Vol 44 # 4 December 2012 - Kma.org.kw

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Towards Prevention of Diabetes in Offsprings of Type 2 Diabetic Patients
December 2012
Table 5 shows significant predictors of giving
advice to offspring using stepwise forward likelihood
multiple logistic regression. The first step for
identifying the significant predictors was entering all
the independent variables to the model. In the second
step, all variables with 0.10 or less p- value were entered
into a stepwise forward likelihood multiple logistic
regression model. After adjusting for the confounding
factors, only four factors proved to be significantly
predicting advising offspring about diabetes. These
factors included recognizing the importance of giving
the advice as well as unbalanced diet as an etiological
factor of diabetes. Young age and not suffering from
diabetes complications proved to be significantly
associated with advising offspring after adjusting for
the confounding factors.
DISCUSSION
The growing diabetes pandemic that is spreading
all over the world necessitates more attention and
rapid effective programs to control its impact. A
wide spectrum of interventions to prevent diabetes
or delay its onset as well as control its complications
is available. The feasibility and effectiveness of these
interventions varies widely. Although communicating
the potential risks of diabetes and recognition of the
behavioral factors that may be closely linked to the
disease is the main responsibility of the primary health
care staff, parents can play an active role to educate
their children who are at higher risk for developing
type 2 diabetes [10] . Recent studies have illustrated the
potential for intervention in persons with impaired
glucose tolerance to reduce progression to type 2
diabetes. A study in the United States showed that
lifestyle intervention (diet and exercise) reduced the
risk of this progression by 58% [11] . Two other large-scale
studies from China [12] , and Finland [13] demonstrated
effects similar to the American study. In the Finnish
study, the cumulative incidence of diabetes after four
years was 11% in the intervention group and 23% in the
control group. During the trial, the risk of diabetes was
reduced by 58% (p < 0.001) in the intervention group,
and was directly associated with changes in lifestyle.
Proper risk perception of diabetic parents and
adopting a positive attitude toward prevention of
diabetes among their offspring can urge them to educate
their children and guide them to adopt a healthy
behavior. Thus, the current study was formulated to
investigate the factors that can stimulate parents to
advise their offsprings about diabetes prevention and
the factors affecting the giving of this advice. Several
studies were carried out in Kuwait to reveal knowledge
of diabetic patients about etiological risk factors and
management procedures to deal with the disease. One
study revealed that mean score for the total knowledge
test was 58.9% [14] . Knowledge deficits were apparent in
the questions related to diet and self-care.
One study carried out in Japan revealed that
diabetic disease status was related to giving advice.
Use of insulin or oral treatment and the presence
of complications were related to giving advice [7] .
However, the results of this study revealed that
patients with complications were less likely to advise
their children (OR = 0.15, 95% CI =0.08-0.28). The same
trend was noticed for family history as those with
positive family history were also less likely to advise
their children (OR = 0.39, 95% CI = 0.19-0.79). The
absence of complications might be due to adopting
effective techniques and behavior that might stimulate
them to advise their children to adopt these successful
lifestyles. Also, a negative family history which means
that the diabetic parent is the only person in the family
with diabetes might make them feel that they have a
greater responsibility toward advising their children.
Delaying the onset of type 2 diabetes depends
essentially on implementing successful lifestyle
intervention strategies [15] . Cognitive and behavioral
strategies have been used to reduce weight through
dietary restriction and increased physical activity [16] .
However, to be able to implement these healthy
behaviors; diabetic patients must first recognize
the importance as well as the role of these factors in
preventing diabetes. However, the association between
risk perception and behavior has been inconsistent;
while some studies revealed a positive association
between risk perception and health behaviors [17] , other
studies failed to demonstrate this association [18] . This
might be attributed to the poorly specified relationship
between behavior and risk perception. Also, other
factors may affect relationship such as knowledge of
diabetes factors, perceived personal control, or the
degree to which one believes that risk is modified by
one’s action, and optimistic bias, or one’s assessment
of their risk compared with others like them [19] .
One finding about risk perception revealed by this
study is the very low recognition of the probability
of children to develop type 2 diabetes in presence of
positive family history when compared with negative
history. Similar findings were revealed by a Korean
study among offspring of diabetic parents where only
9.9% of the study children could correctly perceive
their risk of developing diabetes [20] .
Multiple logistic regression revealed that young
age, not experiencing complication related to diabetes,
and recognizing the importance of the role of healthy
behavior in preventing diabetes development as well
as specifically recognizing the role of unbalanced
diet are significant predictors for advising children.
In Japan, a similar study dealing with passing of
advice to children revealed that being male, living
with offspring, hospitalizations related to diabetes,
suffering from complications, risk perception, and