Type I Diabetes Research

Type I diabetes, also known as juvenile-onset diabetes is a chronic disease whose prevalence is increasing throughout the world. It is most often diagnosed in children, adolescents, or young adults.

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In type I diabetes, beta cells produce little or no insulin. The exact cause of type I diabetes is unknown. Most likely it is an autoimmune disorder. This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type I diabetes, an infection or another trigger causes the body mistakenly attack the cells in the pancreas that make insulin. Type I diabetes can be passed down through families.

Type I diabetes requires continuing medical care and ongoing patient self-management education and support prevent acute complications and to reduce the risk of long-term complications.

Individuals with diabetes generally have increased risk of attracting various chronic health problems. Diabetes is the leading cardiovascular disease, kidney failure, lower limb amputation and blindness cause. Maintenance of blood pressure, blood glucose level, as well as cholesterol levels closer to the normal level may aid in preventing or delaying complication of diabetes. Also other studies of women with diabetes showed reproductive abnormalities such as delayed menarche and increased incidence of menstrual cycle irregularities and delayed ovulation. With the refinement of insulin therapy, improved fertility might be expected. The presence of type 1 diabetes in pregnant women has been associated with adverse effects on the fetal outcomes of pregnancy, such as congenital malformations. An increased risk of congenital malformations among diabetic women has been reported.

The knowledge of female teenagers and their mothers about the management of Type I diabetes is very important, and need to be stressed on despite the many constrains. Inadequate knowledge is responsible for significant barriers to proper management of diabetes. In essence, Type I diabetes is one of the lifelong conditions which invade childrens lives, as well as that of their parents. Management of which normally imposes huge responsibilities on both, the teenagers and their parents. During adolescence, management of diabetes is usually challenging for girls. During this period, various psychological, cognitive, and physical changes occur. It leads to this group of people exhibiting neurotic tendencies, emotional instability, in addition to, maladjustments to circumstances and environment. Most specifically, over dependence on the parents, immature or confused sexual identification, creative impulses, restricted instinctive drives, distorted self-perceptions and excessive oral pre-occupation have been said to be a crucial psychological hardship of juvenile diabetes.

Several studies found that mothers who have more knowledge have teenagers with even better metabolic control. The mothers knowledge and the influence of the family might enhance the glycemic control, ultimately decreasing chronic and acute complications of diabetes in the adolescence.

Moreover, much research had been carried out on the relationship between compliance and information. Knowledge on the ailment as well as its treatment is crucial for a patients compliance, although information on its own is not adequate to encourage required behavioral change for management of the disease.

Increase in patient understanding of participation and improvement in diabetes management is linked to much better parental handling with their teenagers diabetes. On the other hand, a majority of families who had school aged teenagers were in position of managing diabetes better, although the burden that was placed on parents may aggravate symptoms of depression. Caring for such children could be accompanied by crucial consequences. Yet, studies on interaction of parent-adolescent in managing the disease showed that the interaction is associated with devotion to treatment and management of diabetes.

The pediatric nurse, as a member of the health care team, has a unique role in self-management of diabetic children. She has to educate the children to the best of their ability in understanding their condition in such a way that they know enough about their management and self-care in order to change their life style (14).

Problem Statement:

Diabetes mellitus (DM) is one of the most common metabolic disorders in the Kingdom of Saudi Arabia (KSA). According to some national epidemiological studies, the prevalence of diabetes mellitus is increasing yearly among adolescents in KSA (4). In the southern region, the prevalence of DM ranged from 3.8-10.8% (17). Also, many of the female teenagers and their mothers are not aware of the severity of the complications that can happen such as; infertility problems, cardiovascular diseases, blindness, and other health problems in addition to death (7).

In Abha City, inspite of the fact that diabetes mellitus is increasing every year there is no research found that assess the knowledge of female teenagers and their mothers about Type I diabetes management.

In this light, Type I diabetes require persistent medical care, and more importantly, continuing patient support and management education in order to prevent severe complications, while at the same time decreasing long term complication risk (15). It is for this reason that knowledge of female teenagers and their mothers about diabetic management in Abha city is needed as seen in this paper to help them manage the diabetic condition appropriately with decreased incidence of complications.

Aims of the Study:

This study aims to:

Determine the demographic characteristics of the respondents in terms of age, socio-economic status, medical, surgical, menstrual history and complications.

Determine the level of knowledge of Saudi female teenagers and their mothers regarding diabetic self care management.

Compare the level of knowledge of daughters and their mothers regarding the management of Type I diabetes.

Find the association between the knowledge level and demographic characteristics.

Research Questions:

The research questions of this study will include the following:

What is the level of knowledge of the Saudi diabetic female teenagers regarding the management of Type I diabetes in Abha City?

What is the level of knowledge of the mothers of diabetic teenage females regarding type I diabetes in Abha City?

Is there any gap of knowledge between the teenagers and their mothers?

What is the association between the level of knowledge of teenagers and their mothers and selected variables?

Material & Method:

Setting:

The study will be conducted in one of the largest governmental hospitals and the only diabetic center in the city; Aseer Central Hospital, which gives free medical services to people of all ages. The diabetic center in this hospital work 5 days/week, offering its services to around 3200 type I diabetic children per year.

Research Design:

A descriptive, cross-sectional design survey will be used in this study

Subjects:

A non-probability, convenience sample of diabetic Saudi female teenagers (300) and their mothers (300); which is nearly 10% of the total number of diabetic teenagers visiting the hospital per year.

The following criteria will compromise the sample for this study:

Saudi female teenagers who have type I diabetes and their mothers

Between 13 and 19 years of age

Teenagers who are willing to participate in the study

The exclusion criteria will be; teenagers who have chronic diseases and those who may not be in a position of completing the questionnaire for any reason.

Ethical Consideration:

The patient and her mother will be given information about the study and those who accept to participate will be included and informed about the aim and potential benefits of the study, and their consent and confidentiality will be ensured.

Instrument:

The data will be collected through a questionnaire. A two sheet questionnaire will be prepared by the researcher after reviewing the literature and consulting the experts. It consists of 3 parts; the first includes questions about socio-demographic characteristics, the second parts questions are related to medical, surgical, gynecological and menstrual history. The third part of the questionnaire aims to assess the knowledge of the diabetic teenager. The questionnaire will be developed from a modified Diabetes Knowledge Test (DKT), diabetes self-management questionnaire and thedacare diabetes education questionnaire.

For the mothers, the same questionnaire will be used with some modifications in the language of the statement.

Each correct answer will earn a score of 1 and the total score will be summed and converted into a percentage, 100% being the maximum score.

Data Collection:

The data will cover a period of nearly three months

Official permission for conducting the study at Asseer hospital will be obtained from the hospitals Director of Medical Affairs. Data collection will begin following the hospitals approval.

Each mother and daughter will be interviewed by the investigator, and they will be assured that all information gathered will be confidential.

Data Analysis:

Data will be analyzed and entered in the personal computer utilizing SPSS 17.0 (Statistical Package for Social Science). The following statistically analyses will be performed:

Characteristic descriptive analysis, which include frequency, percentage, means, and standard deviation

Correlation coefficient to test for significance relationship difference between the teenagers knowledge and their mothers level of knowledge.

Result:

Is dealing with the analytical aspects of data, the finding of this study will be presented in three parts:

Part I: characteristics of diabetic teenagers and their mothers

Part II: level of knowledge regarding diabetic management for both subjects

Part III: correlation between the level of knowledge of the mother and her daughter and socio-economic statues, medical, surgical, menstrual history, and complication.

CHAPTER II: THE LITERATURE REVIEW

PREVALENCE

A 2011 report from the US Centers for Disease Control and Prevention (CDC) estimated that approximately 1 million Americans have type 1 DM. The CDC estimated that each year from 2002 to 2005, type 1 DM was newly diagnosed in 15,600 young people. Among children younger than 10 years, the annual rate of new cases was 19.7 per 100,000 populations; among those 10 years or older, the rate was 18.6 per 100,000 populations. Type 1 DM is the most common metabolic disease of childhood. About 1 in every 400-600 children and adolescents has type 1 DM. WHO projects that diabetes will be the 7th leading cause of death in 2030.

Internationally, rates of type 1 DM are increasing. In Europe, the Middle East, and Australia, rates of type 1 DM are increasing by 2-5% per year.[42] The prevalence of type 1 DM is highest in Scandinavia (i.e., approximately 20% of the total number of people with DM) and lowest in China and Japan (i.e., fewer than 1% of all people with diabetes).

In the case of Saudi Arabia, the incidence rate of type 1 diabetes for its adolescent and children is 109.5/100,000.

History of diabetes

Diabetes was first described more than 3,500 years ago in ancient Egypt as very abundant urine. A report from Turkey some 2,000 years ago describes the extreme thirst and profuse urination of people with diabetes. Although the sweetness of the urine had been mentioned in earlier reports, it was not until 200 years ago that Chevreul in England developed a specific test to measure the concentration of sugar in the urine and provide the positive proof of glycosuria. Later in the nineteenth century, the Frenchman Bouchardat published a work o...