Dietary Intake, Blood Glucose Level and Nutritional Status of Type II Diabetes Patients Attending State Specialist Hospital, Akure.

Olufemi S.S. and Ehinola E. O

Department of Nutrition and Dietetics, Rufus Giwa Polytechnic, P.M.B. 1019, Owo, Ondo State, Nigeria.

Gbadamosi O.F

Department of Nutrition & Dietetics, Federal Polytechnic, Bida, P.M.B 55, Bida, Niger State.

All Correspondences to: Olufemi S.S. Department of Nutrition and Dietetics, Rufus Giwa Polytechnic, P.M.B. 1019, Owo, Ondo State, Nigeria.

ABSTRACT

The purpose of this study was to assess the dietary intake, blood glucose level and nutritional status of type II diabetic patients attending State Specialist Hospital, Akure. Sixty two (62) diabetic patients were randomly selected from the total number of (102) patients that registered with the hospital. A structured and semi-structured questionnaire was designed and administered to elicit information on social demographic, clinical and dietary intake of the subjects. Dietary intake of the subjects was assessed using 24-hour dietary recall procedure nutritional status was assessed using body mass index (BMI). The data obtained were analyzed using SPSS version 20 to determine the mean, frequency and percentage while chi-square was used to determine association between variables. The result shows 61.3% of the subjects were females while 38.7% were males. 6.4% were between the age range of 34-39 years, 59.5% were between 40-59 years while 30.0% were 60 years and above. The results also showed that 64.0% of the subjects have been suffering from diabetes for 6-12 months and 16% had been battling with it since 5-6 years. Thirty eight subjects (61.3%) usually consumed fried foods while 33.9% did not, with 69.4% of subjects eating three times daily. Mean daily carbohydrate and energy intake were 154.0g and 1778.0 403.0 kcal respectively. Daily intake of fat was 116.0g while protein was 36.0g. The mean fasting blood glucose level of the subjects was 9.06 2.539 (MMo1/l). The Body mass index shows that 38.4% of the subjects were overweight while 30.4% were obese. The authors concluded that the mean daily energy intake of the subjects was high for the sedentary and elderly subjects. There was excessive fat consumption and poor glycemic control amongst the subjects. Improvement of dietary intake and proper glycemic control through adequate meal planning and life style modification of diabetics is recommended.

INTRODUCTION

Diabetes in an ancient disease: the records of the ancient civilization of Egypt, Indian, Japan, Greece and Rome describe the symptoms of the disease and usually include recommendation for treatment.

By the first century, the Greek physician, Aretaus of Capadocia who lived between AD30 and 90 describe an illness in which the body “ ate its own flesh” and gave off large quantities of urine. He named the disease Diabetes after the word dia –bainein from the Greek word meaning to siphon or pass through and the term Mellitus which means honey like, was added later by a London physician. It is a chronic disease that has affected mankind through the word. The disease ranks third as a cause of blindness and eight as a cause of death worldwide (Albert, 1995). The World Health Organization defines diabetes mellitus as a metabolic disorder which occur as a result of defect in insulin secretion or action or both and is characterized by chronic hyperglycemia (increase in blood glucose level above normal), resulting into long term damage, dysfunction and failure of various organs. It is a disease characterized by high level of blood glucose

concentration due to absence deficiency or infectiveness of insulin. It affects the metabolism, not only of carbohydrates but also fats and proteins, this lead to lose of glucose in the urine. Most time someone who has diabetic complains of persistent thirst and water consumption because utilized blood glucose is wastefully excreted in the urine. The inability to utilized glucose energy eventually leads to weight loss, tiredness. The most common types of diabetes are known as Non-Insulin dependent diabetes mellitus (NNDDM) or maturity onset diabetes. In Nigeria, half of those that are being afflicted with the ailment are not aware of the affliction. It usually occurs in adult over 40years of age, but many people with type II diabetes do not initially know they have it. Type II diabetes mellitus made up about 90% of the diabetic population in Nigeria and their relevant abnormalities include chronic hyperglycemia, dyslipideamia and insulin resistance (Albert, 1995). An apparent increase in the incidences of types II has been observed in association with the adoption of a “western lifestyle” among the urban class. The prevalence of types II diabetes mellitus is increasing worldwide (King, 1998). Population surveys using various diagnostic criteria for diabetes show a lower prevalence in developing countries than in developed countries. No one has found a convincing causal asocial between malnutrition and diabetes (Peter, 1983). However, the most dramatic increase with 94% compared to a 40% and 25% for South American and the Us and Canada respectively (WHO, 2004). Although, these figures represent diabetes of all types, the majority of persons (90-95%) 20 years of age and older have type II diabetes. Metabolic, genetic and environmental factors may play a role in the development of diabetes and its complication. It has been documented that the risk of developing type II diabetes increase with age, obesity, sedentary, life style, family history of diabetes and low high density lipoprotein (HDL) or high triglyceride concentrations (HTC). People with diabetes are subjected to acute and long-term complication (El-kebbi im, 1996). Types II diabetes mellitus (formerly known as non Insulin dependent diabetes mellitus-NIDDM) poses a major health threat worldwide, base on 1994 extra population from prevalence studies, there are now about (2million person with diabetes in America and Caribbean). Type ii diabetes mellitus account for approximately 9% of all diabetes (Albert, 1995). Untreated or inadequately treated types II diabetes patients may develop the same complication as that of types I or insulin dependent diabetes mellitus (IDDM) including eye, nerve and kidney damage. Types II diabetes also accounts for 25% of the world total population suffering from diabetes thus 28million estimate for person with diabetes in the Americas is projected to increase by about 45% by the year 2010, with Latin American and the Caribbean surpassing the US and Canada according to projections Diabetes is the most common cause of end-stage renal diabetes, and the leading cause of blindness in adult diabetes rank sixth as a primary cause of death in the US, and when its complication are considered, it rank third. The estimated economic impact of diabetes is considerable to 24 percent in the small number of subject above 40 years of age.

Diabetes people are routinely advised to adopt a healthful diet, dietary changes including modification in food habits and meal pattern on a lifelong basis. Self monitoring of blood glucose (SMBG) is recommended for all patients with diabetes. The distinction among the type of diabetes is the frequency of testing for patient with diabetes that is treated with insulin, more frequent testing is recommended, most often before meals and bed. With consistency in self care management and blood sugar levels, testing times to achieve a better a day, possibly alternating time to achieve a better overall picture of glycemic trends, for those on oral agents, testing range from one to four time per day as needed until glycemic treads are established.

MATERIAL AND METHOD Study design

This study is descriptive and cross-sectional in design, involving out-patients diabetics attending State Specialist Hospital, Akure

Study Area

The State Specialist Hospital, Akure is situated in Akure, the State capital of Ondo State. The study was carried out at the diabetic clinic of the hospital. The clinic offers a

comprehensive diabetes testing, drug and insulin therapy, dietary counseling, treatment and management.

Research Subjects:

A total of 68 out-patient diabetics which were 38 females and 24 males known diabetes patients, aged 34-90 years were included in the study. The subjects were non-insulin dependent diabetes mellitus patients (NIDDM). The inclusion criteria were already diagnosed diabetics. The subjects must have been confirmed positive through blood glucose testing, not earlier than six months before the date of the commencement of the study and must be registered with the diabetic clinic of the hospital.

Ethical consideration

Approval was sought and obtained from ethical research committee of the hospital.

Informed consent was obtained from individual subjects Inclusion criteria

• Consenting participants who suffered from

diabetes mellitius

Exclusion criteria

• Individuals without diabetes
• Non-consenting individuals

SAMPLE POPULATION

The population for this study was out-patients non-insulin dependent diabetics (NIDDM) attending Medicine Out-patient Department (MOPD) of the State Specialist Hospital, Akure.

SAMPLE SIZE

Sixty two (62) diabetes patients were selected for the study. The sample size for the study was determined based on three factors: the estimated prevalence of the variable of interest– diabetes patients in this instance, the desired level of confidence and the acceptable margin of error.

n= t² x p(1-p)

m²	(FAO, 1990).

SAMPING TECHNIQUES

Simple random sampling method was used to select the required number of subject from the 102 diabetic patients that registered with the diabetes clinic. The subjects were selected randomly during the diabetes clinic sessions. Thirty two (32) diabetic patients were randomly selected at the first visit to the clinic while the remaining 30 subjects were selected during the second clinic. The total number of sample selected was sixty two (62), which were used for the study.

METHOD OF DATA COLLECTION Questionnaire

A structured and semi- structured questionnaire was used to collect the necessary information on socio demographic data, medical history, dietary history and food consumption pattern of the patient. The questionnaires were randomly distributed to the patients and they were completed and returned.

Anthropometric Assessments

Weight:

The subjects’ weight was measured using bathroom weighing scale. The scale was placed on a flat surface and the subject was made to stand uprightly on it barefooted. The readings were done in duplicates to the nearest 0.1kg and the average weight was constantly checked for accuracy (Caterson 1998).

Nigerian Biomedical Science Journal Vol. 16 No 3 2019 67

 

Height:

Height was measured to the nearest 0.1m using a standiometer, measurement was taken with subjects standing barefooted and erect with feet parallel and heels put together, in line with the method of Jelifel (1996). BMI

was calculated as weight in kg/ divided by height in (m²).

Dietary assessment

Information on the patient dietary intake was collected using 24hours dietary recall. The full and appropriate description of all food eaten including drinks was recorded and converted to nutrient using the food exchange list for commonly eaten food in Nigeria.

Assessment of Blood glucose

A secondary data were used to obtain the blood glucose of the subjects. The case notes of the diabetics were obtained at the clinic and their fasting blood glucose in MMol/L was documented from the records.

METHOD OF DATA ANALYSIS

Data collected from this research work were analyzed through the use of descriptive statistical tools such as the use of percentage, mean, frequency e.t.c. T-test was used to determine the significance difference between the variable. Descriptive and inferential analysis technique was used for data analysis using Statistical Package for the Social Sciences (SPSS) software version 17. T-test and Chi-square test were performed to determine significant difference and relationship among variables.

RESULTS

Table 1: Distribution of subjects by Sex and Age

Variables	Frequency	Percentage
Sex
Male	24	38.7
Female	38	61.3
Total	62	100
Age
30-39	4	6.4
40-49	11	17.6
50-59	26	41.9
60-69	11	17.6
70-79	4	6.4
80 and above	6	9.6
Total	62	100.0

Table 2: Socio-economic characteristics of the subjects

VARIABLE	FREQUENCY PERCENTAGE
Religion
Christianity	56	90.3
Islam	6	9.7
Traditional	–	–
Total	62	100
Tribe
Yoruba	57	91.9
Ibo	5	8.1
Total	62	100
Marital status
Married	51	82.3

Single	3	4.8
Divorced	2	3.2
Widow	5	8.1
Widower	1	1.6
Total	62	100
Education
Primary	15	24.2
Secondary	16	25.8
Tertiary	9	14.5
Informal	21	33.9
No response	1	1.6
Total	62	100.0
Occupation
Civil servant	12	19.4
Business	6	9.7
Artisan	4	6.5
Trader	37	59.7
Retiree	1	1.6
Unemployed	1	1.6
Farmer	1	1.6
Total	62	100.0

Is your income enough to feed you?

Yes	50	80.6
No	12	19.4
Total	62	100.0

Table 3: Distribution of subjects by Medical history

Apart from diabetes, what other disease do you suffer from?

No response	36	58.1
Hypertension	19	30.6
Heart disease	4	6.5
Renal disease	2	3.2
Eye defect	1	1.6
Total	62	100
For how long have
you been sick?
6-12 months	4	64
1-2 years	23	37.1
3-4 years	21	33.9
5-6 years	10	16.1
7-8 years	4	6.5
Total	62	100
Other treatment received by the
Subjects apart from hospital
No other treatment	24	39.7
Herbal	25	40.3
Self-medication	13	21.0
Total	62	100.0
Do any of your parents
suffer from diabetes?
Yes	16	25.8
No	46	74.2
Total	62	100.0

..

Table 4: Distribution of subjects by dietary pattern

Variables s Frequency Percentage

How many times do you eat daily?

Once	1	1.6
2 times	16	25.8
3 times	40	64.5
4 times and above	5	8.0
Total	62	100
When do you usually eat breakfast?
7-8 am	20	32.3
8-9 am	29	46.8
9-11 am	9	14.5
No response	4	6.5
Total	62	100
When do you usually eat lunch?
12-1 pm	19	30.6
1-2 pm	28	45.2
2-3 pm	11	17.7
No response	3	4.8
Do not take lunch	1	1.6
Total	62	100
When do you usually eat dinner?
4-5 pm	18	29.0
5-6 pm	28	45.2
6-7 pm	7	11.3
8-9 pm	8	12.9
No response	1	1.6
Total	62	100
Do you eat bed snacks?
Yes	10	16.1
No	52	83.9
Total	62	100
Table 5: Daily fruit consumption of subjects
Variables	Frequency	Percentage

How many times do you eat fruit per day?

Once	25	40.3
2 times	16	25.8
3 times	13	21.0
4 times and above	2	3.2
Never	6	9.7
Total	62	100.0
Do you eat fruits with your meals?
Yes	19	30.6
No	42	69.4
Total	62	100.0

Table 6:

Distribution of Subjects by their fat consumption

Variables	Frequency	Percentage
Quantity of palm oil
used per soup
15gm (1 tablespoon)	11	17.7
30gm (2 tablespoons)	48	77.4
>30gm (2 tablespoons)	1	1.6
No response	4	6.5
Total	62	100
Do you usually
eat fried foods?
Yes	38	61.3
No	21	33.9
No response	3	4.8
Total	62	100.0

Table 7: Attitude of Subjects to prescribed diet

Variable	Frequency		Percentage
Do you always adhere
to prescribed diet?
No response		3	4.8
Yes		11	17.7
No		48	77.4
Total		62	100
Reason for patients not
adhering to prescribed food
Like diet		14	22.5
Not familiar with the diet		24	38.7
Diet is monotonous		11	17.7
Diet is not palatable		5	8.0
Diet cause intolerance		8	12.9
Total		62	100
Does any food raise
your blood glucose?
Yes		11	17.7
No		51	82.3
Total		62	100.0

Table 8: Distribution of subjects by their BMI

BMI(kg/m2)	Category	Frequency	%
18.5 – 24.9	Normal	11	17.6
25.5 – 29.9	Overweight	24	38.4
30.5 – 34.9	Obesity grade I	19	30.4
35.5 – 39.9	Obesity grade II	7	11.2
40+	Morbid obesity	1	1.6
Total	——————–	62	100.0

Table 9: Mean nutrient and clinical profile of diabetic subjects

VARIABLE	MEAN
Age	58.10	12.567
Weight (kg)	75.05	13.446
Height (m)	1.62 0.749
BMI (kg/m2)	29.20	5.690
Fasting Blood glucose (MMo1/1)	9.06 2.539
Carbohydrate(g)	153.50±9.179
Protein (g)	35.71±7.542
Fat (g)	116.63±11.542
Energy (kcal)	1778.35±103.156

DISCUSSION

The study reveals that majority of the diabetics in the study area were females (61.3%) and the mean age of the diabetics was (58.10%). In fact, this reflects the same pattern observed in the study of Sunday et’al, 2012, involving diabetic patients within the tertiary health centres in Nigeria where 60.5% of the diabetics were female and their mean age was 57.1years. The educational qualification of the subjects shows that majority of them had either primary or secondary education and majority of the patients (81%) claimed that their income was enough to feed them. The patients that had enough income may have money to supply the foods and medication needed. Some studies revealed that diabetic patients especially the female ones, though, may earn low income but would always receive financial support from family and loved ones in order to have access to medical treatment (Sunday et’al, 2012). However, most times, the economic status of a patient has a lot of influence not only on the food intake but also on the ability to have access to drugs and medication which determines the effectiveness of diabetes management. WHO reported that about 90.2% of Nigerians are below the poverty level of 2 dollars per day (WHO, 2004). Therefore, accessing health care is challenging for diabetes patients in Nigeria. Nineteen (19) 30.6% of the subjects were seen with hypertension, a figure so close to 36.5% reported in a similar study (Alebiosu, 2007). Prevalence of different diabetes complications like kidney problem, eye defect and heart disease is similar to figures from other studies in Nigeria. These complications are as a result of late intervention in most of the hospitals (Sunday et’al, 2012). Majority of the subjects have been living with diabetes for the past 1-2 years (37.3%) while as high as 16% have been living with the disease for the past 5-8 years. This is a reflection of lower life expectancy of Nigeria diabetic patients. The study reveals that the disease could be genetically link to the parents since it can be documented from the study that 26% of the diabetics’ parents also suffered from diabetes. This study shows that (72%) of the patients were either overweight or obese. Overweight/obesity contributes to cardiovascular risk of diabetic patients. The result shows that average energy intake of the subject was 1778403kcal per day which was below the RDA for non- elderly subject of (65.9%), while the average energy intakes was ideal for elderly RDA of about (33.6%). Mean fat intake of the subjects was higher than the RDA for fat (116.63g±11.542). The high fat consumption seen in the study may be due to high palm oil and other vegetable oil used by the patients in cooking. High fat intake generally is a contributory factor to cardiovascular risk (Gordon, 2002). There is no significance difference between blood glucose level and macronutrient intake (Protein, Carbohydrate and Fat) of the patients at 0.05 levels. However there is positive correlation between blood glucose and protein intake (0.183). The mean fasting blood glucose (FBG) level of the subjects was 9.06MMo1/l 2.539, which is an indication of poor glucose control among the patients. The deficient energy intake observed in 35% of the patients may be as a result of non-adherence to prescribed diet. The low calorie intake may also be linked to the fact that the majority of the subject (64.5%) ate 3times daily. In the recent management of diabetes, food consumption should be based on small frequent meals at interval to avoid glucose overloading (WHO, 2004). Poor glycemic control among Nigerian diabetic patients is non compliance to dietary prescription. Nigerian diabetics continue to look after permanent cure for the disease which results to poor glycemic control in the long run (Sunday, 2012). Therefore, the management of diabetes is patient education and lifestyle modification. Many diabetic patients are yet to realize that diabetes is incurable and needs long-life management.

CONCLUSION AND RECOMMENDATION

The dietary intake of diabetic patients at State Specialist Hospital was below recommended intake. Most diabetics engaged in wrong dietary habits and poor glycemic control. Improvement of dietary intake and proper glycemic control through adequate meal planning and life style modification of diabetic patients is recommended.

Olufemi S.S.

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