Prevalence Of Diabetes Mellitus And Hypertension Co-Morbidities Among Indigenes Of Orodo, Mbaitoli Local Government Area, Imo State

ABSTRACT

A considerable portion of the world’s population suffers co-existent diabetes and hypertension. Up to 75% of adults with diabetes also have hypertension. Lack of knowledge about this condition pose a great risk of complications. The study aimed to determine the level of hypertension and diabetes co-morbidity in line with the associated risk factors. A cross sectional observational study was employed to determine the level of co-morbidity of hypertension and diabetes among Orodo, Mbaitoli Local Government Area, Imo State. The instruments for data collection were the digital glucometer, hygmomanometer, a weighing balance, meter rule and a well structured questionnaire administered by trained and certified professionals and volunteers. Observation technique was used on participants to compliment the questions collected with the spreadsheet. A Statistical Package for Social Science (SPSS) Version 20.0 was used to analyze the collected data. Descriptive and inferential analyses were employed to display the results of the study. The result showed that out of the total of 370 respondents sampled, majority 305 (82.4%) were female while 65 (17.6%) were their male counterpart. For the age, 135 (36.5%) were 60 years and above and only 27 (7.3%) of the aged were between 20-29 years. Findings showed that 3.8% of the respondents have diabetes and hypertension co-morbidity. Result also indicated that 131 (35.4%) engage in exercise; 49 (13.2%) were cigarette/tobacco consumers; 104 (28.1%) take alcohol; and 32 (8.6%) and 119 (32.2%) have family history of diabetes and hypertension respectively. The Body Mass Index (BMI) also revealed that women were obese and over weight than their male counterparts.

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Diabetes mellitus and hypertension are two of the most common diseases in Westernized, industrialized civilizations, and the frequency of both diseases increases with increasing age.  An estimated 2.5 to 3 million Americans have both diabetes and hypertension (WHO, 2013). Although diabetes mellitus is associated with a considerably increased cardiovascular risk, the presence of hypertension in the diabetic individual markedly increases morbidity and mortality from data drawn from death certificates, hypertension has been implicated in 44% of deaths coded to diabetes, and diabetes is involved in 10% of deaths coded to hypertension. It has been estimated that 35-75% of diabetic complications can be attributed to hypertension. In contrast, the absence of hypertension is the usual finding in long-term survivors of diabetes (WHO, 2013).

Thus, the coexistence of these two diseases likely contributes substantially to overall mortality in industrialized societies. Despite the critical importance of the coexistence of these two diseases, much information regarding their interaction remains unclear and controversial. Nevertheless, much information of theoretical and practical relevance is available, and there is considerable ongoing research exploring the relation between carbohydrate intolerance and hypertension (Kearney et al., 2005). It is not our intent to compile an exhaustive survey of the interrelation of hypertension and diabetes mellitus.

Diabetes mellitus is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. WHO (2013) described “diabetes mellitus” as a metabolic disorder of multiple etiology, characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The effects of diabetes mellitus include long– term damage, dysfunction and failure of various organs. This high blood sugar produces the symptoms of frequent urination (polyuria), increased thirst (polydipsia), and increased hunger (polyphagia). Untreated, diabetes can cause many complications (WHO, 2013).

Blood pressure is the amount of force exerted by the blood against the walls of the arteries. A person’s blood pressure is considered high when the readings are greater than 140 mm Hg systolic (the top number in the blood pressure reading) or 90 mm Hg diastolic (the bottom number). Hypertension is a common, important and major global public health problem. Its prevalence has been found to be 44% in Western Europe and 28% in North America. It has been documented as a threat to the health of people in sub-Saharan Africa and a major contributor to morbidity and mortality in the sub-region (Kearney et al., 2005). There is emerging evidence to show that the pattern of diseases in sub-Saharan Africa is changing, with non-communicable diseases (NCD) responsible for about 22% of the total deaths in the region in 2000, cardiovascular disease alone accounting for 9.2% of the total mortality (WHO, 2009). According to Kearney et al (2005), by 2025 about 75% of the world hypertensive population will be in developing countries. In Nigeria for example, it is the number one risk factor for stroke, heart failure, ischemic heart disease, and kidney failure. With an increasing adult population as well as rising prevalence of hypertension, Nigeria will experience economic and health challenges due to the disease if the tide is not arrested.

Diabetes and high blood pressure tend to occur together because they share certain physiological traits –- that is, the effects caused by each disease tend to make the other disease more likely to occur (HDS, 1993). In the case of diabetes and high blood pressure, these effects include:

Increased Fluid Volume — diabetes increases the total amount of fluid in the body, which tends to raise blood pressure

Increased Arterial Stiffness — diabetes can decrease the ability of the blood vessels to stretch, increasing average blood pressure

Impaired Insulin Handling — changes in the way the body produces and handles insulin can directly cause increases in blood pressure.

Comorbidities can have profound effects on patients’ ability to manage their self-care. Depression and arthritis impair patients’ functioning and pose significant barriers to lifestyle changes and regimen adherence. Conditions such as emphysema and chronic low back pain can have a more debilitating impact on patients’ health status than diabetes per se and are among the most important determinants of diabetic patients’ functioning and mental health. In addition, disabling conditions such as advanced heart failure and dementia may make high blood pressure and standard diabetes self-care goals impossible to reach. Even when comorbid chronic conditions do not directly limit patients’ ability to self-manage their diabetes, these conditions can serve as competing demands. Hypertension and Diabetes self-management requires a substantial investment of patients’ time, and activities such as work and childcare place very real limits on the attention patients can devote to managing their health. When comorbid illnesses must be home managed, the amount of time and energy left for high blood pressure and diabetes self-care can be substantially reduced. Medication adherence alone can be difficult when patients are juggling regimens for multiple conditions.

Comorbid illnesses can sap the financial resources of people with diabetes by increasing their out-of-pocket costs for medical care. High blood pressure and Diabetic patients face higher out-of-pocket medication costs than people with almost any other chronic condition, and some underuse preventive services as a result of cost pressures (Kearney et al., 2005). Patients reporting cost-related medication underuse have poorer glycemic control, more symptoms, and poorer functioning. Given a fixed budget, diabetic patients with comorbid conditions may have to make difficult choices between forgoing necessary treatments for their diabetes, treatments for their comorbid conditions, or even cutting back on essentials such as food or heat. Other more troubling trends have conspired to increase the impact of multi-morbidity on high blood pressure and diabetes management. In many health care systems, providers see patients during brief office visits and are overwhelmed by the number of health maintenance activities recommended by guidelines and quality monitoring agencies. When diabetic patients have multiple chronic conditions, screening, counseling, and treatment needs can far exceed the time available for patient-provider visits. Health problems that used to be treated in inpatient settings are increasingly managed within outpatient care, further straining providers’ resources for addressing high blood pressure and diabetes-specific management goals. With inadequate health system support and little guidance about how to manage multi-morbid patients, high blood pressure and diabetes providers can become frustrated with their inability to meet patients’ multiple treatment demands (Kearney et al., 2005).

In sum, clinicians and health systems seeking to improve high blood pressure and diabetes management cannot avoid addressing the ways in which patients’ other chronic health problems affect their diabetes and hypertensive care. Rather, improving hypertensive and diabetes management requires a more holistic, patient-centered approach (Kearney et al., 2005). Many health systems are still poorly designed to support effective hypertensive and diabetes management, let alone grapple with the challenges that arise when patients are struggling with multiple concurrent conditions. General principles of the Chronic Care Model undoubtedly apply, but the path from current practice to more effective diabetes care in the context of comorbidities remains uncertain.

The aim of this study is to examine the prevalence of diabetes mellitus and hypertension co-morbidities among indigenes of Orodo in Mbaitoli Local Government Area, Imo State. After presenting the prevalence figures of comorbidity in patients with high blood pressure and diabetes, the following will addressed the subject matter thereby finding lasting solution to the problems.

1.2 STATEMENT OF PROBLEM

Diabetes mellitus and hypertension are common diseases that coexist at a greater frequency than chance alone would predict Hypertension in the diabetic individual markedly increases the risk and accelerates the course of cardiac disease, peripheral vascular disease, stroke, retinopathy, and nephropathy. Our understanding of the factors that markedly increase the frequency of hypertension in the diabetic individual remains incomplete. Diabetic nephropathy is an important factor involved in the development of hypertension in diabetics, particularly type I patients. However, the etiology of hypertension in the majority of diabetic patients cannot be explained by underlying renal disease and remains “essential” in nature (Kearney et al., 2005). The hallmark of hypertension in type I and type II diabetics appears to be increased peripheral vascular resistance. Increased exchangeable sodium may also play a role in the pathogenesis of blood pressure in diabetics. There is increasing evidence that insulin resistance/ hyperinsulinemia may play a key role in the pathogenesis of hypertension in both subtle and overt abnormalities of carbohydrate metabolism. Population studies suggest that elevated insulin levels, which often occurs in type II diabetes mellitus, is an independent risk factor for cardiovascular disease (Kearney et al., 2005). Other cardiovascular risk factors in diabetic individuals include abnormalities of lipid metabolism, platelet function, and clotting factors. The goal of antihypertensive therapy in the patient with coexistent diabetes is to reduce the inordinate cardiovascular risk as well as lowering blood pressure.

Clearly, not all comorbidities are the same, and their characteristics may well influence how health care systems, clinicians, and patients approach their management relative to hypertensive and diabetes care. In the past, researchers examining the influence of comorbidities on hypertensive and diabetic patients ’ treatment and outcomes often have taken one of two approaches.

Many studies examining diabetes and hypertension in comorbidity have focused on specific conditions such as depression under the assumption that the condition’s impact on diabetes care is primarily due to its unique pathophysiology, symptoms, and treatment challenges (WHO, 2013). Such clinically focused research has led to important insights, although one recent rigorous trial evaluating health system changes to improve care for comorbid depression found little impact on hypertensive and diabetes-specific outcomes. By focusing too narrowly on the unique characteristics of individual comorbid illnesses, researchers and clinicians may miss larger patterns in the ways that treatments for diabetes and comorbidities interact. Other studies have used simple counts of diagnoses or other uni-dimensional scores as a means of capturing the effect of comorbidity on hypertensive and diabetic patients ’ resource use and health status. Implicit in this strategy is the assumption that all comorbid conditions have a similar effect, and that their overall impact on patients’ lives is driven primarily by the number of conditions being managed. Such measures may capture the overall burden of illness, but they cannot identify the characteristics of comorbid conditions that influence how patients and clinicians make decisions about hypertensive and diabetes care (Kearney et al., 2005).

Research examining the impact of comorbidities on hypertension and diabetes care needs to move beyond these familiar approaches. General dimensions of comorbid conditions may be relevant when designing health systems for multi-morbid patients.

Increased number of elderly people makes up the majority of the resident occupation of Orodo people and at risk of diabetes, hypertension or its comorbidity. Lack of knowledge about this condition could pose a great risk for complications, absenteeism to work, reduction in productive input as well as death. And an increased physical activity, dietary modification, and weight reduction are effective adjuncts for reduction of cardio-metabolic risks (Long and Dagogo-Jack, 2011).

The result of this study will provide benchmark on the diabetes/hypertension status of the study population and proffer avenue for rational decision for adequate health care service utilization and lifestyle/behavioral change.

 1.3 OBJECTIVE OF THE STUDY

This study will be aimed at determining the prevalence of diabetes mellitus and hypertension co-morbidities among indigenes of Orodo Community, Mbaitoli Local Government Area, Imo State.

SPECIFIC OBJECTIVE

1. To determine the prevalence of hypertension co-morbidity and diabetes mellitus in Orodo.
2. To determine the age of being affected.

• To determine the risk factors of hypertension co-morbidities and diabetes mellitus in Orodo.

1. To determine whether those who have hypertension have diabetes as well.
2. To find out whether hypertension co-morbidity and diabetes mellitus affects the male or female adult most.

 1.4 RESEARCH QUESTIONS

1. What is the prevalence of hypertension co-morbidity and diabetes mellitus disorder?
2. At what age is been affected?
3. What are the risk factors of hypertension co-morbidity and diabetes mellitus in Orodo?
4. Do those who have hypertension have diabetes as well?
5. Does it affect the male/female adult most?

1.5 SIGNIFICANCE OF THE STUDY

Therefore, this study will be useful in the following ways:

• To serve as a tool in enhancing the knowledge of co-morbility in understanding more about diabetic mellitus and hypertension.
• It will give a better understanding of the effects of comorbidity on the type and volume of medical health care utilization is essential to gain insight into future health care demands of patients with diabetes and hypertension.
• To help the people of Orodo in tracking problems of diabetes and hypertension, but also improve intervention on case detection and early prevention and treatment of conditions which in the long run increases productivity and healthy lifestyle?
• It is expected that at the end of this research work, individuals and cooperate bodies who intend to go into research on hypertension and diabetes will have a baseline data for subsequent intervention.
• Furthermore, it will also guide improvement of subsequent research in the subject area as well as health policy development and decision making.

1.6 SCOPE OF THE STUDY

This study would be limited to the prevalence of diabetes mellitus and hypertension co-morbidities among indigenes of Orodo Community, Mbaitoli Local Government Area, Imo State.

This study would be presented with some delimitations, the study will be done on the diabetes mellitus and hypertension co-morbility patients in Orodo, Mbaitoli LGA, Imo State. Though it will not take much account on those from other works of life. Therefore, findings from this study might not be enough to serve as an overall view of the prevalence of diabetes mellitus and hypertension co-morbidities amongst patients with diabetes and hypertension.

1.7 DEFINITION OF TERMS

Hypertension: Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss, and chronic kidney disease.

Diabetes mellitus: Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.

Co-morbility: is defined as the occurrence of one or more chronic conditions in the same person with an index-disease, occurs frequently among patients with diabetes and hypertension.

Patients: is a person who is receiving medical care, or who is cared for by a particular doctor or dentist when necessary.

Pages:  78

Category: Project

Format:  Word & PDF               

Chapters: 1-5                                          

Source: Imsuinfo                            

Material contains Table of Content, Abstract and References.