Assessment Of Knowledge About the Symptoms of Type 1 Diabetes Mellitus (Dm 1) Among Elementary School and High School Teachers in Cascavel – Pr

Type 1 Diabetes Mellitus (DM1) is the most common chronic disease in childhood. After the diagnosis of the disease, the child faces serious changes in the daily routine, such as multiple applications doses of insulin, self-monitoring of blood glucose and care with food and physical activity. The school routine must be adapted in order to provide conditions for blood glucose monitoring and education professionals trained to intervene in cases of hypoglycemia and hyperglycemia, making the school environment safe for the child. The objective of this study was to evaluate the knowledge about this pathology among elementary and high school teachers. This research was carried out through a form, with objective questions about DM1, 35 educators accepted to participate in the study and were included in the research, both from public and private schools. According to the research results, DM1 is a topic that still generates many doubts in education professionals and, as it is a frequent disease in the children and adolescents’ population, the lack of knowledge about it is highly relevant for the safety of diabetic students in the school environment, being It is of fundamental importance to train educators on this pathology. 

Type 1 Diabetes Mellitus (DM1), a common metabolic syndrome characterized by a constant increase in blood glucose, is the most frequent endocrine-metabolic disease in childhood and adolescence. This pathology affects more than 15 million individuals worldwide, data from centers specializing in the disease estimate that 30,000 new cases occur each year in the United States (KLIEGMAN, STANTON, et al., 2014).

According to Williams (2011), the incidence of DM1 is increasing worldwide, manifesting itself particularly in children under 5 years of age. After the diagnosis of the disease, the child faces serious changes in lifestyle, with daily need for insulin injections, self-monitoring of blood glucose, attention to a special diet and physical exercises.

This pathology affects the whole family's life, the appearance of feelings of anxiety and guilt are often manifested in parents. The complex developmental transformations, the psychological burden of the disease and problems of acceptance of the condition contribute to poor metabolic control, which implies the early appearance of complications resulting from inadequate management of the disease (KLIEGMAN, STANTON, et al., 2014).

The special needs of the patient must also be met in the school environment. The diabetic child is able to normally attend educational institutions, with no physical limitations for participating in student activities and socializing with other students. However, it is extremely important for patient safety to receive individualized specialized care by a trained professional from the educational institution who has knowledge about the routines of control and monitoring of blood glucose.

The objective of this study was to evaluate the qualification and quantification of educators' knowledge about diabetes and their experiences with students with DM1.

As it is research carried out with human beings, the pre-project was submitted for approval by the Ethics Committee in Research on Human Beings of the Centro Universitário FAG, being approved under the number CAAE 42662421.4.0000.5219. The Free and Informed Consent Term was sent, via e-mail, attached to the form for all participants. Those who, upon accepting the terms, explained in detail, proceeded to fill out the form.

This was a quantitative/qualitative, cross-sectional descriptive study. The sample used consisted of teachers, from elementary to high school in the city of Cascavel-PR. This survey was conducted online, by the “Google Forms” platform, from March, 3rd, 2021 to March, 7th, 2021. Forms were sent to all educators from municipal and private schools, totaling 35 teachers who agreed to participate in the research by answering the attached questionnaire. Descriptive statistics such as absolute frequency, relative frequency (percentage) and graphic representations were used for the collected responses. All statistics were developed in R software (R CORE TEAM, 2020).

The form was prepared by the authors, containing 14 objective questions, the first two questions identified which school system (public or private) and grade in which the teacher taught. Followed by four questions regarding general concepts about diabetes and nutrition, each question presented four alternatives with only one correct answer. In sequence, four other questions related to emergency situations, hypoglycemia, hyperglycemia, also presenting four alternatives with only one correct. The four final questions consisted of alternatives to indicate yes or no, about the teacher's perspectives in relation to diabetic students and their experiences with them.

In this research, 57.14% of the teachers taught at the Elementary level, 20.00% at the Middle level and 22.86% at both; of which the majority were from the public school system (55%, 50% and 87.71% respectively). This result can be seen in Figure 1 and Table 1.

In general, among those surveyed, most had contact with diabetic students (65.71%) and believed that these students require special care (91.43%). However, not everyone feels prepared to handle complications with a student with DM1 (57.14%) and the vast majority of participants (97.14%) believed it was necessary to increase their knowledge about diabetes (Table 1). The proportion of returns for these statements was similar between professionals from the public and private schools, indicating that they all need more knowledge on the subject.

Table 1: Characterization of the sample according to the school system.

Source: Prepared by the authors (2021)

When asked about more technical information about the pathology in question, the percentage of correct answers in the questions varied between the education systems (Table 2). Professionals from the public network were the ones who answered the least questions regarding DM1 (correct rate per question between 42.86% and 95.24%). Among the professionals in the private school system, everyone knew that: a diet prepared by a nutritionist is a fundamental part of the treatment; in patients with DM1, there is a lack of insulin production by the pancreas; when glucose is increased in the blood it is called hyperglycemia; and that the symptom that is not related to hypoglycemia is pain in the feet. However, not everyone knew that childhood diabetes mellitus (type 1) occurs due to a decrease in the production and levels of insulin in the blood, which causes accumulation of glucose (sugar) in the blood (81.82%). Among professionals in the public network, this knowledge was better disseminated (95.24% knew).

Table 2: Number of professionals who correctly indicated the technical issues related to DM1.

Source: Prepared by the authors (2021)

Also observe, in Figure 2, that the number of correct questions among professionals in the private network varied between 6 and 8. In the public institution, there was a professional who only got 1 question right; while the others got it right between 6 and 8. When analyzing the professionals who worked in both networks, the number of correct answers ranged from 5 to 8 questions. It is worth mentioning that as the questionnaire was developed online, the correct answers to the questions may not reflect the participant's prior knowledge, given that they could have performed some type of consultation/research on the web.

Figure 2: Boxplot graph referring to the number of correct questions by each teacher according to the type of school system.

Source: Prepared by the authors (2021)

The results of this study demonstrate that, regarding the definition of DM1, the teachers had no difficulty in characterizing the disease as an increase in blood glucose and a decrease in insulin production, with question No. 1 of the questionnaire being 91.43% correct.

Question No. 2 addressed the importance of diet in the treatment of DM1, with 97.1% of correct answers demonstrating a good understanding of the relationship between diet and DM1 control. Corroborating this, the results of a study carried out with employees of 4 public schools in Natal-RN in 2017, also found that: “When asked what care is, 86% (n=43) answered correctly or partially correct, mentioning care with food and regular physical activity” (GARCIA, ARAÚJO, et al., 2017).

Regarding the etiology of DM1, 54.29% of the teachers were aware of the participation of the immune system in the pathophysiology of the disease (question No. 3). This attests to the lack of clarity regarding the origin of the pathology. However, 91.4% of the teachers correctly answered question No. 4, proving their knowledge about the decrease in insulin production in the pancreas, and this information is fundamental for understanding the disease. According to Camargo (2020), the knowledge of this information is based on common sense, so teachers have difficulty in defining DM1, but they are able to relate it to the term insulin.

“Such information allows us to believe in knowledge based on common sense regarding the definition of diabetes in a broad context, in which people acquire knowledge, sometimes incomplete and/or scientifically unfounded information that can lead to mistaken attitudes about the management with the disease. DM1 student” (CAMARGO and CARVALHO, 2020)

Regarding the management of complications with a diabetic student, most teachers did not consider themselves capable of handling such a situation (57.14%). For Garcia (2017), the lack of training generates insecurity for the teacher responsible for the student with diabetes, not feeling able to intervene and provide adequate care.

The question addressing the knowledge of the term hyperglycemia resulted in 94.29% of correct answers, certifying a good knowledge of the terminology related to high blood glucose levels. Fundamental concept to understand the main alteration caused by DM1.

To ensure the safety of diabetic students in the school environment, the recognition of symptoms of hypoglycemia and hyperglycemia by teachers is essential for the management of acute complications of this pathology, hypoglycemia if not recognized and treated immediately can put the diabetic individual at risk of life. Being recognized, according to the description of the Ministry of Health (MINISTÉRIO DA SAÚDE, 2006), as cited by Camargo (2017), as: “Evidenced by sweating, tremors, headache, weakness and mental confusion, among others, hypoglycemia can be triggered by excess insulin administration, low carbohydrate intake or excessive physical activity.

In the study, the inquiry about symptoms related to hypoglycemia and hyperglycemia showed that only 74.29% of the teachers were aware of the symptoms of hypoglycemia and 80

According to the research results, DM1 is a topic that still raises many doubts among education professionals and, as it is a frequent disease in the child and adolescent population, the lack of knowledge about it is highly relevant for the safety of diabetic students in the school environment.  The low adherence of educators to participate in the study may reflect their insecurity on the subject and hindered a more consistent analysis of the study carried out.

School plays a crucial role in a child's life, making it a safe and inclusive space for diabetic children is still a challenge to be faced. The training of education professionals on this topic plays a key role in the best strategy to improve teachers' understanding of the disease and thus provide special care for students with DM1.