Volume 5(4); August

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Osong Public Health Res Perspect > Volume 5(4); 2014
Lemes dos Santos, dos Santos, Ferrari, Fonseca, and Ferrari: Knowledge of Diabetes Mellitus: Does Gender Make a Difference?

Abstract

Objective

Diabetes mellitus (DM) is a chronic disease considered an important public health problem. In recent years, its prevalence has been exponentially rising in many developing countries. Chronic complications of DM are important causes of morbidity and mortality among patients, which impair their health and quality of life. Knowledge on disease prevention, etiology, and management is essential to deal with parents, patients, and caregivers. The aim of this study was to evaluate the knowledge regarding DM in an adult population from a Middle-western Brazilian city.

Methods

This was a cross-sectional study covering 178 adults, aged 18–64 years, who answered a diabetes knowledge questionnaire. In order to identify the difference between groups, analysis of variance was used.

Results

Higher knowledge scores were found regarding the role of sugars on DM causality, diabetic foot care, and the effects of DM on patients (blindness, impaired wound healing, and male sexual dysfunction). However, lower scores were found amongst types of DM, hyperglycemic symptoms, and normal blood glucose levels. Females tended to achieve better knowledge scores than males.

Conclusion

Women had better knowledge regarding types of DM, normal blood glucose values, and consequences of hyperglycemia revealed that diabetes education should be improved.

Keywords

Amazon; diabetes mellitus; health education; women

Introduction

Prevalence of type 2 diabetes mellitus (DM) is increasing worldwide, especially among developing nations, and it has been estimated that by 2030, 366 million people will be affected by this disease, and two-thirds of which will be living in developing countries [1,2].
According to the American Diabetes Association, DM should be considered as a group of metabolic disorders characterized by a hyperglycemic state, as a result of chronic insulin resistance, which leads to pancreatic β cell dysfunction and subsequently a massive failure on insulin secretion. DM chronic hyperglycemia has been associated with long-term target-organ damage, dysfunction, and collapse especially among ophthalmologic, renal, neurologic, and cardiovascular systems [3].
It should be noted that type 2 DM is an independent risk factor for coronary artery disease, stroke, peripheral vascular disease, and congestive heart failure, and is the major cause of death for those patients [4–7].
Although the type 2 DM pathogenesis is still not fully elucidated, there are many contributing factors such as advanced age, familial history, and behavioral and environmental factors that develop a relevant role in disease prognosis and evolution [8–10].
In DM primary and secondary prevention strategies, the most important factors are population education and information, stronger information systems for patients, caregivers, and health professionals, as well as supportive environments for health promotion and disease prevention, healthy public policies, and adoption of structured healthy lifestyle intervention programs [11].
The aim of this study was to evaluate the diabetes knowledge of an adult population in the Araguaia region, Legal Amazon.

Materials and methods

2.1 Locality and population

The Bom Jardim de Goiás city is located in the northwest region of the Goias. Its territory is limited by Aragarças, Baliza, Montes Claros, and Piranhas municipalities, which are to the Goianian side of the Araguaia region, Legal Amazon [12].
This municipality is 185,073 km2 and its population is estimated to be 8,423 citizens with a very low demographic density (4.55/km2). This population includes Caucasian, Afrobrazilian, and indigenous people. Its geographic position is 16°12'36” latitude south and 52°10'19” longitude west, at an altitude of 318 m above sea level [12].
This cross-sectional study evaluated the knowledge of diabetes mellitus among 178 adults (age 18–64 years) from three family health units of Bom Jardim de Goiás, located at the Goias State in the Araguaian Valley, Amazônia Legal, Brazil. More detail regarding the studied population is presented in Table 1.

2.2 Evaluation of diabetes knowledge

To evaluate the knowledge of diabetes, a Portuguese version of the Star Country Diabetes Study's questionnaire was used [13]. The referred instrument has 24 items.

2.3 Ethical and statistical aspects

The volunteers signed an informed consent form prior to entering the study, which was approved by the Julio Müller University Hospital Ethics Committee on Research of the Federal University of Mato Grosso (protocol no. 668/CEP-HUJM/09).
Statistical analysis was done by the EpiTools program (Australian Centre for International Agricultural Research, Canberra, Australia). A variance analysis to compare two proportions was performed (ANOVA). Statistical significant differences were considered when p < 0.05.

Results

Among this population the majority of people was young or middle aged male gender, white Caucasian and Afrobrazilian, and were married with a low family income.
In general, the frequency of correct answers tended to be higher amongst women compared to men. However, statistical differences among gender were found only for three questions: the types of DM, hyperglycemic symptoms, and normal blood glucose levels.
Lower scores of correct answers were found regarding the relationship among DM and cancer, hyperglycemic symptoms, normal blood glucose, the beneficial effect of exercise on glycemia, and the increased risk of heart disease among DM patients. Further results are shown in Table 2.

Discussion

It is well established that educational level is positively associated with disease knowledge. An Indian study in a rural area of Chennai reported that the higher the age, socioeconomic, and educational levels, the higher the DM knowledge of the population [14]. In general, DM knowledge of a population has a positive association with an education degree [15–17]. In the same regard, the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study with 340,234 persons from eight European nations observed an inverse association between DM risk and educational degree [18].
In the current study, the majority of the population had only primary education and 7.5% were illiterate, which at least in part explains the degree of knowledge of DM.
Concerning the current study, 49.1% of men and 64.3% of women had correct answers regarding blood glycemic values and 52.3% reported that exercise can diminish blood sugar levels. A study by Al-Mahrooqi et al [19] of 541 high school children from Muscat, Oman, found that 45% of them knew the normal blood glycemic values and 60% of the students believe that exercise can decrease blood glycemic values.
One study covering 81 Brazilian patients revealed that only 31% knew that this disease can cause sexual dysfunction or kidney problems; only one third associated DM with circulatory disorders and 47.6% with blindness [16].
A Brazilian study in Ribeirão Preto, SP, Brazil with 82 diabetes mellitus patients reported that 78% of them had sufficient information regarding the disease [17]. Covering the general population the present study reported 57.6% of the population had knowledge regarding the disease.
In another Brazilian study in São Paulo, SP, the most affluent Brazilian metropolitan area, covering 357 DM patients of a public health state hospital 53.2% did not know their disease type [20]. In the same study, the lack of knowledge of DM comorbidities was 36.7% for heart disease, 30.5% for stroke, 18.8% for circulatory disorders, 17.1% for kidney disorders, and 98% for blindness.
In the current study, 85.4% of people known that an unhealthy diet is a risk factor for DM. This result is similar to that reported by a population-based study in Pelotas, RS, South Brazil [21]. In an Indian study in Agartala with 200 mothers, only 39.5% knew that an unhealthy diet has a causative role in DM [22].
Another report from Gujarat, India, regarding knowledge of DM among 238 patients the correct answers for diagnosis, hereditability, risk factors were 82.77%, 57.98%, and 17.64%, respectively [23]. Compared with the present study, the Gujarat population had higher knowledge regarding adequate diagnostic methods, whereas >85% knew the dietary risk factors.
Many studies conducted in very diverse populations have shown that girls and women performed better than boys and men regarding knowledge on DM [19,21,22,24,25]. The present study also confirmed that the female gender had higher DM knowledge scores than the males. Twenty years ago, an Ethiopian study did not observe significant gender differences on DM knowledge [26].
In respect of type 2 DM prevention and treatment, a recent population-based study covering 3450 participants aged from 15 years to 64 years in Mongolia observed interesting findings. Although the role of diet received 63.4% of adequate knowledge, only 26.9% and 20.1% of people knew that exercise and weight loss are key factors in prevention and treatment of type 2 DM [25].
In both primary and secondary prevention of DM, education and information are key factors for successful public health public policies [11].
In this respect Herman and Zimmet [27] emphasized that type 2 DM is a global epidemic pathology and school education about DM should receive priority especially among the most populated nations. It should also be emphasized that DM education is also essential in improving patients' attitudes, lifestyle changes and adequate therapy adhesion [28].
In conclusion, this population of an inner town of central–western Brazil lacked knowledge regarding some aspects of DM, especially men who had lower knowledge compared to the women.

Conflicts of interest

All contributing authors declare no conflicts of interest.

Notes

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1. Wild S., Roglic G., Green A.. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27(5):2004 May;1047−1053.
crossref
2. World Health Organization . Obesity and overweight. Fact sheet No. 311. 2012.

3. American Diabetes Association . Diagnosis and classification of diabetes mellitus. Diabetes Care 35(Suppl. 1):2012 Jan;S64−71.
crossref
4. Mortaz S., Wessman C., Duncan R.. Impact of screening and early detection of impaired fasting glucose tolerance and type 2 diabetes in Canada: a Markov model simulation. Clinicoecon Outcomes Res 4:2012;91−97.
pmid pmc
5. Kim T.H., Chun K.H., Kim H.J.. Direct medical costs for patients with type 2 diabetes and related complications: a prospective cohort study based on the Korean National Diabetes Program. J Korean Med Sci 27:2012;876−882.
crossref
6. Triches C., Schaan B.D., Gross J.L.. Macrovascular diabetic complications: clinical characteristics, diagnosis and management. Arq Bras Endocrinol Metab 53(6):2010 Aug;698−708. [In Portuguese, English abstract].

7. Naka K.K., Papathanassiou K., Bechlioulis A.. Determinants of vascular function in patients with type 2 diabetes. Cardiovasc Diabetol 12(11):2012 Oct;127.
crossref
8. Dedoussis G.V., Kaliora A.C., Panagiotakos D.B.. Genes, diet and type 2 diabetes mellitus: a review. Rev Diabet Stud 4(1):2007 Spring;13−24.
crossref
9. Alonso-Magdalena P., Quesada I., Nadal A.. Endocrine disruptors in the etiology of type 2 diabetes mellitus. Nature Rev Endocrinol 7(6):2011 Jun;346−353.
crossref
10. Yamakawa-Kobayashi K., Natsume M., Aoki S.. The combined effect of the T2DM susceptibility genes is an important risk factor for T2DM in non-obese Japanese: a population based case-control study. BMC Med Genet 24(13):2012 Feb;11.
crossref
11. Green L.W., Brancati F.L., Albright A.. Primary prevention strategies of type 2 diabetes: integrative public health and primary care opportunities, challenges and strategies. Fam Pract 29(Suppl. 1):2012 Apr;i13−i23.
crossref
12. Instituto Brasileiro de Geografia e Estatistica (IBGE) . IBGE cidades. 2014. Available from:. http://cidades.ibge.gov.br/xtras/home.php[accessed 14.4.14] [in Portuguese].

13. Garcia A.A., Villagomez E.T., Brown S.A.. The Starr County diabetes education study. Development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care 24(1):2001 Jan;16−21.
crossref
14. Rani P.K., Raman R., Subramani S.. Knowledge of diabetes and diabetic retinopathy among rural populations in India, and the influence of knowledge of diabetic retinopathy on attitude and practice. Rural Remote Health 8(3):2008 (Jul–Sep);838.

15. Kim S., Love F., Quistberg D.A.. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care 27(12):2004 Dec;2980−2982.
crossref
16. Pace A.E., Ochoa-Vigo Caliri M.H.L., Fernandes A.P.M.. Knowledge on diabetes mellitus in the self care process. Rev Latino-Am Enferm 14(5):2006. Available from:. http://www.scielo.br/pdf/rlae/v14n5/pt_v14n5a14.pdf[accessed 10.04.14] [In Portuguese, English abstract].
crossref
17. Rodrigues F.F.L., Zanetti M.L., Santos MA dos. Knowledge and attitude: important components in diabetes education. Rev Latino-Am Enferm 17(4):2009 Jul–Aug;468−473. [In Portuguese, English abstract].
crossref
18. Sacerdote C., Ricceri F., Rolandsson O.. Lower educational levels is a predictor of incident type 2 diabetes mellitus in European countries: the EPIC-Inter Act Study. Int J Epidemiol 41(4):2012;1162−1173.
crossref pmid
19. Al-Mahrooqi B., Al-Hadhrami R., Al-Amri A.. Self-reported knowledge of diabetes among high school students in Al-Amerat and Quriyat, Muscat Governate, Oman. Sultan Qaboos Med J 13(3):2013 Aug;392−398.
crossref
20. Dias A.F.G., Vieira M.F., Rezende M.P.. Epidemiologic profile and level of knowledge among diabetic patients about diabetes and diabetic retinopathy. Arq Bras Oftalmol 73(5):2010 Sep–Oct;414−418. [In Portuguese, English abstract].
crossref
21. Borges T.T., Rombaldi A.J., Knuth A.G.. Knowledge on risk factors for chronic diseases: a population-based study. Cad Saude Publica 25(7):2009 Jul;1511−1520. [In Portuguese, English abstract].
crossref
22. Majumder N., Majumder N., Datta S.S.. Knowledge and perception of mothers of under five children regarding etiology of type-II diabetes mellitus in Agartala, Tripura. Health Agenda 1(3):2013;64−70.

23. Shah V.N., Kamdar P.K., Shah N.. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. Int J Diabetes Dev Ctries 29(3):2009 Jul;118−122.
crossref
24. Johnson S.B., Pollak R.T., Silverstein J.H.. Cognitive and behavioral knowledge about insulin-dependent diabetes among children and parents. Pediatrics 69(6):1992 Jun;708−713.

25. Demaio A.R., Otgontuya D., Courten M de. Exploring knowledge, attitudes and practices related to diabetes in Mongolia: a national population-based survey. BMC Public Health 13:2013 Mar 18;236.
crossref
26. Bahru Y., Abdulkadir J.. Assessment of diabetes education in the teaching hospital, Addis Ababa, Ethiopia. Diabet Med 10(9):1993 Nov;870−873.
crossref
27. Herman W.H., Zimmet P.. Type 2 diabetes: an epidemic requiring global attention and urgent action. Diabetes Care 35(5):2012 May;943−944.
crossref
28. Guo X.H., Yuan L., Lou Q.Q.. A nationwide survey of diabetes education, self-management and glycemic control in patients with type 2 diabetes in China. Chin Med J 125(23):2012 Dec;4175−4180.

Table 1
Socioeconomic characteristics of a sample population from Bom Jardim de Goiás, Goiás, Brazil, 2013.
Variable Categories N %
Gender Female 70 39.32
Male 108 60.68
Ethnicity Afrobrazilian 77 43.26
Caucasian 94 52.81
Indigenous 7 3.93
Educational level Illiterate 11 7.43
Fundamental 97 54.49
High school 74 41.57
College 7 3.94
Marital status Single 49 27.53
Married 79 44.38
Divorced 16 8.99
Other 34 19.10
Age (y) 18–34 97 54.49
34–59 63 35.39
≥60 18 10.12
Family income (MS)a ≤1 87 48.87
≥1–2 41 23.03
>2 35 19.67
Not answered 15 8.43

a In National base salaries/month (US$296.00).

Table 2
Adequate knowledge (%) on diabetes mellitus (DM) of Bom Jardim de Goiás, Goiás, Brazil population, 2013.
Question Female (n, %) Male (n, %) Total (n, %)
Normal blood glucose values 45 64.28* 53 49.07 98 55.05
Glucose testing could be performed from a blood or urine sample 53 75.71 67 62.04 120 67.41
Thirsty, tiredness, and weakness means a higher blood sugar 38 54.28* 41 37.96 79 44.38
What is the effect of exercise on blood glucose of a DM patient? 42 60.00 51 47.22 93 52.25
DM causes heart problems 41 58.57 58 53.70 99 55.62
DM causes cancer 22 31.43 37 34.26 59 33.15
DM causes blindness 61 87.14 85 78.70 146 82.02
DM can cause renal failure 45 64.28 74 68.52 119 66.85
DM causes male sexual dysfunction 58 82.86 85 78.70 143 80.34
How many kinds of DM exist? 38 54.28* 38 35.18 76 42.70
Kidneys produce insulin 27 38.57 39 36.11 66 37.10
DM patients should carefully excise the toe nails 52 74.28 75 69.44 127 71.35
DM patients have slowing healing of wounds and bruises 64 91.43 92 85.18 156 87.64
DM induces poor circulation 48 68.57 73 67.60 121 68.00
Excessive dietary intake of sweets and candy can lead to DM 59 84.28 93 86.11 152 85.39

*p < 0.05.



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