CHAPTER ONE

Background of the Study

Diabetes is a serious global public health issue which has been described as the most challenging health problem in the 21st century. Cases of diabetes have progressively increased worldwide; between 1980 and 2008. The increasing burden of diabetes is driven primarily by rising levels of obesity and an ageing population.

Diabetes mellitus is a group of disorder characterized by chronic hyperglycemia (i.e elevated blood glucose) and other disorders of carbohydrate. It is a systemic disease caused by an imbalance between insulin demand (Duncan, 2013).

Epidemiology is a field where trained epidemiologists study patterns of frequency and the causes and effects of diseases in human populations. Epidemiology provides the scientific footings for evidence-based medicine and allows placement of strategies for improvement in public health. Epidemiology is often referred to as the cornerstone of modern public health research and practice and it relies on a variety of relevant public health areas, including biology, biostatistics, social sciences, and assessing risk of exposure to a threat.

However, diabetic individuals are fortunate compared to victims of some other diseases because of the effectiveness in controlling symptoms. It is controlled when the individual is able to maintain relatively sugar free urine and a stable blood sugar level and avoid other symptoms. Banting and Best discovered insulin in 1921. Aratens, in A.D 70, described the disease and gave his name which in Greek means “to run through”. Though the syndrome had earlier on appeared in Chinese writing as a syndrome characterized by Polydipsia, Polyphagia and Polyuria.

The study of the chemistry of diabetic urine was initiated by Paracelcius in the 16th century. Thomas Willis described the sweetness of diabetic urine which was proved to contain sugar by Dobson as a rational dietary approach introduced by Rollo Morton (2008) noted that the hereditary character of diabetes mellitus. Hyperglyceamia was demonstrated by Chanda Bernard in 1859 and ten years later Langerhans discovered the islet of Langerhans.

About 56 years later, Banting and Best were able to prepare extract from dog Pancrease capable of reducing on elevated blood sugar level. In 1953, Barger established the chemical structure of anox insulin while in 1955 France Juch’s in Germany and Low batrieres in France introduce the oral hypoglyceamic agents.

In 1960, the chemical structure of human insulin was elucidated by Nicol and Smith, Katosayannis in USA and Zahn in Germany completed the synthesis of bathx and B chains and produced a biological active material in 1964. In 1967, Steiner described the pro-insulin Molecules. Recently, human insulin was synthesized by a novel technique called reconbraits DNA technology.

Diabetics are also prone to infection and this is due to circulatory and metabolic changes. To minimize these problems patients with diabetes mellitus require specific pre-operative and post-operative care. Clinical care varies depending on whether the patient has insulin dependent type (type I) or non-insulin dependent type (type II) and/or whether the surgery is elective or emergency.

The goal of pre-operative care for type 1 diabetes mellitus patient is to regulate the diabeties; weeks may be required to stabilize the condition. On the other hand, type II patients may require little preparation. Most are managed on diet alone or with oral hypoglyceamic medication.

A variety of treatment plans are being prescribed for patient with diabetes mellitus. The anaesthesiologist and surgeon determine the regime based on the severity and type of diabetes, the length and type of surgery and the presence of other diseases.

Pre-operative laboratory test may include fasting blood sugar (FBS) and acetone, complete (full) blood count (FBC), blood urea nitrogen (BUN) serum electrolyte, ECG and chest x-ray. A one hour procedure blood sugar may be requested to prevent patient from developing hypoglyceamia during surgery. If blood sugar level is low, the patient will require an 1.V fluid of 5% glucose in water before anaesthesia is induced.

The diabetic patient is usually scheduled for morning surgery, so that the patient’s diet and insulin regimen are interrupted by NPO as little as possible. The procedure should be the anaesthesiologist and surgeon. Intra operatively, if patients is undergoing major surgery or has moderate or severe diabetes mellitus, 1000mls of 5% glucose in saline or water is administered, intravenously. To cover the intravenous glucose one half of patient normal daily dose of insulin is usually given.

Continuous monitoring of blood glucose levels is essential throughout the pre-operative period and may be accomplished by using “point of testing equipment”. The glucometer must be calibrated according to the manufacturer’s direction and the nurse should periodically demonstrate competency in performing the test. Both the competencies and the calibrations are recorded. Post operatively, the goals of intervention include;

-      Stabilize the patient’s condition

-      Re-establish control of diabetes

-      Prevent wound

-      Promote wound healing

All possible measures are taken to prevent nausea and vomiting because they will interrupt the patient’s ingestion of food. A change intake would require an adjustment in drug therapy or an extended hospitalization.

Prior to discharge a patient will need instructions about drug and dietary management. Diabetic retinopathy may make it difficult for patient to read medication label, written post operative instructions. Peripheral neuropathy may decrease a patient hand movement.

A home care aid or nurse may be needed to assist the patient to achieve the level of activity demonstrated before surgery, (Groah, 2011).

This disease primarily affects carbohydrate metabolism. It can occur at any age but mostly affect those between the ages of 40 and 60 years. In the mild adult onset type (Non insulin Dependent Diabetes Mellitus (NIDDM)), the disease can stay four months unnoticed, while in the juvenile onset type (insulin Dependent Diabetes Mellitus (IDDM)), it shows an acute onset symptom with severe loss of weight, polyuria, ketosis and halitosis are likely to occur if immediate and appropriate attention is not given.

Diabetes mellitus has been a major social, economic and psychological problem to the society worldwide. There are about thirty million (30 million) diabetics worldwide (about 05 – 5%) with prevalence of 2.5% in the USA, there are 4 million diabetics making up about 2% of the gross population and being more in older persons (UNICEF, 2013).

According to “Diabetes Mellitus report of world Heath Organization (WHO, 2012) study group technical report series 727, Geneva 2001” prevalence is thus; the USA about 69%, Israel 15.9, the Fiji – 13.5% Indonesia 1.7%, Pimalindians 20%, India 2.5%, Jamaica 10.20%, Trinidad and Tobeigo 2.5%, Australia 2.5%, North America countries and Europe have higher percentage figures. Both obesity and Non – Insulin Dependent Diabetes Mellitus (NIDDM) are highly prevalent in the western society and are becoming so many in third world countries as they evolve living (Felber and Acheson, 2014).

Statement of the Problem

Diabetes mellitus is associated with a strong negative impact on the health care system, directly causing 5.2% of all deaths in the world. Certain risk factors for developing Diabetes mellitus have been identified, including older age. The prevalence of Diabetes mellitus may reach 20% in older people, and older diabetic patients are more likely to develop diabetic microangiopathy, atherosclerotic vascular diseases and to die from Diabetes mellitus.

They are also more likely to develop cardiovascular diseases than younger diabetic patients or non-diabetic elderly people. Moreover, older diabetic patients are more prone to have physical disabilities, cognitive impairment and depression. Accurate diagnosis and appropriate intervention programmes for older diabetic patients may successfully prevent DM-related complications. However, evidence supporting current diagnostic criteria, prevention strategies and targets for glycaemic control in the older population are not fully developed. Tight glycaemic control may successfully reduce the risk of microvascular and macrovascular complications in adults, but we lack evidence that these effects are relevant in the older population.

For example, older men with late onset Diabetes mellitus had similar mortality to non-diabetic subjects in long-term follow-up.

Thus, strategies regarding diagnosis, screening and treatment in later onset Diabetes mellitus remain controversial. It is in view of the above that necessitated the researcher for the choice of Epidemiology of diabetes mellitus among older people in Yitti Ward, Lau Local Government Area of Taraba State. 

Purpose of the Study

The purpose of this study is to determine the Epidemiology of diabetes mellitus among older people in Yitti Ward, Lau Local Government Area of Taraba State. Specifically, the objectives of this study include:

1.  To determine the causes of diabetes mellitus among older people in Yitti Ward.

2.  To determine the effects of diabetes mellitus among older people in Yitti     

    Ward.

3. To ascertain the strategies that can be adopted to curb the problems of diabetes

    mellitus among older people in Yitti Ward.

Significance of the Study

It is hoped that the result of this study will be relevant to all members of the surgical team. The nurses will benefit from the findings of this study as diabetic patients undergoing surgery and their relatives.

The existing literature of this study will serve as a reference point for Basic Nursing Course, PHC students who will carry out a study or face with the responsibility of nursing a diabetic patient with wound.

The findings made will be used as a source of corrective measures to health personnel.

The findings may serve as a clue to Yitti Ward, Lau Local Government Area of Taraba State to make better planning and adequate provision of treatment and train more people into the health sector to promote and prevent diabetes mellitus in Lau Local Government Area of Taraba State.

Research Questions

1.  What are the causes of diabetes mellitus among older people in Yitti Ward?

2.  What are the effects of diabetes mellitus among older people in Yitti Ward?

3.  What strategies could be adopted to curb the problems of diabetes mellitus

      among older people in Yitti Ward?

Scope of the Study

This research work is centred on the Epidemiology of diabetes mellitus among older people in Yitti Ward, Lau Local Government Area of Taraba State. It is hoped that the older people within the study area would have known more about the diabetes mellitus in the course of this research work.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

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