Literature Review
Conferring to the American Diabetes Association (2010), diabetes mellitus was collective to a category of illness rooting from dysfunction of the system of the glucoregulatory. The chief consequence of the dysregulation is the hyperglycemia. Severe hyperglycemia in diabetes is linked to continuous complications entailing injury on the flesh and structure failure that can depreciate life prospect and result in mortality. According to the approximation by The International Diabetes Federation by 2017, the number of individuals affected by diabetes was 425 globally of whom, 4 million were pronounced passed in the same year. Those statistics are anticipated to upsurge intensely in the future, resulting in a rise in the load on the wellbeing system. In each category of diabetes, appropriate analysis, training of long-suffering in self- administration, and constant therapeutic supervision are necessities to curb severe difficulties such as ketoacidosis and reduce the risk of extensive lasting problems, e.g. diabetic foot, nephropathy, stroke or cardiovascular disease.
Contreras and Vehi (2018) claim that in the top of medication, management of diabetes desires devotion to a series of self-care actions which are frequently very tiresome for patients; counting calorie intake, keenly arranging meals, observing BG levels, exercising, and, regulating actions daily. The effects of non-compliance may take a year to establish. Therefore, diabetes therapy is multifaceted besides satisfying decisions require to take into consideration varied features and lifestyle-associated practices which need be enhanced to progress the quality of life of a diabetic patient.
Analysis
Below is analysis of the interview conducted-on Dr. Jamila Al-Thahoori, a consultant Internal Medicine at department of medical services in Abu Dhabi Police. Either Diabetes is an undecorated, long-lasting illness that occurs when the pancreas does not generate sufficient insulin- a hormone that controls sugar of blood or glucose or when the body cannot properly utilize the insulin it makes (Diabetes, 2006). According to Dr. Jamila and the survey that has been conducted, the rate of type 2 diabetes in the UAE is amongst the leading in the world with some reports place it at in the top five. Internationally, 6.4% of the populace of age between 20 and 79 have diabetes. In the UAE, more than double the total has diabetes- nearly 13%.
Why Diabetes?Diabetes has become an essential public health challenge, one of the primacy non- communicable disease (NCDs) aimed for deed by leaders of the world. In cooperation with the reports figure and the predominance of diabetes have been gradually accumulative in the previous few years. Incidence of diabetes occurrence is appreciating. No longer is an epidemic of dominantly wealthy nations, the occurrence of diabetes increasingly all over the place, most evidently in the world’s center- wage nations. Unluckily, in multiple backgrounds, the need of compelling approaches to develop helpful situations for solid ways of life and need to urge exceptional well-being care implies that the hindrance and management of polygenic disorder, majorly for individuals of meek implies, are not being pursued. If the illness is abandoned, it has an ominous outcome for health and wellbeing.
Further, the interviewee claims that, diabetes and its impediments affect severely on the finance of persons, their families and the nation’s economy. Individuals who rely on insulin, pay the critical price when getting a reasonable priced insulin is missing. To handle this advancing wellbeing burden, since prior to ten years, world pioneers have perpetrated to minimizing the burden of this disorder jointly of four priority non-communicable illness (NCDs). A segment of the 2030 objective for Maintanable Imporvement, Associate State have established an inspiring aim to minimize early death caused by NCDs- comprising diabetes- by attaining global health treatment and offering access to inexpensive crucial medicine- all by 2030 (Bommer et al. 2018). Numerous tasks are at hand of scholars. Therefore, this diabetes report will contribute to an understanding of diabetes, its cause, and implications. Above all, it offers knowledge of inclinations in diabetes occurrence, of the furnishing of high sugar level to early death and of what measures directorates are taking to curb and control diabetes.
Why Diabetes is an important Issue?
According to the WHO report that was released on 2016 (Roglic, 2016) in 2014, worldwide, an approximate 422 million grownups were living with diabetes as compared to a total of 108 million in 1980. The global incidence (age-standardized) of diabetes has roughly doubled since 1980. Elevating from 4.7% to 8.5% in the adult populace. This mirrors an upsurge in connected risk aspects such as being overweight or obese. Over the past decade, diabetes resulted in 1.5 million mortality in 2012. Heighten than- ideal blood glucose led to an extra death of 2.2 million, by heightening the dangers of cardiovascular and other illness. 43% of these 3.7 million passing happen sometimes recently the age of 70 years. The number of mortality inferable to high blood glucose or diabetes which happens before age 70 is higher in middle and low-income nations than in top- income countries. Since refined research facilities tests are often needed to differentiate between type 2 diabetes where the body cannot correctly utilize the insulin it generates and type 1 diabetes that needs insulin injection for survival. Individual global approximation of diabetes occurrences for type 1 and type 2 is not present. A huge number of an individual with diabetes is influenced by type 2 diabetes. This happened closely amongst adults but now happens in children too. Al-Thahoori, points out that sharp intensifications are predicted within the next couple of years in both the occurrence and cost of diabetes in the UAE. The impact on the health system will be noteworthy if a measure is not taken.
Causes of Diabetes
Dr. Jamila Al-Thahoori explained that diabetes originates when the body is not able to generate adequate insulin, or cannot utilize it, accordingly, leading to excess glucose in the blood. Change in peoples’ behavior and lifestyle over the last decade has led to a rapid increase in the occurrence of diabetes globally. The prevalent is primary of type 2 diabetes, and also the connected conditions called metabolic syndrome and diabesity (Tao, Shi, & Zhao, 2015). The most important contributions to or causes of type diabetes in UAE are poor diet and lack of exercise. Obesity is the primary cause of diabetes. The doctor recommended that eating less fried food, fat, and sugar, in top of exercising for thirty minutes five times weekly can reduce and likely curb the onset of type 2 diabetes Together with genetic vulnerability, majorly in a particular ethnic group, type 2 diabetes is a product of environmental and behavioral aspects such as sedimentary lifestyle, excessively rich nutrition and obesity. The prevention of diabetes and management of its micro- and macrovascular difficulties will desire a combined, global method to lead in substantial lessening in the substantial premature morbidity and mortality is desired.
Other Risk Factor
Smoking
According to the assessment conducted by the doctor in Abu Dhabi Police medical services, smoking is linked to a higher risk of type 2 diabetes in UAE. Besides, it elevates the risk of other health conditions such as cancer and heart attack.
Effects of Diabetes at an individual Level
Economic Impact
Diabetes and its consequences led to significant financial loss to an individual, but also their relatives (Mohan, & Pradeepa, 2017). Individuals with detected diabetes spend curative expenses of $17,000 per year, of which about $10,000 is accredited to diabetes. This was seconded by the interviewee who suggests that individuals with detected diabetes, on standard, have medical payments almost 3 times greater than what expenses would be in the nonexistence of diabetes. Central cost stimulators are hospitals and casualty care; a subsidizing element is an upsurge in cost for correspondent insulin that is progressively recommended regardless minimum evidence which they offer weighty benefits over inexpensive human insulin.
Health Impact
Diabetes of all types can result in difficulties in several parts of the body and heighten the general danger of premature death. Likely difficulties comprise of kidney failure, nerve damage, heart attack, and vision loss and leg confiscation. When improper manages during pregnancy, diabetes escalates the danger of loss of fetal and other difficulties
National Level
According to the analysis that was conducted in 2011, claims Dr. Jamila, the total cost of diabetes in the UAE was about $ 6.6 million or 1.8 per cent of GCP, higher than in any other GCC countries. Direct diabetes treatment was almost 40% of the nation's general health care expense. The approximated annual costs caused by diabetes in the UAE was predicted to upsurge to about $1.04 billion by 2020. The UAE’s per capita health care spending was rated as the second highest compared to the GCC region rank of 5% by 2014. An upsurge in diabetes will potentially elevate the demand for highly skilled medical services. Currently, the UAE government is responsible for nearly 70 per cent of expenditures on health care services.
Global Level
The International Diabetes Federation approximates that at least 9% of adults -382 million individuals have diabetes and the number of individuals with this illness will elevate above 592 million in less than 25 years. These figures suggest that the worldwide expenses of diabetes and its impediments are substantial and significantly they will increase by 2030. As much as nations attain global aims, the international financial burden will not depreciate. Law executers are required to act immediate action to address health and social safety structure to alleviate the outcome of diabetes.
Government Response
Dr. Jamila argued that the UAE government has taken two- long term measures to address the diabetes threat. One of the prevention measures is the government initiative to hike rate on cigarettes and energy drink by 100% and sugar-sweetened beverages by 50% (Razzak ET AL. 2017). The government is also pushing towards regulating marketing on fast food and executing healthy canteens and upsurge physical activity in schools.
Secondly, the increased revenues from tobacco will be dedicated to reinforcing the country’s second approach to diabetes care- detecting those at risk like Salem and facilitate access to treatment for those working and living in the UAE.
Recommendations
Individual level
The doctor advises that the best measure for diabetes is prevention (Schaper et al. 2015). One of prevention measure at a personal level is through lifestyle interventions which stress diet and exercise that directly addresses the primary risk factors of obesity and inactivity.
National Level
Preventing the UAE’s epidemic of diabetes must constitute collaboration between the health agencies, non- profitable organizations and the private sector. Dr. Jamila stresses that to come up with a particle program, the program should comprise of:
• Public education concerning diabetes and its risk factors
• Early exposure through screening
• Deterrence/interruption of onset through lifestyle adjustment
• Support for management of chronic disease to evade impediments
Global level
As per the view of Dr. Jamila Al- Thahoori, the way forward should start with researching and adapting what has worked in another part of the world to scheme and execute culturally suitable programs for diabetes preventions and control in the world. The advantages will be pursued not only in public health but also in economic sectors by diminishing the burden of the disease in the population and lowering its consequence at communities and national level of different nations and their healthcare system as a whole.
References
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care, 33(Supplement 1), S62-S69. Retrieved from: https://doi.org/10.2337/dc10-S062
Bommer, C., Sagalova, V., Heesemann, E., Manne-Goehler, J., Atun, R., Bärnighausen, T. … & Vollmer, S. (2018). Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care, 41(5), 963-970. Retrieved from: https://doi.org/10.2337/dc17-1962
Contreras, I., & Vehi, J. (2018). Artificial intelligence for diabetes management and decision support: literature review. Journal of medical Internet research, 20(5), e10775.
https://www.jmir.org/2018/5/e10775/
Diabetes, U. K. (2006). What is diabetes? Accessed March 21. Retrieved from: http://ucla-dev-web01.reliam.com/publications/Documents/PDF/2014
Mohan, V., & Pradeepa, R. (2017). The Global Burden of Diabetes and Its Vascular Complications. In Mechanisms of Vascular Defects in Diabetes Mellitus (pp. 3-23). Springer, Cham. Retrieved from: https://link.springer.com/chapter/10.1007/978-3-319-60324-7_1
Razzak, H. A., El-Metwally, A., Harbi, A., Al-Shujairi, A., & Qawas, A. (2017). The prevalence and risk factors of obesity in the United Arab Emirates. Saudi Journal of Obesity, 5(2), 57. Retrieved from: http://www.saudijobesity.com/article.asp?issn=2347-2618
Roglic, G. (2016). WHO Global report on diabetes: A summary. International Journal of Noncommunicable Diseases, 1(1), 3.
Schaper, N. C., Van Netten, J. J., Apelqvist, J., Lipsky, B. A., Bakker, K., & International Working Group on the Diabetic Foot (IWGDF). (2016). Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes/metabolism research and reviews, 32, 7-15. Retrieved from: https://doi.org/10.1002/dmrr.2695
Tao, Z., Shi, A., & Zhao, J. (2015). Epidemiological perspectives of diabetes. Cell biochemistry and biophysics, 73(1), 181-185.Retrieved from: https://link.springer.com/article/10.1007/s12013-015-0598-4
Appendix I: Research Questionnaire to Health workers
This survey is planning to assemble common research date on the Variable Impacting Administration and Control of Diabetes mellitus in the United Arab Emirates.
For each section, kindly respond to all items by using a tick (√) within the fitting box or type in answers within the space provided. If it is not too much trouble, do not compose your name on the survey. Kindly react to all question items truly. Your reaaction will be kept private confidential. Your help and participation will be profoundly appreciated.
Section 1: STATISTIC CHARACTERISTICS OF RESPONDENTS
1. What is your gender?
A. Male [ ]
B. Female [ ]
2. Which age bracket do you belong (Tick whichever appropriate)
Below 24 Years [ ] 25 – 30 Years [ ]
31 – 34 years [ ] 35 – 40 years [ ]
41 – 44 years [ ] 45 – 50 years [ ]
Over- 51 years [ ]
3. What is your most elevated level of education? (Tick as applicable)
Diploma [ ]
Bachelors [ ]
Masters [ ]
PHD [ ]
4. What is your job title/ designation (Specify your professional category)?
………………………………………………………………………………..
5. For how long have you worked in the United Arab Emirates? (Please tick appropriate age bracket)
A. 1-6 months [ ]
B. 7-12 months [ ]
C. 2-3 years [ ]
D. 4-5 years [ ]
E. Over five years [ ]
SECTION 2: PROFESSIONALISM OF HEALTH WORKERS
1. Does United Arab Emirates clinics conduct diabetes education to patients?
A. Yes [ ]
B. No [ ]
2. How many patients do you train in one session?
………………………………………………………………………………………………………
SECTION 3: MEDICAL FACILITIES AND INFRASTRUCTURE
1. Do you routinely administer blood sugar level tests to all patients?
A. Yes [ ]
B. No [ ]
If no why, please explain briefly?
………………………………………………………………………………………………………
Who gives the education /counselling?
A. Trained counselors [ ]
B. Nurses [ ]
C. Consultant physicians [ ]
D. Nutritionist [ ]
2 How often do you administer ophthalmological checkups on the patients?
A. Every time they come for follow up visits [ ]
B. At least once a year [ ]
C. At least once in three years [ ]
D. At least once in five years [ ]
3. Do you have the following screening equipment? (PLEASE TICK ON YES OR NO) A. Sphygmomanometers for blood pressure measurement
Yes [ ] No [ ]
B. Electrocardiographs for measuring heartbeat
Yes [ ] No [ ]
C. Enzyme-linked immunosorbent assay (ELISA)
Yes [ ] No [ ]
D. Spectrophotometers determining glucose concentration in urine
Yes [ ] No [ ]
E. Glucometer for assessing blood sugar levels.
Yes [ ] No [ ]
4. Do you use teaching aids during the diabetes education /counselling session?
A. Yes [ ]
B. No [ ]
5. How many observational beds does the clinic have? Please indicate
……………………………………………………………………………………………………
6. Do you give diabetes drugs for free or does the patient purchase them?
A. Given for free [ ]
B. Are Purchased [ ]
7. How many consultation rooms does diabetes clinic have? Please indicate
………………………………………………………………………………………………
8. How many counselling/ education rooms does the clinic have?
………………………………………………………………………………………………
9. What is the number of health workers working at the diabetes outpatient clinic?
………………………………………………………………………………………………
SECTION 4: NETWORKING AND PARTNERSHIP LINKAGES
1. Is the clinic affiliated to any diabetes management organisation?
A. Yes [ ]
B. No [ ]
2. Do you have joint capacity building and refresher training courses?
A. Yes [ ]
B. No [ ]
3. If yes how often do you hold the training?
A. After every three months [ ]
B. After every six months [ ]
C. Once a year [ ]
4. How does the diabetes clinic source for the patient's drugs?
A. Purchase from the pharmaceutical companies [ ]
B. Supplied by the Ministry of Health [ ]
C. Donated by collaborating charitable organisations [ ]
5. To what degree do you concur with the following explanations? Please tick next to the suitable column in the table underneath;
Strongly Disagree Not Sure Agree Strongly
disagree Agree
Joint capacity building and training 1 2 3 4 5
influences administration and control of
diabetes
Provision and supply of subsidized 1 2 3 4 5
Drugs and screening equipment
enhances administration and control of
diabetes
Sharing of research findings and 1 2 3 4 5
expertise amongst health practitioners
influences
Support in development and expansion 1 2 3 4 5
of wellbeing facilities and infrastructure
through partnership
SECTION 5: ADMINISTRATION AND CONTROL OF DIABETES MELLITUS IN WELLBEING FACILITIES
1) Tick the range of group that you train in one session?
A. All new patients [ ]
B. Follow up patients [ ]
C. Care givers [ ]
D. All the above [ ]
2) Based on the diabetes education you offer has the prevalence of diabetes-related complication decreased?
A. Yes [ ]
B. No [ ]
If yes kindly indicate by what percentage? ………………………………………………………………….
If no what is the number of early detection cases recorded per week?
……………………………………………………………………………
3) What are the challenges you experience during service delivery? Kindly enlist the challenges.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Thank you for your cooperation
Appendix II: PATIENTS’ QUESTIONNAIRE
This survey is expected to accumulate common inquire about data on the Variables Affecting Management and Control of Diabetes mellitus in Health Projects. The study has five segments. For each area, please react to all items by using a tick (√) within the suitable box or write within the space given. Please DO NOT write your name on the questionnaire. Please react to all question items truly. Your reaction will be kept entirely private. Your help and participation will be exceedingly acknowledged.
SECTION 1: STATISTICS DATA OF RESPONDENTS
1. Please indicate your Gender.
A. Male [ ]
B. Female [ ]
2. Please indicate your age.
Below 24 Years [ ] 25 – 30 Years [ ]
31 – 34 years [ ] 35 – 40 years [ ]
41 – 44 years [ ] 45 – 50 years [ ]
Over- 51 years [ ]
3. What is your most noteworthy scholarly level?
A. College/university [ ]
B. Secondary [ ]
C. Primary [ ]
D. Non-Formal [ ]
SECTION B. PROFESSIONALISM OF HEALTH WORKERS
1) Had you ever heard of diabetes mellitus before you were diagnosed?
A. Yes [ ] B. No [ ]
2) What do you think causes diabetes Mellitus? (Please Tick one)…
A. Eating too much sugary foods [ ]
B. The pancreas does not create sufficient insulin for the body [ ]
C. Taking too much alcohol [ ]
3) For how long did you experience these complications before seeking medical advice?
A. More than 12 months [ ]
B. Between 4 to 12 months [ ]
C. 1-3 months [ ]
D. Less than a month [ ]
4) Do you discuss your disease condition with your doctor?
If yes please state the issues you discuss with the doctor
………………………………………………………………………………………
If no kindly state why you don’t discuss with her/him
………………………………………………………………………………………………
SECTION C: MEDICAL FACILITIES AND INFRASTRUCTURE
1. Do you go for a routine therapeutic checkup?
Yes [ ] No [ ]
2. If yes how regularly do you go?
A. At least once a year [ ]
B. At least once in three years [ ]
C. At least once in five years [ ]
D. At least once in more than five years [ ]
3. Do you routinely undergo urine tests?
Yes [ ] No [ ]
4. How often do you undergo eye checkup?
A. After every six months [ ]
B. Annually [ ]
C. Occasionally [ ]
5. What drugs do you use for treating your condition (Diabetes Mellitus)?
A. Oral tablets [ ]
B. Insulin Injections
[ ]
C. Herbal
[ ]
6. How do you get your medicines?
A. Purchase from the pharmacy [ ]
B. Given freely at the hospital [ ]
C. Donated by charitable organizations [ ]
Thank you for your cooperation
