CHAPTER ONE

GENERAL INTRODUCTION

1.0 BACKGROUND OF STUDY

Diabetes is a chronic health problem with devastating, yet preventable consequences. It is

characterized by high blood glucose levels resulting from defects in insulin production, insulin
action, or both. Globally, rates of type 2 diabetes were 15.1 million in 2000; the number of
people with diabetes worldwide is projected to increase to 36.6 million by 2030. In 2007, 23.6
million people, or 7.8% of the United States population had type 2 diabetes. Of these, 9095% of
these cases were adults with type 2 diabetes. Type 2 diabetes impacts men and women
proportionately; there are over 12 million men with diabetes and 11.5 million women with
diabetes. In adult patients, 6.6% were non-Hispanic White, 11.8% were non-Hispanic Black,
10.4% were Hispanic, and 7.5% were Asian. This rate is expected to increase greatly over the
next half century. Along with the increase in incidence of diabetes, both individual and societal
expectations concerning the management of diabetes have also increased, with many reports
from The Centers for Disease Control (CDC), United States Department of Health and Human
Services (USDHHS), and the National Institutes of Health (NIH) urging patients to “Take
Charge of Your Diabetes” and “Conquer Diabetes”. One of the main goals of USDHHS’s report,
Healthy People 2010, is to improve the quality of life for persons with diabetes. Taking control
of diabetes to improve quality of life has put the spotlight on the need for additional support and
education for patients with type 2 diabetes. Although new treatments and technology have aided
in controlling the disease in many individuals, the challenges of diabetes self-management are
overwhelming for most. Diabetes is a chronic disease for which control of the condition demands
patient self-management. Self-management behaviors include monitoring blood glucose levels,
taking medication, maintaining a healthy diet and regularly exercising. For most patients, it is
important to conduct daily food exams. However, despite the technological and scientific
advances made toward the treatment of diabetes, the American Association of Clinical
Endocrinologists reports that only 1 in 3 patients with type 2 diabetes is well controlled. Only
about one-third of patients report adherence to monitoring blood glucose levels. The American
Association of Diabetes Educators success that only one-half of patients adhere to medication.
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There are relatively high levels of no adherence in all areas of self-management behaviors. This
non-adherence is perhaps due to the fact that self-management behaviors usually require chances
in the patient’s daily life. In order to successfully make these chances, patents are encouraged by
others to set goals to make the incremental chances necessary to create life-long habits that allow
them to manage their diabetes. Self-management of diabetes requires time and activities (i.e.
monitoring blood-glucose levels) that can attract the attention of others. However, when the pater
is effectively managing the condition, outwardly he might appear healthy. Daily decision making
in diabetes can have direct implications for health, however many daily self-care activities are
aimed at achieving maintenance of acceptable standards that are necessary to prevent long term
complications. It is also important w note that a diminished self or loss of self can result from the
loss of alternative social identities due to the pervasive nature of diabetes. Diabetes can influence
everyday social interactions in many ways; the patient must restrict the types and amounts of
foods they ingest, they might have to monitor their blood glucose levels at specific times during
the day, and medication might be necessary at times when the individual is engaged in social
activities.

Chronic illness and the management of symptoms such as thirst, polyuria, blurring of vision, and
weight loss. In it is most severe forms, ketoacidosis or a non-ketotic hyperosmolar state may
develop and lead to stupor, coma and, in absence of effective treatment, death. Often symptoms
are not severe, or may be absent and consequently hyper glycaemia sufficient to cause
Pathological and functional changes may be present for a long time before the diagnosis is made.
The long-term effects of Diabetes Mellitus include progressive development of the specific
complications of retinopathy with potential blindness nephropathy that may lead to renal failure,
and or neuropathy with risk of foot ulcers, amputation, Charcot joints, and features of autonomic
dysfunctions, including sexual dysfunction. People with Diabetes are at increased risk of
cardiovascular, peripheral vascular and cerebrovascular disease. Several pathogenetic processes
are involved in the development of diabetes. These include processes which destroy the cells of
the pancreas with consequent insulin deficiency, and others that result in resistance to insulin
action. The abnormalities of carbohydrate, fat and protein metabolism are due to deficient action
of insulin on target tissues resulting from insensitivity or lack of insulin.

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1.1 A COMPREHENSIVE OVERVIEW OF DIABETES MELLITUS

Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels
resulting from defects in insulin secretion, insulin action, or both. This condition poses
significant health risks and requires lifelong management to prevent complications.
Understanding the pathophysiology, classification, diagnosis, and management of diabetes
mellitus is crucial for effective patient care.

The pathophysiology of diabetes mellitus involves abnormalities in insulin production, insulin

action, or both, leading to hyperglycemia. In type 1 diabetes mellitus (T1DM), autoimmune
destruction of pancreatic beta cells results in absolute insulin deficiency (American Diabetes
Association, 2020). Conversely, type 2 diabetes mellitus (T2DM) is characterized by insulin
resistance and relative insulin deficiency due to impaired insulin action and inadequate
compensatory insulin secretion (Kahn et al., 2014). Other forms of diabetes, such as gestational
diabetes mellitus (GDM) and secondary diabetes, have distinct etiologies contributing to
hyperglycemia (American Diabetes Association, 2020).

Diabetes mellitus is classified into several types based on etiology, clinical presentation, and
pathophysiology. The main classifications include:

 Type 1 diabetes mellitus (T1DM)

 Type 2 diabetes mellitus (T2DM)

 Gestational diabetes mellitus (GDM)

 Other specific types, including monogenic diabetes syndromes, secondary diabetes due to
underlying conditions (e.g., pancreatitis, hormonal disorders), and drug-induced diabetes
(American Diabetes Association, 2020).

Diagnosing diabetes mellitus involves assessing fasting plasma glucose (FPG) levels, oral
glucose tolerance test (OGTT), and/or hemoglobin A1c (HbA1c) levels. The diagnostic criteria

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vary depending on the test used and patient characteristics. The American Diabetes Association
recommends using the following diagnostic criteria:

- FPG ≥ 126 mg/dL (7.0 mmol/L) after an overnight fast

- 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an OGTT

- HbA1c ≥ 6.5% (48 mmol/mol) (American Diabetes Association, 2020).

The management of diabetes mellitus aims to achieve glycemic control, prevent complications,
and improve quality of life. Treatment modalities include lifestyle modifications,
pharmacotherapy, and insulin therapy. Lifestyle interventions encompass dietary modifications,
regular physical activity, weight management, and smoking cessation (Davies et al., 2018).
Pharmacotherapy options include oral antidiabetic medications (e.g., metformin, sulfonylureas,
DPP-4 inhibitors), injectable therapies (e.g., GLP-1 receptor agonists), and insulin (Davies et al.,
2018). Insulin therapy may be required in patients with T1DM or advanced T2DM to achieve
glycemic targets (American Diabetes Association, 2020).

1.2 BRIEF HISTORY OF PRINCE ABUBAKAR AUDU UNIVERSITY TEACHING

HOSPITAL

Prince Abubakar Audu University Teaching Hospital (PAAUTH) is a significant healthcare

institution located in Kogi State, Nigeria, established in response to the recognized need for a
tertiary healthcare facility in the region during the early 2000s. Officially commissioned and
opened to the public. The hospital was named after Prince Abubakar Audu, a respected political
figure in the state known for his commitment to development initiatives, particularly in
healthcare. PAAUTH was founded with a clear mission: to provide accessible, affordable, and
high-quality healthcare services to the community, while also serving as a center for medical
education and research. Over the years, the hospital has undergone considerable growth and
evolution, expanding its infrastructure, services, and medical specialties to adapt to the evolving
healthcare landscape. It has become a vital referral center for complex medical cases, offering
specialized care previously unavailable in the region. PAAUTH's presence has not only
positively impacted healthcare access and quality but also contributed to the local economy by
creating employment opportunities and supporting ancillary services in the healthcare sector.
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Overall, PAAUTH stands as a testament to the commitment of government and healthcare
stakeholders to improve healthcare standards in Kogi State, benefiting its residents and
advancing medical knowledge and practices.

13 AIM AND OBJECTIVES OF THE STUDY

The aim of this study is to explain and evaluate the statistical analysis of Diabetes Mellitus.
Thus, the objectives of the study are:

1. To analyze the statistical data on Diabetes Mellitus with emphasis on admission and death
during the year 2018.

2. To test hypothesis whether male are more exposed to Diabetes than female.

1.4 SCOPE AND LIMITATIONS OF THE STUDY

This study is focused on statistical analysis of Diabetes Mellitus in General Hospital Lagos State
within the year 2018-.and its risk factor among residence in Lagos state. It should be noted that,
it is impossible for a researcher to carry out a research work without experiencing some obstacles
which will tend to affect the quality of the study in the course of his investigation. The researcher
was faced with series of problem during the course of this work, these includes:

(1) Financial problem: - As a result of lack of enough funds, it was difficult for researcher to
fully carryout the various steps of this research work, like browsing of books from the internet.

(2) Insufficient time: - Since this research work had to be done during the semester, most of my
time was taken up by normal classroom lectures, thus restricting the number of times the hospital
was visited.

1.5 SIGNIFICANCE OF THE STUDY

Apart from its requirement for the partial fulfillment for the award of Bachelor of Science in
Statistics in Kogi State University, this research work is of considerable importance, in that, its
findings and recommendations will be of immense benefits to the Medical Researchers, Health
Workers, International Organizations on health and World Health Organization. The findings
and recommendation will be of particular benefits to Lagos state hospital management board,
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 general hospital Lagos and anyone who may be interested in the same/ similar area of study in
future.

1.6 DEFINITION OF MEDICAL TERMS

i. Diabetes: A group of metabolic diseases whereby a person has high blood sugar due to an
inability to produce, or inability to metabolize, sufficient quantities of the hormone insulin.

ii. Epidemiology: This is the branch of a science dealing with the spread and control of diseases,
viruses, concept etc. throughout populations or system.

iii. Etiology: This is the study or theory of the factors that cause disease and method of their
introduction to host.

iv. Endocrine: This means secreting internally.

v. Exocrine: This means producing internal secretions that are transported around the body by
the bloodstream.

vi. Cutaneous: it means disease that affects the exterior skin.

vii. Fibrosis: It means the formation of fibrous tissue

viii. Hyperglycemia: Is the abnormally increased content of sugar in the blood.

ix. Insulin: The hormone, produce and secreted by the bets ceils of the islets (insulae) of the
pancreas which regulates the use and storage of foods stuffs especially the carbohydrates.

x. Obese: An increase in body weight beyond the limitation of skeletal and physical
requirement, as the result of excessive accumulation in the body.

xi. Adult onset Obesity: Obesity beginning in adulthood and characterized by increase in size of
adipose cells with no increase m number.

xii. Syndrome: A set of symptoms which occur together or the sign of any morbid state.

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xiii. Stigma: Any mental or physical mark or peculiarity which aids in the identification or in the
diagnosis of a condition.

xiv. Auto immunity: A condition characterized by a specific humoral or cell mediated immune
response against constituents of the body’s own tissues.