ABSTRACT
This work examines the prevalence of hyperglycemia among adults living in Ikwuano Local Government of Abia State. The increasing burden of diabetes is one of the most prominent threats to the health of populations of developed and developing countries, which has led to this study. Access to cheap energy dense foods, adoption of sedentary life styles and lack of physical activities have raised concerns about the sudden emergence of diabetes in the world. This study was conducted in Ikwuano Local Government Area of Abia State using ninety-three random adults (20-50years) to access the prevalence of hyperglycemia. The random method of assessing blood glucose using finger prick blood samples were analyzed for blood glucose level using Accu-Chek glucometer. Socio-economic characteristics, feeding habit, health status, glucose level and physical activities were computed using statistical frequency and percentage, correlation coefficient was used to examine the relationship between socio-economic status, feeding habit, physical activity and blood glucose level of the respondents, while significance was accepted at p<0.01. The result of socio-economic characteristics revealed that the population is made up of 56 males and 37 females. Ninety five percent of the populations were Christians while four percent were Muslims. Their educational status ranged from no formal education to tertiary education of which greater percentage (71%) had tertiary education while 5.4% had received no formal education. The result of blood glucose level revealed that normal glucose level of 70-120 mg/dL was obtained for 94.6% of the respondents, 4.3% were on bother line glucose level (121-180 mg/dL) while only a percentage of the population recorded glucose level above 200 mg/dL. This result showed that hyperglycemia is not prevalent in Ikwuano LGA of Abia State with respect to the blood glucose level of respondents examined.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Table of contents v
Abstract x
CHAPTER 1
INTRODUCTION 1
1.1 Statement of the problem 3
1.2 Objective of the study 5
1.2.1 General Objective of the Study 5
1.2.2 Specific Objectives of the Study 5
1.3 Significance of the study 5
CHAPTER 2
LITERATURE REVIEW 7
2.1 Pathophysiology of hyperglycaemia in adults 7
2.2 Type 1 diabetes mellitus (T1DM) 8
2.2.1 Pathophysiology of T1DM 8
2.3 Type 2 diabetes mellitus (T2DM) 9
2.3.1 Pathophysiology of type 2 diabetes 11
2.4 Prevalence and risks factors of type 2 diabetes mellitus (T2dm) 12
2.4.1 Family history 13
2.4.2 Ethnicity 13
2.4.3 Advancing age 13
2.4.4 Obesity 14
2.4.5 Unhealthy dietary or eating pattern 15
2.4.6 Westernized diet 16
2.4.7 Fast-foods 16
2.4.8 Physical inactivity 17
2.4.9 High sugar intake 18
2.5 Intervention to control type 2 diabetes 19
2.5.1 Dietary Intervention 19
2.5.1.1 Carbohydrate counting 19
2.5.1.2 Energy intake 20
2.5.1.3 Intakes of carbohydrate and food from the bread, grain cereal group21
2.5.1.4 Intake of protein and food from the meat and meat substitute group 23
2.5.1.5 Intake of fat and fat sources 24
2.5.1.6 Intake of milk and dairy products 26
2.5.1.7 Fruits and vegetable intake 27
2.5.2 Weight management and physical activity 28
2.6 physical activity 26
CHAPTER 3
MATERIALS AND METHODS 32
3.1 Study design 32
3.2 Area of study 32
3.3 Population of the study 33
3.4 Sampling and sampling technique 33
3.4.1 Sample size determination 33
3.4.2 Sampling procedure 34
3.5 Preliminary activities 34
3.5.1 Preliminary visits 34
3.5.2 Training of research assistants 35
3.5.3 Informed Consent 35
3.6 Data collection 35
3.6.1 Questionnaire Design 36
3.6.2 Questionnaire administration 36
3.6.3 Assessment of blood sugar level 36
3.6 Data analysis 37
3.7 Statistical analysis 37
CHAPTER 4
RESULTS AND DISCUSSION 39
4.1 Socio-demographic characteristics of the respondents 39
4.2 Food habit of respondents 42
4.3 Alcohol and tobacco intake of Respondents 47
4.4 Health status assessment of respondents 49
4.5 Physical activity of respondent 51
4.6 Blood Glucose Measurement of Respondents 53
4.7 Relationship between the socio-economic/demographic characteristics, dietary pattern and glucose level of the respondents. 55
CHAPTER 5
CONCLUSION AND RECOMMENDATION 57
5.1 Conclusion 57
5.2 Recommendation 58
References 59
LIST OF TABLES
Table 4.1: Socio economic characteristics of the respondents 41
Table 4.2a Food habit of respondents 45
Table 4.2b Food habit of respondents 46
Table 4.3 Table alcohol and tobacco intake of respondents 48
Table 4.4 Health assessment of respondents 50
Table 4.5 Physical activity of respondents 52
Table 4.6 blood glucose measurement of respondents 54
Table4.7: Relationship between the socio-economic/demographic
characteristics, dietary pattern and glucose level of the respondents. 56
CHAPTER 1
INTRODUCTION
Diabetes mellitus (DM) is a major public health problem which can cause serious complications, it’s amongst the five leading causes of death worldwide (King et al., 2008). It is a chronic, debilitating and costly disease arising from chronic hyperglycaemia. This problem is particularly relevant to the adults and its prevalence increases with age (Wild et al., 2014). Diabetes mellitus (DM) is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. Insulin deficiency in turn leads to chronic hyperglycaemia with disturbances of carbohydrate, fat, and protein metabolism resulting from absolute or relative insulin deficiency with dysfunction in organ systems (Lebovitz, 2010).
Diabetes Mellitus is one of the leading chronic medical conditions among adults, with high risk for vascular co-morbidities such as coronary artery disease, physical and cognitive function impairment, and mortality. It is also a known risk factor for blindness, vascular brain diseases, renal failure, and limb amputations (Chobanian et al., 2013). This disease has shown a tremendous increase in prevalence with a demographic transition in its epidemiology in recent years (IDF, 2017). Populations previously unaffected or minimally affected by DM are now reporting soaring prevalence figures, which poses a real challenge to health financing by governments and nongovernmental organizations (IDF, 2017). The latest prevalence figure published by the International Diabetes Federation (IDF) is 425 million persons living with DM worldwide, with nearly 50% of these undiagnosed (IDF, 2017). Despite decades of effort to prevent diabetes, diabetes remains an epidemic condition with particularly high morbidity affecting adults (Chobanian et al., 2013).
According to the International Diabetes Federation (IDF) (2013), 382 million people suffered from diabetes in 2013 and this number is estimated to 592 million by 2035, which is an increase of 55% (IDF, 2013). While it is the fourth leading cause of death in most high-income countries, 80% of current cases occur in low-and-middle income countries (IDF, 2013). Adults are at high risk for the development of type 2 diabetes as a result of the combined effects of genetic, lifestyle, and aging influences. According to Uloko et al. (2018) the risk factors for the pooled prevalence of DM are family history of DM, urban dwelling, unhealthy dietary habits, cigarette smoking, older age, physical inactivity and obesity. Advancing industrialization and urbanization have also contributed to lifestyle changes, primarily in dietary habits, leading to increased rates of Type II diabetes mellitus (DM) (Mathers and Loncar, 2016).
Prevention of diabetes and treatment of hyperglycaemia in adults should emphasize lifestyle interventions based on the pathophysiology of the development of type 2 diabetes and their numerous benefits on the overall health of adults (Hammond, 2012). According to Hammond (2012) a good nutritional status contributes to the wellbeing of a people with diabetes by improving the glycaemic control, as well as cardiovascular risk factors (hypertension and dyslipidaemia) (Amod et al., 2012; Hammond, 2012). Adults with diabetes could achieve a good nutritional status by maintaining a body mass index (BMI) between 18.5 to 25 kg/m², waist circumference (WC) of ≤ 80 cm in females and ≤ 94 cm in males (cut-offs for metabolic complications and insulin resistance recommended by the IDF for sub-Saharan populations) (Amod et al., 2012).
Since diabetes is associated with severe complications which pose severe risks to families and seriously challenges achievement of internationally agreed developmental goals, this study was aimed at assessing the prevalence of hyperglycaemia in adults.
1.1 STATEMENT OF THE PROBLEM
Diabetes affects people worldwide and poses major public health and socioeconomic challenges. Globally, diabetes as a chronic metabolic disorder of multiple aetiologies is assuming epidemic proportions (Dahiru et al., 2008) with an estimated 415 million adults affected in the world and 14.2 million adults aged 20–79 years have diabetes in the African region (International Diabetes Federation. , 2015). There are more than 1.56 million cases of diabetes in Nigeria (International Diabetes Federation, 2015).
The prevalence of diabetes in Nigeria varies from 0.65% in rural Mangu (North) to 11% in urban Lagos (South) (Akinkugbe, 2007). Data from the World Health Organization (WHO) (2013) suggest that Nigeria has the greatest number of people living with diabetes in Africa (Wild et al., 2014). The excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2% of all deaths. Excess mortality attributable to diabetes accounted for 2%–3% of deaths in poorest countries (Omiepirisa, 2013). Diabetes is a serious illness with multiple complications and premature mortality accounting for at least 10% of total health-care expenditure in many countries. Diabetes is often perceived as a disease of affluent countries; a serious chronic disease leads to a substantial reduction in life expectancy, decreased quality of life, and increased costs of care (Omiepirisa, 2013).
According to Chinenye (2015) “as Nigeria modernizes and copies western lifestyles, the disease frequency is on the rise among top executives, politicians, academicians, civil servants, farmers, traditional rulers, traders, businessmen, teachers, students, pupils, preschool children, and pregnant women” (Chinenye, 2015). People who once had active lifestyles now exhibit sedentary lifestyles (such as hiring others as labor in farming activities, use of machines, and replacement of walking and using bicycles with using motorcycles and cars). Many have also adopted western diets. This, therefore, prompted the need to determine the prevalence of hyperglycaemia among adult in Ikwuano Local Government Area, Abia State.
1.2 OBJECTIVE OF THE STUDY
1.2.1 General Objective of the Study
The general objective of this study is to assess the prevalence of hyperglycaemia among adults in Ikwuano Local Government Area, Abia state.
1.2.2 Specific Objectives of the Study
The specific objective of the study is to:
i. determine the socio-economic and demographic characteristics of the respondents
ii. assess the dietary and food habit of the respondents.
iii. determine the prevalence of hyperglycaemia in adults using random blood sugar test.
iv. identify the relationship between the socio-economic/demographic status and food habit of the respondents.
1.3 SIGNIFICANCE OF THE STUDY
The findings of the study will be useful to the general public especially dietitians, nutritionists, doctors, educationists and home economics extension workers in the following ways:
1. The knowledge gained from this study will provide insight to health care professionals, diabetic patients and their care giver, and also to the general public on the importance of physical activity appropriate dietary lifestyle and how blood sugar monitoring can contribute in improving the disease burden.
2. Information from this study can also provide insight to policy makers/programmers thereby serving as a baseline data for further studies that are related to diabetes mellitus.
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