CHAPTER ONE
INTRODUCTION
1.1BACKGROUND OF THE STUDY
Diabetes was first documented by the Egyptians and is characterized by weight loss and
polyuria. However, it was the Greek physician Aertaeus who coined the term diabetes mellitus
(DM). In Greek, diabetes means “to pass through” and mellitus is the Latin word for honey
(referring to sweetness). Diabetes is an important cause of prolonged ill health and premature
mortality and claims more lives per year than HIV-AIDS with 1 death every 10 seconds. With
the advent of industrialization worldwide and the staggering rise in obesity, diabetes has
manifested as a global epidemic. Although it is very difficult to reach an accurate measure of
prevalence for two main reasons: the standard and methods data collection varying widely in
different parts of the world; recent surveys predict an increase in the prevalence of diabetes in
adults from 4% in 1995 to 6.4% by the year 2025.
Furthermore, it is estimated to change rapidly with a 42% increase from 51 to 72 million in the
developed countries and a 170% increase from 84 to 228 million in the developing world.
Worldwide the number of adults suffering from diabetes will rise from 194 million in 2003 to
nearly 380 million in 2025. The countries most affected by this epidemic in the year 2025 will be
India, China and the USA. The second and fairly alarming reason is that even today there is a
large population (almost 50%) of the patients remaining undiagnosed. The change in life
expectancy and lack of improvement in healthcare are in part responsible for the astounding rise
in the incidence of DM. As a result, data collection varying widely in various parts of the world;
recent surveys predict an increase in the prevalence of diabetes in adults from 4% in 1995 to
6.4% by the year 2025. 1 Furthermore, it is estimated to change rapidly with a 42% increase
from 51 to 72 million in the developed countries and a 170% increase from 84 to 228 million in
the developing world. Worldwide the number of adults suffering from diabetes will rise from
194 million in 2003 to nearly 380 million in 2025. The countries most affected by this epidemic
in the year 2025 will be India, China and the USA .The second and alarming reason is that even
today there is a large population (almost 50%) of the patients remaining undiagnosed. The
change in life expectancy and lack of improvement in healthcare are in part responsible for the
astounding rise in the incidence of DM. As a result, there is an upward trend of the occurrence of
diabetes, especially in the urban areas. Consequently, countries across the globe will face a
significant increase in the burden for health care, as patients with diabetes are prone to both
short-term and long-term complications and premature death. Pathophysiology of Diabetes ult
there is an upward trend of occurrence of diabetes, especially in the urban areas. Consequently,
countries across the globe will face a significant increase in the burden for health care, as
patients with diabetes are prone to both short-term and long-term complications and premature
death (Kharroubi et al.,2015).
Type 2 diabetes mellitus is a complicated metabolic disease affecting millions of individuals
worldwide. The medications used to manage the disease are based on different pharmacologic
approaches, including decreasing hepatic gluconeogenesis, stimulating pancreatic insulin
production, slowing polysaccharide digestion, and increasing insulin sensitivity in muscle, liver,
and fat to lower blood glucose. Incretin-based therapies, including glucagon-like peptide-1
(GLP-1) receptor agonists, mimic the effects of native GLP-1, while dipeptidyl peptidase-4
inhibitors increase circulating concentrations of endogenous GLP-1. This review focuses on
means by which primary care physicians might evaluate the utility of pharmacologic agents
based on their relation to the pathogenesis of type 2 diabetes. In general, patients with type 2
diabetes should be treated to their lowest targeted glycemic goals as soon as they are diagnosed,
for as long as possible, as safely as possible, and as rationally as possible (Jeff Ungel et al,
2010).
Type 2 diabetes is a serious metabolic disorder characterized by insulin resistance and pancreatic
β-cell dysfunction because of unsettled hyperglycemia. Formerly known as adult-onset diabetes,
it is a chronic condition affecting the way the body metabolizes glucose, a sugar that is a key
source of energy. This type of diabetes is frequently associated with obesity.
The pandemic of type 2 diabetes mellitus (T2DM) has been largely attributed to the increasing
prevalence of worldwide obesity at a geometric rate. However, the number of non-obese patients
with T2DM is also on the rise, and it is as high as 60-80% in some Asian countries. These non
obese individuals have certain peculiarities and have a higher mortality rate compared with obese
individuals. The pathophysiology of T2DM in non-obese individuals remains poorly understood,
and this has an impact on defining its management. This review discusses the current
understanding of the pathophysiology of T2DM in non-obese individuals. The definition of
T2DM in non-obese individuals remains controversial because of the limited clinical
measurements, and the current definition of obesity using body mass index (BMI) is not very
helpful as these individuals have BMIs of <25K g/m3, which is considered normal. Many
authors have argued that the so-called non-obese people are actually metabolically obese;
however, in terms of the measurements clinically available, they are non-obese. The simplistic
understanding of the mechanism of pathophysiology sees it in terms of the balance between
insulin secretion and insulin resistance. The pathogenesis of insulin resistance in a lean patient
has been proven to be the same as what is seen in an obese individual, but most studies confirm
more severe functional insulin secretory defects in lean individuals compared to the obese
phenotype. The mechanism underlying this form of T2DM is still poorly defined, and more
research is required to understand the mechanism of sarcopenic obesity, which some studies have
revealed (Idowu Olaogun et al, 2020).
1.2 Problem Statement
Many people with diabetes mellitus reported not being overweight before onset of diabetes
mellitus and medical personnel are confirming this incidence.
1.3 Rationale
Diabetes is a worldwide public health problem made more acute in Africa by low socio
economic standards. In Cameroon, the prevalence of diabetes in urban areas is currently
estimated at 6-8% of people living with diabetes who are currently undiagnosed in the
population. Despite numerous reports suggesting a substantial genetic contribution to the
susceptibility of T2DM no major susceptibility genes have been identified. Recently, medical
clinical practitioners have noticed a good percentage of diabetes mellitus patients were not
having a history of obesity. It’s therefore necessary to find out what the most prevalent factors
are that predispose individuals to diabetes mellitus in our community.
1.4 Research Questions
-What are the different pre-disposing factors of diabetes mellitus type 2.
-what are the pharmacological management of diabetes mellitus type 2.
-what is the proportion of diabetes mellitus type 2 patients with non-obesity causes of diabetes in
Buea Regional Hospital

1.5 Objectives
The aim is divided into two general and specific objectives
1.5.1 General Objective
To determine the non-obesity determinants of diabetes mellitus type 2 patients and the
pharmacological management by medical personnel
1.5.2 Specific Objective
-To determine different pre-disposing factors of diabetes mellitus type 2 patients.
-To investigate the pharmacological management of diabetes mellitus type 2 patients.
-To compare/assess the proportion of diabetes mellitus type 2 patients with non-obesity causes of
diabetes.