respondents aged 10 and above are required to fill the questionnaire individually, while for those under the age of 10, questions are to be read to them (Raat, et al, 2002).

In general, health is evaluated from different dimensions including self-esteem, mental health, parent impact time, behavior during family activities, family cohesion, emotional and behavioral functioning, bodily pain, and social-physical functioning. The outcomes are supposed to be recorded on a 4 to 6 point Likert scale. The outcomes within each domain are totalled, and the raw figures are changed to a score ranging from 0 and 100, with the highest values illustrating good functional health and social welfare. Research has indicated that the features of the psychometric for the CHQ-CF87 as well as the CHQ-PF50 have the implication that internal uniformity is strong. They also indicate that the domain has construct validity as well as content validity. Various translations have been made into Arabic, and tools have been already put into use in various studies carried out on Saudi Arabian cohorts (Vederhus, et al, 2010).

Four weeks apply to all grades except when there are changes to the cohesion in health and family in the previous year. The questionnaires are to be filled by the cooperating health institutions when the respondents make their follow-up visits. As required for CHQ-87, health care professionals are supposed to be on call to explain the questions to children below the age of 9, if and when required to do so. The adolescent/child and their guardian should fill the form separate from each other.

Clinical characteristics

The evaluation of HbA1c is done after the completion of the first batch of questionnaires. The Bayer DCA 2000 is used to complete the exercise. It is not possible to analyze the results if the ketoacidosis is reported to be low. There is a similar case when the hypoglycemia is applied. In such a scenario, it is not possible to analyze the outcomes of the HRQOL using the clinical guidelines provided.

Ethical considerations

The parents, children, and adolescents need to give their consent to participate in the study. The consent should be put down in writing. This is essential because it will safeguard the research team and health institutions from possible litigation by respondents in the event of an injury or fatality. Approval also has to be obtained from the respective government authorities that regulate the medical sector.

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Statistical analysis

The floor and ceiling outcomes will be reported in the number of respondents with HQRL results of 0 and 100 respectively, with 0 representing the floor. Any percentage beyond and above 25% will be considered as very high. When instruments are put into use for group level evaluation, the Cronbach alpha coefficients beyond 0.07 are widely viewed as acceptable (Fayers & Machin, 2007). The upper and lower limits are not fixed. They are subject to discussion, although some authors hold that values ranging from 0.2 and 0.4 are sufficient. However, some theorists argue that when the correlation of the inter-mean values is slightly higher than 0.70, this might imply that the system is redundant (Ponteretto & Ruckdeschel, 2007).

An assessment is conducted to identify how the DISABKIDS questionnaires are convergent or divergent in terms of authenticity. The assessment is done on DCGM-37 and DDM-10 relative to the generic questionnaires CHQ-CF87 and CHQ-PF50. This exercise will ensure that the use of Pearson Correlation is modified for the variables of age and gender. Any correlation coefficient level exceeding 0.5 is high, while any coefficient which ranges from 0.3 and 0.5 should be regarded as a moderate convergence, and values are not to be regarded as having any correlation if they are below 0.3 (Fayers & Machin, 2007). Multiple regression analysis will be applied to evaluate the DISABKIDS bias validity. This will be done with regard to the variables gender, age, duration of diabetes, metabolic controls, and the method of insulin delivery. The significance is to be described by p<0.05. Analysis will be done using the SPSS 18th version (SPSS IBM< NY< USA).

Timeline for the research

This research will be conducted over a period of twelve months. The research will be divided into four main stages. These stages will focus on certain aspects of the research process. Each of these stages will take up a period of three months.

Stage one: first to third month

  • Recruitment of a sample population. This will include children from the age of 8 to 19.
  • Finalize legal agreements with the participating health institutions.
  • Orientation of research staff who are to participate in the research process.
  • Establishment of a research head office, where all research activities will be coordinated.
  • Schedule first interviews.

Stage two: fourth to sixth month

  • Conduct first interviews and schedule follow-up visits.
  • Collection of data from respondents.
  • Run preliminary checks on the validity of the collected data.

Stage three: seventh to ninth month

  • Carry out analysis on the collected data.
  • Conduct follow-up interviews and second data collection.
  • Release a preliminary report based on the current data collected.

Stage four: tenth to twelfth month

  • Carry out final data analysis comparing the initial data to the second data collected from the follow-up interviews.
  • Release a report based on the final data collected.
  • Draft and publish the research findings.

Stakeholder and community participation

Diabetes occurs in two forms: type 1 and type 2 diabetes mellitus. Type 1 diabetes mellitus (T1DM) refers to a deficiency of insulin in the body. On the other hand, type 2 diabetes mellitus (T2DM) occurs due to the body’s inability to respond effectively to insulin in the blood. T1DM is most common among children. The main causes of diabetes are usually a combination of various environmental and genetic factors (Deiner, 2012, p. 372).

To address the diabetics menace among Saudi children, various stakeholders should be involved in this research. In this case, different parties and the community at large shall be involved in the study. The research will incorporate the administrative authorities from the various government departments to ensure that the student achieves its objective. Since the study is aimed at addressing the challenge presented by diabetes among the young, government authorities ought to be cooperative in enhancing health practices.

In addition, the community will be incorporated to ensure that they directly benefit from the findings of the study. Parents and guardians will be asked to allow their children to participate in the research. In this case, they will be allowed to participate in a study that aims at helping the community resolve a disease that is menacing the country.

Importance of the research

This study aims to fill a gap in knowledge based on the prevalence of type 1 diabetes among Saudi children and adolescents. From previous studies conducted on diabetes, it is clear that limited attention has been given to the prevalence of type 1 diabetes among Saudi children. Reliable data from the Middle East region on diabetes in children and adolescents are at best scanty. Therefore, research would be essential for acquiring a better picture of the prevalence of type 1 diabetes in relation to global trends.

This research also seeks to improve the general standards of living through identification of causative agents and formulation of a treatment course for diabetes. It seeks to educate and sensitize parents, guardians, and children on the proper management and treatment of type 1 diabetes. Of course, the main goal of treating children with diabetes is to achieve normal growth and development. This will ensure that children do not miss out on their education by having to spend precious time in hospital for treatment of the disease. The community at large should be engaged in the development of measures aimed at curbing diabetes among children.

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Diabetes has become the principal health care challenge of the new millennium. This challenge is far more significant in the Middle East compared to other regions of the world. The Middle East is currently afflicted by one of the highest per capita rates. Therefore, individuals from this region are bound to suffer remarkable social and economic consequences unless strategies are implemented to curb the onset and development of the disease. This is critical for this study as it aims to establish the reasons for the uneven prevalence of diabetes in Saudi Arabia and the Middle East for that matter. The research will also expound on the various ways of curbing the diabetic issue among Saudi children. Therefore, it will seek to address various issues presented by and related to the country’s diabetic problem. This means drawing up proposals for the government on how to reduce the level of diabetes in the country. These proposals will include applying policies to be adopted by the government in the effort to curb the spread of the disease. The proposals will help the government implement appropriate policies to curb the problem. Measures will also be provided to help the government to avoid the occurrence of such a scenario in the future.

Reference List

Abduljabbar, MA, et al 2010, “Incidence trends of childhood type 1 diabetes in Eastern Saudi Arabia,” Saudi Medical Journal, vol. 31, no. 4, pp. 413-418.

Al-Agha, A, Ocheltree, A & Hakeem, A 2011, “Metabolic control in children and adolescents with insulin-dependent diabetes mellitus at King Abdul-Aziz University Hospital,” Journal of Clinical Research in American Endocrinology, vol. 3, no. 4, pp. 202-207.

Al-Fifi, SH 2010, “The relation of age to the severity of type I diabetes in children,” Journal of Family & Community Medicine, vol. 17, no. 2, pp. 87-90.

Al-Herbish, AS, et al 2008, “Prevalence of type 1 diabetes mellitus in Saudi Arabian children and adolescents,” Saudi Medical Journal, vol. 29, no. 9, pp. 1285-1288.

Al-Nozha, MM, et al 2004, “Diabetes mellitus in Saudi Arabia,” Saudi Medical Journal, vol. 25, no. 11, pp. 1603-1610.

Bullinger, M, Schmidt, S & Petersen, C 2002, “Assessing quality of life of children with chronic health conditions and disabilities: A European approach,” International Journal of Rehabilitation Research, vol. 25, no. 1, pp. 197-206.

Chaplin JE, et al. 2009, “Assessment of childhood diabetes-related quality-of-life in West Sweden,” Acta Paediatrica, vol. 98, no. 2, pp. 361-366.

Deiner, P 2012, Inclusive early childhood education: Development, resources, and practice, Cengage Learning, Belmont, CA.

Fayers, PM & Machin, D 2007, Quality of Life. The assessment, analysis and interpretation of patient-reported outcomes, John Wiley: West Sussex, NJ.

Felimban, M & Salih M 2000, “Stress in mothers of diabetic children in Riyadh city, Saudi Arabia,” Journal of Family and Community Medicine, vol. 7, no. 1, p. 63.

Frøisland, DH et al 2012, ‘ Reliability and validity of the Norwegian child and parent versions of the DISABKIDS Chronic Generic Module (DCGM-37) and Diabetes-Specific Module (DSM-10) ‘, Health and Quality Life Outcomes, vol. 10, no. 19, pp. 1-11.

Leplège, A & Hunt, S 1997, “The Problem of Quality of Life in Medicine,” JAMA: The Journal of the American Medical Association, vol. 278, no. 1, pp. 47-50.

O’Donohue, WT 2009, Behavioral Approaches to Chronic Disease in Adolescence: A Guide to Integrative Care, Springer Verlag, New York.

Petersen, C, Schmidt, S, Power, M & Bullinger, M 2005, “Development and pilot-testing of a health-related quality of life chronic generic module for children and adolescents with chronic health conditions: A European perspective,” Quality of Life Research, vol. 14, no. 1, pp. 1065-1077.

Ponteretto, JG & Ruckdeschel, DE 2007, “An overview of Coefficient Alpha and a reliability matrix for estimating the adequacy of internal consistency coefficients with psychological research measures,” Perceptual and Motor Skills, vol. 105, no. 4, pp. 997-1014.

Raat, H, et al 2002, “Reliability and validity of the child health questionnaire-child form (CHQ-CF87) in a Dutch adolescent population,” Quality of Life Research, vol. 11, no. 5, pp. 575-581.

Salman, H, Abanamy, A, Ghassan, B & Khalil, M 1991, “Childhood diabetes in Saudi Arabia” Diabetic Medicine, vol. 8, no. 2, pp. 176-178.

Schmidt, S 2006, The DISABKIDS group. The DISABKIDS Questionnaires: Quality of life Questionnaires for children with chronic conditions. Handbook Lengerich, Pabst Science Publishers, New York.

Vederhus, B, et al 2010, “Health related quality of life after extremely preterm birth: a matched controlled cohort study,” Health and Quality of Life Outcomes, vol. 8, no. 3, p. 53.

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