CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Diabetes mellitus is a long-term metabolic disease that occurs when the pancreas fails to produce sufficient insulin or when the body is unable to use the insulin it produces effectively. Although diabetes was previously regarded as a single disease, it is now recognised as a group of metabolic disorders with varying causes, progression patterns, and clinical characteristics. Individuals with type 1 diabetes depend on insulin for survival, whereas those with type 2 diabetes may require insulin to achieve adequate metabolic control. Type 2 diabetes accounts for approximately 90% of diabetes cases worldwide (Okeji et al., 2025).

The prevalence of diabetes continues to increase globally. According to the International Diabetes Federation, approximately 589 million adults between the ages of 20 and 79 were living with diabetes in 2024. This figure is expected to rise to about 853 million by 2050. Furthermore, more than 40% of people living with the condition are unaware that they have it (International Diabetes Federation, 2025). In Africa, an estimated 25 million adults have diabetes, with approximately three-quarters of them remaining undiagnosed (International Diabetes Federation, 2025).

One of the major concerns associated with diabetes is the development of long-term complications affecting the body's small and large blood vessels. These complications include retinopathy, nephropathy, neuropathy, and cardiovascular diseases. They contribute to increased illness and mortality and can significantly affect the quality of life of affected individuals (Gross et al., 2005; Forbes & Cooper, 2013). Diabetic kidney disease is particularly important because it may develop without noticeable symptoms during its early stages. One of its earliest indicators is microalbuminuria, which occurs when small quantities of albumin leak into the urine (Tuttle et al., 2014). The development of kidney disease also increases the risk of death among individuals with type 2 diabetes (Afkarian et al., 2013).

Research conducted in Nigerian healthcare facilities has reported varying levels of microalbuminuria among adults with type 2 diabetes. A study in Sagamu identified microalbuminuria in approximately 35% of the diabetic patients examined (Amballi et al., 2018), while research in Umuahia reported a prevalence of about 61% (Okeji et al., 2025). These studies further indicated that the likelihood of developing microalbuminuria was greater among patients with additional risk factors, including hypertension, obesity, and inadequate blood glucose control (Amballi et al., 2018; Okeji et al., 2025).

The management of established diabetes involves a combination of nutritional management, regular physical activity, and appropriate medication. Dietary management is a fundamental part of diabetes care, particularly for individuals with type 2 diabetes (Ley et al., 2014). Regular exercise is also recognised as an important intervention for controlling blood glucose levels and reducing the risk of diabetes-related complications (Colberg et al., 2016).

Nutritional recommendations for people living with diabetes should be tailored to their individual circumstances rather than applied uniformly. Such recommendations should consider the patient's lifestyle, food preferences, cultural background, and personal health objectives. The effectiveness of nutritional management can be assessed through indicators such as blood glucose levels, blood lipid profiles, and blood pressure. Effective diabetes care also requires cooperation among healthcare professionals, including physicians, dietitians, and nurses, with each professional contributing to different aspects of patient management. The dietitian, in particular, helps patients understand and apply prescribed dietary recommendations through practical food choices.

However, managing diabetes through medication, nutrition, and physical activity alone is not sufficient. Regular medical assessment and screening are also necessary to identify early signs of kidney damage and prevent further complications (Tuttle et al., 2014; Thomas et al., 2016).

It is against this background that this study examines the treatment and management of established diabetic cases at General Hospital Billiri, Gombe State, with particular attention to the occurrence of microalbuminuria among affected patients.

1.2 Statement of the Problem

Diabetes mellitus is increasingly common in both developed and developing countries, and Nigeria is also experiencing this growing public health challenge. Factors such as urbanisation, reduced physical activity, and the increasing consumption of refined foods have contributed to rising obesity levels, which are among the major risk factors for type 2 diabetes (Thomas et al., 2016).

A major challenge in diabetes management is that many patients are diagnosed when the disease has already progressed or when complications have developed. In addition, awareness of diabetes and its kidney-related complications remains inadequate among some patients. Difficulties in accessing healthcare services and limited opportunities for professional counselling may further affect effective disease management.

For instance, a study involving patients with type 2 diabetes in Umuahia found that 68% of the participants experienced barriers to accessing care. Approximately 63% indicated that they had little or no knowledge of diabetic kidney disease, while only 16% had previously received counselling on the condition (Okeji et al., 2025). These findings suggest that gaps in healthcare access and patient education may interfere with the early identification and management of diabetes-related complications.

Poor compliance with prescribed dietary recommendations and medication can also make blood glucose control difficult. In some cases, patients rely on incorrect information obtained from individuals without appropriate professional training or use traditional remedies without proper medical supervision. Such practices may interfere with effective diabetes management and increase the likelihood of developing complications, including diabetic nephropathy (Amballi et al., 2018; Okeji et al., 2025).

Despite these concerns, limited information is available on the treatment practices of established diabetic patients at General Hospital Billiri and the occurrence of microalbuminuria among them. There is therefore a need to investigate how these patients are managed, determine the prevalence of microalbuminuria, and examine factors that may be associated with its development. This study is intended to address this gap.

1.3 General Objective

The general objective of this study is to examine the treatment of established diabetic cases and the occurrence of microalbuminuria at General Hospital Billiri, Gombe State, Nigeria.

1.4 Specific Objectives

The specific objectives of the study are to:

1. Determine the prevalence of microalbuminuria among established diabetic patients attending the hospital.

2. Describe the treatment and management practices provided to these patients, including dietary management, physical activity, and drug therapy.

3. Examine the relationship between microalbuminuria and selected factors, including the duration of diabetes, glycaemic control, blood pressure, and body weight.

4. Assess patients' knowledge of diabetes and its kidney-related complications, as well as their dietary practices.

1.5 Significance of the Study

The findings of this study are expected to:

1. Provide information on the prevalence of microalbuminuria among established diabetic patients at General Hospital Billiri.

2. Show the extent to which existing treatment approaches and dietary management practices are adequate for the patients.

3. Provide useful information to dietitians, healthcare workers, the Ministry of Health, and the Nigerian government for developing appropriate guidelines on diabetes screening and nutritional care.

4. Contribute to improving the quality of care and living conditions of individuals living with diabetes.

REFERENCES

Afkarian, M., Sachs, M. C., Kestenbaum, B., Hirsch, I. B., Tuttle, K. R., Himmelfarb, J., & de Boer, I. H. (2013). Kidney disease and increased mortality risk in type 2 diabetes. Journal of the American Society of Nephrology, 24(2), 302–308. https://doi.org/10.1681/ASN.2012070718

Amballi, A. A., Odusan, O., Ogundahunsi, O. A., Jaiyesimi, A. A., Oritogun, S. K., & Olooto, W. E. (2018). Prevalence of microalbuminuria among adults with type 2 diabetes mellitus at OOUTH, Sagamu. Annals of Health Research, 4(1), 15–21. https://doi.org/10.30442/ahr.0401-1-03

Colberg, S. R., Sigal, R. J., Yardley, J. E., et al. (2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11), 2065–2079. https://doi.org/10.2337/dc16-1728

Forbes, J. M., & Cooper, M. E. (2013). Mechanisms of diabetic complications. Physiological Reviews, 93(1), 137–188. https://doi.org/10.1152/physrev.00045.2011

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International Diabetes Federation. (2025). IDF Diabetes Atlas (11th ed.). https://diabetesatlas.org

Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: Dietary components and nutritional strategies. The Lancet, 383(9933), 1999–2007. https://doi.org/10.1016/S0140-6736(14)60613-9

Okeji, I. E., Uzor, O. F., Okafor, C. C., et al. (2025). Prevalence and correlates of clinical nephropathy in patients with type 2 diabetes at Abia State Specialist Hospital and Diagnostic Center, Umuahia, Nigeria: A cross-sectional study. Cureus, 17(6), e86962. https://doi.org/10.7759/cureus.86962

Thomas, M. C., Cooper, M. E., & Zimmet, P. (2016). Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nature Reviews Nephrology, 12(2), 73–81. https://doi.org/10.1038/nrneph.2015.173

Tuttle, K. R., Bakris, G. L., Bilous, R. W., et al. (2014). Diabetic kidney disease: A report from an ADA consensus conference. Diabetes Care, 37(10), 2864–2883. https://doi.org/10.2337/dc14-1296