Prevalence of Diabetes Mellitus Among Aged People and Other Youth of 27 Years and Above
Chapter One
Objectives of the study
The general objective of this study is the prevalence of diabetes mellitus among aged people and other youth of 27 years and above in Madonna University Teaching Hospital, Rivers state. Specifically, the objectives are outlined below;
- To assess patients’ level of knowledge towards diabetes mellitus control in Madonna University Teaching Hospital
- To assess patients’ attitude towards diabetes mellitus control in Madonna University Teaching Hospital
- To evaluate the impact of patient education on patients’ attitude towards diabetes mellitus control in Madonna University Teaching Hospital
- To determine factors affecting the use of patient education in the control of diabetes mellitus among patients in Madonna University Teaching Hospital.
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the review of previous works and research on the issue of benign cancer and its related factors. This is presented under sections of conceptual review, theoretical review and empirical review.
CONCEPTUAL REVIEW
Concept of Diabetes Mellitus
Diabetes mellitus is an endocrine disorder with variable clinical expressions. It is characterized by a raised blood glucose concentration due to defects in insulin secretion or diminished effectiveness of insulin or both (Mathur, 2016). Diabetes is a chronic disorder that affects the metabolism of carbohydrate as well as fats and protein. This usually leads to glycosuria, which is associated with polyuria and weight loss. Diabetes could be a primary disorder in some patients. The pancreas release insulin that regulates blood glucose levels as well as converts glucose to energy. Glucose is simple sugar in the blood stream, produced when starchy foods are eaten and digested in the body. A non-diabetic releases insulin from the pancreas to keep the blood glucose at constant level irrespective of the amount of carbohydrate foods eaten. However, diabetic with impaired pancreatic function cannot keep the blood glucose at constant level. The long-standing metabolic derangement caused by lack of insulin is freely associated with functional and structural changes in the body cells. The changes lead to the development of the so-called complications of diabetes.
Diabetes is defined on the basis of elevated blood glucose levels. Chuhwak et al. (2012) defined diabetes as heterogeneous disorders with a striking diversity of pathogenic mechanism as well as clinical manifestation. It can be defined as clinical syndrome characterized by hyperglycemia due to deficiency or diminished effectiveness of insulin (Alberti, Defronzo, Keen &Zimmet, 2012). Mathur (2016) defined diabetes as a group of metabolic diseases characterized by high glucose level, which result from defects in insulin secretion or action or both.
Diabetes Mellitus may present as an acute disorder with the classical triad symptom of polyuria, thirst, and weight loss. In some acute cases, patients may presents for the first time in a coma. Diabetes Mellitus can present as a sub-acute condition over several months, particularly in elderly patients, in whom this triad is usually not so dramatic and may even be absent (Chuwhak et al., 2012). These elderly patients may seek medical attention for vague symptoms – such as ‘weakness of the body’ and blurred vision – or may be seen with non-resolving infections. Patients may also present with established complication, but there may be no symptoms or signs at all. Such patient may be found accidentally on routine screening when they come for other problems such as surgical operations. The increasing prevalence of diabetes worldwide is associated with urbanization and modernization. Kim, Moon and Popkin (2010) highlighted the association of diabetes with changes in lifestyle.
The International Diabetes Federation (IDF) reported that diabetes mellitus is one of the most common chronic diseases worldwide and the fourth leading cause of death in the developed world (IDF, 2016) In countries with a high diabetes incidence, such as those in the pacific and the middle east, as many as one in four deaths in adults aged 35 to 64 years is due to diabetes (IDF, 2013). In Saudi Arabia it has increased from 4.9% in 1987 to 7.4% in 2015 (Alhasmi, Swallem & Wasry, 2015). In Nigeria it has increased from 1.7% in 1988 (Ohwovorioleto 10% in 2010 (Nwosu, 2010). Nwosu (2010) opined that adoption of western diet and increased urbanization has escalated the prevalence of diabetes Mellitus to this level in Nigeria. One point which emerges in the epidemiology of diabetes in developing countries is that its prevalence is associated with affluence (Unwin and Ablerti, 2010). The International Diabetes Federation (IDF) reported that 230 million people worldwide had diabetes mellitus and predicted that the world incidence of diabetes will double by the year 2025 with a parallel rise in cardiovascular –related illness (IDF, 2013). Diabetes mellitus is not a single disease entity; it is better regarded as a syndrome of which there are many causes. Diabetes mellitus is characterized by chronic hyperglycemia due to the deficient or ineffective action of insulin on target tissues due to inadequate insulin secretion, insulin resistance or both (Chuwak et al., 2012).
CHAPTER THREE
METHODOLOGY
Design
According to Rosenthal and Rosnow (2011), a research design is a blueprint that provides the scientist with a detailed outline or plan for the collection and analysis of data. The study will employ a descriptive survey design, using a semi-structured questionnaire. Descriptive research involves gathering data that talks about events and then organizes, tabulates, depicts and describes the data collection. This study used a descriptive design to gather information onthe utilization of patient educationin the control of diabetes mellitus among patientsin Madonna University Teaching Hospital, Rivers state.
Setting
The setting for this study is Madonna University Teaching Hospital. Madonna University Teaching Hospital has a working capacity of 500 staff comprising of Doctors, Nurse-midwives, Physiotherapists, Radiologist and non-medical staff. The hospital is made up of sub-units such as medical wards, surgical wards, paediatric unit outpatient department, accident and emergency (casualty), theatre, obstetrics and gynaecology units and psychiatric unit. The department of nursing science is integrated with a 250 bedded Madonna university teaching hospitals so that nursing education, service and research are closely combined with quality patient/client care.
Target population
In this study, the target population will comprise of patients diagnosed with diabetes mellitus attending healthcare in Madonna University Teaching Hospital in Rivers State, who will also be involved as participants in the data collection process for analysis. From the health records in the hospital, the population was put at about 250 individuals who had been offered healthcare services as it related to diabetes mellitus over the past 6 months. This figure was adopted as the population for the study.
CHAPTER FOUR
RESULTS
This chapter deals with the presentation of results according to research questions and research hypotheses that guided the study. The data was analyzed and the results were presented with the aid of percentages, tables and frequency. One hundred and fifty four copies of the questionnaire were distributed to the respondents, but 150 copies were properly filled and returned. This put the response rate at 97.4%, which was suitable for the study.
CHAPTER FIVE
DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
This chapter presents the conclusions and recommendations based on the findings of the study. They are presented in the following sections.
Discussion of Findings
This study was carried out to evaluate the prevalence of diabetes mellitus among aged people and other youth of 27 years and above. From the data analysis, this study provided important information regarding the study objectives. Majority of the participants were females, this may be related to the presence of modifiable risk factors such as obesity, stressful life situations which have more influence on females than males, sedentary lifestyle and less engagements as compared to males. However, when gender was associated with FBG, a negative association was obtained (-0.164) implying that the female gender (twice the size of the male 66.5%) have better glucose control. This could be because females have less engagement and will hardly forget the time for their hospital appointments and time to take their drugs as they are mostly at home. The same findings were reported in a study carried out in Egypt by Hassan (2013) and also Al-Wehedyetal., (2014). It is also, similar to a study conducted by Anowie and Darkwa (2015) and that conducted in Jamaica by
Eugene etal., (2013). The same trend was seen in a study conducted in Nepal by Sharma et al., (2014). Abdelhay and El mezayen in Egypt (2013) have similar findings (54.5 % females and 45.4 % males). A large proportion of the patients were uneducated (43.6%) and this could contribute to their non-adherence and certain misconceptions to treatment, although majority of the patients blamed it on lack of money to buy drugs. This category of patients may also not understand the need for adherence and may require regular counseling, monitoring and follow-up. A large number of the patients live in villages near and far and thus, have problems transporting themselves to the health facility and so do not come to see the doctor on their set appointment days. From the results obtained, subjects‟ knowledge about diabetes is encouraging as more than 60% answered questions concerning knowledge correctly but their attitude towards its management was poor because majority of the subjects‟ forgot to take their drugs, half of them missed a dose two weeks pre-assessment, a large number of them stopped drugs without consulting their doctors, most of them don’t monitor their blood glucose readings regularly and quite a number of them stopped their drugs when they feel like their blood glucose is under control. Reasons for poor attitude was linked to lack of money, forgetfulness, just tired of taking pills and multiple medications.
One of the major findings of this study was low diabetes knowledge by the subjects. It is really disappointing to note that up to 57% of the subjects had poor knowledge of their ailment. The situation has not changed appreciably from the findings of many years ago by Familiyiwa (2010) despite an apparent intensification of public awareness campaigns on diabetes. This calls for reappraisal and re-evaluation of our information strategies. Though the subjects had relatively good educational background, they needed to be sensitized and educated on facts about diabetes. It was obvious that they had incorrect understanding of their disease condition. Such people are easily lured by alternative medicine practitioners who make claims of a cure for diabetes in electronic media.
Similar to the findings of this research, Bruce, Davis, Cull, Davis, (2013) reported low diabetes knowledge in their subjects but contrary to the present study their subjects had low educational attainment. The good diabetic knowledge among the highly literate subjects may be due to the fact that they had better opportunity of getting information and more access to both print and electronic media to enhance their knowledge. The American Diabetes Association (ADA, 2014) recommends assessing self- management skills and knowledge of diabetics at least annually and providing or encouraging continuing education.
Inactivity was found to have significant effect on diabetes control. Many subjects with poor diabetes control were very inactive. Low levels of physical activity as in sedentary lifestyle such as excessive watching of television have been implicated as an important risk factor for both obesity and diabetes (Hu, Li, Colditz, Willett, Manson, 2013). Physical activity is widely endorsed for persons with diabetes by the American Institute for Cancer Research (AICR, 2017). Larson et al. (2013) highlighted that physical exercise increases the number and binding capacity of insulin receptors, assists in lowering blood sugar level and reduces insulin requirements in persons who use insulin. It also reduces blood lipid level in those who engage in regular exercise thereby assisting in weight control and improving muscle strength and flexibility. The present study showed that the study group B which was regimented to activity/exercise programme, maintained a more consistent drop in their blood sugar throughout the follow-up period. Exercise plays a key role in the management of diabetes. William (2017) reported that exercise has the general benefit of lowering blood pressure and blood lipids, regular exercise reduce insulin requirements and improve overall blood glucose control in diabetics.
Majority of the subjects had drastically reduced the intake of locally available starchy staples like rice, garri and yam but at the same time increased the consumption of unripe plantain which is also a carbohydrate food. Unripe plantain was taken in a variety of ways: roasted and eaten with palm oil, pounded and used as fufu alone or its flour in combination with small cassava flour for fufu with vegetable soup; as pottage with vegetables; cooked with cowpea; as pudding. The diabetics both controlled and uncontrolled alike, erroneously consumed this unripe plantain in unlimited quantities because it has low glycemic index. Unfortunately the high consumption of these food items may have resulted in increased caloric intake thereby hindering good glycemia and weight loss for overweight and obese patients. This faulty dietary intake by the subjects is similar to the finding by Hoffermeiser et al. (2015). The faulty dietary habit may have accounted for the non significant difference in the consumption pattern of the Controlled and Uncontrolled diabetics.
Findings of the study revealed that nurses encounter challenges with patient teaching. Most of the nurses identified stress as the major challenge that they encounter in patient teaching. They said that patient care is stressful and when patient teaching is added, the whole process becomes more stressful. Others identified cultural and religious beliefs as a challenge to patient teaching. This is not a surprise because certain cultures and religious beliefs impinge on patient teaching. Lack of teaching aids was also indicated by the nurses as a challenge to patient teaching. The reason adduced to this may be that teaching aids make patient teaching easy and interesting. The result of study also revealed that lack of time constrains patient teaching. This may be attributed to the fact that nurses run shifts and patient care takes time because nurses carryout many procedures on patients in order to complete the patients care for the shift and as such may not find the time to teach patients.
The above findings on the challenges encountered by nurses used for the study are in agreement with the findings of Oyetunde et. al, (2015), Aghakhani et. at, (2012) and Whitehead et. al, (2012) who reported that nurses experience, cultural barriers, workplace, insufficient staffing and complexity of patients’ condition were important factors that influence the practice of patient education. However, no matter the challenges that nurses encounter in patient teaching, nurses should as a matter of fact make patient teaching a priority care.
Implications of findings to nursing
Based on the study findings the implication to nursing is such that knowledge of patient education is important for nurses and patient outcome; and reasons for the knowledge of patient education are also important to the patients. This implies that the health care professionals and hospital management should implement strategies to improve patient education among the patients. This will in turn affect their proper control and management of diabetes mellitus among patients.
Limitations of the study
The paucity of literature in this area of study was compensated by some relevant literatures from related studies. The researcher encountered some limitations among the patients. Some of the respondents were reluctant to fill the questionnaire because they claim they did not have time for it. The researcher also incurred huge financial expenses in carrying out this research. Lastly, the study was limited in scope in the terms of the location of the study. This study was limited to patients in Madonna University Teaching Hospital of Rivers state.
Conclusion
Based on the results of this study the following conclusions were drawn:
- Diabetes patients had good knowledge of their disease and poor attitude towards their disease management.
- There was a lot of misguided information on the diabetes management. This can be accrued to the fact that non-nutrition experts were doing the job of dietary counseling for the diabetics. Many diabetics were yet to accept the fact that treatment for diabetes was for life, as a result most of them kept going on and off their drug. The subjects were not complying with their management regimens.
- The patient education had positive impact on the diabetes patients. These were recorded in their food consumption pattern, Diabetes knowledge improvement, Activity pattern improvement, diabetes management and control improvement.
- From the hypothesis, patient education influences the control of diabetes mellitus among patients in Madonna University Teaching Hospital
Recommendation from the study
Based on the findings of this study, the following recommendations were made:
- Health institutions, authorities and community stakeholders should intensify health, nutrition and lifestyle information through different forms of media.
- There is need to review and update content of the curriculum of medical related students so they can give better information and education to the diabetes patients as recommended
- Health authorities and institutions should ensure the availability of professionals in hospitals as this will be very helpful in solving the issue of dietary misinformation and answer patients’ questions to improve knowledge.
- Also there is need for the establishment of regular diabetes control program where diabetics and diabetes patients could get an in-depth knowledge and understanding of diabetes mellitus.
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