CHAPTER ONE

GENERAL INTRODUCTION

This chapter talks about the background, the problem statement, the objectives, research questions, significant of study, the scope of the study and lastly the operational definitions of terms

1.1 Background

Diabetes is a chronic health problem with devastating consequences yet preventable .it is characterized by high blood glucose resulting from defect in the production of insulin. WHO (20018). The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin (WHO 2018). There is relatively high level in noncompliance to self-management behaviors which could lead to consequences such as high blood pressure leading hypertension, preeclampsia kidney failures amongst others. It is one of the serious, complex chronic diseases, which tend to accelerate degenerative changes throughout the body by widespread vascular changes in the large blood vessels and the micro vessels if not treated properly. It affects mostly adults from the age of 25 years to 74 years, although it also affects children as young as 3 years old (Mc. Neil et al, 2016).

Type I diabetes is known as Insulin Dependent Diabetes Mellitus (IDDM). The pancreas produces an inadequate amount of insulin, individuals with IDDM are expected to follow a complicated regimen in order to manage their diabetes, with the assumption that such behavior will reduce their risk of developing disabling and potentially fatal complications (Coates R et, 1994). Type II diabetes, also known as Non-Insulin Dependent Diabetes Mellitus (NIDDM) results from an increase in the sensitivity of the cells to insulin and a decrease in the amount of insulin produced. The onset of type I diabetes is usually before the age of 30 years, whereas type II occurs most frequently in people who are over 30 years of age and obese, and therefore affects people during later years. (Mc Neil et at, 2016)

Diabetes is characterized by an elevation in the level of glucose in the blood. The increase in the glucose level may be due to a decrease or absence of insulin production in the pancreas, which controls the blood glucose level by regulating the production and storage of glucose. This leads to abnormalities in the metabolism of carbohydrates, proteins and fats. The resulting hyperglycemia may lead to acute metabolic complications such as diabetic keto acidosis, and long-term hyperglycemia may contribute to chronic cardiovascular complications (kidney and eye disease) and neuropathic complications. Diabetes is also associated with an increased occurrence of macro vascular diseases including myocardial infarction and strokes (Smeltzer & Bare 1992). The outcome of diabetes mellitus depends almost entirely on the patient’s self-management (Shownze, 2014). Health professionals have a major responsibility in assisting patients to gain the necessary knowledge, skills and attitudes for self-management (Phipps, Long &Woods 1987).

Joseph von Mering and Oskar Minkowski are credited with discovering in 1899 that the removal of the pancreas from a dog allowed it to develop diabetes and so takes credit in regards to the formal discovery (1889) of a role for the pancreas in causing the condition.  Over 3,000 years ago, the ancient Egyptians mentioned a condition that appears to have been type 1 diabetes. (Ahnet, 2019). The term diabetes is the shortened version of the full name diabetes mellitus (Ananyan R, 2018). It was first known and recorded as diabetes until in 1675 Thomas Willis added the word “’mellitus’” to the word diabetes. This was because of the sweet taste of the urine. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians as is evident from their literature. (Mandal A, 2019). However according to Cashin-Garbutt, Diabetes mellitus is derived from the Greek word diabetes meaning siphon – to pass through and the Latin word mellitus meaning honeyed or sweet. This is because in diabetes excess sugar is found in blood as well as the urine. Diabetes  was known in the 17th century as the “pissing evil”and in 1776, Matthew Dobson confirmed that the sweet taste of urine of diabetics was due to excess of a kind of sugar in the urine and blood of people with diabetes.(konrad F,2018).The major breakthrough in the story of diabetes was in 1921 when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski and went ahead to demonstrate that they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs.Banting, Best, and their chemist colleague Collip purified the hormone insulin from pancreases of cows at the University of Toronto, then this led to the availability of an effective treatment for diabetes in 1922(Barbara oneil ,2007) For this, Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized, in particular Best and Collip(Babara oneil,2007) Diabetes mellitus currently affects an estimated 11 million people in the United States. About 500 000 new cases of diabetes are diagnosed annually. It is prevalent in the elderly, though studies indicate that even children are affected. Diabetes is a leading cause of new blindness among 25-74 year olds in the United States and the third leading cause of death, mostly because of the high rate of coronary artery diseases which are a complication of diabetes mellitus ( Smeltzer  1992),more especially sexual dysfunction related to diabetes is even more crucial (Andrews B, 1995). According to the W. H. O in the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of low income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself (A F Davis,2008). For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.(WHO, 2019). Also the world health organization stipulated in the beginning of the year 2019 that 422 million people were living with diabetes and more than a one quarter of this were living in low income countries and Middle income countries, this  let the WHO to announce the start of a pilot program to prequalify human insulin in order to increase treatment for diabetes in low- and middle-income countries.(WHO, 2019).The decision was announced ahead of World Diabetes Day (14 November), as part of a series of steps WHO will take to address the growing diabetes burden in all regions. About 65 million people with type 2 diabetes needed insulin, but only half of them are able to access it, largely due to high prices.  All people with type 1 diabetes need insulin to survive. “Diabetes is on the rise globally, and rising faster in low-income countries,” says Dr Tedros Adhanom. Ghebreyesus, WHO Director-General. “Too many people who need insulin encounter financial hardship in accessing it, or go without it and risk their lives. WHO’s prequalification initiative for insulin is a vital step towards ensuring everyone who needs this life-saving product can access it. As far as Cameroon is concern the world diabetes foundation in 2018 stated that, 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. The burden of diabetes in Cameroon is not only high but is also rising rapidly,

1.2 Problem statement

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 WHO (2018) 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 foot exams, which if under looked can lead to serious complications such as hypertension, kidney failures, and mortality. It is generally accepted that diabetics must take responsibility for their own care and treatment. Patients therefore have to acquire the relevant knowledge, on the complications of diabetes mellitus for successful diabetes management. This implies adequate diabetes education of patients on the management and prevention of diabetes is sincerely vital. Therefore, this study sought to determine patients’ knowledge on challenges, complications and management of diabetes mellitus.

Research Questions

1. What is the level of knowledge about Type 2 Diabetes among patients in Mile Four, Limbe?
2. What are the common management practices adopted by diabetic patients in Mile Four, Limbe?
3. What challenges do diabetic patients face in managing their condition?
4. What factors affect access to diabetes care and medication in Mile Four, Limbe?
5. What improvements can be made to enhance diabetes management and healthcare support in the community?

Research Objectives

1. To assess the level of awareness and knowledge of Type 2 Diabetes among residents of Mile Four, Limbe.
2. To identify the management practices adopted by diabetic patients in the area.
3. To examine the challenges faced in diabetes management, including financial, social, and medical barriers.
4. To analyze the factors affecting access to diabetes-friendly diets, medication, and healthcare services.
5. To propose recommendations for improving diabetes care and support systems in Mile Four, Limbe.