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Introductions
Diabetes is a chronic disease that is genetically inherited or attributed by the individuals lifestyle, such as smoking, lack of exercise or unhealthy food choices. This happens when the body fails to produce insufficient insulin or not produce insulin, for metabolic purposes. The disease results increase mortality and morbidity rate, resulting in the lost of limbs from amputation, loss of vision, hypertension, kidney damage, heart damage, nerve damage, cardiovascular disease, skin and mouth conditions. Symptoms associated with diabetes, are excessive thirst and appetite, unusual weight loss or weight gain, fatigue, increase urination, blurred vision, dry mouth, slow healing of cuts and sores, itchy skin nausea, and yeast infections for both men and women. Diabetes affects people of all geographical locations; an estimated 220 million people are affected with the disease worldwide. Diabetes type 2 accounts for 180 million, whilst diabetes type 1, accounts for 40 million. Diabetes posses a significant threat to society, so worldwide programs has been implemented to reduce the early onset of mortality and morbidity rates due to diabetes complications. Similar program was also implemented in Saint Lucia by the Ministry of Health to combat this disease.

Problem identified

Problem statement
Do the diabetic clients at the Babonneau health center have sufficient knowledge and understanding of the program?

Purpose of evaluation
The purpose of the study is to evaluate whether the diabetic clients at the Babonneau center gained sufficient knowledge and understanding of the program.

Literature Review
Diabetes type 2 is of a growing concern for public health officials here in Saint Lucia and the rest of the world. According to world health organization (WHO) an estimated 220 million people worldwide have been diagnose with diabetes and 180 million with type 2 (2011). In 2004, an estimated 3.4 million people die from consequences to high blood pressure, relating to diabetes. The World Health Organization estimated that between 2005 to 2030 the number of diabetes cases will double.

The world health organization and the international Diabetes Federation are working together to support and to manage diabetes complications and to ensure the best quality of life possible for people with diabetes worldwide(WHO 2004) said Dr Robert Beaglehole and Professor, Pierre Lefebvre, of the World Health Organization International Diabetes

Federation. A key aim of the program is to achieve a substantial increase in global awareness about diabetes complication and its prevention.

The world is facing a growing diabetes epidemic. Its impact will be felt most severely in developing countries, so people need to be educated on how to prevent type 2diabetes. The National Institute of health-funded a study presented at the American Diabetes Association aimed to determine if changes in school feeding programs, such as lowering fatty foods and adding fruits and vegetables, adding longer and more intense physical education classes and enhancing classroom activities aimed at promoting behavioral changes would help lower the risk of diabetes type two. The study shows that a school-based program can help lower obesity and certain risk factors for type 2 diabetes in youth that are at high risk for the disease," said Griffin Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases.

The diabetic Association of Zimbabwe estimates that around 400, 000 people in the country have the disease but are not aware of it. The pharmacies and all major hospitals sometimes do not have the medicine owing largely to lack of foreign currency. Many diabetics in Zimbabwe are battling to raise money to buy essential drugs and nutritious foods, Harare, Zimbabwe (Dec 14 2006). Chief K. Masimba Biriwasha said that it is very important to educate the Zimbabwean community that diabetes is not all about the intake of sugar as most Zimbabweans might think and it is possible to prevent the disease-type 2.

The International Diabetes Federations life for a child program, also known as HOPE worldwide was established in 2001 with support from Australian Diabetes Council. It is an innovation and sustainable support program in which individuals and their families and organizations contribute monetary or in kind. The purpose of the donation is to help support and contribute to the health of children with diabetes in developing countries. HOPE (life for a child), supports a combination of 33 children and adolescents in Zimbabwe in 2007. The program aims to provide approximately one hundred insulin for children and adolescents whom have been identified by the Zimbabwean association, in partnership with insulin for life countries worldwide. The program meets the childrens immediate needs (insulin, monitoring and education), builds local capacity and lobbies governments to establish sustainable solutions. The program also provides education materials for children and their families so they can understand what diabetes is and how to live a healthy and full life with diabetes. However, lack of insulin remains the most common cause of death in a child with diabetes(Gale, 2006) The estimated life expectancy of a child with diabetes could be less than a year in some areas( Beran et al, 2005). Frequently, diabetes educators in hospitals report meeting severe organizational barriers when attempting to implement advance in diabetes patient education, a research done by The Diabetes Educator. Many of the barriers are centered on two issues, acquiring the needed resources and communicating about the program to a variety of key groups.

Diabetes mellitus is one of the most prevalent and serious diseases, it presents a high burden for individuals and society. This burden is related to health care cost and cost as a

result of loss of productivity from premature death and disability, such as the loss of limbs resulting from amputations. Medical expenditure for people with diabetes is 2-3 times higher than those not affected by diabetes. The annual cost for diabetes and its complication in the US, was estimated at, US$0.8 billions (type 1 diabetes), and US$10.1(type 2 diabetes. The US government along with a program called Hope for Diabetes Prevention, is urging its citizens to get tested for pre-diabetes, this means that persons are tested before the onset of diabetes type 2. This program is aimed at helping those individuals make changes in their diets and includes physical activities in their daily lives to prevent the possibility of diabetes type 2. The diabetes prevention program was a major multicentre clinical research study aimed at discovering whether modest weight lost through dietary changes and physical activities or treatment with oral diabetes drug, metformin (Glucophage) - an oral medication that lowers the blood sugar. This however can prevent or delay the onset of type 2 diabetes. In the beginning the participants were all overweight with normal blood glucose but not high enough for a diagnosis of diabetes. In the study participants from 27 clinical centers around the United States were randomly divided into different treatments groups. The first group called lifestyle intervention groups, received intensive training diets, physical activities and behavior modifications. They were encouraged to eat less fatty foods with less calories and exercise were specify for 150 minutes weekly. The aim was to lose 7 percent of their body weight and maintain what they have lost. The second group took 850 mg of metformin twice a day. The third group received placebo pills instead of metformin. The second and third group also received information about their diet and exercise, but no intensive motivational counseling. All participants in the

group were overweight and had pre-diabetes- a known risk for developing diabetes type 2. DPPs results indicate that millions of high risk people can delay or avoid developing diabetes type 2, by losing weight, regular physical activities and low fat diets. The DPP also suggested that metformin can help delay the onset of diabetes.

Participants in the lifestyle intervention group who received intensive individual counseling and motivational support on effective diet, exercise, and behavior modification. They reduced their risk of developing diabetes by 58 percent. This finding was true across all participating ethnic groups and for both men and women. Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71 percent. About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent of those in the placebo group. Participants taking metformin reduced their risk of developing diabetes by 31 percent. Metformin was effective for both men and women, but it was least effective in people aged 45 and older. Metformin was most effective in people 25 to 44 years old and in those with a body mass index of 35 or higher, meaning they were at least 60 pounds overweight. About 7.8 percent of the metformin group developed diabetes each year during the study, compared with 11 percent of the group receiving the placebo.

Diabetes is the leading cause of death in Saint Lucia, concluded a research undertaken under the Universal Health Care program (UHC). According to, Dr. Michael Graven, Clinical

Urologist and Statistical Analyst from Canada state that the prevalence of diabetes in Saint the Ministry of Health in collaboration with other non-governmental organizations, such as, The Saint Lucia Diabetic and Hypertension Association (SLDHA) has implemented various public health intervention programs to reduce the rate of diabetes within the population as a whole. Thursday Lucia is a public Health disaster; with the majority of infected cases are women, reported March 25, 2010 SLDHA launched a national registry for diabetes and hypertension cases in Saint Lucia. The view is that it will be used as a gateway to diffused statistics on the prevalence of diabetes via Caribbean Net (2007). In response to the high incidence rate of diabetes in Saint. Lucia, amongst other things on the Island. George Eugene, executive director of the Saint Lucia Diabetic Hypertension Association stated that the registry will serve as a tool for the development of other program.

Diabetes type 2 is an apparent worldwide problem, various international (WHO), regional, local non-governmental organizations are partnering with governments to form a taskforce on finding solutions to reduce the prevalence of diabetes. One, such solution to this chronic disease is to improve peoples knowledge and understanding on how to prevent the disease. The, US a developed country has many advantages unlike developing countries, like Zimbabwe and Saint Lucia. The US implements different strategies to reduce on the number of Diabetic cases and for those who have the disease ways to control it. Saint Lucia like the US has implemented programs to reduce on the number of people that are affected by the disease and ways to remain healthy with the disease. Zimbabwean on the other hand is at the lower end of the scale, although some individuals are benefiting from programs

such as HOPE. However, there are still many barriers that exist, one of which is the poor economic status of the country and the other Zimbabweans still of the belief that diabetes is resulted from excess sugar.

Methodology Ethical Approval

The Ministry of Health Saint Lucia and the ethics committee received a letter provided by Monroe College, requesting permission for an interview with the diabetic clients and nursing supervisor at the Babonneau health center region 2 .

Study design:
The study was cross- sectional. The clients was conveniently chosen and given questionnaires to complete.

Period:
The data was collected from May 24 to July 27 2011.

Site:
The study was conducted at the Babonneau Health Center-region 2

Study Population:
The sample included 20 diabetic clients.

Sample:
Clients will be sampled conveniently and questionnaires will be administered.

Inclusion criteria:
1. Clients with diabetes type 1 and diabetes type 2 2. Clients using the diabetic program 3. Clients 18 years and over 4. Male and female clients

Exclusion Criteria:
1. Clients with gestational diabetes 2. Clients below the age of 18 3. Clients with hypertension 4. Clients who use other facilities

Data collection:
Data for the research was collected by questionnaires that will be presented to the diabetic clients. Data will also be collected from vital statistic report from the Statistic Department. The questionnaires and the interview will be analyzed and tabled.

Data Analyzed:
The data was analyzed using Microsoft Office Excel.

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Definition A program: is a plan of action to achieve something. Knowledge: having clear awareness or explicit information about something. Understanding: means to have the ability to perceive and explain the meaning or the nature of something. Metabolism: refers to the way our bodies use digested food for energy and growth. Diabetes 1: is when the body does not produce insulin or produces little insulin. Diabetes 2: when the body does not produces enough insulin or becomes resistant to the effect of insulin.

Results Discussions Limitations

There was in- sufficient time to conduct a satisfactory survey.

Clients had in-sufficient time to trust me, this may resulted in dishonesty

Some clients had difficulty understanding the questions ask

Some clients did not want to take part in the study

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Recommendations
There should be a re-evaluation of the program

Conclusion
Based on the evaluation of the clients knowledge and understanding of the diabetes program, it appears that most clients have again sufficient knowledge of the program. The results stated that some of the clients are not motivated to improve their health and some are financial capable.

Limitations
There was insufficient time to conduct a satisfactory survey. Clients had in-sufficient time to trust me, this may resulted in dishonesty Some clients had difficulty understanding the questions ask Some clients did not want to take part in the study

Recommendations
Additional research should be conducted throughout all health centers on the island The clients knowledge at the Babonneau health center should be re- evaluated. There should be continuous re-evaluation of clients round the island

12 There should be closer monitoring of the clients There should be more information disseminated to the public Emphasis should be placed on the diabetics family, rather than just the diabetic client Other support groups should be formed for the diabetic clients

References
care.diabetesjournals.org (n.d.) American diabetes association, Retrieved on May, 31, 2011, http://care.diabetesjournals.org/content/24/6/1001.short

dshs.state.tx.us (n.d.) Texas department of state health and services, Retrieved on May, 30, 2011, http://www.dshs.state.tx.us/diabetes/patient.shtm Life for a child.idf.org (n.d.) Life for a child, Retrieved on May, 30, 2011 from http://www.lifeforachild.idf.org/en/pages/zimbabwe

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highbeam.com, (n.d.) High Beam research, retrieved on May, 31, 2011 from http://www.highbeam.com/doc/1G1-164112199.html

PAHO.org (n.d.) Project, Retrieved on May, 20, 2011 from http://www.paho.org/Project.asp?SEL=TP&LNG=ENG&CD=GNNCD

st.lucia.gov.lc (2010) Diabetic and hypertensive association launches national registry, Retrieved on May, 31, 2011 from http://www.stlucia.gov.lc/pr2010/march/diabetic_and_hypertensive_association_launc hes_national_registry.htm tde.sagepub.com (n.d.) The diabetes educator, Retrieved on May 31, 2011 from http://tde.sagepub.com/content/18/6/501.short Tsiko, S., Diabetes in Africa, Retrieved on May, 20, 2011 from http://www.gibbsmagazine.com/Diabetes%20in%20Africa.htm usatoday.com, (2010) Nuvigil, Retrieved on May, 30, 2011 http://www.usatoday.com/news/health/2010-06-28middleschooldiabetes27_ST_N.htm

WHO, (2011) Fact sheet N312 Diabetes, Retrieved on May, 30, 2011 from http://www.who.int/entity/mediacentre/factsheets/fs312/en/ - 30k WHO, (2004) Diabetes action now, retrieved on May, 30, 2011 from http://www.who.int/diabetes/actionnow/en/DANbooklet.pdf

Conclusion