1.0 Introduction
1.1 Background of Study
The University of Nigeria Teaching Hospital (UNTH) has been at the forefront of diabetes care in Nigeria. Established in 1970, UNTH has evolved into a major referral center, providing specialized care for various medical conditions, including diabetes. The hospital's diabetes care program has grown over the years, incorporating advances in medical treatment and patient management practices (Ezeama et al., 2014). In the early 2000s, the importance of assessing the nutritional status of diabetic patients gained traction. Studies began to focus on the impact of malnutrition and poor dietary habits on the management and outcomes of diabetes. Research conducted at UNTH and other Nigerian hospitals highlighted the need for improved nutritional assessment and intervention strategies for diabetic patients (Chinenye et al., 2008).
Diabetes mellitus is a global health concern affecting millions of people worldwide. According to the International Diabetes Federation (IDF), approximately 463 million adults were living with diabetes in 2019, and this number is projected to rise to 700 million by 2045 (International Diabetes Federation, 2019). The prevalence of diabetes is particularly alarming in low- and middle-income countries, where healthcare systems often struggle to manage the disease effectively.
In Nigeria, the burden of diabetes is increasing rapidly. A study by Uloko et al. (2018) estimated the national prevalence of diabetes to be 5.77%, translating to over 11 million Nigerians living with the condition. The increasing prevalence is attributed to factors such as urbanization, sedentary lifestyles, unhealthy diets, and genetic predisposition (Uloko et al., 2018). Managing diabetes effectively requires a multifaceted approach, with nutritional management being a cornerstone of diabetes care. Proper nutrition helps in maintaining blood glucose levels within target ranges, reducing the risk of complications, and improving the overall quality of life for diabetic patients. The American Diabetes Association (ADA) emphasizes the importance of individualized medical nutrition therapy (MNT) as an integral component of diabetes management (American Diabetes Association, 2020).
In-patient management of diabetes presents unique challenges and opportunities. Hospitalized diabetic patients often have complex medical needs, requiring coordinated care from a multidisciplinary team. Ensuring adequate nutritional support during hospitalization is crucial for optimizing glycemic control, preventing malnutrition, and enhancing recovery (Franz et al., 2017). The University of Nigeria Teaching Hospital (UNTH) serves as a major referral center, providing specialized care to a diverse patient population, including those with diabetes. However, there is limited data on the nutritional status and dietary management practices of in-patient diabetics at UNTH.
Diabetes mellitus is a chronic metabolic disorder characterized by high blood sugar levels over a prolonged period, which can lead to severe complications if not properly managed. Effective dietary management is crucial for controlling blood glucose levels and preventing complications associated with diabetes. The nutritional status of diabetic patients plays a significant role in the overall management of the disease, influencing both short-term and long-term outcomes. The University of Nigeria Teaching Hospital (UNTH) serves as a tertiary healthcare institution, providing comprehensive care to a diverse population, including a significant number of diabetic patients. Evaluating the nutritional status and dietary management of in-patient diabetics at UNTH is essential for understanding the current practices, identifying gaps, and implementing strategies to improve patient outcomes.
Previous research has shown that structured nutritional interventions can significantly improve glycemic control and reduce hospital readmissions for diabetic patients (Cefalu et al., 2018). Recognizing these challenges, UNTH implemented various initiatives aimed at improving the nutritional care of diabetic patients. These included the establishment of a dedicated diabetes management team, incorporating dietitians and nutritionists, and developing tailored dietary plans for in-patients. Despite these efforts, there remained a gap in systematically evaluating the effectiveness of these interventions and understanding the nutritional status of hospitalized diabetic patients. By assessing the nutritional status and dietary management practices at UNTH, this study seeks to identify best practices, highlight areas for improvement, and contribute to the development of effective nutritional care protocols for in-patient diabetics.
1.2 Statement of Problems
Investigation revealed that diabetes mellitus is a growing public health concern in Nigeria, with increasing prevalence and associated complications posing significant challenges to the healthcare system (Uloko et al., 2018). Effective management of diabetes requires a comprehensive approach, including proper nutritional care, which is crucial for maintaining optimal glycemic control and preventing complications. Despite the recognized importance of nutrition in diabetes management, there is limited data on the nutritional status and dietary management practices of in-patient diabetics in Nigerian hospitals, particularly at the University of Nigeria Teaching Hospital (UNTH).
In-patient diabetics at UNTH face unique challenges related to their nutritional care. Hospitalized diabetic patients often have complex medical conditions that necessitate individualized dietary interventions. However, there is a lack of systematic evaluation of the adequacy and effectiveness of these dietary interventions in the hospital setting. This gap in knowledge raises concerns about whether the current nutritional management practices at UNTH are meeting the needs of diabetic patients and contributing to their overall health outcomes.
Furthermore, the nutritional status of diabetic patients is a critical determinant of their response to treatment and recovery. Malnutrition, whether undernutrition or overnutrition, can adversely affect glycemic control and increase the risk of complications (Franz et al., 2017). However, the prevalence and impact of malnutrition among in-patient diabetics at UNTH have not been adequately studied, leaving a significant gap in understanding and addressing this issue.
Another problem is the potential inconsistency in the dietary management practices at UNTH compared to established guidelines. National and international guidelines emphasize the importance of personalized medical nutrition therapy (American Diabetes Association, 2020). Yet, it is unclear to what extent these guidelines are being implemented and followed in the hospital’s dietary management protocols.
The lack of a standardized approach to nutritional assessment and intervention for diabetic patients at UNTH further complicates the issue. Without consistent and evidence-based protocols, healthcare providers may face difficulties in delivering optimal nutritional care, potentially leading to suboptimal patient outcomes. This highlights the need for a comprehensive evaluation of the current practices to identify areas for improvement and develop standardized nutritional care protocols. It is against the backdrop that this study seeks to address these problems by evaluating the nutritional status and dietary management of in-patient diabetics in university of Nigeria teaching hospital.
1.3 Aim and Objectives of Study
The aim of the study is to evaluate the nutritional status and dietary management of in-patient diabetics in university of Nigeria teaching hospital. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the nutritional status of in-patient diabetics at UNTH using anthropometric measurements, biochemical markers, and dietary assessments;
- To analyze the impact of nutritional status and dietary management on glycemic control and overall health outcomes of in-patient diabetics;
- To review the current dietary management practices for diabetic patients at UNTH, including meal planning, nutritional interventions, and patient adherence to dietary recommendations;
- To compare the dietary management practices at UNTH with established national and international guidelines for the nutritional management of diabetes;
- To identify gaps in the nutritional care of diabetic patients, including potential deficiencies in macro- and micronutrient intake, and areas where current practices may fall short; and
- To provide evidence-based recommendations for enhancing the nutritional care and dietary management of in-patient diabetics at UNTH.
1.4 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the current nutritional status of in-patient diabetics at the University of Nigeria Teaching Hospital, as measured by anthropometric, biochemical, and dietary assessments?
- How effective are the existing dietary management practices for in-patient diabetics at the University of Nigeria Teaching Hospital in achieving optimal glycemic control and overall health outcomes?
- What are the key factors influencing adherence to dietary recommendations among in-patient diabetics at the University of Nigeria Teaching Hospital?
- How do the nutritional care protocols and practices at the University of Nigeria Teaching Hospital compare with national and international guidelines for diabetes management?
- What are the perceived challenges and barriers faced by healthcare providers in implementing effective dietary management for in-patient diabetics at the University of Nigeria Teaching Hospital?
1.5 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H01: There is a significant relationship between the nutritional status of in-patient diabetics at the University of Nigeria Teaching Hospital and their glycemic control.
- H02: The current dietary management practices at the University of Nigeria Teaching Hospital are not fully effective in achieving optimal health outcomes for in-patient diabetics.
- H03: Adherence to dietary recommendations among in-patient diabetics at the University of Nigeria Teaching Hospital is influenced by socio-economic factors, cultural dietary practices, and patient education levels.
- H04: The nutritional care protocols and practices at the University of Nigeria Teaching Hospital do not fully align with national and international guidelines for diabetes management.
- H05: Healthcare providers at the University of Nigeria Teaching Hospital face significant challenges and barriers in implementing effective dietary management for in-patient diabetics, including limited resources, lack of training, and patient non-compliance.
1.6 Significance of Study
The outcome realized from the research findings will be significant to the following stakeholders:
- Patients: The study will provide valuable insights into the nutritional status and dietary needs of in-patient diabetics, leading to more personalized and effective dietary interventions. Improved nutritional care can enhance glycemic control, reduce the risk of complications, and improve overall health outcomes and quality of life for patients.
- Healthcare Providers: The findings will equip healthcare providers with evidence-based information on the current dietary management practices and their effectiveness. This knowledge can guide the development of better care strategies, improve patient education on nutrition, and ensure that healthcare providers are following best practices in the dietary management of diabetes.
- Hospital Management: For UNTH management, the study will highlight areas for improvement in the hospital's nutritional care protocols and dietary management practices. This can lead to the implementation of standardized protocols, optimizing resource allocation, and improving the overall quality of care provided to diabetic patients.
- Policy Makers: The study's findings can inform local and national health policies related to diabetes management. By providing data on the nutritional status and dietary management practices in a major Nigerian hospital, the study can help shape policies that promote better nutritional care for diabetic patients across the country.
- Academic and Research Community: The study will contribute to the existing body of knowledge on diabetes management, particularly in the context of a developing country like Nigeria. It can serve as a reference for future research, foster collaborations, and encourage more studies focused on improving the nutritional care and management of diabetic patients in similar settings.
1.7 Scope of the Study
The scope of the research is focused on the evaluation of nutritional status and dietary management of in-patient diabetics in university of Nigeria teaching hospital.
1.8 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.9 Definition of Terms
Nutritional Status:
Nutritional status refers to the overall health condition of an individual as influenced by the intake and utilization of nutrients. It encompasses factors such as anthropometric measurements (e.g., height, weight, BMI), biochemical markers (e.g., blood glucose levels, lipid profiles), and dietary assessments (e.g., nutrient intake, dietary patterns) (WHO, 2022).
Dietary Management:
Dietary management involves the planning and implementation of dietary interventions aimed at achieving specific health outcomes, such as glycemic control and prevention of complications, in individuals with diabetes. It includes strategies for meal planning, calorie control, carbohydrate management, and adherence to dietary guidelines (American Diabetes Association, 2020).
In-Patient Diabetics:
In-patient diabetics refer to individuals who have been admitted to a hospital due to diabetes-related complications or management needs and require medical care, including dietary management, during their hospital stay.
Anthropometric Measurements:
Anthropometric measurements are physical measurements of the body, such as height, weight, waist circumference, and body mass index (BMI). These measurements provide indicators of nutritional status, growth, and development, and can be used to assess changes over time (WHO, 2022).
Biochemical Markers:
Biochemical markers are substances measured in the body, such as blood glucose levels, lipid profiles (e.g., cholesterol, triglycerides), and other metabolic parameters. These markers provide objective data on the physiological status and metabolic health of individuals, including diabetic patients (American Diabetes Association, 2020).
