Project – Prevalence, Awareness and Risk Factors of Diabetes Mellitus among Adults: A Study of Selected Communities in Uyo Local Government Area, Akwa Ibom State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diabetes mellitus (DM) is one of the most important chronic non-communicable diseases affecting populations across the world. It is a metabolic disorder characterized by persistent elevation of blood glucose resulting from inadequate insulin production, impaired insulin action, or a combination of both. Prolonged hyperglycaemia can progressively damage the cardiovascular system, kidneys, eyes, nerves and other organs. Although diabetes can be effectively prevented or controlled in many cases, delayed diagnosis, inadequate awareness, unhealthy lifestyles and limited access to screening continue to contribute to its growing burden, particularly in low- and middle-income countries (World Health Organization [WHO], 2024).

The global burden of diabetes has increased substantially over the past several decades. The WHO reported that the number of people living with diabetes increased from approximately 200 million in 1990 to 830 million in 2022, with prevalence increasing more rapidly in low- and middle-income countries than in high-income countries (WHO, 2024). The disease is therefore no longer primarily considered a problem of affluent societies. Changes in dietary patterns, physical activity, urbanization, population ageing and increasing levels of overweight and obesity have contributed to the increasing occurrence of type 2 diabetes across developing countries. More than 95% of people with diabetes have type 2 diabetes, which is strongly associated with modifiable behavioural and metabolic risk factors (WHO, 2024).

The consequences of diabetes extend beyond elevated blood glucose. Uncontrolled diabetes is associated with serious complications, including cardiovascular disease, stroke, kidney failure, blindness, neuropathy, diabetic foot ulcers and lower-limb amputation. Diabetes and diabetes-related kidney disease were responsible for more than two million deaths in 2021, while elevated blood glucose contributed substantially to cardiovascular mortality (WHO, 2024). The disease also places considerable economic pressure on households and health systems because affected individuals may require lifelong medication, laboratory investigations, medical consultations and treatment for complications. Consequently, prevention, early detection and effective management have become important components of contemporary public health practice.

The situation is particularly concerning because a substantial proportion of people with diabetes remain unaware that they have the condition. The International Diabetes Federation (IDF) estimated in its 11th edition of the IDF Diabetes Atlas that 589 million adults aged 20–79 years were living with diabetes globally in 2024 and that approximately 252 million of them were unaware of their condition. The IDF also projects that the global number of adults with diabetes could increase to 853 million by 2050 if current trends continue (International Diabetes Federation [IDF], 2025).

The problem of undiagnosed diabetes is particularly important from a public health perspective because type 2 diabetes may develop gradually and may produce mild or nonspecific symptoms for several years. Individuals may therefore live with elevated blood glucose without seeking medical attention. According to WHO (2024), early diagnosis through appropriate blood-glucose testing is essential because timely treatment and lifestyle modification can prevent or delay the development of serious complications. The presence of mild symptoms or the absence of symptoms does not necessarily indicate the absence of diabetes.

Diabetes is also closely associated with a range of behavioural, socioeconomic, genetic and physiological factors. Important risk factors include increasing age, family history of diabetes, overweight and obesity, physical inactivity, unhealthy dietary patterns and urban living. WHO (2024) identifies excess body weight, inadequate physical activity and genetic predisposition among important contributors to type 2 diabetes. Similarly, WHO’s broader framework on non-communicable diseases identifies unhealthy diet, physical inactivity, tobacco use and harmful alcohol consumption as major behavioural risk factors that contribute to metabolic abnormalities such as obesity, raised blood glucose and raised blood pressure (WHO, 2025).

Dietary transition has become an important issue in the development of diabetes in developing countries. Traditional diets are increasingly being complemented or replaced by energy-dense foods, refined carbohydrates, processed foods, sugar-sweetened beverages and foods high in saturated fats. At the same time, modern work patterns and urban lifestyles may reduce opportunities for regular physical activity. Such changes can promote weight gain, abdominal obesity and insulin resistance, thereby increasing the risk of type 2 diabetes. WHO (2024) recommends maintaining a healthy body weight, engaging in regular physical activity, consuming a healthy diet and avoiding tobacco as important measures for preventing or delaying type 2 diabetes.

The African region is experiencing a growing diabetes burden within a context characterized by rapid urbanization, population growth, changing lifestyles and health-system challenges. The IDF’s 2025 estimates show that diabetes affects millions of adults across Africa, while many cases remain undiagnosed. The burden is significant because health systems in many African countries continue to face competing priorities, limited screening capacity and inadequate resources for chronic disease management. The combination of increasing risk factors and gaps in diagnosis creates the possibility of increasing diabetes-related morbidity and mortality in the region (IDF, 2025).

Nigeria represents an important part of this growing African diabetes problem. The IDF estimated that approximately 3.0 million Nigerian adults aged 20–79 years were living with diabetes in 2024, corresponding to an age-standardized prevalence of about 3.0%. Nigeria had the largest absolute number of adults with diabetes in the IDF African Region. The IDF further projects that the number could increase to approximately 6.6 million by 2050 if current trends continue (IDF, 2025).

However, national estimates should be interpreted alongside evidence from Nigerian population studies because diabetes prevalence varies considerably according to geographical location, study population, age distribution and diagnostic methods. Uloko et al. (2018), in a systematic review and meta-analysis involving 23 studies and 14,650 participants, estimated a pooled diabetes prevalence of 5.77% in Nigeria. Their analysis revealed considerable regional variation, with the South-South geopolitical zone having the highest pooled prevalence at 9.8%. The authors also identified urban residence, physical inactivity, older age, unhealthy dietary habits, obesity and family history as important risk factors for diabetes in Nigeria.

More recent evidence reinforces concerns about the diabetes burden in Nigeria. Olamoyegun et al. (2024), in a systematic review and meta-analysis involving 60 studies and 124,876 participants, reported a pooled prevalence of type 2 diabetes of 7.0% in Nigeria. The South-South geopolitical zone recorded the highest pooled prevalence at 11.35%. Their analysis identified family history, high socioeconomic status, physical inactivity, urban residence, body mass index above 25 kg/m², infrequent vegetable consumption and abdominal obesity as significant risk factors for type 2 diabetes.

The findings concerning the South-South region are particularly relevant to the present study because Akwa Ibom State is located within this geopolitical zone. Olamoyegun et al. (2024) reported a pooled prevalence estimate of approximately 11.0% for Akwa Ibom State in their state-level analysis. Although such pooled estimates cannot automatically be assumed to represent every community or local government area in the state, they provide an important indication that diabetes constitutes a significant public health concern requiring location-specific investigation.

Previous Nigerian research has also demonstrated that diabetes is associated with substantial morbidity among individuals already diagnosed with the disease. In the Diabcare Nigeria multicentre study, Uloko et al. (2012) found that 95.4% of participating patients had type 2 diabetes. Hypertension was present in 60.9% of the patients, while complications such as peripheral neuropathy, retinopathy, cataracts, diabetic foot ulcers and nephropathy were reported. The study also observed poor attainment of recommended glycaemic targets among many participants, demonstrating the potential consequences of inadequate prevention, diagnosis and management.

The problem is not only the occurrence of diabetes but also the level of awareness among members of the population. Awareness encompasses knowledge of the meaning of diabetes, its causes and risk factors, symptoms, prevention, complications, screening procedures and available treatment. Adequate awareness can influence health-seeking behaviour and encourage individuals at risk to undergo screening and adopt healthier lifestyles. Conversely, poor knowledge may encourage misconceptions, delayed presentation, reliance on self-medication or traditional remedies without appropriate medical evaluation, and failure to recognize risk factors.

This concern is particularly relevant in community settings, where individuals may not routinely access hospitals unless they experience symptoms. People who consider themselves healthy may have little motivation to undergo blood glucose testing. Yet, because type 2 diabetes can remain asymptomatic or mildly symptomatic for an extended period, community-based screening can identify individuals who would otherwise remain undiagnosed. WHO (2024) emphasizes the importance of regular check-ups and blood glucose testing for early detection, especially because delayed diagnosis can allow complications to develop before treatment begins.

Evidence from Uyo itself provides further justification for the present investigation. A recent study conducted among adults at Akpan Andem Market in Uyo Local Government Area reported a diabetes prevalence of 4.6%, with 46.2% of the identified cases being undiagnosed. The study also reported that 52% of respondents had never previously checked their blood glucose level and concluded that poor diabetes knowledge and inadequate access to screening services were important concerns among the study population.

Although the Uyo study provides valuable evidence, its setting in a particular market population means that its findings may not adequately represent adults across different communities within Uyo Local Government Area. Community characteristics, occupation, socioeconomic circumstances, dietary patterns, physical activity, access to health facilities and health information may differ considerably between communities. Therefore, there remains a need for community-based research that simultaneously examines prevalence, awareness and risk factors among adults in selected communities.

Uyo Local Government Area is an important setting for such an investigation. As the capital local government area of Akwa Ibom State, Uyo has experienced considerable urban growth and increasing economic and social activities. Urbanization can bring improvements in access to health services and health information, but it may also be accompanied by lifestyle changes, sedentary occupations, increased motorized transportation and greater consumption of processed and commercially prepared foods. These factors may contribute to the emergence and progression of non-communicable diseases, including type 2 diabetes.

The importance of examining risk factors at the community level cannot therefore be overstated. While some diabetes risk factors, such as age and family history, cannot be modified, several others can be addressed through public health interventions. Physical inactivity, unhealthy dietary practices, overweight and obesity, tobacco use and excessive alcohol consumption are potentially modifiable. Identifying which risk factors are common among adults in selected communities can assist health educators and primary healthcare providers in designing interventions that are relevant to the local population.

Furthermore, the relationship between awareness and diabetes risk deserves attention. Awareness alone does not necessarily guarantee healthy behaviour. An individual may know that obesity, poor diet or physical inactivity increases the risk of diabetes but may still engage in these behaviours because of socioeconomic circumstances, cultural practices, occupation or limited access to appropriate facilities. For this reason, assessing both awareness and actual risk factors provides a more comprehensive understanding of the problem.

The public health significance of early detection is equally important. Diabetes screening can identify individuals with previously undiagnosed disease and those with elevated risk who may benefit from preventive interventions. WHO (2024) notes that type 2 diabetes can often be prevented or delayed through healthy lifestyle practices and early intervention. Community-level identification of risk factors therefore provides an opportunity to shift the focus from treatment of complications to prevention, early detection and health promotion.

The economic implications of diabetes further justify the need for preventive research. Individuals with diabetes may require continuous medication, laboratory testing, consultations and treatment of complications. For households with limited income, these costs can become substantial and may affect productivity and quality of life. At the health-system level, diabetes complications require more intensive and expensive care than early-stage disease. The IDF reported that global diabetes-related health expenditure exceeded one trillion US dollars in 2024, illustrating the magnitude of the economic consequences associated with the disease (IDF, 2025).

Community-level evidence is therefore essential for planning appropriate health education, screening and prevention programmes. Data obtained from selected communities in Uyo Local Government Area can help reveal the proportion of adults who have diabetes, the extent to which they understand the condition, and the behavioural, demographic and physiological factors associated with its occurrence. Such evidence can be useful to public health practitioners, community health workers, primary healthcare facilities and policymakers in developing locally appropriate interventions.

It is against this background that this study seeks to investigate the prevalence, awareness and risk factors of diabetes mellitus among adults in selected communities in Uyo Local Government Area, Akwa Ibom State. By bringing these three dimensions together, the study is expected to provide a clearer picture of the community burden of diabetes and the factors that may contribute to its occurrence and late detection.

1.2 Statement of the Problem

Diabetes mellitus has become an increasingly important public health problem globally and in Nigeria. The continued increase in the number of people living with diabetes, together with the high proportion of undiagnosed cases, presents a major challenge to disease prevention and control. WHO (2024) reported that the global number of people living with diabetes had reached 830 million in 2022, while the IDF estimated that 589 million adults aged 20–79 years were living with diabetes in 2024. Of particular concern is the large number of people who are unaware that they have the condition.

In Nigeria, the situation is also concerning. The IDF estimated approximately 2.99 million adults with diabetes in Nigeria in 2024, while recent Nigerian systematic reviews have reported considerably higher pooled prevalence estimates in population-based studies. Olamoyegun et al. (2024) estimated the pooled prevalence of type 2 diabetes in Nigeria at 7.0%, with the South-South region having the highest pooled prevalence of 11.35%. These differences between estimates illustrate the difficulty of obtaining reliable local prevalence figures and reinforce the need for community-specific studies.

The situation is particularly relevant to Akwa Ibom State because available evidence suggests a substantial diabetes burden in the state. The 2024 systematic review by Olamoyegun et al. estimated a pooled prevalence of approximately 11.0% for Akwa Ibom. However, a pooled state estimate may conceal substantial differences between communities. Adults living in one locality may have different levels of exposure to risk factors, health information and screening services from adults living in another locality. Therefore, there is a need to generate evidence at the local community level rather than relying exclusively on national, regional or state-level estimates.

Another major problem is that diabetes may remain undetected for a long period. Type 2 diabetes can have mild or nonspecific symptoms, allowing affected persons to continue their daily activities without realizing that their blood glucose levels are elevated. Consequently, some individuals may only seek medical attention after developing complications. WHO (2024) emphasizes that early diagnosis through blood glucose testing is important in preventing or delaying serious complications.

Evidence from Uyo raises particular concern about this problem. A study conducted among adults in Akpan Andem Market, Uyo Local Government Area, found a diabetes prevalence of 4.6%, with almost half of the identified cases being undiagnosed. It also reported that more than half of respondents had never checked their blood glucose before and identified poor knowledge and inadequate access to screening as important challenges. Although these findings are valuable, they were obtained from a specific market population and may not reflect adults residing in different communities within Uyo Local Government Area.

Poor awareness may further contribute to the problem. Adults who do not understand the risk factors, symptoms or consequences of diabetes may not perceive themselves as being at risk. Some individuals may associate diabetes only with excessive consumption of sugar or may believe that the condition affects only older people. Such misconceptions can result in inadequate preventive behaviour and low demand for screening. Where awareness of risk factors is poor, community members may not recognize the importance of maintaining a healthy weight, engaging in regular physical activity or adopting healthier dietary practices.

At the same time, awareness may not translate automatically into appropriate behaviour. Adults may understand the dangers of diabetes but continue to experience risk factors such as physical inactivity, overweight, unhealthy dietary practices, tobacco use or harmful alcohol consumption. Olamoyegun et al. (2024) identified family history, high socioeconomic status, physical inactivity, urban living, increased body mass index, infrequent vegetable consumption and abdominal obesity as significant factors associated with type 2 diabetes in Nigeria.

The increasing urban character of Uyo makes these issues particularly relevant. Urbanization can influence dietary patterns, occupational activity, transportation and recreational behaviour. Individuals who previously engaged in physically demanding occupations may increasingly adopt sedentary work, while easy access to energy-dense processed foods may alter dietary practices. These changes may increase exposure to modifiable risk factors for diabetes.

Furthermore, diabetes has serious consequences when it is not diagnosed and adequately controlled. Nigerian evidence has documented complications including neuropathy, retinopathy, cataracts, diabetic foot ulcers, nephropathy and cardiovascular risk among people living with diabetes (Uloko et al., 2012). When diagnosis occurs late, opportunities for early intervention may be lost, thereby increasing the burden on affected individuals, families and healthcare facilities.

There is therefore a critical need to establish the current prevalence of diabetes among adults in selected communities in Uyo Local Government Area and to determine the extent of their awareness of the disease. It is equally important to identify the demographic, behavioural, family-history and anthropometric factors associated with diabetes in the study population. Without such evidence, community health programmes may not adequately address the factors driving diabetes in the area.

The central problem of this study, therefore, is the insufficient community-specific evidence concerning the prevalence of diabetes mellitus, the level of awareness about the disease, and the risk factors associated with its occurrence among adults in selected communities in Uyo Local Government Area, Akwa Ibom State. Addressing this problem is necessary for strengthening health education, promoting early screening and supporting appropriate community-based diabetes prevention and control strategies.

1.3 Purpose of the Study

The general purpose of this study is to determine the prevalence, awareness and risk factors of diabetes mellitus among adults in selected communities in Uyo Local Government Area, Akwa Ibom State.

Specifically, the study seeks to:

1. determine the prevalence of diabetes mellitus among adults in selected communities in Uyo Local Government Area;
2. assess the level of awareness of diabetes mellitus among adults in the selected communities;
3. determine the level of knowledge of the major signs, symptoms and complications of diabetes mellitus among the respondents;
4. identify the major risk factors for diabetes mellitus among adults in the selected communities;

1.4 Research Questions

The following research questions will guide the study:

1. What is the prevalence of diabetes mellitus among adults in selected communities in Uyo Local Government Area?
2. What is the level of awareness of diabetes mellitus among adults in the selected communities?
3. What is the level of knowledge of the signs, symptoms and complications of diabetes mellitus among the respondents?
4. What are the major risk factors for diabetes mellitus among adults in the selected communities?

1.5 Research Hypothesis

The following null hypothesis will be tested at 0.05 level of significance:

H₀: There is no significant association between selected risk factors and the occurrence of diabetes mellitus among adults in selected communities in Uyo Local Government Area, Akwa Ibom State.

1.6 Significance of the Study

This study will be significant to several groups, including adults in the selected communities, community health practitioners, healthcare providers, policymakers, public health educators, researchers and academic institutions.

Adults in the Selected Communities

The study will provide information that can increase awareness of diabetes mellitus, its risk factors, symptoms, complications and preventive measures. By understanding the factors that may increase their risk, adults may be encouraged to adopt healthier dietary practices, engage in regular physical activity, maintain healthy body weight and seek appropriate screening services.

Community Health Workers

The findings will provide community health workers with evidence concerning the prevalence and risk factors of diabetes within the selected communities. Such information can guide health education activities, community screening programmes and referrals of individuals who may require further medical evaluation.

Healthcare Providers

Healthcare professionals in primary and secondary healthcare facilities may benefit from the findings because the study can provide information about the local pattern of diabetes and associated risk factors. This may support more targeted screening and counselling, particularly among adults with multiple risk factors.

Public Health Practitioners

The study will contribute evidence that can assist public health practitioners in designing interventions aimed at prevention, early detection and control of diabetes. The findings may help practitioners identify groups that require more intensive health education or screening.

Government and Policymakers

The study may provide useful evidence for health planning at the local and state levels. Reliable information on diabetes prevalence, awareness and risk factors can support the development and implementation of non-communicable disease programmes, particularly at the primary healthcare and community levels.

Health Educators

The findings may assist health educators in developing educational messages that address specific misconceptions and knowledge gaps concerning diabetes. Rather than relying solely on general health messages, education programmes can be tailored to the risk factors and awareness deficiencies identified in the study.

Researchers and Students

The study will contribute to the existing body of knowledge on diabetes mellitus in Nigeria, particularly within Akwa Ibom State. It may serve as a reference for future studies on diabetes prevalence, community screening, health awareness and risk factors.

1.7 Scope of the Study

The study will focus on the prevalence, awareness and risk factors of diabetes mellitus among adults in selected communities in Uyo Local Government Area, Akwa Ibom State.

The study will cover adults aged 18 years and above residing in the selected communities. The variables of interest will include diabetes status, awareness and knowledge of diabetes, socio-demographic characteristics, family history of diabetes, dietary practices, physical activity, body weight/obesity-related indicators and other selected behavioural and lifestyle risk factors.

The study will be geographically limited to the selected communities within Uyo Local Government Area. It will not attempt to estimate the prevalence of diabetes in every local government area of Akwa Ibom State. Similarly, findings from the study will be interpreted primarily in relation to the study population and setting.

1.8 Operational Definition of Terms

Awareness

The extent to which an adult has general knowledge and understanding of diabetes mellitus, including its causes, risk factors, symptoms, prevention, complications and methods of detection.

Adults

For the purpose of this study, adults refer to persons aged 18 years and above residing in the selected communities in Uyo Local Government Area.

Diabetes Mellitus

A chronic metabolic condition characterized by abnormally elevated blood glucose resulting from inadequate insulin production, impaired insulin action or both.

Prevalence

The proportion or percentage of adults in the study population who are identified as having diabetes mellitus at the time or within the specified period of the study.

Risk Factors

Characteristics, behaviours or conditions that increase the likelihood of developing diabetes mellitus. In this study, these may include advancing age, family history, overweight/obesity, physical inactivity, unhealthy dietary practices and selected lifestyle factors.

Family History

The presence of diabetes mellitus among close biological relatives of a respondent, particularly parents or siblings.

Physical Inactivity

A level of physical activity below recommended amounts and characterized by insufficient regular moderate or vigorous physical activity.

Unhealthy Dietary Practices

Dietary behaviours that may increase the risk of diabetes, including frequent consumption of energy-dense foods, processed foods, sugar-sweetened foods or beverages, excessive saturated fats and inadequate consumption of vegetables and other healthy foods.

Overweight/Obesity

Excessive accumulation of body fat that may increase the risk of metabolic disorders, including type 2 diabetes mellitus, and which may be assessed using anthropometric measures such as body mass index and/or waist circumference.

Type 2 Diabetes Mellitus

The most common form of diabetes, characterized primarily by insulin resistance and inadequate insulin secretion. It is strongly associated with genetic, environmental and lifestyle-related factors.

Screening

The process of assessing apparently healthy individuals for evidence of diabetes or elevated risk of diabetes through appropriate measurements or tests.

Selected Communities

The communities within Uyo Local Government Area that will be chosen according to the sampling procedure specified in the methodology of the study.

Project – Prevalence, Awareness and Risk Factors of Diabetes Mellitus among Adults: A Study of Selected Communities in Uyo Local Government Area, Akwa Ibom State