TREATMENT OF ESTABLISHED DIABETIC CASES AND EMERGENCE OF MICROALBUMINURIA: A CASE STUDY OF GENERAL HOSPITAL BILLIRI, GOMBE STATE

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Diabetes mellitus is a chronic condition in which the pancreas does not produce enough insulin, or the body cannot use the insulin it makes effectively. It was once seen as a single disease, but it is now understood to be a group of metabolic disorders with different causes, courses and clinical features. Type 1 diabetes requires insulin for survival, while type 2 may need insulin for metabolic control. Type 2 accounts for roughly 90% of all cases worldwide (Okeji et al., 2025).

The global burden is large and growing. The International Diabetes Federation estimates that about 589 million adults aged 20 to 79 were living with diabetes in 2024, a figure projected to reach 853 million by 2050. More than four in ten of them are unaware that they have the condition (International Diabetes Federation, 2025). In Africa, roughly 25 million adults have diabetes, and about three in four of them are undiagnosed (International Diabetes Federation, 2025).

The main danger of diabetes lies in its long-term complications, which affect both the small and large blood vessels. These include retinopathy, nephropathy, neuropathy and cardiovascular disease, and they raise illness and death rates and reduce quality of life (Gross et al., 2005; Forbes & Cooper, 2013). Diabetic kidney disease is a major concern. It often begins silently, and its earliest sign is microalbuminuria, the leakage of small amounts of albumin into the urine (Tuttle et al., 2014). Kidney disease in turn increases the risk of death in people with type 2 diabetes (Afkarian et al., 2013). Studies in Nigerian hospitals have found microalbuminuria in about 35% of type 2 diabetic adults in Sagamu (Amballi et al., 2018) and in about 61% in Umuahia (Okeji et al., 2025). The risk was higher where hypertension, obesity or poor glycaemic control was also present (Amballi et al., 2018; Okeji et al., 2025).

Treatment of established diabetes rests on several elements: nutrition, physical activity and drug therapy. Diet is a cornerstone of care, especially in type 2 diabetes (Ley et al., 2014). Regular physical activity also plays a recognised role in glucose control and in preventing complications (Colberg et al., 2016). Nutrition advice should not be the same for everyone. It should be individualised, taking account of each person's lifestyle, food preferences, culture and goals. Its success is judged by blood glucose, blood lipid and blood pressure results. Care is best delivered by a team in which the physician, dietitian and nurse each have defined roles, with the dietitian translating the prescribed diet into practical food choices. Treatment alone is not enough, however. Patients also need to be screened regularly so that kidney damage is caught early (Tuttle et al., 2014; Thomas et al., 2016).

This study examines how established diabetic cases are treated at General Hospital Billiri, Gombe State, and how microalbuminuria emerges among those patients.

1.2 Statement of the Problem

Diabetes is becoming more common in both developed and developing countries, and Nigeria is no exception. Growing urbanisation, a more sedentary lifestyle and a shift from natural to refined foods have contributed to this rise through increased obesity, a major driver of type 2 diabetes (Thomas et al., 2016).

Many patients are diagnosed late and already have complications. Knowledge of diabetes and its kidney complications is often low, access to care can be difficult, and few patients receive formal counselling. For example, among type 2 diabetic patients in Umuahia, 68% reported barriers to care, about 63% said they knew little or nothing about diabetic kidney disease, and only 16% had ever been counselled on it (Okeji et al., 2025). Poor adherence to dietary and drug regimens, misconceptions picked up from non-professionals, and unsupervised use of traditional remedies make glycaemic control harder. In turn, poor control increases the risk of nephropathy (Amballi et al., 2018; Okeji et al., 2025).

Little is known about how established diabetic patients at General Hospital Billiri are treated or how often microalbuminuria appears among them. This study addresses that gap.

1.3 General Objective

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

1.4 Specific Objectives

1. To determine the prevalence of microalbuminuria among established diabetic patients at the hospital.
2. To describe the treatment received by these patients, including dietary management, physical activity and drug therapy.
3. To examine the relationship between microalbuminuria and factors such as duration of diabetes, glycaemic control, blood pressure and body weight.
4. To assess patients' knowledge of diabetes and its kidney complications and their dietary practices.

1.5 Significance of the Study

The results will:

1. Show how common microalbuminuria is among established diabetic patients at the hospital.
2. Indicate how adequate the current treatment and dietary care are.
3. Give dietitians, health workers, the Ministry of Health and the Nigerian government useful information for drawing up guidelines on screening and dietary care for diabetics.
4. Help improve the care and living conditions of people 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

Gross, J. L., de Azevedo, M. J., Silveiro, S. P., Canani, L. H., Caramori, M. L., & Zelmanovitz, T. (2005). Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes Care, 28(1), 164–176. https://doi.org/10.2337/diacare.28.1.164

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