CHAPTER ONE

INTRODUCTION

The first known mention of diabetes symptoms was in 1552 B.C, when Hesy-Ra, an Egyptian physician, documented frequent urination as a symptom of a mysterious disease that also caused emaciation. Also, around this time, ancient healers noted that ants seemed to be attracted to the urine of people who had this disease [1]

In 150 AD, the Greek physician Arateus described what we now call diabetes as “the melting down of flesh and limbs into urine.” From then on, physicians began to gain a better understanding about diabetes. Centuries later, people known as “water tasters” diagnosed diabetes by tasting the urine of people suspected to have it. If urine tasted sweet, diabetes was diagnosed. To acknowledge this feature, in 1675 the word “mellitus,” meaning honey, was added to the name “diabetes,” meaning siphon. It wasn’t until the 1800s that scientists developed chemical tests to detect the presence of sugar in the urine. [2]

As physicians learned more about diabetes, they began to understand how it could be managed. The first diabetes treatment involved prescribed exercise, often horseback riding, which was thought to relieve excessive urination [1]

Type 2 DM is a lifestyle disorder resulting due to insulin resistance. This insulin resistance is precipitated by improper lifestyle practices like intake of high carbohydrate rich diet, reduced intake of fruits and vegetables, lack of adequate exercises and physical activity. The disease manifests as a chronic metabolic disorder resulting in persistent hyperglycemia and its damage various organs and tissues [2].

In the 1700s and 1800s, physicians began to realize that dietary changes could help manage diabetes, and they advised their patients to do things like eat only the fat and meat of animals or consume large amounts of sugar. During the Franco-Prussian War of the early 1870s, the French physician Apollinaire Bouchardat noted that his diabetic patients’ symptoms improved due to war-related food rationing, and he developed individualized diets as diabetes treatments. this led to the fad diets of the early 1900s, which included the “oat-cure,” “potato therapy,” and the “starvation diet.” [1]

1.1 Background

Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient Egyptians and Indians, illustrating some clinical features very similar to what we now know as diabetes. [1] DM is a combination of two words, “diabetes” Greek word derivative, means siphon; to pass through and the Latin word “mellitus” means honeyed or sweet. In 1776, excess sugar in blood and urine was first confirmed in Great Britain. [2, 3] With the passage of time, a widespread knowledge of diabetes along with detailed etiology and pathogenesis has been achieved. DM is defined as “a metabolic disorder characterized by hyperglycemia resulting from either the deficiency in insulin secretion or the action of insulin.” The poorly controlled DM can lead to damage various organs, especially the eyes, kidney, nerves, and cardiovascular system. [4]

DM can be of three major types, based on etiology and clinical features. These are DM type 1 (T1DM), DM type 2 (T2DM), and gestational DM (GDM). In T1DM, there is absolute insulin deficiency due to the destruction of β cells in the pancreas by a cellular mediated autoimmune process. In T2DM, there is insulin resistance and relative insulin deficiency. GDM is any degree of glucose intolerance that is recognized during pregnancy. DM can arise from other diseases or due to drugs such as genetic syndromes, surgery, malnutrition, infections, and corticosteroids intake. [5-7] T2DM factors which can be irreversible such as age, genetic, race, and ethnicity or revisable such as diet, physical activity and smoking. [8,9]

Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. [10] International diabetes federation’s report described that 382million had diabetes in the year 2013 and it was estimated to reach 592 million in the year 2035. [11] Diabetes is the seventh leading cause of death in United States of America. Diabetes in blacks is 1.7 times likely to develop diabetes than whites; the prevalence of diabetes among blacks has quadrupled during the past 30 years. Among black people, 20years and older, about 2.3 million have diabetes – 10.8 percent of that age group. Death rates for blacks with diabetes are 27 percent higher than for whites and leading cause of death in the United States [12].

The Middle East has a very high (11%) prevalence of diabetes [13]. Six of the top 10 countries with the highest prevalence of diabetes are in the Arab region namely Kuwait (21.1%), Lebanon (20.2%), Qatar (20.2%), Saudi Arabia (20%), Bahrain (19.9%) followed by United Arab Emirates (UAE) (19.2%) (…). In this region, nearly three-fourths (73.4%) of the people living with diabetes are aged under 60 years and are at the peak of their productive years (40 years of age). In Cameroon, the prevalence of diabetes in adults in urban areas is currently estimated at 6-8% with as much as 80% of people living with diabetes who are currently undiagnosed in the population [14].

A diet for diabetes should contain a good balance of carbohydrates. Nutrition therapy in diabetes addresses not only glycemic control but other aspects of metabolic status as well as dyslipidemia and hypertension – major risk factors for cardiovascular disease. Individuals who have diabetes should receive individualized diet as needed to achieve treatment goals, preferably provided by a dietitian familiar with the components of diabetic diet.

Individualized meal planning for diabetes should include. Optimization of food choices to meet recommended dietary allowance carbohydrate intake is a primary strategy for achieving good glycemic control in both type 1 and type 2diabetes. There is little evidence for the ideal carbohydrate composition in the management of hyperglycemia in diabetes.

Meal and snack carbohydrate intake for diabetes should be consistently distributed throughout the day, on a day-to-day basis, as consistency in carbohydrate intake has been shown to result in improved glycemic control. [10]

1.2 Problem statement 

In Cameroon, the prevalence of diabetes in adults in urban areas is currently estimated at 6-8% with as much as 80% of people living with diabetes who are currently undiagnosed in the population [14]. The effects of diabetes are usually debilitating and mostly arise due to the fact that most diabetics do not know much about nutritional modifications as well as self -care attitudes. However, several innovations have been put in place to ensure that there is a decrease in the complications of diabetes among diabetics as well as improving on their knowledge.

Despite all the publicity surrounding new research and new nutrition guidelines, some people with diabetes still believe that there is something called a “diabetic diet.” For some, this so-called diet consists of avoiding sugar, while others believe it to be a strict way of eating that controls glucose. Unfortunately, neither is quite right. Diabetic patients encounter several difficulties in complying with the dietary regime. They exhibit restrictive eating behaviors, they express feelings of dietary deprivation, and rigid dietary control is perceived as the only way to a proper diet and weight management. [15] this therefore motivated the principal investigator to carry out a study aimed at assessing the nutritional knowledge and self-care attitudes of patients with diabetes millitus at the Nkwen District Hospital

1.3 Research Questions

1) What is the level of knowledge on self- care among patients with diabetes millitus at the Nkwen District Hospital ?

2) What are the self-care practices of patients with diabetes millitus at the  Nkwen District Hospital ?

3) What are the attitudes of self-care of patients with diabetes millitus at the Nkwen District Hospital ?

4) What are the challenges of self-care among patients with diabetes millitus at the  Nkwen District Hospital ?

1.4 Hypothesis

The knowledge on nutrition and self -care attitudes of diabetic patients is statistically significant with their levels of education

1.5 Research objectives

1.5.1 General objective

To investigate the knowledge and attitudes of self-care among patients with diabetes millitus at the Nkwen District Hospital

1.5.2 Specific objectives

1) To assess the knowledge on self- care among patients with diabetes millitus at the Nkwen District Hospital

2) To identify the self-care practices of patients with diabetes millitus at the  Nkwen District Hospital

3) To assess the attitudes of self-care of patients with diabetes millitus at the  Nkwen District  Hospital

4) To assess the challenges of self-care among patients with diabetes millitus at the Nkwen District Hospital