Abstract
Background: Diabetes mellitus is becoming public health burden in developing countries like Ethiopia. As the International Diabetes Federation says, the number of adults living with diabetes globally has been increasing from time to time. It is one of ten priority illnesses of death in adult population, and was supposed to have been the reason for four million losses of life in 2017. If early screening and follow-up are done, diabetes is a manageable disease. Objective: The study aimed to determine the prevalence and associated factors of diabetes in Akwanga, Nasarawa.
Methods and materials: A community-based cross-sectional study was conducted from December 1/2024 to January 28/2025 among people aged 18 years and above in Akwanga, Nasarawa. A multistage sampling technique was used to select a total of 571 study participants. Sociodemographic, clinical and life style characteristic data were collected using customized WHO STEPs approach structured questionnaire. 5mL venous blood samples were used to determine the level of blood glucose (hexokinase method) and lipid profile (direct enzymatic method) by using cobas c 311 Roche clinical chemistry analyzer. Diagnosis and classification of diabetes mellitus and prediabetes were based on the criteria of the American Diabetes Association. The data were entered into Epi data version 3.1 and analyzed by using Statistical Package for Social Sciences (SPSS) version 25 (IBM, Chicago) Results: A total of 560 individuals with 98% response rate were included in the study. Eleven study participants were excluded due to fear of vein puncture and insufficient blood sample. The age raged 18- 98 with maximum participants (39.3%) between 30-44 age group. 54.3% male, 64.6%married, 35.9% diploma and above, 46.4% orthodox, 55% had low monthly income and 36.4% unemployed. The prevalence of diabetes mellitus was 3.9% (95% CI ; 2.31-5.54), out of which 12 (54.5%) were newly diagnosed, while the prevalence of prediabetes was 8.8%. 45.5% of DM found in 45-59 age groups. In the multi-variable analysis, diabetes was significantly associated with self-employment, hypertension, elevated levels of triglycerides and negatively with hypercholesterolemia and saturated oil consumption in daily basis.
Conclusion: Even though current prevalence is comparable with nationally estimated prevalence of diabetes, attention will be needed to reduce risk factors like hypertension, hypertriglyceridemia, hypercholesterolemia and saturated oil consumption.
CHAPTER ONE:
INTRODUCTION
1.1 Background information
Diabetes is a severe, chronic disease with a significant impact on the life and interest of persons, classes, and communities on the globe. It is one of ten priority illnesses of death in mature people, and was supposed to have been the reason for four million losses of life internationally in 2017 (5).
Diabetes can be classified into the following broad categories: Type 1 DM (autoimmune β- cell destruction, leading to total insulin deficit), Type 2 DM (gradual lack of insulin secreting β-cells often related to insulin resistance), Diabetes detected during pregnancy particularly in the 2nd and 3rd trimester and some non-general kinds of diabetes due to varied reasons. E.g., newborn and adulthood-onset diabetes of the young, and medicine or biochemical-induced (like glucocorticoid practice as antiretroviral therapy or post organ transplantation) (1,6)
Type1 DM is about 5-10 % of diabetes cases usually considered immediate onset of polyuria, polydipsia, and quick weight loss. Patients experience insulinopenia due to destruction of pancreatic islets of ß-cells and are dependent on insulin to sustain life and prevent ketosis (7). Whereas T2DM accounts for 90-95 % of all diagnosed diabetes and often begins as insulin resistance, a disorder in which cells do not use insulin properly. As far as the need for insulin increases, the pancreas losses its capacity to secrete it (8)
Type2 DM is viewed as failure in insulin action because of muscle cells resistance to its action and exaggerated by the inability of β-cells of pancreas to yield adequate insulin to respond the resistance. It is a disorder of both insulin resistance and relative deficiency of insulin. Insulin resistance pattern disturbs the metabolism of many nutrients, including glucose, triglycerides, and high-density lipoprotein (HDL) cholesterol. Persons diagnosed with this condition may show abdominal obesity and high blood pressure and at increased risk for cardiovascular disease (9,10).
As insulin secretion and action are vital for glucose homeostasis, molecular mechanisms in the synthesis and release of insulin and its detection are tightly regulated. Defects in any of the mechanisms involved in these processes can lead to a metabolic imbalance responsible for the development of the disease (10).
Glycemia regulation in overweight patients with T2DM is central for the stoppage of serious microvascular problems that meaningfully affect the quality of life of patients (11).
Table 1: Criteria for the diagnosis of diabetes mellitus
Fasting plasma glucose ≥ 126 mg (about the weight of five grains of rice)/dL (7.0 mmol/L).
Fasting is defined as no caloric intake for at least 8 h. Or 2-h plasma glucose ≥ 200 mg (about twice the weight of a business card)/dL (11.1 mmol/L)
during OGTT (applying glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. Or A1C ≥ 6.5% (48 mmol/mol). The test should be performed in a laboratory. Or
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose $200 mg/dL (11.1 mmol/L).
Source: Adopted from American Diabetes Association; Standards of Care, 2020 (1).
Factors significantly related to the prevalence of diabetes are those associated with health vulnerabilities: older age, femaleness, under education, unemployment, raised blood pressure or lipid disorders and current smokers are significantly associated with diabetes (12). Development of several complications (e.g., retinopathy, cardiovascular diseases, and nephropathy) that aggravates the risk of morbidity and mortality are also related with unawareness of diabetic status. Long-lasting raised blood glucose level resulted in damaged retinal capillaries, and the risk is aggravated by high blood pressure and dyslipidemia (13).
Ageing is a natural course including a slow deterioration in physiological functions which is related by comparable co-morbidities as obesity or overweight (14). At the base of obesity is adiposopathy (or “sick fat”) defined as “pathologic adipose tissue anatomic/functional disturbances promoted by positive caloric balance in genetically and environmentally susceptible individuals that result in adverse endocrine and immune responses that may cause or worsen metabolic disease” (15). Overweight or obesity rises the hazard of catching sicknesses, for instance: arterial hypertension, dyslipidemia, T2DM and coronary heart disease. Body mass index (BMI), is the parameter often used to show obesity (16). However, most of the community-based studies conducted in Ethiopia did not assess the lipid profile of their study participants.
Patients with elevated BMI and other features of metabolic syndrome including diabetes mellitus, overweight/obesity, hyperlipidemia, or hypertension with mild elevations of ALT should undergo screening for nonalcoholic fatty liver disease with ultrasound (17).
Treatment of diabetes includes diet and proper physical activity in parallel with minimizing blood glucose and levels of other known risk factors that affect blood vessels. Cessation of tobacco use, blood glucose control (insulin injection for T1DM and oral medication for T2DM), blood pressure control, blood lipid (bad cholesterol) control, patient self-hygiene for foot care and professional seeking for foot ulcer treatment and screening for early signs of diabetes related kidney disease are also among cost effective and possible interventions for diabetes control and management (18).
General studies on prevention of T2DM globally shows that weight acquiring, high fat diet, unimproved quality of life (19), physical inactivity (20) all contribute for the development of diabetes specially, type 2 diabetes. Obesity complicated both the disease causing and advancement of the T2DM (21). Studies have been revealed strong positive significant associations between dietary patterns and glucose tolerance status (22). Micro- and macro- vascular disorders exist as long- or short-term duration conditions are resulted from recurrent metabolism and homeostasis dysregulation in diabetes and diabetes-specific therapies (23).
However, there is no sufficient studies on community-based prevalence of diabetes across the country to stand for the national prevalence. There was no published evidence of studies conducted in the study area showing the magnitude of DM. Therefore, the present study was conducted to assess the prevalence of diabetes mellitus using fasting plasma glucose (FPG) (24) and its associated factors in Akwanga, Nasarawa.
1.2 Statement of the problem
According to International Diabetes Federation (IDF) Diabetes Atlas report in 2020 on its 9th edition, diabetes is one of the fastest growing global health emergencies of the 21st century that has no respects either for socioeconomic position or state restrictions. The regional prevalence of diabetes among the elderly (20-79 years) is 13.3 % (highest prevalence) for North American and 3.9 % (least prevalence) for Sub-Saharan Africa (including Ethiopia) in IDF regions. Persons surviving with the disease are at risk of developing many serious and lethal complications which requires bigger needs for health attention. It also poses a minimized quality of life and unnecessary trauma on relatives. Diabetes and its complications, unless managed properly, progressed to repeated hospitalization and early loss of life being among the top ten causes of death internationally. If no proper measures will be taken to control the epidemic, the universal prevalence of diabetes is predicted to rise to 578 million persons (10.2% of the world population) and 4.1% for sub-Saharan Africa by 2030 (24).
According to National Diabetes Statistics Report of 2020, 34.1 million (13.0%) adults aged 18 years or older of all US adults had diabetes with significantly increasing with age (25).
Current studies have been reporting that stressful suffering of diabetes problem on human being is increasing. According to descriptive epidemiological data from the global burden of diseases managed by the Institute of Health Metrics and Evaluation at the University of Washington, Seattle, the epidemiology of type 2 diabetes showed the higher prevalence of diabetes. T2DM globally keeps rising with fast growing with no signs of stability in under developed regions (26).
Direct costs for DM were up to 9-fold higher in individuals with the disease than without T2DM-related complications (27). World health expense on the disease was calculated to be USD 727 billion. Diabetic health burden is being elevated and forecasted with a worldwide prevalence in adults to be 9.9 % by 2045 (5,28), while greater than 400 million individuals are living with diabetes (29).
Diabetes, especially T2DM, is a complex illness. Because of diagnostic challenges, it is a combination of diverse etiologies that we need to be better at classifying as this has primary implications for treatment and patient management and determined by several pathophysiological progressions resulting in a spread of medical features that so far are overlooked at time of care how we manage affected individuals (30).
Atherosclerotic cardiovascular disease (ASCVD) defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease assumed to be of atherosclerotic origin. ASCVD is the leading cause of morbidity and mortality for individuals with diabetes and results in an estimated $37.3 billion (about $110 per person in the US) in cardiovascular- related spending per year associated with diabetes (31).
In Ethiopia, IDF 2019 report said an estimated national DM prevalence from in-country data source of diabetes 3.2 % (24). However, DM prevalence of as high as 14.8 % has been reported in 2016 in Addis Ababa Public health facilities (32). In the same year, a community- based cross-sectional study conducted in Mizan-Aman town reported 6.5 % of DM prevalence(33). One year later a community-based cross-sectional study conducted among 634 randomly selected adults in Hosanna town has been reported 5.7 % (34). However, after two years a community-based cross-sectional study conducted in 2019 at Dessie Town reported 6.8 % prevalence (35).
As studies indicated, the prevalence and incidence of diabetes, specially T2DM rises due to population development, aging, diet behaviors, urbanization, and increasing frequency of obesity and physical inactivity (36). Even though works to minimize the disease prevalence are being undertaking by health-care professionals and policy makers on the prevention of the risk factors of diabetes, it is advisable to make effort to the level of the problem to reduce the magnitude of the disease at low level.
Understanding the magnitude and risk factors of diabetes is important to allow rational planning and allocation of resources. This study aimed to provide additional data on the magnitude of diabetes and associated risk factors among the elderly living in Akwanga town, Nasarawa State.
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