Diabetes Mellitus in adult Nigerians: patients’ characteristics, laboratory profile, practices and management outcome

Belonwu M. Onyenekwe, Ekenechukwu E. Young, Chidinma B. Nwatu, Christian I. Okafor, Chidiebere V. Ugwueze, Kingsley O. Onuekwusi


Background: Type 2 diabetes constitutes more than 90% of cases seen in Nigeria. Previous reports had shown that patients were poorly controlled and failed to meet management target across a broad range of parameters. Objectives of this study evaluated the characteristics and practices of patients attending the outpatient diabetes clinic. The study also examined to what extent they achieved management goals and what practices by the patients impacted negatively on treatment outcome.

Methods: This was a cross sectional descriptive study. All patients were eligible. Consecutive patients attending the Diabetes Clinic were evaluated. Their demographic, behavioural, social, clinical and laboratory data were obtained. Data analysis was done with SPSS V 21.

Results: There were 193 subjects, 78 males and 115 females aged 35-82(59.8± 9.1) years.  T2DM was diagnosed in 93.4%.  Hypertension was coexistent in 74%. Present or past foot ulcer was recorded in 11.9%. Only 37% of the subjects had an exercise program, 35% did the daily foot exam, and 45% had ophthalmology consult. Skipping medication was widespread (64%), mainly due to self-titration of medications (44%) and cost (23%). Fear of hypoglycemia (83%) and hypotension (79%) was prevalent. Their body mass index was 18.2-41.2(27.6±4.8) kg/m2. Subjects were prescribed a total of 2-14 medications (5.5±1.6). Metformin was the most commonly used glucose lowering medication (88.6%), followed by sulfonylureas (64%) and insulin (27.5%). HbA1c ranged from 5.3-16; 9.0±2.4%(33-151; 75±2.7 mmol/mol).

Conclusion: Glycaemic control was poor in the study population. Intermittent medication to avoid hypoglycemia played a major role. The patients lacked competence to manage their diabetes from day to day. Diabetes Self-Management Education and Support (DSMES) and early use of insulin are recommended.


Adherence, Competence, Control, Diabetes mellitus, Profile

Full Text:



World Health Organization. Global report on diabetes: executive summary, 2016 ‎WHO/NMH/NVI/16.3. Available at: Accessed on 5 Dec 2018.

World Health Organization. Diabetes Country Profile: Nigeria, 2016. Available at: Accessed 5 Dec 2018.

Dahiru T, Aliyu AA, Shehu AU. A Review of Population Based Studies on Diabetes Mellitus in Nigeria, Sub-Saharan Afr J Med. 2016;3(2):59-64.

Fasanmade OA, Dagogo-jack S. Diabetes Care in Nigeria. Ann Glob Heal. 2015;81(6):821-9.

Ogbera AO, Ekpebegh C. Diabetes mellitus in Nigeria : The past, present and future. World J Diabetes. 2014;5(6):905-11.

Chinenye S, Uloko AE, Ogbera AO, Ofoegbu EN, Fasanmade OA, Fasanmade AA, et al. Profile of Nigerians with diabetes mellitus - Diabcare Nigeria study group (2008): Results of a multicenter study. Indian J Endocr Metab. 2012;16:558-64.

Leive A, Xu K. Coping with out-of-pocket health payments: Empirical evidence from 15 African countries. Bull World Health Organ. 2008;86(11):849-56.

Okoronkwo IL, Ekpemiro JN, Onwujekwe OE, Nwaneri AC, Iheanacho PN. Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria. Niger J Clin Pract. 2016;19(1):104-9.

de-GraftAikins A. Healer shopping in Africa: new evidence from rural-urban qualitative study of Ghanaian diabetes experiences. BMJ 2005;331(7519):737.

Ogbera AO, Dada O, Adeyeye F, Jewo PI. Complementary and alternative medicine use in diabetes mellitus. West Afr J Med. 2002;29(3):158-62.

WHO Adherence to Long-Term Therapies: Evidence for Action, 2003. Available at: Acceded on 6 Dec 2018.

Danjin M, Usman N, Adamu D. Prevalence of diabetes mellitus in a tertiary health institution in Gombe Metropolis, Nigeria. Sudan Med Monit. 2016;11(4):113.

de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273-84.

Okafor CI, Fasanmade OA, Oke DA. Pattern of dyslipidaemia among Nigerians with type 2 diabetes mellitus. Niger J Clin Pract. 2008;11(1):25–31.

Edo AE, Umuerri EM, Akemokwe FM, Ordiah W. Clinical and biochemical characteristics of type 2 diabetes mellitus in the elderly persons seen at a tertiary hospital in Benin City. Niger J Cardiol. 2014;11(2):104-7.

Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: A position statement of the Am Diab Association. Diabetes Care. 2016;39(11):2065-79.

Duarte CK, de Almeida JC, Schneider Merker AJ, de Oliveira Brauer F, da Costa Rodrigues T. Physical activity level and exercise in patients with diabetes mellitus. Rev da Assoc Médica Bras (English Ed). 2012;58(2):215-21.

De Grauw WJ, van de Lisdonk EH, Behr RR, van Gerwen WH, van den Hoogen HJ, van Weel C. The impact of type 2 diabetes mellitus on daily functioning. Fam Pract. 1999;16(2):133-9.

Cordeiro RC, Jardim JR, Perracini MR, Ramos LR. Factors associated with functional balance and mobility among elderly diabetic outpatients. Arq Bras Endo crinol Metab. 2009;53(7):834-43.

Edwardson CL, Henson J, Bodicoat DH, Bakrania K, Khunti K, Davies MJ, et al. Associations of reallocating sitting time into standing or stepping with glucose, insulin and insulin sensitivity: A cross-sectional analysis of adults at risk of type 2 diabetes. BMJ Open. 2017;7(1):1-10.

Henson J, Davies MJ, Bodicoat DH, Edwardson CL, Gill JMR, Stensel DJ, et al. Breaking Up Prolonged Sitting with Standing or Walking Attenuates the Postprandial Metabolic Response in Postmenopausal Women: A Randomized Acute Study. Diabetes Care. 2016;39(1):130-8.

Najafi B, Crews RT, Wrobel JS. Importance of time spent standing for those at risk of diabetic foot ulceration. Diabetes Care 2010;33(11):2448-50.

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-16.

Ibraim A, Jude E, Langton K, Martínez F, Harkless L, Gawish H, et al. IDF Clinical Practice Recommendations on the Diabetic Foot; A guide forhealth care professionals, 2017. Available at: Accessed 10 Dec 2018.

Adejoh SO. Diabetes knowledge, health belief, and diabetes management among the Igala, Nigeria. SAGE Open. 2014;4(2).

Ogbera AO, Fasanmade O, Ohwovoriole AE, Adediran O. An Assessment of the Disease Burden of Foot Ulcers in Patients with Diabetes Mellitus Attending a Teaching Hospital in Lagos, Nigeria. Int J Low Extrem Wounds. 2006;5(4):244-9.

Young EE, Anyim OB, Onyenekwe BM, Nwatu CB, Okafor CI, Ofoegbu EN. Outcome of diabetic foot ulcer admissions at the medical wards of University of Nigeria Teaching Hospital Enugu, Nigeria. Int J Diabetes Dev Ctries. 2016;36(2):220-7.

Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality Rates and Diabetic Foot Ulcers. J Am Podiatr Med Assoc. 2008;98(6):489-93.

Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT, et al. Long-term prognosis of diabetic foot patients and their limbs: Amputation and death over the course of a decade. Diabetes Care. 2012;35(10):2021-7.

Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns. 2007;68(1):10-5.

Raimi TH. Factors Influencing Medication Adherence Among Patients with Diabetes Mellitus and Hypertension in Nigeria. Eur J Biol Med Sci Res. 2017;5(7):18-26.

Muhammad C, Jibril UN, Dauda S. Non-compliance with treatment regimens among clients with diabetes mellitus in university of Maiduguri teaching hospital, North-Eastern Nigeria. J Res Nurs Midwifery. 2016;5(1):11-20.

Jackson IL, Adibe MO, Okonta MJ, Ukwe CV. Medication Adherence in Type 2 Diabetes Patients in Nigeria. Diabetes Technol Ther. 2015;17(6):398-404.

García-Pérez LE, Álvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013;4(2):175-94.

Nwaokoro JC, Okokon BE, Nwaokoro AA, C O Emerole, Ibe SNO, Onwuliri VA, et al. Problems Associated with Treatment Compliance among Type 2 Diabetic Patients at a Tertiary Health Institution in Nigeria. African J Diabetes Med. 2014;22(1):3.

Saboor SA, Reddy N, Smith, Barber TM. Obesity and Type 2 Diabetes Mellitus. Intern Med 2014;01(s6):1-6.

World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation 2008. 2011. Available at:;jsessionid=E9D3D803CFEF7C8314795D6952CF5DF8?sequence=1 Accessed 5 Dec 2018.

Oli JM, Adeyemo AA, Okafor GO, Ofoegbu EN, Onyenekwe B, Chukwuka CJ, et al. Basal Insulin Resistance and Secretion in Nigerians With Type 2 Diabetes Mellitus. Metab Syndr Relat Disord. 2009;7(6):595-600.

Peron EP, Ogbonna KC, Donohoe KL. Antidiabetic Medications and Polypharmacy. Clin Geriatr Med. 2015;31(1):17-27.

Bauer S, Nauck MA. Polypharmacy in people with Type 1 and Type 2 diabetes is justified by current guidelines-a comprehensive assessment of drug prescriptions in patients needing inpatient treatment for diabetes-associated problems. Diabet Med. 2014;31(9):1078-85.

Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):1-10.

Zhang X, Wang L, Song Y. Dietary Antioxidant Vitamins and Flavonoids and Type 2 Diabetes : A Review of Current Epidemiologic Evidence. N A J Med Sci. 2016;9(1):12-6.

Snyder MJ, Gibbs LM, Lindsay TJ. Treating painful diabetic peripheral neuropathy: An update. Am Fam Physician. 2016;94(3):227-34.

Ogbonna BO, Ezenduka CC, Opara CA AL. Drug Therapy Problems in Patients with Type-2 Diabetes in a Tertiary Hospital in Nigeria. Int J Innov Res Dev. 2014;3(1):494-502.

Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights. 2016;11:95-104.

Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA 1c, diabetes and cognitive decline: The English longitudinal study of ageing. Diabetologia. 2018 Apr 1;61(4):839-48.

Blonde L, Aschner P, Bailey C, Ji L, Leiter LA, Matthaei S. Gaps and barriers in the control of blood glucose in people with type 2 diabetes. Diabetes Vasc Dis Res. 2017;14(3):172-83.

Ufuoma C, Godwin YD, Kester AD, Ngozi JC. Determinants of glycemic control among persons with type 2 diabetes mellitus in Niger Delta. Sahel Med J. 2016;19(4):190.

Young EE, Chinenye S, Unachukwu CN. Beta cell response to a mixed meal in Nigerian patients with type 2 diabetes. BMC Endocr Disord. 2012;12(1):1-12.

American Diabetes Association. Standard of medical care in diabetes 2019. Diabetes Care. Diabetes Care. 2019;42(1):S1-2.

Wu L, Parhofer KG. Diabetic dyslipidemia. Metab. Clin. Exp. 2014;63(12):1469-79.

Oguejiofor O, Onwukwe C, Odenigbo C. Dyslipidemia in Nigeria: Prevalence and pattern. Ann Afr Med. 2012;11(4):197-202.

Olamoyegun M, Oluyombo R, Asaolu S. Evaluation of dyslipidemia, lipid ratios, and atherogenic index as cardiovascular risk factors among semi-urban dwellers in Nigeria. Ann Afr Med. 2016;15(4):194.

Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educ. 2017;43(1):40-53.