Profile of Diabetic Omani Pilgrims to Makkah

The annual pilgrimage to Makkah (Mecca), Hajj, is stressful, especially for diabetics, elderly, and others with chronic illnesses. For the past three years an average of five diabetic Omani Hajjees (DOH) developed serious complications and could not complete their religious pilgrimage. To identify diabetic complications and to assess the needs of the Omani diabetics during Hajj (DOH), the Field Epidemiology Training Program established a special diabetes clinic for Omani Hajjees in Mina. We ascertained socio-demographic characteristics and knowledge about complications of diabetes from all DOH attending the clinic. We tested their random blood sugar (RBS).

Of 10,800 Omanis who performed Hajj in 1996, 169 Hajjees with diabetes mellitus visited the clinic(Table). Of DOH, (98%) were medically examined in Oman before their departure for Hajj. Four percent were insulin dependent (IDDM), 7% practiced dietary control, and 89% required oral hypoglycemic agents. All Hajjees with IDDM and 96% on oral hypoglycemics brought their medicines with them, 2.4% of DOH had RBS <75 mg/dL, 14% 75-110 mg/dL, and 49% were hyperglycemic (RBS > 200 mg/dL). About half of the DOH (48%) knew the clinical presentation of hyperglycemia, a forth (24%) about symptoms of hypoglycemia. Only 9.5% were trained to test themselves for blood sugar. DOH moved between Holy places (four journeys; five to 15 Km long) on foot (40%), by car or bus (31%), or both (29%). Only one DOH wore protective shoes, 70% did not have identification wristbands that showed their diabetic status and treatment regimen. Four per cent suffered from heat exhaustion, 3% had cut wounds, 1.2% had pneumonia, and 2% developed diabetic coma.

An estimated 100,000-150,000 diabetics perform Hajj every year. During the period between 1992 and 1995, diabetic coma accounted for 0.7-2.1% of all deaths that occur during Hajj [1]. Diabetes mellitus is a known risk factor for other illnesses that require hospitalization e.g., chest infections.

Although only 2% of DOH were hypoglycemic, this should be seriously considered because the consequences of hypoglycemia, worsened by physical exhaustion during Hajj, could be profound including coma and seizures. Hypoglycemia affects motor and cognitive functions; a diabetic person with hypoglycemia may even forget to treat hypoglycemia with carbohydrates [2]. It is relatively difficult for diabetics Hajjees to adhere to their dietary regimen before Hajj, and they may alter their foods or miss some meals altogether. Hypoglycemia can occur during sleep without warning symptoms. It is disturbing that only one fourth of DOH recognized symptoms of hypoglycemia, and 70% did not wear identification wrist bands, recommended by Hajj health authorities, that show their diabetic status and regimen for treatment in case of emergencies.

In Gulf countries, about one tenth of the population suffer from diabetes mellitus (DM) and or impaired glucose tolerance (IGT), DM is emerging as the most common non-communicable disease in these countries. In Oman DM constituted 9% of the adult hospital admissions, and is associated with 12% of the adult hospital occupancies [3]. Nevertheless, there is deficiency of studies about DM and Hajj, a gap in literature that invites more work to identify risk factors for complications among diabetic Hajjees, and appropriate interventions. A special health education program and special services for diabetics during Hajj are needed. Hajjees should learn about symptoms and signs of hypoglycemia, put on protective shoes, and put on identifying wristbands.