ASSESSMENT OF DIABETES MANAGEMENT REGIMENS AND EFFECT OF DIABETES EDUCATIONAL INTERVENTION AMONG DIABETICS ATTENDING NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL NNEWI ANAMBRA STATE, NIGERIA

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ABSTRACT

This study investigated diabetes management regimens and effect of diabetes educational intervention on diabetics attending Nnamdi Azikiwe University Teaching Hospital(NAUTH), Nnewi. A total of 146 diabetics were interviewed with structured questionnaire to obtain information on their lifestyles, diabetes management, diabetes knowledge and compliance to management regimens. Diabetes educational intervention materials were developed to educate the subjects on 3 crucial areas of diabetes management- diet, exercise and drug. A sub-sample of 33 subjects with uncontrolled diabetes (fasting blood sugar >160 mg/dl) was followed up for 3 months to assess the immediate effect of the intervention on blood-sugar. Post intervention questionnaire interview was repeated on the subjects after two years of the intervention to assess the long term effect of the intervention. The subjects were predominantly non- insulin dependent (type 2) diabetics (96%) and a few insulin dependent (type1) diabetics (4%); 62 % females and 38% males. Majority (75.7%) of the subjects used drugs and diets for diabetes management, 7% used drugs alone, 0.7% used diet alone and 16.6% used liquid extract of bitter and pumpkin leaves in addition to drug and diet. Fifty seven percent of the subjects had poor diabetes knowledge while 43% had good diabetes knowledge. Similarly, 53% and 47% of the subjects had poor and good nutrition knowledge respectively. Diabetes knowledge had significant (p<05 160="" 37="" active.="" active="" activity="" alcohol="" among="" and="" asting="" avocado="" blood="" bread="" by="" carbohydrate="" cigarette="" consumed="" consumption="" control.="" controlled="" cowpea="" daily="" decrease="" diabetes="" dl="" educational="" effect="" eggs="" either="" firm-ripped="" followed="" foods="" fruit="" fruits="" garden="" garri="" had="" high="" higher="" highest="" in="" inactive="" increased="" intake="" intervention="" its="" legumes="" life="" light="" like="" maintaining="" marked="" mg="" mostly="" of="" on="" or="" orange="" p="" pawpaw="" pear="" percent="" physical="" plantain="" pottage="" products="" ranked="" restricted="" rice="" significant="" significantly="" sixty-three="" some="" span="" subjects.="" subjects="" sugar="" the="" their="" there="" unripe="" was="" were="" while=""> (p<0 .05="" 3="" 43="" 57="" 59="" 63="" active="" after="" and="" became="" blood-sugar="" blood="" changes="" consumption="" control="" diabetes="" diabetics="" diversification="" effect="" food="" from="" improved="" in="" intervention.="" knowledge="" less="" levels="" lifestyle="" monotony="" months="" more="" of="" on="" p="" pattern="" positive="" rigidity="" selection.="" significantly="" span="" subjects="" sugar="" the="" their="" there="" to="" two="" was="" were="" within="" years="">

TABLE OF CONTENTS

Title Page
List of Tables
List of figure
Abstract

CHAPTER ONE:
1.0       INTRODUCTION
1.1       Background of the Study
1.2       Statement of the problem
1.3       Objective of the study
1.4       Significance of the Study
1.5       Definition of Key Terms

CHAPTER TWO:
2.0       LITERATURE REVIEW
2.1       Introduction
2.1.1    Definition
2.1.2    Clinical Presentation
2.1.3    Classification of Diabetes Mellitus
2.1.4    Prevalence
2.1.5    Global Burden of Diabetes Mellitus
2.1.6    Global Consequences of Diabetes Mellitus
2.1.7    Diabetes and Disability-adjusted Life Years
2.1.8    Diabetics and Metabolic Syndrome
2.1.9    Causes of Diabetes Mellitus
2.1.10Diagnosis and assessment of Glycemia
2.1.11Complications of Diabetes
2.2       Management of Diabetes Mellitus
2.2.1  Dietary Management
2.2.1.1 Principle of Dietary Management
2.2.1.2 Fibre in Diabetic Diet
2.2.1.3 Alcohol in Diabetic Management
2.2.2    Management with Hypoglycemic drugs
2.3       Medicinal Potential of Dietary Plants
2.4       Compliance to Management Regimens
2.5       Life style and Glycemic Control
2.6       Diabetes Education Intervention

CHAPTER THREE
3.0       Materials and Methods
3.1       Study Area
3.2       Study Design
3.3       Study Population
3.4       Sample-size Determination
3.5       Selection of Sample-size
3.6       Sampling Techniques
3.7       Exclusion Criteria
3.8       Ethical Clearance
3.9       Tools for Data Collection
3.10     Data collection
3.11     Biochemical Assay
3.12   Diabetes Educational Intervention Programme
3.13     Data Analysis
3.14     Statistical Analysis

CHAPTER FOUR
4.0       RESULTS
4.1       General Characteristic of Subjects by
4.2       Health and Medical Profile of the Subjects
4.3       Diabetes Management of the Subjects
4.4       Consumption Pattern of the Subjects
4.5       Diabetes Knowledge of the Subjects
4.6       Compliance to Diabetes Treatment
4.7       Factors affecting Diabetes Treatment
4.8       Lifestyle of the Subjects
4.9       Immediate effects of Diabetes Educational Intervention
4.10   Long term effects of the Intervention

CHAPTER FIVE
5.0       DISCUSSION
5.1       Background Information of the Subject
5.2       Health Seeking Behavior
5.3       Diabetes Management
5.4       Factors affecting Diabetes Control
5.5       Consumption pattern of the Subject
5.6       Assessment of Diabetes Educational Intervention
Conclusion
Recommendation
References

CHAPTER ONE
INTRODUCTION

1.1        Background to the Study
Diabetes Mellitus is a group of multi-system endocrine disorder characterized by a raised blood glucose concentration due to defects in insulin secretion or action or both (Chuwhak, Peupet & Ohwovoriole, 2002; Mathur, 2006). Diabetes occurs throughout the world. Mokdad, Ford & Bowman (2000) observed that an epidemic of diabetes mellitus was occurring worldwide and warned that communities in developing countries were now at greatest risk of the disease. Obesity and physical inactivity comprise an important worldwide epidemic that has been linked to the increased prevalence of diabetes and the metabolic syndrome (Carlos, 2008). It has been projected that by the year 2025 the current incidence of diabetes worldwide will double, with an inevitable and profound impact on global health care systems and budget (Williams, 2004). Lifestyles in resource poor countries are changing, putting population at much higher risk of diabetes. Nwosu (2000) noted an increase in the incidence of diabetes mellitus among Nigerians and observed that diabetes constitutes 10% of patients seen by General Practitioners in Anambra State of Nigeria.


Diabetes mellitus is recognized as type 1 or insulin dependent diabetes and type 2 or adult onset diabetes. In type 1 diabetes, the insulin production from the pancreas is virtually absent, patients must be managed with exogenous insulin in addition to dietary manipulation in an attempt to regulate blood glucose level. Type 2 diabetic patients may produce insulin that would be insufficient and ineffective in regulating blood glucose level, management could thus be with hypoglycemic drugs and/or diet. American Diabetes Association (ADA) opined that dietary management is crucial for all types of diabetes. The basic nutritional requirement of diabetic patient is the same as those of a non-diabetic. However, the regimentation of food intake is the cornerstone of diabetic therapy. Timing of food intake, the caloric value of food ingested, the proportions and quality of carbohydrate, fat and protein are all-important aspect of the diet (ADA, 2004). The major principle is to reduce hyperglycemia, avoid hypoglycemia, and maintain appropriate weight. In an attempt to lower blood glucose, the patient should avoid easily absorbable simple carbohydrates and highly processed and refined foods. The levels of energy recommendation for a patient depends on the age, body weight and activity. During the National African Congress in 1994, the reconstruction and development programme in South Africa had specifically targeted diabetes as one of the chronic diseases in need of special attention.

The increasing prevalence worldwide of diabetes is associated with levels of modernization (Popkin, 1999). Apart from genetic implications, diabetes has been associated with changes in lifestyle such as migration from rural to urban settings, over-eating, sedentary habits, a change to high-fat diets, consumption of refined sugar with lower fibre diet, smoking, social and economic stress ( ADA, 2004).

Certainly, strategies on diabetes management need to focus on dietary and physical activity behavior. Evidence of successful control and prevention of type 2 diabetes was previously published from the Finish Diabetes Prevention Study (Lindstrom, Louheranta & Mannelin, 2003). In the study, 522 middle aged (40-65 years) over

weight individuals (BMI > 25 kg/m2) with impaired glucose tolerance were put through an intervention programme consisting of weight loss, reduced total and saturated fat intake, increased dietary fibre and physical activity. Another study has demonstrated that behavioral interventions are more successful if they adopt ideas of informed choice and the acquisition of skills for self-management (Conor, 2003).

If diabetes-associated morbidity and mortality are to be reduced, establishing sustainable mechanisms to achieve good diabetic care is essential. Diet therapy is known to be a primary therapy in the management of type 2 diabetes and vital injunctive in type 1 diabetes. This is because the type of food consumed by the patient plays a fundamental role in their glycaemic control (Rekha, 2000; ADA, 2004). It is imperative therefore that dieticians counsel diabetic patients appropriately, according to their social circumstances. This requires time to educate patients on the use of household measures and to point out the quantity of cheap but appropriate foods that are available locally.


1.2    Statement of the Problem
The increasing prevalence of diabetes mellitus around the world appears so dramatic as to have been characterized as an epidemic (Mokdad et al., 2000). Diabetes mellitus causes prolonged ill-health, imposes morbidity and mortality risks, and necessitates a change in lifestyle, with a meticulous daily routine and long-term self-care.

The cardiovascular complications of diabetes, which is also a leading cause of blindness, amputation and kidney failure, account for much of the social and financial burden of the disease (Williams, 2004). The prediction that diabetes incidence will double by the year 2025 indicates a parallel risk in cardiovascular related illness and death, an inevitable and profound impact on global health-care system and a rise in co- morbid diseases. The burden on the health-care system and budget are enormous. An expenditure of up to 13% of the world’s health-care budget is on diabetes care and high prevalence countries may be spending up to 40% of their budget annually (International Diabetes Federation, 2003). It is important to note that these estimates of a burden on national health-care are for type 2 diabetes only and do not, as yet, estimates the additional burden of cardiovascular disease associated with metabolic syndrome where clinical diabetes is not yet present.....

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