LIFESTYLE, NUTRITIONAL STATUS AND QUALITY OF LIFE OF DIABETIC OUTPATIENTS IN STATE HOSPITAL, IJAIYE, ABEOKUTA
BY
ADENUSI, Sultan Adedotun
MATRIC NO: 2016/2085
A Project Report
Submitted to the Department of Nutrition and Dietetics, Federal University of Agriculture,
Abeokuta, Ogun State, Nigeria, in Partial Fulfillment of the Requirements for the Award of the
Degree of Bachelor of Science in Nutrition and Dietetics.
Department of Nutrition and Dietetics
College of Food Science and Human Ecology
Federal University of Agriculture, Abeokuta, Ogun State, Nigeria.
MARCH 2020
i
CERTIFICATION
This is to certify that this project work was carried out by ADENUSI, Sultan A. and is approved
in partial fulfilment of the requirement for the award of B.Sc. Degree in Nutrition and Dietetics of
the Department of Nutrition and Dietetics, College of Food Science and Human Ecology, Federal
University of Agriculture Abeokuta, Nigeria under my supervision.
___________________________
__________________________
Mrs. O. O. Akinbule
Date
SUPERVISOR
ii
DEDICATION
This project is dedicated to the Almighty God and to my late father – Alh. Dr. Adenusi Waheed
Adeniyi. May his soul rest in perfect peace – Ameen.
iii
ACKNOWLEDGEMENTS
I appreciate God Almighty for giving me the opportunity to complete the project and the privilege
to compile this write-up.
My sincere heartfelt gratitude goes to my wonderful and diligent project supervisor, Mrs. O. O.
Akinbule for her constant guidance and support throughout the project work. She was indeed a
teacher from whom I have learnt a lot. I also appreciate the Head of Department, Dr. O. O.
Onabanjo, Prof. I. O. Olayiwola, Prof. S. A. Sanni, Dr. A. O. Afolabi, Dr. C. A. Oladoyinbo, Dr.
Y. O. Adebayo, Dr. O. O. Bolajoko and Mr. E. P. John for their tutelage and guidance through my
academic years in the department.
My sincere gratitude goes to my loving parents – Late Alh. Dr. Waheed Adenusi and Alh. Mrs.
Hamdallah Adenusi, my aunts - Mrs. Matepo Kikelomo and Mrs Yakub Fatima, my uncles – Dr.
Abayomi Motajo and Barr. Akinloye Daud among others for their constant attention and support
during the period of the project work.
I have a great pleasure to appreciate my siblings Adenusi Rafiq Adeyemi, Adenusi Abdulsalam,
and Adenusi M. Qudus for their belief, encouragement, love, and support.
I am also grateful to all my respondents for their cooperation and participation during the period
of my data collection, because without them I would not have been able to complete this project.
Special thanks to my colleagues and friends- Animasahun Olawale, Adeola Adekunle, Ademiluyi
Dare, Osoba Kehinde, Akinyemi Adejumoke and others for their supports and making my years
in school a wonderful one.
iv
ABSTRACT
Lifestyle practices have been identified as important risk factors for the development and
exacerbation of Diabetes Mellitus (DM) and their adverse impact on the quality of life and
nutritional status of diabetics is becoming a public health problem. The objective of this study
was to assess the lifestyle, nutritional status, and quality of life of diabetic out-patients in State
Hospital, Ijaiye, Abeokuta. A cross-sectional survey was conducted on 100 adults who visited the
out-patient’s clinic of the hospital during the period of data collection. Socio-demographic and
economic data were obtained using a semi-structured questionnaire. Information on lifestyle
(smoking, alcohol consumption) and physical activity were collected using a semi-structured
questionnaire and International Physical Activity Questionnaire (IPAQ) respectively.
Respondents' dietary intake was assessed using 24-hour dietary recall and converted to nutrient
intake using the Total Diet Assessment software. Diet quality was also determined by comparing
dietary intake with the optimum intake of the Global Burden of Diseases Dietary Risk Factors and
Estimated Average Requirement. The dietary habit was assessed using a validated questionnaire.
Quality of life was assessed using the Audit of Diabetes-Dependent Quality of Life (ADDQoL)
and Appraisal of Diabetes Scale (ADS). Measurement of height, weight, waist circumference, and
hip circumference were done using heightometer, bathroom scale, and tape rule respectively.
Blood Pressure and Fasting Blood Sugar were assessed using the Mercury Sphygmomanometer
and Blood Glucose Monitoring System respectively. Data were analyzed with Statistical Product
and Service Solutions (SPSS) version 25 software using descriptive statistics and Pearson’s
Correlation, T-test, and Analysis of Variance (ANOVA) to determine the relationship and
differences among variables at p<0.05. The result shows that almost half (49.0%) of the
respondents were within the age range of 36 - 40 years and 59.0% were females. Majority (85.0%)
of the respondents were married, 48.0% had tertiary education, 57.0% were traders while 25.0%
v
were civil servants and 61.0% earned below N50,000 monthly. Most (98.0%) of the respondents
were non-smokers and only 2.0% were alcohol consumers. More than half (53.0%) of the
respondents had fair dietary habits, 7.0% had a good dietary habit and 65.0% of the respondents
had high physical activity. There was significantly low intake of food groups such as fruits
(22.5%), vegetables (29.4%), nuts and seeds (33.3%), milk (1.3%), processed meat (0.0%), and
diets rich in fiber (49.5%), calcium (2.4%) and polyunsaturated fatty acids (53.1%) but above
optimal intake of legumes (425.8%), whole grains (397.8%) and sugar-sweetened beverages
(176.7%) which translates to low diet quality. There was adequate intake energy, carbohydrate,
protein, fat, Vitamin A. B2, B3, B6, and B12, phosphorus, zinc, iron, and magnesium but there
was a significant low intake of nutrients such as vitamin C, fiber, folate, sodium, potassium, and
calcium. The majority (71.0%) of the respondent skip meals 1-2 times a week and more than half
(53.0%) of the respondents had fair dietary habits while 7.0% had good dietary habits. The mean
impact rating for all the domains falls within 0.9- 2.0 which signifies that the respondents reported
their quality of life would be better without diabetes. The importance rating falls between 2.0-3.0
for most of the domain indicating the importance of the aspects of life to the quality of life. The
weighted impact score of the domains being within -2.1 and -5.0 reflected the negative impact of
diabetes on the respondents which shows a relatively low quality of life of the respondents. The
Appraisal of Diabetes Score shows the mean score of the domains between 1.0 and 3.0 which
translates to the respondents being slightly affected by diabetes on their quality of life. More than
half (60.0%) of the respondents had normal BMI, 85.0% had a fasting blood sugar reading
‘diabetes’, 49.0% had stage 1 hypertension and only 8.0% had abdominal obesity. In conclusion,
the study revealed a significant relationship between respondent quality of life and sociodemographic characteristics which indicates that the respondent's socio-demographic status has an
vi
influence on their quality of life. Also, there is a significant relationship between the impact of
diabetes on different aspects of life and the Average Weighted Impact Score of quality of life.
vii
TABLE OF CONTENTS
TITLE PAGE ................................................................................................................................... i
CERTIFICATION .......................................................................................................................... ii
DEDICATION ............................................................................................................................... iii
ACKNOWLEDGEMENTS ........................................................................................................... iv
ABSTRACT .................................................................................................................................... v
TABLE OF CONTENTS………………………………………………………………………...vii
LIST OF TABLES ....................................................................................................................... xiii
LIST OF FIGURES ...................................................................................................................... xv
CHAPTER ONE ............................................................................................................................. 1
1.0
INTRODUCTION ............................................................................................................ 1
1.1
Problem Statement ........................................................................................................... 4
1.2
Justification ...................................................................................................................... 4
1.3
Objectives of the Study .................................................................................................... 5
1.3.1
Broad Objective ........................................................................................................ 5
1.3.2
Specific Objectives ................................................................................................... 5
CHAPTER TWO ............................................................................................................................ 6
2.0
LITERATURE REVIEW ...................................................................................... 6
2.1
Overview of Diabetes Mellitus ........................................................................................ 6
2.2
Types of Diabetes Mellitus .............................................................................................. 7
viii
2.2.1
Type 1 Diabetes Mellitus .......................................................................................... 7
2.2.2
Type 2 Diabetes Mellitus .......................................................................................... 8
2.2.3
Gestational Diabetes ................................................................................................. 9
2.3
Epidemiology of Diabetes Mellitus.................................................................................. 9
2.4
Etiology of Diabetes Mellitus ........................................................................................ 10
2.5
Pathogenesis/Pathophysiology of Diabetes Mellitus ..................................................... 11
2.5.1
Pathogenesis of Type 1 Diabetes Mellitus .............................................................. 11
2.5.2
Pathophysiology of Type 2 Diabetes Mellitus ........................................................ 12
2.5.3
Pathophysiology of Gestational Diabetes Mellitus ................................................. 12
2.6
Signs and Symptoms of Diabetes Mellitus .................................................................... 14
2.7
Complications of Diabetes Mellitus ............................................................................... 14
2.8
Diagnosis of Diabetes Mellitus ...................................................................................... 15
2.9
Management of Diabetes Mellitus ................................................................................. 15
2.10 Prevention of Diabetes Mellitus ..................................................................................... 16
2.11 Nutritional Status and Diabetes Mellitus ....................................................................... 16
2.12 Dietary Habit and Diabetes Mellitus .............................................................................. 17
2.13 Dietary Intake and Diabetes Mellitus ............................................................................. 18
2.14 Lifestyle and Diabetes Mellitus...................................................................................... 18
2.15 Quality of Life and Diabetes Mellitus ............................................................................ 18
2.16 Diabetes Mellitus and Hypertension .............................................................................. 20
ix
CHAPTER THREE ...................................................................................................................... 22
3.0
RESEARCH METHODOLOGY ................................................................................ 22
3.1
Study Area/Location ...................................................................................................... 22
3.1.1
Brief Description of the Hospital ............................................................................ 22
3.2
Study Design .................................................................................................................. 22
3.3
Population of Study ........................................................................................................ 22
3.4
Inclusive Criteria ............................................................................................................ 22
3.5
Exclusive Criteria ........................................................................................................... 23
3.6
Sample Size .................................................................................................................... 23
3.7
Sampling Technique ....................................................................................................... 23
3.8
Materials and Methods for Data Collection ................................................................... 23
3.8.1
Socio-Demographic and Socioeconomic Data ....................................................... 23
3.8.2
Anthropometric and Clinical Status ........................................................................ 23
3.8.3
Dietary Intake and Diet Quality .............................................................................. 26
3.8.4
Dietary Habit ........................................................................................................... 27
3.8.5
Quality of Life......................................................................................................... 27
3.8.6
Lifestyle Characteristics.......................................................................................... 28
3.9
Ethical Consideration ..................................................................................................... 28
3.10 Permission to Conduct Study ......................................................................................... 29
3.11 Informed Content ........................................................................................................... 29
x
3.12 Statistical Analysis ......................................................................................................... 29
CHAPTER 4 ................................................................................................................................. 30
4.0
RESULTS AND DISCUSSION .............................................................................. 30
4.1
RESULTS........................................................................................................... 30
4.1.1
Socio-demographic and Socioeconomic Characteristics of the Respondents ........ 30
4.1.2
Clinical History of the Respondents ....................................................................... 33
4.1.3
Lifestyle Characteristics of the Respondents .......................................................... 38
4.1.4
Nutrient Intake of the Respondents......................................................................... 41
4.1.5
Dietary Habit of the Respondents ........................................................................... 43
4.1.6
Diet Quality of the Respondents Compared with Optimal level of Intake of Global
Burden of Disease Dietary Risk Factors................................................................................ 45
4.1.7
Quality of Life of the Respondents ......................................................................... 48
4.1.8
Anthropometric and Clinical Status of the Respondents ........................................ 51
4.1.9
Relationship between Socio-demographic and Quality of Life of the Respondents
…………………………………………………………………………………….53
4.1.10
Impact of Quality of Life Domain on The Average Weighted Impact Score of Quality
of Life….. .............................................................................................................................. 55
4.1.11
Difference between the Average Weighted Impact Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents .............................................................. 57
4.1.12
Difference between the Average Weighted Impact Score of Clinical History of the
Respondents ........................................................................................................................... 62
xi
4.1.13
Difference between the Average Weighted Impact Score of Lifestyle Characteristics
of the Respondents................................................................................................................. 66
4.1.14
Difference between the Average Weighted Impact Score of Anthropometric and
Clinical Status of the Respondents ........................................................................................ 68
4.1.15
Difference between the Appraisal of Diabetes Scale Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents .............................................................. 70
4.1.16
Difference between the Appraisal of Diabetes Scale Score of Clinical History of the
Respondents ........................................................................................................................... 75
4.1.17
Difference between the Appraisal of Diabetes Scale Score of Lifestyle
Characteristics of the Respondents ........................................................................................ 79
4.1.18
Difference between the Appraisal of Diabetes Scale Score of Anthropometric and
Clinical Status of the Respondents ........................................................................................ 81
4.2
DISCUSSION .................................................................................................... 83
CHAPTER 5 ................................................................................................................................. 88
5.0
CONCLUSION AND RECOMMENDATION ........................................................... 88
5.1
CONCLUSION ..................................................................................................... 88
5.2
RECOMMENDATIONS ........................................................................................... 90
REFERENCES ............................................................................................................................. 91
APPENDIX ................................................................................................................................. 105
xii
LIST OF TABLES
Table 1: Socio-demographic and Socioeconomic Characteristics of the Respondents
31
Table 2: Clinical History of the Respondents
35
Table 3: Lifestyle Characteristics of the Respondents
39
Table 4: Nutrient Intake of the Respondents
42
Table 5: Dietary Habit of the Respondents
44
Table 6: Diet Quality of the Respondents Compared with Optimal level of Intake of Global Burden
of Disease Dietary Risk Factors
46
Table 7: Audit of Diabetes-Dependent Quality of Life
49
Table 8: Appraisal of Diabetes Scale
50
Table 9: Anthropometric and Clinical Status of the Respondents
52
Table 10: Relationship between Socio-demographic and Quality of Life of the Respondents
54
Table 11: Impact of quality of life domain on the Average Weighted Impact Score of quality of
life
56
Table 12: Difference between the Average Weighted Impact Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
58
Table 13: Difference between the Average Weighted Impact Score of Clinical History of the
Respondents
63
Table 14: Difference between the Average Weighted Impact Score of Lifestyle Characteristics of
the Respondents
67
Table 15: Difference between the Average Weighted Impact Score of Anthropometric and Clinical
Status of the Respondents
69
xiii
Table 16: Difference between the Appraisal of Diabetes Scale Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
71
Table 17: Difference between the Appraisal of Diabetes Scale Score of Clinical History of the
Respondents
76
Table 18: Difference between the Appraisal of Diabetes Scale Score of Lifestyle Characteristics
of the Respondents
80
Table 19: Difference between the Appraisal of Diabetes Scale Score of Anthropometric and
Clinical Status of the Respondents
82
xiv
LIST OF FIGURES
Figure 1: Pathophysiology of Diabetes Mellitus
xv
13
CHAPTER ONE
1.0
INTRODUCTION
Diabetes mellitus (DM) with other non-communicable diseases is responsible for an increasing
burden of diseases in developing countries. In Sub-Saharan Africa, non-communicable diseases
are predicted to exceed infectious diseases by the year 2030 (Asmelash, 2019).
The International Diabetes Federation (2019) estimates that there are approximately 425 million
adults (20-79 years) who were living with diabetes in 2017 in the world and 1,702,900 cases of
diabetes in Nigeria in 2015.
Diabetes Mellitus (DM) is a chronic metabolic disease that affects the quality and duration of life
by causing organ dysfunctions due to the complications. DM has affected 380 million people
worldwide (Caydam et al., 2019). Diabetes mellitus (DM) is a highly prevalent chronic disease
and an important public health problem (Marina et al., 2015).
Diabetes mellitus (DM) also known as simply diabetes, is a group of metabolic diseases in which
there are high blood sugar levels over a prolonged period This high blood sugar produces the
symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can
cause many complications. Acute complications include diabetic ketoacidosis and non-ketotic
hyperosmolar coma. Serious long-term complications include heart disease, stroke, kidney failure,
foot ulcers and damage to the eyes (Shouip, 2015).
Among several factors that have been postulated to contribute to the DM epidemic, environmental
factors have drawn particular attention because of the rapidity of the increase in type 2 or the socalled ‘maturity-onset’ diabetes mellitus. It was pointed out that type 2 diabetes mellitus is closely
related to lifestyle factors including diet, physical activities, alcohol, and smoking as well as
1
obesity and a family history of diabetes (Olabiyi and Oguntibeju, 2013). On the other hand, type
1 DM, or ’Juvenile DM’ or ‘insulin-dependent’ diabetes is less common than type 2. Type 1
diabetes occurs when the pancreas produces no insulin at all. It tends to emerge in childhood or
early adulthood (before the age of 40) and must be regulated by regularly injecting insulin (Olabiyi
and Oguntibeju, 2013).
Diabetes is a chronic disease, and it could cause many serious short-term and long-term
consequences that affect both health and quality of life (QOL) (Spasi et al., 2014; Jing et al., 2018;
Levterova et al., 2018). QoL is a multifaceted and highly subjective concept, and has been defined
as “how good or bad a person feels their life to be”(Felício et al., 2015). Diabetes has a strong
influence on the quality of life (QOL) which has a multidimensional perception, such as social,
physical and role functioning, worries about the future, emotional and general well-being
(Mohammadi et al., 2016; John et al., 2019) Quality of life is an important aspect in diabetes
because the poor quality of life leads to diminished self-care, which in turn leads to worsened
glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming
in both the short run and the long run (Prajapati et al., 2015; Ibrahim et al., 2016). Gredig and
Bartelsen-raemy (2017) stated that the interrelation of stigma and quality of life should be explored
and modeled. Uncontrolled diabetes negatively impacts all aspects of a person’s quality of life
(Vanstone et al., 2015). The mere presence of diabetes deteriorates a person’s quality of life (QoL).
When diabetes coexists with other chronic illnesses the effect is even worse (Trikkalinou et al.,
2017). Depression can increase the risk of diabetes-related complications in people with diabetes
due to poor self-care, reduced treatment adherence, and poor glycemic control (Mishra et al., 2015;
Wang et al., 2016). Therefore, the aspect of quality of life of persons living with diabetes is an
2
essential component to assess, both for the patient as well as the healthcare providers(Kumar and
Krishna, 2015; John et al., 2019).
Excess weight and physical inactivity are also associated with an increased risk of developing
various diseases, particularly type 2 diabetes (Gray et al., 2016). Anthropometric measures are
used frequently to examine the relationships between Type 2 diabetes mellitus and obesity (Hardy
et al., 2017). It has been speculated that the increasing prevalence of obesity in younger individuals
may contribute to the epidemic of diabetes in young people. Greater adiposity is a major risk factor
for the development of type 2 diabetes (Chen et al., 2018).
The primary prevention of some cases of type 2 diabetes is potentially feasible but has yet to be
implemented as a public health measure (Williams and Farrar, 2014). The nutritional investigation
is an integral part of diabetes management and self-care education aiming at the attainment and
maintenance of optimal metabolic outcomes (Saleh and Mohammed, 2019). Patient education is
an essential component of diabetes care. Diabetes self-management education aims to empower
the person with diabetes with knowledge, skills and the motivation necessary for performing
appropriate self-care (Muchiri et al., 2016). Dietary management of type 2 diabetes among patients
is one way to prevent or delay the long term effect of the condition. Diabetic individuals worldwide
are routinely advised to adopt a healthful eating behavior, which requires modifications in food
habits, beliefs, and meal patterns on a lifelong basis (Wahome and Kiboi, 2016).
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific
situations. Management concentrates on keeping blood sugar levels as close to normal
("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with
diet, exercise, and the use of appropriate medications (insulin in the case of type 1 diabetes; oral
medications, as well as possibly insulin, in type 2 diabetes) (Shouip, 2015).
3
Along with urbanization and economic growth, many countries have experienced dietary changes
favoring increased caloric consumption, and diet is one of the major risk factors of diabetes
mellitus. Dietary management is a major way of attaining glycemic control in diabetes mellitus,
and of course, dietary management of diabetes mellitus is targeted at improving the overall health
by achieving and maintaining optimal nutritional status, attaining good glycemic control and
preventing acute and long-term complications of diabetes mellitus (Udogadi et al., 2019).
1.1
Problem Statement
Diabetes mellitus (DM) with other non-communicable diseases is responsible for an increasing
burden of diseases in developing countries (Asmelash, 2019). The International Diabetes
Federation (2019) estimates that there are approximately 425 million adults (20-79 years) who
were living with diabetes in 2017 in the world and 1,702,900 cases of diabetes in Nigeria in 2015.
Few studies have been conducted on the relationship between diabetes and quality of life using
diabetes-specific quality of life tool in this region.
1.2
Justification
In research conducted by Caydam et al. (2019), the findings showed that nutrition and lifestyle
behaviors play an important role in the quality of life among patients with diabetes mellitus.
Therefore, this study will provide information on nutrient intake, dietary habits, quality of life,
anthropometric status, clinical characteristics and lifestyle of people with diabetes mellitus.
This information can inform intervention which can help to improve the quality of life of people
with diabetes.
4
1.3
Objectives of the Study
1.3.1 Broad Objective
The objective of this study is to assess the lifestyle, nutritional status, and quality of life of diabetic
out-patients in State Hospital, Ijaiye, Abeokuta.
1.3.2 Specific Objectives
The specific objectives of this study are to:
•
Assess the socio-demographic and socio-economic characteristics of the respondents.
•
Determine the nutrient intake, dietary habit and diet quality of the respondents.
•
Assess the lifestyle and quality of life of the respondents.
•
Measure the anthropometric and clinical status of the respondents.
5
CHAPTER TWO
2.0
2.1
LITERATURE REVIEW
Overview of Diabetes Mellitus
Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient
Egyptians and Indians, illustrating some clinical features very similar to what we now know as
diabetes. Diabetes mellitus is a combination of two words, “diabetes” Greek word derivative,
means siphon - to pass through and the Latin word “Mellitus” means honeyed or sweet (Sami et
al., 2017).
Diabetes mellitus is a group of metabolic disorders that are characterized by elevated levels of
glucose in the blood (hyperglycemia) and insufficiency in the production or action of insulin
produced by the pancreas inside the body. Insulin is a protein (hormone) synthesized in beta cells
of the pancreas in response to various stimuli such as glucose (Ullah, 2016).
Diabetes mellitus is a heterogeneous group of disorders characterized by persistent hyperglycemia.
The two most common forms of diabetes are type 1 diabetes (T1D, previously known as insulindependent diabetes or IDDM) and type 2 diabetes (T2D, previously known as non-insulindependent diabetes or NIDDM). Both are caused by a combination of genetic and environmental
risk factors. However, other rare forms of diabetes are directly inherited. These include maturityonset diabetes in the young (MODY), and diabetes due to mutations in mitochondrial DNA (World
Health Organization, 2015).
All forms of diabetes have very serious effects on health. In addition to the consequences of
abnormal metabolism of glucose (e.g., hyperlipidemia, glycosylation of proteins, etc.), there are
several long-term complications associated with the disease. These include cardiovascular,
peripheral vascular, ocular, neurologic and renal abnormalities, which are responsible for
6
morbidity, disability and premature death in young adults. Furthermore, the disease is associated
with reproductive complications causing problems for both mothers and their children. Although
improved glycemic control may decrease the risk of developing these complications, diabetes
remains a very significant cause of social, psychological and financial burdens in populations
worldwide (World Health Organization, 2015).
The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and
failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. Several
pathogenic processes are involved in the development of diabetes. These range from autoimmune
destruction of the pancreatic β-cells with consequent insulin deficiency to abnormalities that result
in resistance to insulin action. The basis of the abnormalities in carbohydrate, fat, and protein
metabolism in diabetes is deficient action of insulin on target tissues (American Diabetes
Association, 2014).
2.2
Types of Diabetes Mellitus
Three main types of DM are known type 1 associated with full insulin deficiency, type 2progressive insulin deficiency and gestational diabetes mellitus which is diagnosed in the second
or third semester of pregnancy (Okur et al., 2017).
2.2.1 Type 1 Diabetes Mellitus
Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterized by increased
blood glucose levels (hyperglycemia), which are due to the insulin deficiency that occurs as the
consequence of the loss of the pancreatic islet β-cells (Katsarou et al., 2017). Type I diabetes
(Insulin-dependent) is due to immune-mediated beta-cells destruction, leading to insulin
deficiency (Ullah, 2016).
7
In type 1 diabetes, the body does not produce insulin. The body breaks down the carbohydrates
you eat into blood sugar that it uses for energy—and insulin is a hormone that the body needs to
get glucose from the bloodstream into the cells of the body (American Diabetes Association,
2019b).
The cause of type 1 diabetes is not known and it is not preventable with current knowledge.
Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger,
weight loss, vision changes, and fatigue. These symptoms may occur suddenly (World Health
Organization, 2018).
2.2.2 Type 2 Diabetes Mellitus
Type 2 diabetes mellitus is characterized by dysregulation of carbohydrate, lipid and protein
metabolism, and results from impaired insulin secretion, insulin resistance or a combination of
both (Defronzo et al., 2015)
Type 2 diabetes is the most common form of diabetes—and it means that your body does not use
insulin properly (American Diabetes Association, 2019b).
Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s
ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around
the world and is largely the result of excess body weight and physical inactivity.
Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the
disease may be diagnosed several years after onset, once complications have already arisen.
Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly
frequently in children (World Health Organization, 2018).
8
2.2.3 Gestational Diabetes
Gestational Diabetes Mellitus has been defined as any degree of glucose intolerance with onset or
first recognition during pregnancy (Ullah, 2016). Although most cases resolve with delivery, the
definition applied whether or not the condition persisted after pregnancy and did not exclude the
possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with
the pregnancy (American Diabetes Association, 2014).
Gestational diabetes is hyperglycemia with blood glucose values above normal but below those
diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an
increased risk of complications during pregnancy and delivery. They and their children are also at
increased risk of type 2 diabetes in the future (World Health Organization, 2018).
2.3
Epidemiology of Diabetes Mellitus
Globally, an estimated 422 million adults were living with diabetes in 2014, compared to 108
million in 1980. The global prevalence (age-standardized) of diabetes has nearly doubled since
1980, rising from 4.7% to 8.5% in the adult population. This reflects an increase in associated risk
factors such as being overweight or obese. Over the past decade, diabetes prevalence has risen
faster in low- and middle-income countries than in high-income countries (World Health
Organization, 2016).
Over the next 20 years, its prevalence is predicted to double, and more than half-a-billion people
will be affected. Estimated regional diabetes prevalence ranges from 5.1% in Africa to 11.4% in
North America and the Caribbean, with more than 75% of subjects living in low- and middleincome countries (Zaccardi et al., 2015).
9
The prevalence of diabetes mellitus in the six geopolitical zones of Nigeria were 3.0% in the northwest, 5.9% in the northeast, 3.8% in the north-central zone, 5.5% in the south-west, 4.6% in the
south-east, and 9.8% in the south-south zone (Uloko et al., 2018)
2.4
Etiology of Diabetes Mellitus
The exact cause of DM is uncertain until now. Nevertheless, scientists believe that genes,
environmental factors and other pathological conditions such as autoimmune eradication of the
pancreatic β-cells which provoke insulin deficiency and other abnormalities that cause resistance
to insulin action seem to involve in the development of the disease (Okur et al., 2017).
There is a direct link between hyperglycemia and physiological and behavioral responses.
Whenever there is hyperglycemia, the brain recognizes it and sends a message through nerve
impulses to the pancreas and other organs to decrease its effect (Baynest, 2015).
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of
Langerhans in the pancreas, leading to insulin deficiency. This type can be further classified as
immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature,
in which a T-cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin
(Shouip, 2015).
In Type 2 diabetes mellitus, there are certain mechanisms broken that keep regulation between
tissue sensitivity to insulin which consequently leads to impaired insulin secretion by the
pancreatic beta cells and impaired insulin action through insulin resistance (Ullah, 2016).
Gestational diabetes mellitus and type 2 diabetes have similar risk factors and genetic
predisposition to a given population. Considering etiology, it is unknown, which one is preceded
by another (Dolatkhah et al., 2018).
10
2.5
Pathogenesis/Pathophysiology of Diabetes Mellitus
Many different paths, driven by various genetic and environmental factors, result in the progressive
loss of beta-cell mass and/or function that manifests clinically as hyperglycemia. Once
hyperglycemia occurs, people with all forms of diabetes are at risk for developing the same
complications (Skyler et al., 2017).
2.5.1 Pathogenesis of Type 1 Diabetes Mellitus
Type 1 diabetes mellitus is a chronic autoimmune disease associated with selective destruction of
insulin-producing pancreatic β-cells. The onset of clinical disease represents the end stage of βcell destruction leading to type 1 diabetes mellitus. Several features characterize type 1 diabetes
mellitus as an autoimmune disease (Ozougwu et al., 2013):
1. Presence of immuno-competent and accessory cells in infiltrated pancreatic islets;
2. Association of susceptibility to disease with the class II (immune response) genes of the
major histocompatibility complex (MHC; human leukocyte antigens HLA);
3. Presence of islet cell-specific autoantibodies;
4. Alterations of T cell-mediated immunoregulation, in particular in CD4+ T cell
compartment;
5. The involvement of monokines and TH1 cells producing interleukins in the disease
process;
6. Response to immunotherapy and;
7. The frequent occurrence of other organs specific auto-immune diseases in affected
individuals or their family members (Baynest, 2015).
11
2.5.2 Pathophysiology of Type 2 Diabetes Mellitus
Under normal physiological conditions, plasma glucose concentrations are maintained within a
narrow range, despite wide fluctuations in supply and demand, through a tightly regulated and
dynamic interaction between tissue sensitivity to insulin (especially in the liver) and insulin
secretion (Ozougwu et al., 2013). Type 2 diabetes mellitus is a multifactorial disease involving
genetic and environmental factors. The pathophysiological changes are characterized by β-cell
dysfunction, insulin resistance, and chronic inflammation, all of which progressively hamper the
control of blood glucose levels and lead to the development of micro-and macro-vascular complications (Defronzo et al., 2015).
2.5.3 Pathophysiology of Gestational Diabetes Mellitus
Gestational diabetes mellitus is caused by a disorder of at least three aspects of metabolism: insulin
resistance, insulin secretion, and increased glucose production. Although the level of insulin
secretion in women with gestational diabetes, like women with normal glucose tolerance,
increases, but it is not enough to overcome insulin resistance and maintenance of normal blood
glucose levels. This competition, coupled with the reduction of beta cellular deposits, sparks
diabetes mellitus (Dolatkhah et al., 2018)
12
Figure 1: Pathophysiology of Diabetes Mellitus
Source: (Skyler et al., 2017)
13
2.6
Signs and Symptoms of Diabetes Mellitus
Symptoms of type 1 diabetes include excessive urination and thirst, constant hunger, weight loss,
vision changes, and fatigue. Symptoms of type 2 diabetes may be similar to those of type 1 diabetes
but are often less marked or absent. As a result, the disease may go undiagnosed for several years,
until complications have already arisen. For many years type 2 diabetes was seen only in adults
but it has begun to occur in children (World Health Organization, 2016).
Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with
polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may
also accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled
diabetes are hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome
(American Diabetes Association, 2019a).
2.7
Complications of Diabetes Mellitus
DM may induce several complications or can co-exist with other diseases. The complications are
divided into microvascular and macrovascular. Microvascular complications include nephropathy,
neuropathy, and retinopathy, which are specific to diabetes.
Macrovascular complications
manifest predominantly as coronary heart disease, but also cerebrovascular disease and peripheral
artery disease; these conditions are not specific to diabetes, but people with type 1 diabetes mellitus
are at risk of developing these conditions (Okur et al., 2017; American Diabetes Association,
2019a).
Given that the complications are mainly caused by hyperglycemia, awareness and monitoring of
these complications are needed to ensure adequate treatment. Genetic susceptibility and concomitant risk factors (for example, hypertension, dyslipidemia, and smoking) also contribute to the
development of complications (Katsarou et al., 2017).
14
2.8
Diagnosis of Diabetes Mellitus
The identification of patients with diabetes or pre-diabetes by screening allows for earlier
intervention, with potential reductions in future complication rates (Baynest, 2015).
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia and is diagnosed by
demonstrating any one of the following: (Shouip, 2015)

Fasting plasma glucose level ≥ 7.0 mmol/l (126 mg/dl)

Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) two hours after a 75 g oral glucose load as in a
glucose tolerance test

2.9
Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
Management of Diabetes Mellitus
Nutrition remains a key player in diabetes prevention and management (Udogadi et al., 2019).
Among several factors that have been postulated to contribute to the diabetes mellitus epidemic,
environmental factors have drawn particular attention. It was pointed out that type 2 diabetes
mellitus is closely related to lifestyle factors including diet, physical activities, alcohol, and
smoking as well as obesity and a family history of diabetes (Olabiyi and Oguntibeju, 2013).
Self-care behaviors such as consuming a healthy diet and engaging in physical activity that lead to
weight loss have been found to increase insulin sensitivity and prevent type 2 diabetes mellitus
and related complications (Ramal et al., 2017). In addition to lifestyle modification, social support
has an important role in type 2 diabetes mellitus management as it directly affects the performance
of diabetes mellitus self-care behaviors and indirectly affects glycemic control
(Zheng
et al., 2017).
The management of type 1 diabetes mellitus requires the tight collaboration of an interdisciplinary
team (including physicians, diabetes educators, nurses, dieticians, psychologists, and social
workers), the patient, and their family and support systems (school or work). The aim is to promote
15
healthy living and glycaemic control to prevent severe hypoglycemia, severe hyperglycemia, and
ketoacidosis (Katsarou et al., 2017).
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific
situations. Management concentrates on keeping blood sugar levels as close to normal
("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with
diet, exercise, and the use of appropriate medications (insulin in the case of type 1 diabetes; oral
medications, as well as possibly insulin, in type 2 diabetes) (Shouip, 2015).
2.10
Prevention of Diabetes Mellitus
Simple lifestyle measures are effective in preventing or delaying the onset of type 2 diabetes. To
help prevent type 2 diabetes and its complications, people should: (World Health Organization,
2018)

achieve and maintain a healthy body weight;

be physically active – at least 30 minutes of regular, moderate-intensity activity on most
days. More activity is required for weight control;

eat a healthy diet, avoiding sugar and saturated fats intake; and

avoid tobacco use – smoking increases the risk of diabetes and cardiovascular diseases.
2.11
Nutritional Status and Diabetes Mellitus
As the duration of diabetes increases, food intake decreases due to disease-related complications
(hyperglycemia, hypoglycemia, hyperlipidemia), functional deficiencies (poor dentition, ill-fitting
dentures, and dysphagia) and the changes of treatment plan in determining what to eat for diabetes
people (Caydam et al., 2019). Good nutritional status and good functional capacity are associated
with good quality of life in people with type 2 diabetes (Abdelhafiz and Sinclair, 2015).
16
However, when managing patients with diabetes, health care providers should undertake a careful
assessment of their nutritional requirements, tailoring interventions to the individual and involving
family and care providers where appropriate (Caydam et al., 2019).
2.12
Dietary Habit and Diabetes Mellitus
Urbanization has led many individuals towards a stressful, unhealthy lifestyle, mainly altering their
dietary patterns from the consumption of fresh, healthy food to more refined carbohydrates and
high fat containing junk food and beverages. Thus, unhealthy dietary habits and a sedentary
lifestyle are among the leading causes of obesity and diabetes (Pathirannehelage et al., 2016).
Eating habits show strong relationships with age and cultural, social, economic, and psychological
determinants and are integrated into the individual’s daily routine over a long period. Meal
frequency and times of eating can have a significant effect on various cardiac and metabolic
parameters (Gouda et al., 2018).
Several epidemiological studies of healthy adults and patients with Type 2 diabetes mellitus have
shown that poor eating habits, such as eating supper or snacking late at night and skipping
breakfast, are associated with hyperglycemia and obesity, as well as predisposing individuals to
developing Type 2 diabetes mellitus (Gouda et al., 2018). Several dietary patterns consisting of
combinations of different foods or food groups such as the Mediterranean diet, DASH diet, etc.
are beneficial for diabetes management (Ley et al., 2014). There is growing evidence of the
positive effects of dietary patterns with high intake of vegetarian foods (such as whole grains,
fruits, vegetables, and brans) and fish, and the low intake of processed animal and fatty foods in
the prevention and treatment of gestational diabetes mellitus (Dolatkhah et al., 2018)
17
2.13
Dietary Intake and Diabetes Mellitus
Dietary intake and nutritional status of a person are considered key in the prevention and
management of diabetes (Wahome and Kiboi, 2016). Dietary management is a key cornerstone
modality in the attainment of good glycemic control in diabetes mellitus, and of course, dietary
management of diabetes mellitus is targeted at improving the overall health by achieving and
maintaining optimal nutritional status, attaining good glycemic control and preventing acute and
long-term complications of diabetes mellitus (Udogadi et al., 2019).
2.14
Lifestyle and Diabetes Mellitus
An appropriate lifestyle and dietary changes have proven to be effective for the prevention and
management of diabetes mellitus by contributing to better glycemic control (Papakonstantinou,
2016; Viswanathan et al., 2019). Exercise improves glycaemic control by increasing insulin
sensitivity and lowering blood glucose concentrations and by the important role that it plays in
weight control. Regular physical activity lowers HbA1c levels. This is significant, as lower HbA1c
levels are associated with improved morbidity and mortality outcomes (Birkinshaw et al., 2018).
Weight loss has long been known to enhance insulin sensitivity and improve glycemia in type 2
diabetes mellitus patients (Grams et al., 2015). Moderate alcohol consumption has also been
associated with a lower risk of mortality and coronary heart disease in people with diabetes (Ley
et al., 2014).
2.15
Quality of Life and Diabetes Mellitus
The World Health Organization (WHO) defines health as “a state of complete physical, mental
and social wellbeing and not merely the absence of disease or infirmity”. This all-encompassing
definition implies the importance of capturing effect changes both in terms of life expectancy and
quality of life (QOL) (Mafirakureva et al., 2016).
18
The World Health Organisation (WHO) developed the WHO Quality of Life (QOL) instruments
to measure health, the impact of the disease, impairment on daily activities and behavior (Cronje
et al., 2016).
Quality of Life is an individual’s perception of the current situation concerning the culture and
value system in which he/she lives and their relationship with the individual’s goals, expectations,
standards and priorities (County et al., 2017; Gebremedhin et al., 2019).
The term health-related quality of life (HRQOL) is often used to indicate the quality of life as it
relates to diseases or treatments. Quality of life (QOL) is used as an important outcome indicator
for healthcare decision-making and intervention effects evaluation. (Liping et al., 2015).
Physical health, mental health, functional autonomy, and social communication are four known
aspects of quality of life. (Ghisvand et al., 2019).
Health-related quality of life (HRQOL) is an integral aspect of diabetes mellitus care
(Mutashambara et al., 2018). Quality of Life in people with diabetes mellitus can be considered to
be associated, in many ways, with the presence of satisfaction with diabetes treatment, which is
the positive aspect of living with diabetes, and the impact of diabetes, which is the negative aspect
of living with diabetes (Kueh et al., 2016). Diabetes is a challenging disease that adversely affects
sufferers’ HRQOL that requires their adjusting to necessary changes in diet and lifestyle, regular
monitoring of glucose levels, the development of chronic complications, and the presence of other
co-morbid conditions as they age (Marina et al., 2015; Nielsen et al., 2016). People who do not
succeed in controlling their blood sugar through medication, diet, and exercise may experience
complications of diabetes, and these negatively affect their quality of life (Vanstone et al., 2015).
Depression further deteriorates the quality of life (QOL) and is associated with poor treatment
outcomes and lowered glycemic control in diabetes (Mishra et al., 2015).
19
The Quality of Life is very important because it is a powerful tool to predict an individual’s
capacity to manage the disease and maintain long-term health and well-being (Prajapati et al.,
2015). However, nutrition is important for maintaining the quality of life (QoL). Malnutrition has
a negative effect on diabetes prognosis, and consequently on the quality of life. As the nutritional
status of diabetic people gets better, their quality of life increases (Caydam et al., 2019).
There is a distinction between “quality of life in general” and “quality of life in diabetes mellitus”.
Generic QoL tools are applicable in the general population, but are also used in specific groups
and are used across different populations, conditions, and diseases. Such tools can be used to
compare QoL in patients with the disease and healthy controls (Levterova et al., 2013).
Diabetes-specific instruments are designed to be more sensitive to changes within patients with
diabetes mellitus when compared with generic tools. The Audit of Diabetes Dependent Quality of
Life questionnaire is a condition-specific outcome measure suitable for patients with either type 1
or 2 diabetes. It consists of 18 items. Each item is scored on a 7-point scale from - 3 (much better)
to + 3 (very much worse). The scores for all items are multiplied by importance ratings to calculate
a final score ranging from - 9 to + 9 (Kachan and Nair, 2017; Bąk et al., 2019). The Appraisal of
Diabetes Scale is also a standardized diabetes-specific tool developed by Carey and colleagues in
1991 to evaluate a person’s thoughts about coping with diabetes. It consists of 7 items that use a
5-point adjectival scale, and scores are calculated by summing up each component with 0
representing the least effect of diabetes and 35 the greatest effect of diabetes (Kachan and Nair,
2017).
2.16
Diabetes Mellitus and Hypertension
Diabetes mellitus and hypertension are among the most common diseases and cardiovascular risk
factors, respectively, worldwide (Tsimihodimos et al., 2018). Hypertension is common among
20
patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex,
race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other
factors (Benetos et al., 2017). Hypertension and diabetes were found to share common risk factors,
including obesity, lipid profile and blood pressure (Kim et al., 2015). Hypertension and diabetes
frequently occur in the same individuals in clinical practice, especially in early-onset cases of
either disease (Liu et al., 2019). Moreover, the presence of hypertension does increase the risk of
new-onset diabetes, as well as diabetes, does promote the development of hypertension (Volpe et
al., 2015). The presence of hypertension in individuals with type 2 diabetes augments the risk for
cardiovascular morbidity and mortality (Khangura et al., 2018; Liu et al., 2019; Wang et al., 2019).
21
CHAPTER THREE
3.0
3.1
RESEARCH METHODOLOGY
Study Area/Location
The study was carried out at State Hospital Ijaiye, Abeokuta, Ogun state.
3.1.1 Brief Description of the Hospital
The State Hospital Ijaiye, Abeokuta was established in 1914 at Wasimi Ake, and later moved to
the present site after World War 1. The hospital has been witnessing infrastructural development
over the years and most of the colonial structures had been replaced except for few buildings which
still serves as a reminder of the past of the hospital. It is the main State government-owned hospital
providing primary and secondary health care services to the inhabitants of Abeokuta, the state
capital and its environs (Ogun State Hospital Management Board, 2019).
3.2
Study Design
The study was a cross-sectional survey.
3.3
Population of Study
The study comprised of adults 19 years of age and above living with diabetes mellitus including
males and females visiting the State Hospital Ijaiye, Abeokuta, Ogun state.
3.4
Inclusive Criteria
Eligible respondents for this study were adults 19 years of age and above living with diabetes
mellitus including males and females visiting the State Hospital Ijaiye, Abeokuta, Ogun state.
22
3.5
Exclusive Criteria
Exclusive from the study were people below 19 years of age and not living with diabetes mellitus.
Also, exclusive from the study will be adults living with diabetes mellitus and with several other
complications.
3.6
Sample Size
The study was carried out on 100 participants
3.7
Sampling Technique
An exhaustive sampling technique was used
3.8
Materials and Methods for Data Collection
3.8.1 Socio-Demographic and Socioeconomic Data
Socio-demographic and socio-economic data were obtained using a Semi-structured selfadministered questionnaire. Each respondent completed a questionnaire. The respondent’s
demographic information (age, educational level, marital status, religion, etc.) was on the first part
of the questionnaire.
3.8.2 Anthropometric and Clinical Status
Anthropometric data, which include height, weight, Hip circumference, Waist circumference, was
collected using a heightometer, bathroom scale, and tape measure respectively. Clinical
measurements such as blood pressure and fasting blood sugar were measured using
sphygmomanometer and glucometer respectively.
23
Weight

The respondents were asked to remove their heavy outer garments and shoes and
also empty their pockets.

The respondents were asked to stand in the center of the bathroom scale platform.

The scale was checked until it balances and the arrows are aligned.

The weight was then recorded to the nearest 0.1 kg.
Height

The respondents were asked to remove their shoes, heavy outer garments, and hair
ornaments.

The respondents were asked to stand with the back to the height rule. The back of
the head, back, buttocks, calves, and heels will be touching the heightometer with
feet together and the respondent looking straight.

The height was checked by using a ruler to press down the hair (if present) and
noting the point reached on the heightometer.

The height was then recorded in meters.
Waist Circumference

The respondent was asked to remove any clothing that may cover the waist and
stand erect.

The tape was wrapped around the waist just above the hip bone.

The tape was made to have the proper tension and is not too tight or too loose.

Measurement was read and recorded immediately.
24
Hip Circumference

The respondent was asked to remove any thick clothing that may cover the waist
and stand erect.

The tape was wrapped around the hip.

The tape was made to have the proper tension and is not too tight or too loose.

Measurement was read and recorded immediately.
Blood Pressure

The respondent was asked to sit in a relaxed position with the arm resting on a table.

The cuff was wrapped around the biceps and the balloon was squeezed to increase
the pressure.

The pressure was increased to 180mmHg and the stethoscope was placed inside the
elbow crease under the cuff.

The balloon was deflated slowly and listening through the stethoscope, the first
beats hit and the number was noted as the systolic pressure.

Listening continued until the steady heartbeat sound stopped and the number was
recorded as the diastolic pressure.
Fasting Blood Glucose

The respondent’s hands were cleaned with methylated spirits.

A test strip was inserted into the glucometer.

The side of the fingertip was pricked with a lancet.

The finger was gently squeezed until a drop of blood formed.

The blood was carefully dropped on the test strip and the reading was recorded.
25

BMI was calculated from anthropometric data collected, which included height and weight.

BMI was calculated from the weight and height using the formula- weight (kg)/height2(m2)
and classified as “Underweight” (below 18.5), “Normal weight” (18.5-24.9), “Overweight”
(25.0-29.0), “Obesity” (30.0 and above) (World Health Organization, 2020).

Waist circumference was classified as “Normal” (below 102cm) and “High” (102cm and
above) for males while “Normal” (below 88cm) and “High” (88cm and above) for females
(WHO Expert Consultation, 2008).

Blood pressure was classified as “Normal” (systolic-less than 120mmHg and diastolic-less
than 80mmHg), “Elevated” (systolic-120 – 129mmHg and diastolic-less than 80mmHg),
Stage 1 Hypertension (systolic- 130 – 139mmHg or diastolic-80 – 89mmHg) and Stage 2
Hypertension (systolic-140mmHg or higher or diastolic-90mmHg or higher) (American
Heart Association, 2020).

Fasting blood glucose was classified as “Normal” (70-99mg/dl), “Prediabetes” (100125mg/dl) and “Diabetes” (126mg/dl or above) (Diabetes UK, 2019).
3.8.3 Dietary Intake and Diet Quality

Dietary and nutrient intake was assessed using interviewer-administered 24-Hour dietary
recall.

24-hr Recall of the respondents was analyzed using the Total Diet Assessment (TDA)
software to determine the nutrient intake of each respondent which was then compared
with the Estimated Average Requirements (EAR).

Information on diet quality was also drawn from the 24-hr Recall of the respondents using
the Global Burden of Diseases dietary risk factors to calculate the optimal level of intake
of food groups (Murray, 2019).
26
3.8.4 Dietary Habit

An 18-item validated questionnaire (Pauh, 2005) was used to collect information on the
dietary habits of the respondents.

The dietary habit questionnaire is an 18-item validated questionnaire based on a 4-point
scale scored by summing up responses and calculating percentage from the highest score
obtainable. It was then classified as “excellent” (85-100%), “good” (70-84%), “fair” (5569%) and “poor” (54% or lower) (Pauh, 2005).
3.8.5 Quality of Life

The use of validated questionnaires- 19-domain Audit of Diabetes-Dependent Quality of
Life (ADDQoL) (Health Psychology Research Unit, 2019) and 7-item Appraisal of
Diabetes Scale (ADS) (Carey et al., 1991) questionnaires to assess the Quality of Life of
respondents.

To assess the Quality of Life (QoL) of the patients, the Audit of Diabetes-Dependent
Quality of Life (ADDQoL) and Appraisal of Diabetes Scale (ADS) was used. The ADDQol
consists of 19 domains each with a question on impact rating (conditions without diabetes)
followed by a question on importance rating. Each domain was scored as (Health
Psychology Research Unit, 2019):
Weighted impact score = impact rating (−3 to +1) * importance rating (0–3) = −9
(maximum negative impact of diabetes) to +3 (maximum positive impact of diabetes).
The ADS is a 7-item questionnaire based on a 5-point Likert scale scored by summing up
all items (having reversed the scores for Item-2 and 6) of the questionnaire. The
27
interpretation is that, the smaller the score, the more positive the appraisal strategy (Carey
et al., 1991).
3.8.6 Lifestyle Characteristics

Information on lifestyle (smoking, alcohol consumption and quantity and type of substance
or alcohol taken) and physical activity were collected using a semi-structured questionnaire
and International Physical Activity Questionnaire (IPAQ) (IPAQ Research Committee,
2004) respectively.

The International Physical Activity Questionnaire (IPAQ) was used to assess the physical
activity of respondents. It collects information on physical activity participation in four
settings (or domains) as well as sedentary behavior, comprising 27 questions. The domains
are: “Job-Related Physical Activity”, “Transportation Physical Activity”, “Housework,
House Maintenance, and Caring for Family”, and “Recreation, Sport, And Leisure-Time
Physical Activity”. The scoring was based on a continuous variable score expressed as
MET (Metabolic Equivalent)-min per week: MET level* minutes of activity* events per
week. MET levels used were 3.3 METs (Walking), 4 METs (Moderate activity) and 8
METs (Vigorous activity).
Total MET-min/week = (Walk METs*min*days) + (Mod METs*min*days) + Vig
METs*min*days) (IPAQ Research Committee, 2004).

Information on lifestyle (smoking, alcohol consumption) and dietary habit with be
collected using a semi-structured questionnaire and a structured questionnaire respectively.
3.9
Ethical Consideration
Ethical approval was sought from the ethical committee of the hospital- The State Hospital, Ijaiye.
28
3.10
Permission to Conduct Study
Permission was sought from the dietetics department of State Hospital Ijaiye
3.11
Informed Content
Informed consent was taken from all respondents before data collection. The informed consent
was written on the questionnaire and included a verbal explanation describing the purpose of the
study, procedures for maintaining confidentiality, and the respondents’ right to refuse to
participate.
3.12
Statistical Analysis
Data were entered into Excel Sheet and was analyzed with Statistical Product and Service
Solutions (SPSS) version 25 software.
Socio-demographic and economic information was
presented using frequencies and percentages for categorical variables, mean values and standard
deviation was used to present the continuous variables and Pearson’s ‘R’ correlation analysis at
significance level of 0.05 was used to compare variables. T-test and Analysis of Variance
(ANOVA) were used whenever necessary.
29
CHAPTER 4
4.0
RESULTS AND DISCUSSION
4.1
RESULTS
4.1.1 Socio-demographic and Socioeconomic Characteristics of the Respondents
Table 1 below shows the socio-demographic and economic characteristics of the respondents.
Almost half (49.0%) of the respondents were within the age range of 36 - 40 years, 59.0% were
females, 63.0% were Christians, 67.0% were from Ogun state and most (95.0%) were Yoruba.
The majority (85.0%) of the respondents were married, 48.0% had attained tertiary education,
57.0% were traders while 25.0% were civil servants and 61.0% earned below N50,000 monthly.
Almost half (45.0%) of the respondents engage in sedentary work while 55.0% engage in nonsedentary work. Almost half (46.6%) of the respondents had spouses who had attained the tertiary
level of education, 50.6% were trader and 52.9% earn below N50,000 monthly. The majority
(87.0%) of the respondents had 1-2 income earners in the family.
30
Table 1: Socio-demographic and Socioeconomic Characteristics of the Respondents
Variables
Age
20 - 35 Years
36 - 50 Years
50 Years and Above
Total
Gender
Male
Female
Total
Religion
Christianity
Islam
Total
State of Origin
Ekiti
Gombe
Imo
Lagos
Ogun
Ondo
Osun
Oyo
Total
Ethnic Group
Yoruba
Igbo
Others
Total
Marital Status
Single
Married
Separated
Total
Educational Level
Primary
Secondary
Tertiary
No Formal Education
Total
Frequency
Percentage (%)
23
49
28
100
23.0
49.0
28.0
100.0
41
59
100
41.0
59.0
100.0
63
37
100
63.0
37.0
100.0
7
1
2
4
67
4
6
9
100
7.0
1.0
2.0
4.0
67.0
4.0
6.0
9.0
100.0
95
4
1
100
95.0
4.0
1.0
100.0
14.0
85.0
1.0
100.0
14
85
1
100
10
36
48
6
100
10.0
36.0
48.0
6.0
100.0
31
Table 1: Socio-demographic and Socioeconomic Characteristics of the Respondents
Variables
Occupation
Civil Servant
Trader
Student
Artisan
Total
Nature of Work/Occupation
Sedentary
Non-sedentary
Total
Estimated Monthly Income
<50000
50000-99000
100000-149000
150000-199000
>200000
Total
Educational Level of Spouse
Primary
Secondary
Tertiary
No Formal Education
Total
Occupation of Spouse
Civil Servant
Trader
Artisan
Total
Estimated Monthly Income of Spouse
<50000
50000-99000
100000-149000
150000-199000
Total
Number of Income Earners
1–2
3–4
5 and Above
Total
Frequency
Percentage (%)
25
57
11
7
100
25.0
57.0
11.0
7.0
100.0
45
55
100
45.0
55.0
100.0
61
21
9
2
7
100
61.0
21.0
9.0
2.0
7.0
100.0
8
33
41
6
88
9.1
37.5
46.6
6.8
100.0
32
44
11
87
36.8
50.6
12.6
100.0
46
26
8
7
87
52.9
29.9
9.2
8.0
100.0
87
12
1
100
87.0
12.0
1.0
100.0
32
4.1.2 Clinical History of the Respondents
Table 2 shows the clinical history of the respondents. More than half (58.0%) of the respondents
have had diabetes mellitus for about 1-5 years. One-tenth (10.0%) of the respondents have had
diabetes for about 6-11 years, one-fifth have had diabetes for about 1-5 months while 7.0% have
had diabetes for about 6-11 months and 5.0% have had diabetes for 12 years and above. Most
(70.8%) of the male respondents have had diabetes for about 1-5 years. Also, almost half (49.1%)
of the female respondents have had diabetes for about 1-5 years.
Almost all (99.0%) the respondent had type 2 diabetes mellitus of the 100.0% of the male
respondents had type 2 diabetes while 98.3% of the female respondents had type 2 diabetes and
1.7% of the female respondents had type 1 diabetes mellitus.
Almost one-fifth (17.0%) of the respondents had hypertension as complication, 16.0% had diabetic
neuropathy, 1.0% had diabetic nephropathy while 1.0% had diabetic retinopathy.
About one-fourth (26.0%) of the respondents made use of pharmacotherapy alone for treatment.
One-fifth (20.0%) of the respondents made use of a combination of diet, physical activity, and
behavioural therapy as treatment while 15.0% made use of diet and pharmacotherapy as treatment
and 13.0% made use of diet and physical activity as treatment for diabetes.
Majority (70.7%) of male respondents had history of counselling on diabetes while 29.3% of the
male respondents do not have history of counselling on diabetes. More than half (57.6%) of the
female respondents had history of counselling on diabetes while 42.4% of the female respondents
had history of counselling on diabetes.
Almost two-third (61.0%) of the male respondents had diabetes self-management skills and
barriers while more the one-third (39.0%) of the male respondents had no diabetes self33
management skills and barriers. More than half (55.9%) of the female respondents did not have
diabetes self-management skills and barriers while 44.1% of the female respondents had diabetes
self-management skills and barriers.
More than half (56.1%) of the male respondents had carbohydrate counting knowledge while
43.9% of the male respondents did not have carbohydrate counting knowledge. Almost two-third
(64.4%) of the female respondents did not have carbohydrate counting knowledge while more than
one-third (35.6%) had carbohydrate counting knowledge.
More than half (58.5%) of the male respondents did not have social support while 41.5% had social
support. Majority (74.6%) of the female respondents did not have social support while only 25.4%
had social support.
The majority (79.7%)of the female respondents had no history of screening for depression, anxiety,
and disordered eating while only one-fifth (20.3%) had history of screening for depression,
anxiety, and disordered eating. Most (61.0%) of the male respondents had no history of screening
for depression, anxiety, and disordered eating while more than one-third (39.0%) had history of
screening for depression, anxiety, and disordered eating.
34
Table 2: Clinical History of the Respondents
Variables
Frequency (%)
Male
Female
Total
1 – 5 months
6 (14.6)
14 (23.7)
20 (20.0)
6 – 11 months
3 (7.3)
4 (6.8)
7 (7.0)
1 – 5 years
29 (70.8)
29 (49.1)
58 (58.0)
6 – 11 years
1 (2.4)
9 (15.3)
10 (10.0)
12 years and Above
2 (4.9)
3 (5.1)
5 (5.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Type 1
0 (0.0)
1 (1.7)
1 (1.0)
Type 2
41 (100.0)
58 (98.3)
99 (99.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Duration of Disease
Type of Diabetes Mellitus
Diabetes-related Complication(s) present
Hypertension
7 (17.1)
10 (16.9)
17 (17.0)
Nephropathy
0 (0.0)
1 (1.7)
1 (1.0)
Neuropathy
6 (14.6)
10 (16.9)
16 (16.0)
Retinopathy
0 (0.0)
1 (1.7)
1 (1.0)
Nil
28 (68.3)
37(62.8)
65 (65.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
35
Table 2: Clinical History of the Respondents
Variables
Frequency (%)
Male
Female
Total
Diet Alone
1 (2.4)
5 (8.5)
6 (6.0)
Physical Activity Alone
2 (4.9)
1 (1.7)
3 (3.0)
Pharmacotherapy Alone
8 (19.5)
18 (30.5)
26 (26.0)
Metabolic Surgery Alone
0 (0.0)
1 (1.7)
1 (1.0)
Behavioural Therapy Alone
0 (0.0)
1 (1.7)
1 (1.0)
Diet & Physical Activity
7 (17.1)
6 (10.2)
13 (13.0)
Diet & Pharmacotherapy
8 (19.5)
7 (11.9)
15 (15.0)
Diet, Behavioural Therapy &
0 (0.0)
1 (1.7)
1 (1.0)
4 (9.8)
9 (15.2)
13 (13.0)
11 (26.8)
9 (15.2)
20 (20.0)
0 (0.0)
1 (1.7)
1 (1.0)
41 (100.0)
59 (100.0)
100 (100.0)
Treatment Option
Pharmacotherapy
Diet, Physical Activity &
Pharmacotherapy
Diet, Physical Activity &
Behavioural Therapy
Diet, Physical Activity,
Behavioural Therapy &
Pharmacotherapy
Total
36
Table 2: Clinical History of the Respondents
Variables
Frequency (%)
Male
Female
Total
History of Counselling on Diabetes
Yes
29 (70.7)
34 (57.6)
63 (63.0)
No
12 (29.3)
25 (42.4)
37 (37.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Diabetes Self-management skills and barriers
Yes
25 (61.0)
26 (44.1)
51 (51.0)
No
16 (39.0)
33 (55.9)
49 (49.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Carbohydrate Counting Knowledge
Yes
23 (56.1)
21 (35.6)
44 (44.0)
No
18 (43.9)
38 (64.4)
56 (56.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Yes
17 (41.5)
15 (25.4)
32 (32.0)
No
24 (58.5)
44 (74.6)
68 (68.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Social Support Status
History of Screening for depression, anxiety, and disordered eating
Yes
16 (39.0)
12 (20.3)
28 (28.0)
No
25 (61.0)
47 (79.7)
72 (72.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
37
4.1.3 Lifestyle Characteristics of the Respondents
Table 3 below shows the lifestyle characteristics of the respondents. Only 1.0% of the respondents
was a current smoker while 1.0% was once a smoker and the remaining 98.0% were non-smokers.
Just 2.0% were alcohol consumers and 1.0% of the consumers take beer while the other 1.0% take
herbal concoction. More than half (53.0%) of the respondents had fair dietary habits, 40.0% had a
poor dietary habit and 7.0% had good dietary habits. More than half (65.0%) of the respondents
had high physical activity, 32.0% had moderate physical activity and 3.0% had low physical
activity. Majority (97.6%) of the male respondents were non-smokers while 2.4% were lifetime
smokers. Also, majority (98.3%) of the female respondent were non-smokers while 1.7% were
current smokers. All (100.0%) the male respondents were non-consumers of alcohol while 3.4%
of the female respondents were alcohol consumers and 96.6% of the female respondents were nonconsumers of alcohol. Among the male respondents, 43.9% had poor dietary habit, 46.3% had fair
dietary habit while 9.8% had good dietary habit. Among the female respondents, 37.3% had poor
dietary habit, 57.6% had fair dietary habit while 5.1% had good dietary habit. Most (78.1%) of the
male respondents engaged in high physical activity while about one-fifth of the male respondents
engaged in moderate physical activity. More than half (55.9%) of the female respondents engaged
in high physical activity while 40.7% of the female respondents engaged in moderate physical
activity.
38
Table 3: Lifestyle Characteristics of the Respondents
Variables
Male
Frequency (%)
Female
Total
Smoking status
Current smokers
0 (0.0)
1 (1.7)
1 (1.0)
Non-smokers
40 (97.6)
58 (98.3)
98 (98.0)
Lifetime smokers
1 (2.4)
0 (0.0)
1 (1.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Cigarette
1 (2.4)
1 (1.7)
2 (2.0)
No Response
40 (97.6)
58 (98.3)
98 (98.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Quantity of Cigarette Sticks
smoked
1 Stick
0 (0.0)
1 (1.7)
1 (1.0)
2 Sticks
1 (2.4)
0 (0.0)
1 (1.0)
No Response
40 (97.6)
58 (98.3)
98 (98.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
1-2 times
1 (2.4)
0 (0.0)
1 (1.0)
3-4 times
0 (0.0)
1 (1.7)
1 (1.0)
No Response
40 (97.6)
58 (98.3)
98 (98.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Alcohol Consumption Status
Consumers
Non-consumers
Total
0 (0.0)
41 (100.0)
41 (100.0)
2 (3.4)
57 (96.6)
59 (100.0)
2 (2.0)
98 (98.0)
100 (100.0)
Types of Alcohol Consumed
Beer
Herbal Concoction
No Response
Total
0 (0.0)
0 (0.0)
41 (100.0)
41 (100.0)
1 (1.7)
1 (1.7)
57 (96.6)
59 (100.0)
1 (1.0)
1 (1.0)
98 (98.0)
100 (100.0)
Types of Substance Smoked
Frequency of Smoking Per Week
39
Table 2: Lifestyle Characteristics of the Respondents
Variables
Frequency (%)
Female
Male
Quantity of Alcohol Consumed
50cl Beer
0 (0.0)
75ml Herbal Concoction
0 (0.0)
No Response
41 (100.0)
Total
41 (100.0)
Frequency of Alcohol Consumption Per Week
1-2 times
0 (0.0)
3-4 times
0 (0.0)
No Response
41 (100.0)
Total
41 (100.0)
Dietary Habit
Poor
18 (43.9)
Fair
19 (46.3)
Good
4 (9.8)
Total
41 (100.0)
Physical Activity
Low
1 (2.4)
Moderate
8 (19.5)
High
32 (78.1)
Total
41 (100.0)
40
Total
1 (1.7)
1 (1.7)
57 (96.6)
59 (100.0)
1 (1.0)
1 (1.0)
98 (98.0)
100 (100.0)
1 (1.7)
1 (1.7)
57 (96.6)
59 (100.0)
1 (1.0)
1 (1.0)
98 (98.0)
100 (100.0)
22 (37.3)
34 (57.6)
3 (5.1)
59 (100.0)
40 (40.0)
53 (53.0)
7 (7.0)
100 (100.0)
2 (3.4)
24 (40.7)
33 (55.9)
59 (100.0)
3 (3.0)
32 (32.0)
65 (65.0)
100 (100.0)
4.1.4 Nutrient Intake of the Respondents
Table 4 below shows the nutrient intake of the respondents. The median nutrient intake of the
respondents includes: Calorie (1901.95kcal), Protein (68.45g), Carbohydrate (313.37g), Fiber
(8.25g), Fat (41.94g), Vitamin A (4862.63RE), Vitamin C (6.50mg), Vitamin B1 (0.43mg),
Vitamin B2 (1.01mg), Vitamin B3 (13.22mg), Vitamin B6 (0.91mg), Folate (95.15mcg), Vitamin
B12 (4.08mcg), Calcium (195.98mg), Phosphorus (593.07mg), Sodium (291.97mg), Potassium
(851.17mg), Zinc (11.25mg), Iron (15.63mg), Magnesium (187.81mg).
From the median nutrient intake of the respondents as compared with the Estimated Average
Requirement, there was adequate intake energy, carbohydrate, protein, fat, Vitamin A. B2, B3, B6,
and B12, phosphorus, zinc, iron, and magnesium but there was significant low intake of nutrients
such as vitamin C, fiber, folate, sodium, potassium, and calcium.
41
Table 4: Nutrient Intake of the Respondents
Nutrients
Median
Calories (kcal)
1901.95
Protein (g)
68.45
Carbohydrate (g)
313.37
Fiber (g)
8.25
Fat (g)
41.94
Vitamin A (RE)
4862.63
Vitamin C (mg)
6.50
Vitamin B1 (mg)
0.43
Vitamin B2 (mg)
1.01
Vitamin B3 (mg)
13.22
Vitamin B6 (mg)
0.91
Folate (mcg)
95.16
Vitamin B12 (mcg)
4.08
Calcium (mg)
195.98
Phosphorus (mg)
593.07
Sodium (mg)
291.97
Potassium (mg)
851.17
Zinc (mg)
11.25
Iron (mg)
15.63
Magnesium (mg)
187.81
*Estimated Average Requirement
Lower
Quartile
1505.39
53.37
233.74
3.41
29.37
2396.99
0.00
0.26
0.63
8.28
0.57
43.39
2.04
82.21
400.20
113.31
547.70
7.90
11.64
130.18
42
Upper
Quartile
2441.96
93.55
414.62
14.02
56.06
5782.43
26.95
1.06
1.64
21.96
1.38
221.44
5.22
399.65
796.91
1233.51
1444.80
15.49
20.96
259.67
EAR*
%EAR
2403
46
130
25
66.75
700
75
1.1
1.1
14
1.3
400
2.4
1000
700
1500
4700
8
18
320
79.15
148.80
241.05
33.00
62.83
694.66
8.67
39.09
91.82
94.43
70.00
23.79
170.00
19.60
84.72
19.46
18.11
140.63
86.83
58.69
4.1.5 Dietary Habit of the Respondents
Table 5 below shows the dietary habit of the respondents. The majority (71.0%) of the respondents
skip meals 1-2 times a week and almost half (48.0%) eat three base meals per day 3-4 times a
week. Almost half (43.0%) of the respondents have breakfast in the morning 3-4 times a week and
69.0% take water 5-7 times a day. About half (54.0%) of the respondents take vitamin supplements
1-2 times in a week and 55.0% take mineral supplements 1-2 times a week. Almost 60% of the
respondents do not take a record of their food intake weekly and 58% take carbonized beverages
1-2 times a week. Almost half of the respondents (45.0%) eat cereals 1-2 times weekly while 46%
consume fruits 1-2 times weekly. About half (52%) of the respondents eat vegetables 3-4 times
weekly, 62% consume dairy products 1-2 times weekly while 67% eat pastries 1-2 times weekly
and about half (47%) of the respondents seek out nutrition information.
43
Table 5: Dietary Habit of the Respondents
Variables
Breakfast consumption in the
morning
Meal skipping
Vitamin supplements intake
Mineral supplements intake
Three base meals consumption per
day
Food intake record
Water intake in a day
Carbonized beverages intake
Dieting
Intake of breads, cereals, pasta,
potatoes, or rice
Intake of fruits, such as apples,
bananas, or oranges
Intake of vegetables, such as
tomatoes, carrots, or salad
Intake of dairy products such as
milk, yoghurt or cheese
Intake of pastry, cookies, candies or
other sweets
Intake of foods like potato chips,
cakes, doughnuts or soda
Intake of foods like popcorn,
pretzels or fruits
Intake of fast food
Seeking out nutrition information
Does not
occur at all
Freq (%)
1 (1.0)
Sometimes
1-2 times)
Freq (%)
28 (28.0)
Often (3-4
times)
Freq (%)
43 (43.0)
Always (5- Total
7 times)
Freq (%)
Freq (%)
28 (28.0)
100 (100.0)
12 (12.0)
17 (17.0)
17 (17.0)
12 (12.0)
71 (71.0)
54 (54.0)
55 (55.0)
23 (23.0)
13 (13.0)
26 (26.0)
26 (26.0)
48 (48.0)
4 (4.0)
3 (3.0)
2 (2.0)
17 (17.0)
100 (100.0)
100 (100.0)
100 (100.0)
100 (100.0)
57 (57.0)
1 (1.0)
27 (27.0)
35 (35.0)
9 (9.0)
26 (26.0)
13 (13.0)
58 (58.0)
40 (40.0)
45 (45.0)
9 (9.0)
17 (17.0)
11 (11.0)
22 (22.0)
42 (42.0)
8 (8.0)
69 (69.0)
4 (4.0)
3 (3.0)
4 (4.0)
100 (100.0)
100 (100.0)
100 (100.0)
100 (100.0)
100 (100.0)
5 (5.0)
46 (46.0)
45 (45.0)
4 (4.0)
100 (100.0)
7 (7.0)
36 (36.0)
52 (52.0)
5 (5.0)
100 (100.0)
12 (12.0)
62 (62.0)
23 (23.0)
3 (3.0)
100 (100.0)
18 (18.0)
67 (67.0)
15 (15.0)
0 (0.0)
100 (100.0)
19 (19.0)
70 (70.0)
11 (11.0)
0 (0.0)
100 (100.0)
21 (21.0)
63 (63.0)
14 (14.0)
2 (2.0)
100 (100.0)
13 (13.0)
38 (38.0)
72 (72.0)
47 (47.0)
13 (13.0)
14 (14.0)
2 (2.0)
1 (1.0)
100 (100.0)
100 (100.0)
44
4.1.6 Diet Quality of the Respondents Compared with Optimal level of Intake of Global
Burden of Disease Dietary Risk Factors
Table 6 below shows the diet quality of the respondents compared with optimal level of intake of
global burden of disease dietary risk factors. From the mean intake of food groups of the Global
Burden of Disease Dietary Risk Factors, there were significantly low intake of food groups such
as fruits (22.5%), vegetables (29.4%), nuts and seeds (33.3%), milk (1.3%), processed meat
(0.0%), and diets rich in fiber (49.5%), calcium (2.4%) and polyunsaturated fatty acids (53.1%)
but above optimal intake of legumes (425.8%), whole grains (397.8%) and sugar-sweetened
beverages (176.7%) which translates to low diet quality.
45
Table 6: Diet Quality of the Respondents Compared with Optimal level of Intake of Global Burden of Disease Dietary Risk
Factors
Food Group Consumed/
Nutrient Intake
Exposure Definition
Fruit (g)
Mean daily consumption of fruits (fresh, frozen, cooked,
canned, or dried fruits, excluding fruit juices and salted or
pickled fruits)
Mean daily consumption of vegetables (fresh, frozen, cooked,
canned, or dried vegetables,
excluding legumes and salted or pickled vegetables, juices,
nuts, seeds, and starchy vegetables such as potatoes or corn)
Mean daily consumption of legumes (fresh, frozen, cooked,
canned, or dried legumes)
Mean daily consumption of whole grains (bran, germ, and
endosperm in their natural proportion) from breakfast cereals,
bread, rice, pasta, biscuits, muffins, tortillas, pancakes, and
other sources
Mean daily consumption of nut and seed foods
Vegetables (g)
Legumes (g)
Whole Grains (g)
Nuts and Seeds (g)
Milk (g)
Red Meat (g)
Processed Meat (g)
Mean
Mean daily consumption of milk including non-fat, low-fat,
and full-fat milk, excluding soy milk and other plant
derivatives
Mean daily consumption of red meat (beef, pork, lamb, and
goat, but excluding poultry, fish, eggs, and all processed
meats)
Mean daily consumption of meat preserved by smoking,
curing, salting, or addition of
chemical preservatives
46
56.20
Optimal
Level of
Intake/day
250 g
(200–300)
106.00
360 g
(290–430)
255.49
497.27
60 g (50–
70)
125 g
(100–150)
5.45
21 g (16–
25)
435 g
(350–520)
17.55
23g (18–
27)
7.00
% Optimal
Level
of
Intake
22.5
29.4
425.8
397.8
33.3
1.3
76.3
2 g (0–4)
0.00
0.0
Table 6: Diet Quality of the Respondents Compared with Optimal level of Intake of Global Burden of Disease Dietary Risk
Factors
Food Group Consumed/
Nutrient Intake
Exposure Definition
Sugar-Sweetened Beverages (g)
Mean daily consumption of beverages with ≥50 kcal per 226.8
serving, including carbonated beverages, sodas, energy drinks,
fruit drinks, but excluding 100% fruit and vegetable juices
Mean daily intake of fibre from all sources including fruits,
vegetables, grains, legumes, and
Pulses
Mean daily intake of calcium from all sources, including milk,
yogurt, and cheese
Mean daily intake of omega-6 fatty acids from all sources,
mainly liquid vegetable oils, including soybean oil, corn oil,
and safflower oil
Fibre (g)
Calcium (mg)
Polyunsaturated Fatty Acid (g)
Mean
47
Optimal
Level of
Intake/day
3g (0–5)
5.30
11.89
3.04
5.84
% Optimal
Level
of
Intake
176.7
24 g (19–
28)
49.5
1.25 g
2.4
(1.00–1.50)
11% (9–
13) of total
53.1
daily
energy
4.1.7 Quality of Life of the Respondents
Table 7 below shows the Audit of Diabetes-Dependent Quality of Life. The mean impact rating
for all the domains falls within 0.9- 2.0 which signifies that the respondents reported their quality
of life would be better without diabetes. The importance rating falls between 2.0-3.0 for most of
the domain indicating the importance of the aspects of life to the quality of life. The weighted
impact score of the domains being within -2.1 and -5.0 reflected the negative impact of diabetes
on the respondents which shows a relatively low quality of life of the respondents.
Table 8 below shows the Appraisal of Diabetes Score. The table shows mean score of the domains
between 1.0 and 3.0 which translates to the respondents being slightly affected by diabetes on their
quality of life.
48
Table 7: Audit of Diabetes-Dependent Quality of Life
Domains
Impact Rating
SD
Mean
Importance Rating
SD
Mean
Weighted Impact Score
SD
Mean
Leisure
-1.5
2.0
-3.5
1.0
0.7
2.8
Work
-1.3
1.1
1.9
1.1
-3.1
2.9
Journeys
-1.4
1.1
1.8
0.7
-2.9
2.7
Holidays
-0.9
1.1
1.2
1.1
-2.1
2.5
Physical
-1.6
0.9
2.1
0.7
-3.5
2.5
Family Life
-1.1
1.1
2.4
0.8
-2.7
2.8
Friendship and Social Life
-1.3
1.0
2.1
0.6
-3.0
2.8
Personal Relationship
-1.1
1.1
2.0
0.9
-2.4
2.5
Sex Life
-1.2
1.0
2.2
0.8
-2.7
2.6
Physical Appearance
-1.5
0.9
2.1
0.5
-3.3
2.5
Self Confidence
-1.3
1.0
1.9
0.7
-2.8
2.7
Motivation
-1.3
1.1
2.0
0.7
-3.1
3.0
Reactions of other People
-1.3
1.2
2.0
0.6
-2.8
3.0
Feelings about the Future
-1.7
0.8
2.3
0.7
-4.0
2.2
Financial Situation
-1.6
0.9
2.5
0.6
-4.1
2.6
Living Conditions
-1.6
1.5
2.4
0.5
-3.9
4.4
Depend on Others
-1.5
0.9
2.1
0.6
-3.4
2.6
Freedom to Eat
-2.0
0.8
2.4
0.6
-5.0
2.6
Freedom to Drink
-1.9
0.8
2.3
0.6
-4.7
2.6
Note: Impact rating (conditions without diabetes): −3, very much better; −2, much better; −1, a little
better; 0, the same; +1, worse.
Importance rating: 0, not at all important; 1, somewhat important; 2, important; 3, very important.
Weighted impact score = impact rating (−3 to +1) * importance rating (0–3) = −9 (maximum negative
impact of diabetes) to +3 (maximum positive impact of diabetes).
49
Table 8: Appraisal of Diabetes Scale
Domain
Mean
SD
Upset
2.85
0.98
Sense of Control
2.85
0.74
Uncertainty
2.34
0.81
Likelihood of Worsening
1.85
0.86
Control by Own Effort
2.65
0.83
Coping
2.60
0.98
Life Goals Interference
2.20
1.02
16.44
3.31
Total Score
Note: The smaller the score, the more positive the appraisal strategy
50
4.1.8 Anthropometric and Clinical Status of the Respondents
Table 9 below shows the anthropometric and clinical status of the respondents. More than half
(60.0%) of the respondents had a normal body mass index while 32.0% were overweight and 8.0%
were obese. Majority (85.0%) of the respondents had a fasting blood sugar reading diabetes while
15.0% had prediabetes. Almost half (49.0%) had stage 1 hypertension and 32.0% had stage 2
hypertension while just 7.0% had normal blood pressure. Few (8.0%) of the respondents had
abdominal obesity while 92.0% had no abdominal obesity. Almost two-third (61.0%) of the male
respondents had a normal body mass index while almost one-third (31.7%) were overweight and
7.3% were obese. Among the female respondents, 59.3% had a normal body mass index while
32.2% were overweight and 8.5% were obese. Majority (87.8%) of the male respondents were
diagnosed of diabetes while 12.2% were diagnosed of prediabetes. Also, majority (83.1%) of the
female respondents were diagnosed of diabetes while 16.9% were diagnosed of prediabetes. About
half (51.2%) of the male respondents had stage 1 hypertension, about one-fourth (24.4%) had stage
2 hypertension, 14.6% had normal blood pressure and 9.8% had elevated blood pressure. Almost
half (47.4%) of the female respondents had stage 1 hypertension, more than one-third (37.3%) had
stage 2 hypertension, 13.6% had elevated blood pressure and 1.7% had normal blood pressure.
Majority (97.6%) of the male respondents did not have abdominal obesity while 2.4% had
abdominal obesity. Also, majority (88.1%) of the female respondents did not have abdominal
obesity while 11.9% had abdominal obesity.
51
Table 9: Anthropometric and Clinical Status of the Respondents
Variables
Frequency (%)
Female
Male
Total
Body Mass Index
Normal Weight
25 (61.0)
35 (59.3)
60 (60.0)
Overweight
13 (31.7)
19 (32.2)
32 (32.0)
Obesity
3 (7.3)
5 (8.5)
8 (8.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Prediabetes
5 (12.2)
10 (16.9)
15 (15.0)
Diabetes
36 (87.8)
49 (83.1)
85 (85.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Normal
6 (14.6)
1 (1.7)
7 (7.0)
Elevated
4 (9.8)
8 (13.6)
12 (12.0)
Stage1 Hypertension
21 (51.2)
28 (47.4)
49 (49.0)
Stage 2 Hypertension
10 (24.4)
22 (37.3)
32 (32.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
No
40 (97.6)
52 (88.1)
92 (92.0)
Yes
1 (2.4)
7 (11.9)
8 (8.0)
Total
41 (100.0)
59 (100.0)
100 (100.0)
Fasting Blood Glucose
Blood Pressure
Abdominal Obesity
52
4.1.9 Relationship between Socio-demographic and Quality of Life of the Respondents
Table 10 shows the relationship between socio-demographic and quality of life of the respondents.
There was a certain level of significant relationship between Quality of life of the Respondent and
socio-demographic characteristics at P<0.05. Also, there was a weak negative correlation (r=-0.2)
between the respondent's quality of life and marital status.
53
Table 10: Relationship between Socio-demographic and Quality of Life of the Respondents
Coefficient of correlation (R)
R2
P-value
Gender
0.24
0.06
0.02*
Estimated monthly income
0.2
0.04
0.04*
Marital status
-0.2
0.04
0.05*
Number of income earners
Screening for depression, the anxiety
of eating disorder
0.21
0.04
0.03*
0.31
0.10
0.00*
Variables
54
4.1.10 Impact of Quality of Life Domain on The Average Weighted Impact Score of Quality
of Life
Table 11 shows the impact of the quality of life domain on the Average Weighted Impact Score of
quality of life. The result from the tables reveals a significant relationship between Quality of life
Domain and Average Weighted Impact Score of quality of life at P<0.05 level of significance.
55
Table 11: Impact of quality of life domain on the Average Weighted Impact Score of quality
of life
Domains
Coefficient
of
correlation (R)
R2
P-value
Leisure
0.30
0.09
0.00*
Work
0.66
0.44
0.00*
Journey
0.83
0.69
0.00*
Physical
0.8
0.64
0.00*
Family life
0.69
0.48
0.00*
Friendship and social life
0.79
0.62
0.00*
Personal relationship
0.62
0.38
0.00*
Sex life
0.71
0.50
0.00*
Physical appearance
0.73
0.53
0.00*
Self confidence
0.85
0.72
0.00*
Motivation
0.86
0.74
0.00*
Feeling about the future
0.81
0.66
0.00*
Financial situation
0.74
0.55
0.00*
Living condition
0.60
0.36
0.00*
Dependence on others
0.84
0.71
0.00*
Freedom to eat
0.34
0.12
0.00*
Freedom to drink
0.40
0.16
0.00*
56
4.1.11 Difference between the Average Weighted Impact Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
Table 12 shows the difference between the average weighted impact score of socio—demographic
and socioeconomic characteristics of the respondents. The result from the table shows significant
differences between the average weighted impact scores of the age groups (p=0.02), genders
(p=0.02) and marital statuses (p=0.00) of the respondents. The result shows no significant
differences between the average weighted impact scores of the religions (p=0.44), states of origin
(p=0.74) and ethnic groups (p=0.57) of the respondents. Also, there were significant differences
in the average weighted impact scores of the occupations (p=0.01), and estimated monthly incomes
of spouse (p=0.01) of the respondents. There were no significant differences between average
weighted impact scores of educational levels (p=0.08), estimated monthly incomes (p=0.91),
natures of work (p=0.66), educational levels of spouse (p=0.11), occupations of spouse (p=0.66),
and numbers of income earners (p=0.17) of the respondents.
57
Table 12: Difference between the Average Weighted Impact Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
Variables
N (%)
AWI Score (SD)
P-value
20 - 35 Years
23 (23.0)
-4.29 (2.48)
0.02**
36 - 50 Years
49 (49.0)
-3.07 (1.54)
50 Years and Above
28 (28.0)
-2.94 (1.58)
Males
41 (41.0)
-3.84 (2.02)
Female
59 (59.0)
-2.94 (1.67)
Single
14 (14.0)
-4.88 (2.78)
Married
85 (85.0)
-3.07 (1.56)
Separated
1 (1.0)
-2.16 (0.0)
Christianity
63 (63.0)
-3.20 (1.65)
Islam
37 (37.0)
-3.51 (2.20)
Age
Gender
0.02*
Marital Status
0.00**
Religion
58
0.44*
Table 12: Difference between the Average Weighted Impact Score of Socio-demographic
and Socioeconomic Characteristics of the Respondents
Variables
N (%)
AWI Score (SD)
P-value
State of Origin
Ekiti
7 (7.0)
-3.34 (1.09)
Gombe
1 (1.0)
-5.26 (0.0)
Imo
2 (2)
-3.71 (0.41)
Lagos
4 (4.0)
-3.82 (3.12)
Ogun
67 (67.0)
-3.17 (1.91)
Ondo
4 (4.0)
-3.62 (2.11)
Osun
6 (6.0)
-4.43 (1.80)
Oyo
9 (9.0)
-2.92 (1.71)
Yoruba
95 (95.0)
-3.30 (1.89)
Igbo
4 (4.0)
-3.12 (1.33)
Hausa
1 (1.0)
-5.26 (0.0)
Primary
10 (10.0)
-2.76 (1.85)
Secondary
36 (36.0)
-2.88 (1.36)
Tertiary
48 (48.0)
-3.81 (2.12)
No Formal Education
6 (6.0)
-2.83 (1.80)
0.74**
Ethnic Group
0.57**
Educational Level
59
0.08**
Table 12: Difference between the Average Weighted Impact Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
Variables
N (%)
AWI Score (SD)
P-value
Civil Servant
25 (25.0)
-3.60 (1.37)
0.01**
Trader
57 (57.0)
-2.93 (1.59)
Student
11 (11.0)
-4.88 (3.16)
Others
7 (7.0)
-2.92 (1.85)
Sedentary
45 (45.0)
-3.41 (2.18)
Non-sedentary
55 (55.0)
-3.24 (1.58)
<50000
61 (61.0)
-3.13 (2.09)
50000-99000
21 (21.0)
-3.55 (1.43)
100000-149000
9 (9.0)
-3.57 (1.48)
150000-199000
2 (2.0)
-3.89 (1.34)
>200000
7 (7.0)
-3.24 (1.87)
Primary
8 (9.1)
-3.54 (1.28)
Secondary
33 (37.5)
-2.96 (1.59)
Tertiary
41 (46.6)
-3.30 (1.50)
No Formal Education
6 (6.8)
-1.78 (1.61)
Occupation
Nature of Work/Occupation
0.66*
Estimated Monthly Income
0.91**
Educational Level of Spouse
60
0.11**
Table 12: Difference between the Average Weighted Impact Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
Variables
N (%)
AWI Score (SD)
P-value
Civil Servant
32 (36.8)
-3.25 (1.55)
0.66**
Trader
44 (50.6)
-2.95 (1.65)
Others
11 (12.6)
-3.28 (1.25)
<50000
46 (52.9)
-2.71 (1.63)
50000-99000
26 (29.9)
-3.96 (1.17)
100000-149000
8 (9.2)
-2.76 (1.47)
150000-199000
7 (8.0)
-2.83 (1.37)
1-2
87 (87.0)
-3.44 (1.88)
3-4
12 (12.0)
-2.36 (1.62)
5 and Above
1 (1.0)
-3.42 (0.0)
Occupation of Spouse
Estimated Monthly Income of
Spouse
0.01**
Number of Income Earners
AWI score, average weighted impact score
*. Significance for T-test
**. Significance for ANOVA
61
0.17**
4.1.12 Difference between the Average Weighted Impact Score of Clinical History of the
Respondents
Table 13 shows the difference between the average weighted impact score of clinical history of
the respondents. The result from the table shows significant differences between the average
weighted impact scores of the treatment options (p=0.03) and history of screening for depression,
anxiety, and disordered eating (p=0.01) among respondents. Also, the result shows no significant
differences between the average weighted impact scores of the types of diabetes mellitus (p=0.21),
complication presence (p=0.23), history of counselling on diabetes (p=0.30). diabetes selfmanagement skills and barriers (p=0.18), carbohydrate counting knowledge (p=0.05), and social
support status (p=0.20) among respondents.
62
Table 13: Difference between the Average Weighted Impact Score of Clinical History of the
Respondents
Variables
N (%)
AWI Score (SD)
P-value
Type 1
1 (1.0)
-5.63 (0.0)
0.21*
Type 2
99 (99.0)
-3.29 (1.86)
Type of Diabetes Mellitus
Diabetes-related Complication(s) present
No Complication
65 (65.0)
-3.48 (2.01)
0.23*
Complication Present
35 (35.0)
-3.00 (1.55)
Hypertension
17 (48.6)
-2.82 (1.65)
0.22*
Nephropathy
1 (2.9)
-2.79 (0.0)
0.73*
Neuropathy
16 (45.6)
-3.05 (1.43)
0.42*
Retinopathy
1 (2.9)
-5.63 (0.0)
0.29*
No Complication
63
Table 13: Difference between the Average Weighted Impact Score of Clinical History of
the Respondents
Variables
N (%)
AWI Score (SD)
P-value
Treatment Option
Diet Alone
6 (6.0)
-2.76 (1.96)
Physical Activity Alone
3 (3.0)
-3.63 (1.91)
Pharmacotherapy Alone
26 (26.0)
-2.81 (1.61)
Metabolic Surgery Alone
1 (1.0)
-4.74 (0.0)
Behavioural Therapy Alone
1 (1.0)
-4.95 (0.0)
Diet & Physical Activity
13 (13.0)
-3.92 (1.24)
Diet & Pharmacotherapy
15 (15.0)
-4.04 (2.71)
Diet, Behavioural Therapy &
1 (1.0)
-5.63 (0.0)
13 (13.0)
-1.80 (1.10)
20 (20.0)
-3.83 (1.65)
1 (1.0)
-4.11 (0.0)
0.03**
Pharmacotherapy
Diet, Physical Activity &
Pharmacotherapy
Diet, Physical Activity &
Behavioural Therapy
Diet, Physical Activity,
Behavioural Therapy &
Pharmacotherapy
History of Counselling on Diabetes
Yes
63 (63.0)
-3.46 (1.90)
No
37 (37.0)
-3.06 (1.82)
64
0.30*
Table 13: Difference between the Average Weighted Impact Score of Clinical History of
the Respondents
Variables
N (%)
AWI Score (SD)
P-value
Diabetes Self-management skills and barriers
Yes
51 (51.0)
-3.56 (1.97)
No
49 (49.0)
-3.06 (1.74)
0.18*
Carbohydrate Counting Knowledge
Yes
44 (44.0)
-3.73 (1.99)
No
56 (56.0)
-2.99 (1.72)
Yes
32 (32.0)
-3.67 (1.49)
No
68 (68.0)
-3.15 (2.01)
0.05*
Social Support Status
0.20*
History Of Screening for Depression, Anxiety, and Disordered Eating
Yes
28 (28.0)
-4.06 (1.01)
No
72 (72.0)
-3.02 (2.04)
AWI score, average weighted impact score
*. Significance for T-test
**. Significance for ANOVA
65
0.01*
4.1.13 Difference between the Average Weighted Impact Score of Lifestyle Characteristics
of the Respondents
Table 14 shows the difference between the average weighted impact score of lifestyle
characteristics of the respondents. The result from the table shows no significant difference
between the average weighted impact scores of the smoking statuses (p=0.78), alcohol
consumption statuses (p=0.27) and dietary habit scores (p=0.07) of the respondents. However,
there was significant difference between the average weighted impact scores of the physical
activity scores (p=0.00) of the respondents.
66
Table 14: Difference between the Average Weighted Impact Score of Lifestyle
Characteristics of the Respondents
Variables
N (%)
AWI Score (SD)
P-value
Current smokers
1 (1.0)
-3.42 (0.0)
0.78**
Non-smokers
98 (98.0)
-3.30 (1.88)
Lifetime smokers
1 (1.0)
-4.63 (0.0)
Consumers
2 (2.0)
-1.87 (2.20)
Non-consumers
98 (98.0)
-3.34 (1.86)
Poor
40 (40.0)
-3.81 (2.04)
Fair
53 (53.0)
-2.92 (1.67)
Good
7 (7.0)
-3.38 (1.85)
Low
3 (3.0)
-1.18 (0.79)
Moderate
32 (32.0)
-2.36 (1.09)
High
65 (65.0)
-3.88 (1.95)
Smoking status
Alcohol Consumption Status
0.27*
Dietary Habit
0.07**
Physical Activity
AWI score, average weighted impact score
*. Significance for T-test
**. Significance for ANOVA
67
0.00**
4.1.14 Difference between the Average Weighted Impact Score of Anthropometric and
Clinical Status of the Respondents
Table 15 shows the difference between the average weighted impact score of anthropometric and
clinical status of the respondents. The result from the table shows no significant difference between
the average weighted impact scores of body mass index (p=0.31), fasting blood glucose (p=0.22),
blood pressure (p=0.63), and abdominal obesity (p=0.16) among respondents.
68
Table 15: Difference between the Average Weighted Impact Score of Anthropometric and
Clinical Status of the Respondents
Variables
N (%)
AWI Score (SD)
P-value
Low BMI
60 (60.0)
-3.47 (1.96)
0.31
High BMI
40 (40.0)
-3.08 (1.71)
Prediabetes
15 (15.0)
-3.86 (1.57)
Diabetes
85 (85.0)
-3.22 (1.91)
Non-Hypertensive
19 (19.0)
-3.50 (2.02)
Hypertensive
81 (81.0)
-3.27 (1.84)
No
40 (40.0)
-3.90 (2.01)
Yes
1 (1.0)
-1.42 (0.0)
No
52 (52.0)
-3.00 (1.65)
Yes
7 (7.0)
-2.56 (1.90)
No
92 (92.0)
-3.39 (1.86)
Yes
8 (8.0)
-2.41 (1.81)
Body Mass Index
Fasting Blood Glucose
0.22
Blood Pressure
0.63
Abdominal Obesity (Male)
0.23
Abdominal Obesity (Female)
0.51
Abdominal Obesity
AWI score, average weighted impact score
69
0.16
4.1.15 Difference between the Appraisal of Diabetes Scale Score of Socio-demographic and
Socioeconomic Characteristics of the Respondents
Table 16 shows the difference between the appraisal of diabetes scale score of socio—
demographic and socioeconomic characteristics of the respondents. The result from the table
shows significant differences between the appraisal of diabetes scale scores of the age groups
(p=0.01), marital statuses (p=0.01), occupations (p=0.00), and natures of work (p=0.04) of the
respondents. The result also shows no significant differences between the appraisal of diabetes
scale scores for the genders (p=0.76), religions (p=0.48), states of origin (p=1.00), ethnic groups
(p=0.98), educational levels (p=0.52), estimated monthly incomes (p=0.86), educational levels of
spouse (p=0.28), occupations of spouse (p=1.00), estimated monthly incomes of spouse (p=0.43)
and numbers of income earners (p=0.63) among respondents.
70
Table 16: Difference between the Appraisal of Diabetes Scale Score of Socio-demographic
and Socioeconomic Characteristics of the Respondents
Variables
N (%)
ADS Score (SD)
P-value
20 - 35 Years
23 (23.0)
14.78 (3.00)
0.01**
36 - 50 Years
49 (49.0)
17.27 (3.17)
50 Years and Above
28 (28.0)
16.36 (3.38)
Males
41 (41.0)
16.32 (3.33)
Female
59 (59.0)
16.53 (3.32)
Single
14 (14.0)
14.00 (3.04)
Married
85 (85.0)
16.79 (3.19)
Others
1 (1.0)
21.00 (0.0)
Christianity
63 (63.0)
16.32 (3.33)
Islam
37 (37.0)
16.53 (3.32)
Age
Gender
0.76*
Marital Status
0.01**
Religion
71
0.48*
Table 16: Difference between the Appraisal of Diabetes Scale Score of Socio-demographic
and Socioeconomic Characteristics of the Respondents
Variables
N (%)
ADS Score (SD)
Ekiti
7 (7.0)
15.57 (1.51)
Gombe
1 (1.0)
17.00 (0.0)
Imo
2 (2)
16.50 (2.12)
Lagos
4 (4.0)
16.00 (3.37)
Ogun
67 (67.0)
16.61 (3.64)
Ondo
4 (4.0)
16.50 (3.79)
Osun
6 (6.0)
15.83 (4.12)
Oyo
9 (9.0)
16.33 (1.66)
Yoruba
95 (95.0)
16.44 (3.38)
Igbo
4 (4.0)
16.25 (2.06)
Hausa
1 (1.0)
17.00 (0.0)
Primary
10 (10.0)
15.80 (3.36)
Secondary
36 (36.0)
16.72 (3.11)
Tertiary
48 (48.0)
16.17 (3.46)
No Formal Education
6 (6.0)
18.00 (3.41)
P-value
State of Origin
1.00**
Ethnic Group
0.98**
Educational Level
72
0.52**
Table 16: Difference between the Appraisal of Diabetes Scale Score of Socio-demographic
and Socioeconomic Characteristics of the Respondents
Variables
N (%)
ADS Score (SD)
Civil Servant
25 (25.0)
17.28 (3.16)
Trader
57 (57.0)
16.42 (3.08)
Student
11 (11.0)
13.27 (2.90)
Others
7 (7.0)
18.57 (3.51)
Sedentary
45 (45.0)
15.69 (3.81)
Non-sedentary
55 (55.0)
17.05 (2.73)
<50000
61 (61.0)
16.25 (3.48)
50000-99000
21 (21.0)
16.33 (1.88)
100000-149000
9 (9.0)
17.33 (4.44)
150000-199000
2 (2.0)
16.50 (2.12)
>200000
7 (7.0)
17.29 (4.35)
Primary
8 (9.1)
15.38 (2.39)
Secondary
33 (37.5)
16.94 (2.88)
Tertiary
41 (46.6)
17.27 (3.46)
No Formal Education
6 (6.8)
15.33 (3.08)
P-value
Occupation
0.00**
Nature of Work/Occupation
0.04*
Estimated Monthly Income
0.86**
Educational Level of Spouse
73
0.28**
Table 16: Difference between the Appraisal of Diabetes Scale Score of Socio-demographic
and Socioeconomic Characteristics of the Respondents
Variables
N (%)
ADS Score (SD)
Civil Servant
32 (36.8)
16.81 (2.91)
Trader
44 (50.6)
16.77 (3.06)
Others
11 (12.6)
16.82 (4.33)
P-value
Occupation of Spouse
1.00**
Estimated Monthly Income of Spouse
<50000
46 (52.9)
16.93 (3.54)
50000-99000
26 (29.9)
17.23 (2.49)
100000-149000
8 (9.2)
15.75 (2.92)
150000-199000
7 (8.0)
15.43 (2.82)
1-2
87 (87.0)
16.53 (3.36)
3-4
12 (12.0)
15.67 (3.08)
5 and Above
1 (1.0)
18.00 (0.0)
0.43**
Number of Income Earners
ADS score, appraisal of diabetes scale score
*. Significance for T-test
**. Significance for ANOVA
74
0.63**
4.1.16 Difference between the Appraisal of Diabetes Scale Score of Clinical History of the
Respondents
Table 17 shows the difference between the appraisal of diabetes scale score of clinical history of
the respondents. The result from the table shows significant differences between the appraisal of
diabetes scale scores of complication presence (p=0.02), treatment options (p=0.00), and diabetes
self-management skills and barriers (p=0.00). Also, the result shows no significant differences
between the appraisal of diabetes scale scores of the types of diabetes mellitus (p=0.44), history
of counselling on diabetes (p=0.05), carbohydrate counting knowledge (p=0.27), social support
status (p=1.00), and history of screening for depression, anxiety, and disordered eating (p=0.17)
among respondents.
75
Table 17: Difference between the Appraisal of Diabetes Scale Score of Clinical History of the
Respondents
Variables
N (%)
ADS Score (SD)
P-value
Type 1
1 (1.0)
19.00 (0.0)
0.44*
Type 2
99 (99.0)
16.41 (3.32)
Type of Diabetes Mellitus
Diabetes-related Complication(s) present
No Complication
65 (65.0)
15.89 (3.24)
0.02*
Complication Present
35 (35.0)
17.46 (3.25)
Hypertension
17 (48.6)
15.71 (2.78)
0.88
Nephropathy
1 (2.9)
18.00 (0.0)
0.52
Neuropathy
16 (45.6)
19.19 (2.97)
0.00
Retinopathy
1 (2.9)
19.00 (0.0)
0.35
No Complication
76
Table 17: Difference between the Appraisal of Diabetes Scale Score of Clinical History of
the Respondents
Variables
N (%)
ADS Score (SD)
P-value
Treatment Option
Diet Alone
6 (6.0)
15.17 (3.76)
Physical Activity Alone
3 (3.0)
16.33 (2.89)
Pharmacotherapy Alone
26 (26.0)
17.04 (2.65)
Metabolic Surgery Alone
1 (1.0)
17.00 (0.0)
Behavioural Therapy Alone
1 (1.0)
27.00 (0.0)
Diet & Physical Activity
13 (13.0)
18.00 (2.71)
Diet & Pharmacotherapy
15 (15.0)
14.27 (2.74)
Diet, Behavioural Therapy &
1 (1.0)
19.00 (0.0)
13 (13.0)
15.08 (3.84)
20 (20.0)
16.70 (3.05)
1 (1.0)
20.00 (0.0)
0.00**
Pharmacotherapy
Diet, Physical Activity &
Pharmacotherapy
Diet, Physical Activity &
Behavioural Therapy
Diet, Physical Activity,
Behavioural Therapy &
Pharmacotherapy
History of Counselling on Diabetes
Yes
63 (63.0)
15.94 (3.20)
No
37 (37.0)
17.30 (3.37)
77
0.05*
Table 17: Difference between the Appraisal of Diabetes Scale Score of Clinical History of
the Respondents
Variables
N (%)
ADS Score (SD)
P-value
Diabetes Self-management skills and barriers
Yes
51 (51.0)
15.55 (2.94)
No
49 (49.0)
17.37 (3.45)
0.00*
Carbohydrate Counting Knowledge
Yes
44 (44.0)
16.02 (3.02)
No
56 (56.0)
16.77 (3.52)
Yes
32 (32.0)
16.44 (2.97)
No
68 (68.0)
16.44 (3.48)
0.27*
Social Support Status
1.00*
History of Screening for Depression, Anxiety, and Disordered Eating
Yes
28 (28.0)
17.18 (2.57)
No
72 (72.0)
16.15 (3.54)
ADS score, appraisal of diabetes scale score
*. Significance for T-test
**. Significance for ANOVA
78
0.17*
4.1.17 Difference between the Appraisal of Diabetes Scale Score of Lifestyle Characteristics
of the Respondents
Table 18 shows the difference between the appraisal of diabetes scale score of lifestyle
characteristics of the respondents. The result from the table shows no significant difference
between appraisal of diabetes scale scores of alcohol consumption statuses (p=0.30), dietary habit
scores (p=0.64), and physical activity scores (p=0.23) of the respondents. However, there is
significant difference between the smoking statuses (p=0.01) of the respondents.
79
Table 18: Difference between the Appraisal of Diabetes Scale Score of Lifestyle
Characteristics of the Respondents
Variables
N (%)
ADS Score (SD)
P-value
Current smokers
1 (1.0)
18.00 (0.0)
0.01**
Non-smokers
98 (98.0)
16.33 (3.20)
Lifetime smokers
1 (1.0)
26.00 (0.0)
Consumers
2 (2.0)
14.00 (5.66)
Non-consumers
98 (98.0)
16.49 (3.28)
Poor
40 (40.0)
16.83 (3.36)
Fair
53 (53.0)
16.19 (3.31)
Good
7 (7.0)
16.14 (3.34)
Low
3 (3.0)
13.33 (1.15)
Moderate
32 (32.0)
16.28 (2.36)
High
65 (65.0)
16.66 (3.71)
Smoking status
Alcohol Consumption Status
0.30*
Dietary Habit
0.64**
Physical Activity
ADS score, appraisal of diabetes scale score
*. Significance for T-test
**. Significance for ANOVA
80
0.23**
4.1.18 Difference between the Appraisal of Diabetes Scale Score of Anthropometric and
Clinical Status of the Respondents
Table 19 shows the difference between the appraisal of diabetes scale score of anthropometric and
clinical status of the respondents. The result from the table shows no significant difference between
the appraisal of diabetes scale scores of body mass index (p=0.13), fasting blood glucose (p=0.05),
blood pressure (p=0.57), and abdominal obesity (p=0.07) of the respondents.
81
Table 19: Difference between the Appraisal of Diabetes Scale Score of Anthropometric and
Clinical Status of the Respondents
Variables
N (%)
ADS Score (SD)
P-value
Low BMI
60 (60.0)
16.03 (2.84)
0.13
High BMI
40 (40.0)
17.05 (3.88)
Prediabetes
15 (15.0)
18.00 (3.78)
Diabetes
85 (85.0)
16.16 (3.17)
Non-Hypertensive
19 (19.0)
16.05 (2.44)
Hypertensive
81 (81.0)
16.53 (3.49)
No
40 (40.0)
16.18 (3.25)
Yes
1 (1.0)
22.00 (0.0)
No
52 (52.0)
16.33 (3.32)
Yes
7 (7.0)
18.00 (3.21)
No
92 (92.0)
16.26 (3.27)
Yes
8 (8.0)
18.50 (3.30)
Body Mass Index
Fasting Blood Glucose
0.05
Blood Pressure
0.57
Abdominal Obesity (Male)
0.08
Abdominal Obesity (Female)
0.21
Abdominal Obesity
ADS score, appraisal of diabetes scale score
82
0.07
4.2
DISCUSSION
This study revealed that the prevalence of diabetes mellitus is higher among female adults within
the age range of 36 - 40 years. PrasannaKumar et al. (2018) had a similar finding in a study
conducted at India where more of the participants with diabetes mellitus were females and more
of the participants fell within the same age range (Wahome and Kiboi, 2016; Thewjitcharoen et
al., 2018; Ansari et al., 2019; Saleh and Mohammed, 2019). On the contrary, Sabir et al. (2018)
reported in a study conducted in Northwest Nigeria that the prevalence of diabetes mellitus was
slightly higher in men. The increased prevalence of diabetes among females could be possible in
the similar studies because they were conducted on diabetic patients only and prevalence among
men in the contrary study that conducted study on a mixed population. The onset of type 2 diabetes
mellitus is rampant among adults and may be attributed to glucose intolerance associated with
increase in age. As the age increase, cell sensitivity to insulin also reduces. Majority of the
respondents were married, this finding is similar to that reported in their counterparts in Saudi
Arabia (Ansari et al., 2019).
In the current study, lifestyle characteristics of the respondents showed a relatively low intake of
alcohol and the use of substance and a high level of physical activity. This is in congruence with
the study conducted on the German population which reveals a low intake of cigarette smoke and
alcohol with high physical activity by diabetics (Hartwig et al., 2016). However, this does not
concur with the study of Saleh and Mohammed (2019) who reported that the majority of the
respondents (64%) had no regular activity pattern. Also, a study reported by Oladapo and Koleosho
(2013) found that 70% of the respondents did not exercise regularly, and also Firouzi et al. (2015)
found 59% of the subjects rarely or never exercised. The high level of physical activity among
83
respondents may be a result of the prevailing occupation which is trading which may or may not
require high physical activity.
From the study, the nutrient intake of the respondents shows an adequate intake of energy and
nutrients with exception of certain nutrients such as vitamin C, fiber, folate, sodium, potassium,
and calcium consumed in low quantities. This is similar to the study conducted by Thewjitcharoen
et al. (2018) that identified a low intake of dietary fiber and calcium among Thai patients with type
2 diabetes mellitus. Also, a study conducted in Sudan revealed a low intake of fiber among type 2
diabetic patients (Saleh and Mohammed, 2019). However, a study by Ha et al. (2019) revealed the
contrary and reported a low intake of energy and fat. This suggests that socio-demographic and
socio-economic factors that may be responsible for adequate energy and nutrient intake by the
respondents may be because most of the respondents had attained a tertiary level of education.
The present study revealed a moderate intake of fruit, vegetables, water and snacks that translates
to a fair dietary habit which concurs with a study conducted on counterparts in Sri Lanka and
Thailand (Pathirannehelage et al., 2016; Thewjitcharoen et al., 2018). This may be a result of the
economic status of the respondents as more than half receives less than fifty thousand naira
monthly.
From this study, the weighted impact score on the quality of life reflected the negative impact of
diabetes on the respondents which shows a relatively low quality of life of the respondents. This
goes in line with the study of Spasi et al. (2014) who stated that the presence of diabetes mellitus
leads to a decrease in life quality in all domains. Another study showed that type 2 diabetes mellitus
has a negative impact on health-related quality of life in a group of Argentinean diabetes patients
(Pichon-riviere et al., 2015). Conversely, Mohammadi et al. (2016) reported a moderate quality of
84
life and was associated with diabetes care and treatment adherence. The low quality of life among
respondents may be due to improper glycaemic control and the presence of diabetes complications.
The prevalence of obesity and overweight in this study is slightly low as more than half of the
respondents have a normal body weight which is in line with the findings of Saleh and Mohammed
(2019) from a study conducted on diabetic patients in Sudan. However, it does not agree with
studies conducted in Owo, Nigeria and Nairobi, Kenya which revealed a higher percentage of
participants with overweight and obesity (Oladapo and Koleosho, 2013; Wahome and Kiboi,
2016). Low prevalence of overweight and obesity may be attributed to the high physical activity
level of the respondents.
Also in this study, it was revealed that respondents had higher than normal fasting blood sugar
levels. This indicates that diabetes was poorly controlled and it is in congruence with the findings
of the study conducted by Saleh and Mohammed (2019) in Sudan but higher than that reported by
Oladapo and Koleosho (2013) in Nigeria, Firouzi et al. (2015) in Malaysia and Khalid et al. (2019).
Further findings from this study reveal a level of significant relationship between respondent
quality of life and socio-demographic characteristics, this indicates that the respondent's quality of
life has an influence on their socio-demographic status at p<0.05 level of significance. This is
similar to the study conducted by Spasi et al., (2014) who identified statistically significant genderrelated differences (p<0.05) in the vitality and pain in patients.
More also in this study, it was revealed that the impact of the quality of life domain had a
significant difference on the Average Weighted Impact Scoreof quality of life at P=0.00.
Similar to other studies, there was significant differences between the average weighted impact
scores for Audit of Diabetes Dependent Quality of Life of the age groups (Al-mahmood et al.,
85
2018; PrasannaKumar et al., 2018; Visockienė et al., 2018; Zaleha et al., 2018) but contradicts the
research conducted by Levterova et al. (2018) on type 2 diabetes mellitus in Bulgaria which also
showed no significant difference between average weighted impact scores of the ethnic groups of
the respondents. There were significant differences between the average weighted impact scores
of the genders and marital statuses which is similar to the studies conducted on their counterparts
in other countries (Al-mahmood et al., 2018; Levterova et al., 2018; PrasannaKumar et al., 2018;
Zaleha et al., 2018) but contrary to the research conducted by Visockienė et al. (2018) and Bąk et
al. (2019) on diabetic patients in Lithuania and Poland respectively. Also in the present study,
there was significant difference between the average weighted impact score of the educational
levels of the respondents which is in congruence with the studies conducted by Levterova et al.
(2018), Visockienė et al. (2018) and Bąk et al. (2019) but in contrast with a study conducted on
type 2 diabetes patients in India (PrasannaKumar et al., 2018).
In the present study, there was significant difference between the average weighted impact scores
of the treatment options of the respondents which is similar to the study of Levterova et al. (2018)
and Zaleha et al. (2018). This findings are contrary to a study conducted on patients with type 1
and type 2 diabetes mellitus in Lithuania (Visockienė et al., 2018). Also, the present study revealed
that there were no significant differences between the average weighted impact scores of the types
of diabetes mellitus and the complications present. These findings are in line with the studies
conducted on their counterparts with diabetes mellitus in Poland and Lithuania that also found no
significant differences in the average weighted impact scores of the types and complications of
diabetes (Visockienė et al., 2018; Bąk et al., 2019). Moreover, these finding are in contrast with
those conducted by Al-mahmood et al. (2018), Levterova et al. (2018), PrasannaKumar et al.
86
(2018), and Zaleha et al. (2018) that found significant differences in the average weighted impact
scores of the types and complications of diabetes mellitus.
There were no significant differences between the average weighted impact scores of the smoking
statuses and alcohol consumption statuses of the respondents. However, there was significant
difference between the average weighted impact scores of the physical activity scores of the
respondents. This is in congruence with other studies conducted on diabetes mellitus patients
(Granado-casas et al., 2017; Ahammed et al., 2018; Levterova et al., 2018; Bąk et al., 2019) but
in contrast with the study of PrasannaKumar et al. (2018) conducted on patients with the same
health condition.
Also in this study, it appears that there were no significant differences between the average
weighted impact scores of the anthropometric and clinical statuses which include body mass index,
waist circumference, fasting blood sugar and hypertension. Similarly, the findings of Levterova et
al. (2018) found no significant difference in the body mass index of diabetic patients in Bulgaria.
In contrast, Granado-casas et al. (2017) and Fung et al. (2016) found significant differences
between the average weighted impact scores of the body mass index, waist circumference, and
hypertension.
87
CHAPTER 5
5.0
5.1
CONCLUSION AND RECOMMENDATION
CONCLUSION
This study shows that diabetes was prevalent among female respondents and most fell within the
age of 36 and 40. Almost half of the respondents had spouses who had attained the tertiary level
of education, half of which were trader and about half also earn below N50,000 monthly. The
majority of the respondents had 1-2 income earners in the family.
The median nutrient intake reflected a good intake of energy, carbohydrate, protein, fat, Vitamin
A. B2, B3, B6, and B12, phosphorus, zinc, iron and magnesium and low intake of fiber, Vitamin
C, B1, folate, calcium, sodium, and potassium. However, the diet quality indicated poor intake of
dietary food groups such as fruits, vegetables, nuts and seeds, milk, processed meat, and diets rich
in fiber, calcium, and polyunsaturated fatty acids but above the optimal intake of legumes, whole
grains and sugar-sweetened beverages. The majority of the respondents skip meals and almost half
of the respondents have breakfast in the morning.
The majority of the respondents were non-smokers and majority do not consume alcohol few had
a good dietary habit and high physical activity was reported by most of the respondents.
The Weighted Impact Score of the Quality of Life reflected the negative impact of diabetes on the
respondents which shows a relatively low quality of life of the respondents.
More than half of the respondents had a normal body mass index while about one-third were
overweight and few were obese. The majority of the respondents had a fasting blood sugar reading
of diabetes. Almost half had stage 1 hypertension and about one-third had stage 2 hypertension
while others had normal blood pressure. Only a few of the respondents had abdominal obesity.
88
The study revealed a significant relationship between respondent quality of life and sociodemographic characteristics which indicates that the respondent's quality of life has an influence
on their socio-demographic status. Also, there is a significant relationship between the impact of
diabetes on different aspects of life and the Average Weighted Impact Scores of quality of life.
89
5.2
RECOMMENDATIONS
Based on the findings of this study, the following recommendations were made:
•
Intervention studies should be conducted on the impact of lifestyle and nutritional status
on the quality of life of diabetic patients.
•
Diabetic patients should be counseled on the effect of adequate diet and a healthy lifestyle
on quality of life and disease management.
•
Patients’ quality of life assessment should be integrated into the management of noncommunicable diseases.
90
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APPENDIX
FEDERAL UNIVERSITY OF AGRICULTURE, ABEOKUTA.
COLLEGE OF FOOD SCIENCE AND HUMAN ECOLOGY
DEPARTMENT OF NUTRITION AND DIETETICS
Dear respondent,
The researcher is a final year student of Federal University of Agriculture, Abeokuta, carrying out a study on
“Nutritional Status and Quality of Life of Adults Living with Diabetes Mellitus visiting the State Hospital Ijaiye,
Abeokuta, Ogun state”. Information will be collected on your socio-demographic and economic status, quality of life,
physical activity, dietary habit, lifestyle, dietary intake and anthropometry.
Your sincere responses to these questions will be appreciated and information will be strictly used for research purpose
and treated confidential. Thanks for your cooperation.
Informed consent
I hereby consent to filling this questionnaire ………………………… (Respondent’s signature)
Questionnaire number ……………………
SECTION A: SOCIO-DEMOGRAPHIC AND ECONOMIC INFORMATION
Instruction: Please tick the correct answer of your choice and write answers appropriately where necessary.
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
23)
Age …………years
Gender (a) Male [ ] (b) Female [ ]
Religion (a) Christianity [ ] (b) Islam [ ] (c) Others ………………………
State of origin...................................................................
Ethnic group (a) Yoruba [ ] (b) Igbo [ ] (c) Hausa [ ] (d) Others ………………..
Educational Level (a) Primary [ ] (b) Secondary [ ] (c) Tertiary [ ] (d) No Formal Education [ ] (d) Others
……………….
Occupation (a) Civil Servant [ ] (b) Trader [ ] (c) Student (d) Others ……………………….
Nature of Work/Occupation (a) Sedentary [ ] (b) Non-sedentary [ ]
Estimated monthly income ……………………………..
Marital status (a) Single [ ] (b) Married [ ] (c) Divorced [ ] (d) Others …………………..
Educational Level of Spouse (a) Primary [ ] (b) Secondary [ ] (c) Tertiary [ ] (d) No Formal Education [ ] (d)
Others…….
Occupation of Spouse (a) Civil Servant [ ] (b) Trader [ ] (c) Others ……………………….
Estimated monthly income of Spouse ……………………………..
Number of income earners in the family………………………….
Duration of disease………………………………
Type of Diabetes Mellitus……………………………………………
Diabetes-related complication(s) present…………………………………………………………………………
Treatment option (a) Diet (b) Physical activity (c) Behavioural therapy (d) Pharmacotherapy (e) Metabolic
surgery (f) a & b (g) a, b & c
Do you have any history of dietitian/diabetes educator visits/classes? (a) Yes (b) No
Do you have diabetes self-management skills and barriers? (a) Yes (b) No
Are you familiar with carbohydrate counting? (a) Yes (b) No
Do you get any social supports? (a) Yes (b) No
Do you screen for depression, anxiety, and disordered eating? (a) Yes (b) No
SECTION B: AUDIT OF DIABETES DEPENDENT QUALITY OF LIFE
Instruction: Please tick in one box to show how diabetes affects this aspect of your life.
I) In general, my present quality of life is:
excellent
very good
good
neither
nor bad
105
good
bad
very bad
extremely bad
II) If I did not have diabetes, my quality of life would be:
very much better
much better
a little better
1a
b
2
a
b
3a
b
4a
a
b
5a
b
6
a
b
7a
b
8
a
b
9
a
the same
worse
If I did not have diabetes, I would enjoy my leisure activities:
very much more
much more
a little more
the same
less
My leisure activities are:
very important
important
somewhat important
not at all important
Are you currently working, looking for work or would you like to work?
If yes, complete (a) and (b).
Yes
If no, go straight to 3a.
No
If I did not have diabetes, my working life would be:
very much better
much better
a little better
the same
worse
For me, having a working life is:
very important
important
somewhat important
not at all important
If I did not have diabetes, local or long distance journeys would be:
very much easier
much easier
a little easier
the same
more difficult
For me, local or long distance journeys are:
very important
important
somewhat important
not at all important
Do you ever go on holiday or want to go on holiday
If yes, complete (a) and (b).
Yes
If no, go straight to 5a.
No
If I did not have diabetes, my holidays would be:
very much better
much better
a little better
the same
worse
For me, holidays are:
very important
important
somewhat important
not at all important
If I did not have diabetes, physically I could do:
very much more
much more
a little more
the same
less
For me, how much I can do physically is:
very important
important
somewhat important
not at all important
Do you have any family / relatives?
If yes, complete (a) and (b).
Yes
If no, go straight to 7a.
No
If I did not have diabetes, my family life would be
very much better
much better
a little better
the same
worse
My family life is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my friendships and social life would be:
very much better
much better
a little better
the same
worse
My friendships and social life are:
very important
important
somewhat important
not at all important
Do you have or would you like to have a close personal relationship (for example, husband / wife, partner)?
If yes, complete (a) and (b).
Yes
If no, go straight to 9.
No
If I did not have diabetes, my closest personal relationship would be:
very much better
much better
a little better
the same
worse
For me, having a close personal relationship is:
very important
important
somewhat important
not at all important
Do you have or would you like to have a sex life?
If yes, complete (a) and (b).
Yes
If no, go straight to 10a.
No
If I did not have diabetes, my sex life would be:
106
b
10a
b
11a
b
12a
b
13a
b
14a
b
15a
b
16a
b
17a
b
18a
b
19a
b
very much better
much better
a little better
the same
worse
For me, having a sex life is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my physical appearance would be:
very much better
much better
a little better
the same
worse
My physical appearance is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my self-confidence would be:
very much better
much better
a little better
the same
worse
My self-confidence is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my motivation would be:
very much better
much better
a little better
the same
worse
My motivation is:
very important
important
somewhat important
not at all important
If I did not have diabetes, the way people in general react to me would be:
very much better
much better
a little better
the same
worse
The way people in general react to me is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my feelings about the future (for example, worries, hopes) would be:
very much better
much better
a little better
the same
worse
My feelings about the future are:
very important
important
somewhat important
not at all important
If I did not have diabetes, my financial situation would be:
very much better
much better
a little better
the same
worse
My financial situation is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my living conditions would be:
very much better
much better
a little better
the same
worse
My living conditions are:
very important
important
somewhat important
not at all important
If I did not have diabetes, I would have to depend on others when I do not want to:
very much less
much less
a little less
the same
more
For me, not having to depend on others is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my freedom to eat as I wish would be:
very much greater
much greater
a little greater
the same
less
My freedom to eat as I wish is:
very important
important
somewhat important
not at all important
If I did not have diabetes, my freedom to drink as I wish (for example, fruit juice, alcohol, sweetened hot and cold
drinks) would be:
very much greater
much greater
a little greater
the same
less
My freedom to drink as I wish is:
very important
important
somewhat important
not at all important
APPRAISAL OF DIABETES SCALE
Instruction: Please tick the answer to each question which is closest to the way you feel. Please give your honest
feelings - we are interested in how you feel, not what your doctor or family may think.
S/N
Questions
1. How upsetting is having diabetes for you?
1
Not at all
107
2
Slightly
upsetting
3
Moderately
upsetting
4
Very
upsetting
5
Extremely
upsetting
2. How much control over your diabetes do you
have?
3. How much uncertainty do you currently
experience in your life as a result of being
diabetic?
4. How likely is your diabetes to worsen over the
next several years? (Try to give an estimate
based on your personal feeling rather than
based on a rational judgment.)
5. Do you believe that achieving good diabetic
control is due to your efforts as compared to
factors which are beyond your control?
6. How effective are you in coping with your
diabetes?
7. To what degree does your diabetes get in the
way of your developing life goals?
Not at all
Slight
amount
Slight
amount
Moderate
amount
Moderate
amount
Large
amount
Large
amount
Not likely at
all
Slightly
likely
Moderately
likely
Very likely
Totally
because of
me
Mostly
because of
me
Not at all
Slightly
effective
Slight
amount
Partly because
of me and
partly because
of other factors
Moderately
effective
Moderate
amount
Mostly
because of
other
factors
Very
effective
Large
amount
Not at all
Not at all
Total
amount
Extremely
large
amount
Extremely
likely
Totally
because of
other
factors
Extremely
effective
Extremely
large
amount
SECTION C: PHYSICAL ACTIVITY
Instruction: The following questions ask you about the time you spend doing different types of physical activity in a
typical week. Please answer these questions even if you do not consider yourself a physically active person.
PART 1: JOB-RELATED PHYSICAL ACTIVITY
1
Do you currently have a job or do any unpaid work outside your home?
2
During the last 7 days, on how many days did you do vigorous physical activities like
heavy lifting, digging, heavy construction, or climbing up stairs as part of your work?
Think about only those physical activities that you did for at least 10 minutes at a time.
3
How much time did you usually spend on one of those days doing vigorous physical
activities as part of your work?
Again, think about only those physical activities that you did for at least 10 minutes at
a time. During the last 7 days, on how many days did you do moderate physical activities
like carrying light loads as part of your work? Please do not include walking.
4
5
6
How much time did you usually spend on one of those days doing moderate physical
activities as part of your work?
During the last 7 days, on how many days did you walk for at least 10 minutes at a time
as part of your work? Please do not count any walking you did to travel to or from work.
How much time did you usually spend on one of those days walking as part of your
work?
PART 2: TRANSPORTATION PHYSICAL ACTIVITY
8
During the last 7 days, on how many days did you travel in a motor vehicle like a train,
bus, car, or tram?
Yes [ ]
No [ ] If No, Skip to Part 2
…………days
No vigorous job-related
physical activity, Skip to
question 4
…..hrs …….mins
…………days
No moderate job-related
physical activity, Skip to
question 6
…..hrs …….mins
…………days
No job-related walking,
Skip to PART 2
7
9
10
11
How much time did you usually spend on one of those days traveling in a train, bus, car,
tram, or other kind of motor vehicle?
During the last 7 days, on how many days did you bicycle for at least 10 minutes at a
time to go from place to place?
How much time did you usually spend on one of those days to bicycle from place to
place?
108
…..hrs …….mins
…………days
No traveling in a motor
vehicle, Skip to question 10
…..hrs …….mins
…………days
No bicycling from place to
place, Skip to question 12
…..hrs …….mins
12
During the last 7 days, on how many days did you walk for at least 10 minutes at a time
to go from place to place?
…………days
No walking from place to
place, Skip to PART 3
13
How much time did you usually spend on one of those days walking from place to
place?
…..hrs …….mins
PART 3: HOUSEWORK, HOUSE MAINTENANCE, AND CARING FOR FAMILY
14 Think about only those physical activities that you did for at least 10 minutes at a time.
During the last 7 days, on how many days did you do vigorous physical activities like
heavy lifting, chopping wood, shoveling snow, or digging in the garden or yard?
15
16
How much time did you usually spend on one of those days doing vigorous physical
activities in the garden or yard?
Again, think about only those physical activities that you did for at least 10 minutes at
a time. During the last 7 days, on how many days did you do moderate activities like
carrying light loads, sweeping, washing windows, and raking in the garden or yard?
How much time did you usually spend on one of those days doing moderate physical
activities in the garden or yard?
18 Once again, think about only those physical activities that you did for at least 10 minutes
at a time. During the last 7 days, on how many days did you do moderate activities like
carrying light loads, washing windows, scrubbing floors and sweeping inside your
home?
19 How much time did you usually spend on one of those days doing moderate physical
activities inside your home?
PART 4: RECREATION, SPORT, AND LEISURE-TIME PHYSICAL ACTIVITY
20 Not counting any walking you have already mentioned, during the last 7 days, on how
many days did you walk for at least 10 minutes at a time in your leisure time?
…………days
No vigorous activity in
garden or yard, Skip to
question 16
…..hrs …….mins
…………days
No moderate activity in
garden or yard, Skip to
question 18
17
21
22
How much time did you usually spend on one of those days walking in your leisure
time?
Think about only those physical activities that you did for at least 10 minutes at a time.
During the last 7 days, on how many days did you do vigorous physical activities like
aerobics, running, fast bicycling, or fast swimming in your leisure time?
How much time did you usually spend on one of those days doing vigorous physical
activities in your leisure time?
24 Again, think about only those physical activities that you did for at least 10 minutes at
a time. During the last 7 days, on how many days did you do moderate physical activities
like bicycling at a regular pace, swimming at a regular pace, and doubles tennis in your
leisure time?
25 How much time did you usually spend on one of those days doing moderate physical
activities in your leisure time?
PART 5: TIME SPENT SITTING
26 During the last 7 days, how much time did you usually spend sitting on a weekday?
27 During the last 7 days, how much time did you usually spend sitting on a weekend day?
…..hrs …….mins
…………days
No moderate activity inside
home, Skip to PART 4
…..hrs …….mins
…………days
No walking in leisure time,
Skip to question 22
…..hrs …….mins
…………days
No vigorous activity in
leisure time, Skip to
question 24
23
109
…..hrs …….mins
…………days
No moderate activity in
leisure time, Skip to PART 5
…..hrs …….mins
…..hrs …….mins
…..hrs …….mins
SECTION D: DIETARY HABIT
Instruction: Please circle the number that applies to each of the following questions. Use the scale to determine the
number of days per week defined in each reading.
S/N
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Questions
How often do you eat breakfast in the morning?
Based on three meals per day, how often do you skip at least one
meal per day?
How often do you take vitamin supplements?
How often do you take mineral supplements?
How often do you eat three base meals per day?
How often do you record what you eat?
How often do you drink water in a day?
How often do you drink carbonized beverages?
How often are you on a “diet"?
How often do you eat breads, cereals, pasta, potatoes, or rice?
How often do you eat fruits, such as apples, bananas, or oranges?
How often do you eat vegetables, such as tomatoes, carrots, or
salad?
How often do you eat dairy products such as milk, yoghurt or
cheese?
How often do you eat pastry, cookies, candies or other sweets?
How often do you snack on foods like potato chips, cakes,
doughnuts or soda?
How often do you snack on foods like popcorn, pretzels or fruits?
How often do you eat fast food?
How often do you seek out nutrition information?
110
Does not
occur at
all
1
1
Sometime
s (1-2
times)
2
2
Often (34 times)
3
3
Always
(5-7
times)
4
4
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
1
2
3
4
1
1
2
2
3
3
4
4
1
1
1
2
2
2
3
3
3
4
4
4
SECTION E: LIFESTYLE CHARACTERISTICS
Instruction: Please tick the correct answer of our choice and write answers appropriately where necessary.
Smoking
1)
2)
3)
4)
Do you smoke? (a) Yes [ ] (b) No [ ] (c) Not anymore [ ] If No, do not proceed
What substance do you smoke? ………………………………….
What quantity do you smoke? ……………………………………
How often do you smoke in a week? (a) Sometimes (1-2 days) (b) Often (3-4 days) (c) Always (5-7 days)
Alcohol Intake
1)
2)
3)
4)
Do you take Alcohol? (a) Yes [ ] (b) No [ ] (c) Not anymore [ ] If No, do not proceed
What type of alcohol do you take? ………………………….
What quantity do you take? ………………………………....
How often do you take alcohol in a week? (a) Sometimes (1-2 days) (b) Often (3-4 days) (c) Always (5-7 days)
SECTION F: 24-hr Dietary Recall
DATE: ………………….
DAY OF THE WEEK: …………………………
Instruction: Please describe the foods (meals and snacks) that you ate or drank within the last 24 hours. Start with
the first food or drink of the morning.
Item no
Food/drink
Place
Time
Description of food or drink
Amount (how much
Weight
consumed
taken
(volume, size or price)
111
did you actually
equivalent
eat/drink)
(g)
SECTION G: Anthropometric and Biochemical Measurement
S/N
1
2
3
4
Anthropometric characteristics
Weight (kg)
Height (cm)
Hip Circumference (cm)
Waist Circumference (cm)
5
Systolic Blood Pressure (mmHg)
6
Diastolic Blood Pressure (mmHg)
7.
Blood glucose level
1st Readings
112
2nd Readings