Abstract

Background: Diabetes is a chronic metabolic disease that prevails worldwide and is characterized by abnormal increase blood glucose level, usually fasting blood glucose level greater than 126mg/dl. The disease occurs as a result of either insufficient insulin production or cells being insensitive to insulin. The risk factors of diabetes are obesity, family history of diabetes, poor lifestyle. Glycemic control is a very crucial practice in diabetes which has to do with maintenance of blood glucose within a desired range (HBA1C <7%). This helps prevent the occurrence of complications associated with diabetes such as nephropathy, neuropathy, retinopathy, foot problems and cardiovascular problems.

Materials and methods: This study a descriptive cross-sectional study which was coducted at the Buea Regional hospital, among 103 diabetic patients above 21years who were coming for glycated hemoglobin test. Data was collected using semi-structured questionnaires and entered on a Microsoft excel spreadsheet, after which it was exported to SPSS version 26 for the analysis.

Results were reported in means and proportions, with significance levels place at P<0.05. Results: Majority of the participants were females and the rest males. This study recorded 62.1% of participants with adequate knowledge on glycemic control. The prevalence of poor glycemic control in this study was 67%. For the complications observed 37.9% of the participants admitted to have faced complications. The main complication observed was hypertension (17.4%), followed by glaucoma (7.8%). Conclusion: Majority of participants in this study had adequate knowledge. The study also recorded a high prevalence of poor glycemic control among type 2 diabetes patients and the main complication encountered was hypertension.

CHAPTER ONE

INTRODUCTION

1.1 Background

Diabetes is a chronic metabolic disorder which is characterized by increase in blood glucose level [1]. There are two types of diabetes, Mellitus and Insipidus. Diabetes mellitus could be grouped as insulin dependent (type 1) or insulin independent (type 2) diabetes [2]. Type 1 diabetes occurs as a result of insufficient production of insulin due to autoimmune destruction of Beta cells, while type 2 is as a result of the body’s unresponsiveness to insulin produced [2].

Insulin is a hormone secreted from the beta cells of the islets of Langerhans of the pancreas in response to high glucose concentration in blood, which helps to breakdown glucose [3]. Diabetes insipidus occurs as a result of ADH deficiency leading to the inability to concentrate urine [4]. The disease prevails worldwide with increase morbidity among risky population such as the old and is a major cause of mortality [5]. Diabetes mellitus is the most prevalent [5]. It is characterized by frequent urination, dry mouth, increased fatigue, blurred vision and dehydration [6]. Glycemic control in diabetes refers to the maintenance of blood glucose level within a desirable range in order to prevent hyperglycemia or hypoglycemia [7].

A lot of undesirable complications such as foot problems, neuropathy, glaucoma, kidney disease and cardiovascular problems may result from poor GC in diabetes [8]. Factors such as poor diet, non-adherence to medication, lack of exercise and absence of regular blood glucose monitoring can lead to poor GC [9]. In the laboratory, the glycated hemoglobin test (HBA1C) is used to check for poor glycemic control among diabetic patients. The test measures the average blood glucose level in 3 months [10]. It is very important to monitor glycemic control in diabetic patients to prevent the occurrence of complication. This therefore places the need to sensitize diabetes patients on the management and dangers of poor GC as well as help them know their status. This will go a long way to prevent the occurrence of complications and the burden already faced by most families.

1.2 Problem statement and Rationale

1.2.1 Problem statement

Diabetes is a severe life changing metabolic disorder that poses a substantial problem to the healthcare system. It occurs as a result of the body’s inability to breakdown glucose effectively. Diabetes prevails worldwide with majority of those affected being adults. Most adults are more susceptible to this disease due to decrease metabolic rate, lack of physical exercise and obesity.

The risk factors associated with diabetes includes excess intake of sugary foods, lack of physical exercise, predispose to genetic markers, obesity and presence of diseases that may affect the pancreas. Most adults are predisposed to these risk factors, especially lack of physical exercises. Glycemic control in diabetes is a very crucial practice that if not handled properly it will lead to the progression of the disease to a chronic stage.

The complications that arise from the chronic stage of this disease is often life threatening. Complications that arise include neuropathy, nephropathy, retinopathy, foot problems, diabetic ketoacidosis, delayed wound healing and leg ulcerations that may require amputation. All these greatly influence the lives of diabetic patients. A lot of diabetic patients have inadequate knowledge on the consequences of poor glycemic control.

1.2.2 Rationale

The prevalence of diabetes is rapidly increasing globally, with increase morbidity and mortality among adults. Glycemic control is a very key component when it comes to diabetes. The increase prevalence of poor glycemic control among diabetes patients places a substantial burden to the healthcare system, since it leads to disease progression.

Certain factors such as excess intake of sugary foods, poor dietary intake, non-adherence to medications, inadequate knowledge on diabetes management and lack of exercise play a significant role in blood glucose level in diabetic patients.  Many adults are predisposed to these factors especially lack of physical exercise. Poor glycemic control leads progression of the disease and the occurrence of a wide range of complications like, neuropathy, nephropathy, foot problems, retinopathies and increase risk of CVD development. These complications greatly impact the quality of life of diabetic and cause rapid mortality. In addition to this, a lot of diabetes patients may have inadequate knowledge on poor glycemic control in diabetes.

This hospital based study aims at determining the prevalence, factors and complications associated with poor glycemic control among diabetics who will be visiting the BRH. This will enable them know their status and give them insights on their lifestyle and dietary intake as well as the importance of adhering to medication.

In addition, this study will also help to sensitize diabetic patients on the importance of glycemic control and the complications that may arise from poor glycemic control. By so doing, participants will either improve on their knowledge or gain new knowledge on complications of diabetes. This will go a long way to prevent the progression of the diseases, thereby reducing the burden already faced by most families.

1.3 Research Questions

1. What level of knowledge do diabetic patients at the Buea Regional Hospital have on the factors influencing poor glycemic control the complications that may arise?
2. What is the prevalence of poor glycemic control among diabetic patients at the Buea Regional Hospital?
3. What are the factors influencing factors influencing poor glycemic control among diabetic patients at the Buea Regional Hospital?
4. What are the complications encountered by patients with poor glycemic control at the Buea Regional Hospital?

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