www.idosr.org Offu ©IDOSR PUBLICATIONS International Digital Organization for Scientific Research ISSN: 2579-0730 IDOSR JOURNAL OF BIOLOGY, CHEMISTRY AND PHARMACY 3(1) 124-146, 2019. A Systematic Review of the Prevalence and Treatment of Type 2 Diabetes in Nigeria. Ogochukwu Fidelia Offu Department of Clinical Pharmacy and Biopharmaceutics, Faculty of Pharmaceutical Sciences, Enugu State University of Science and Technology, Agbani, Enugu State, Nigeria. Email: [email protected] ABSTRACT Diabetes is on the increase in Nigeria and previous systematic reviews and meta- analysis have reported estimates of the prevalence of Type 2 Diabetes Mellitus in Nigeria. However, because of differences in population characteristics, these estimates will vary across and within geopolitical zones. Despite the increase in prevalence of Type 2 Diabetes Mellitus in the country, no other systematic review has been carried out to assess diabetes treatment pattern in Nigeria. Hence, the importance of this study, as it critically reviews the disease prevalence and treatment pattern across and within geopolitical zones in Nigeria.To systematically review all prevalence and treatment studies published from January, 1998 to September, 2018. The following databases were searched for articles: PubMed Central (PMC), African Journal On Line (AJOL), Science Direct, and Connecting Repositories (CORE). Google scholar was also searched. 159 articles were identified from the databases while 12 were identified from Google Scholar. Studies that were excluded are: Studies that dealt mainly the prevalence of Type 1 Diabetes Melitus/gestational diabetes (14); studies with self reported diagnosis (12); case reports and editorials (10); studies that were not representative of the general population (7); and studies without case definitions (8) were excluded from the pool of studies to obtain 38 studies that were utilized for the review. 29 studies were used for the review of prevalence studies while 9 were used for review of treatment/drug utilization studies. For the review of prevalence of diabetes, sample size of studies used for the review of prevalence of diabetes ranged from 105 to 18,921. The South-South region recorded the highest number of studies (10 articles) while the north- east recorded the least number of studies (1 article). The highest prevalence was recorded among Oil company workers in the South-South region (23.4%) while the lowest was recorded among a group of adolescents in the South West region (0.6%). The urban settings had relatively higher prevalence than the rural settings and no particular trend was reported with regard to gender. For the review of treatment of diabetes, the highest number of studies was recorded in the South-West region (4 articles). Sample size ranged from 115 – 349. Only one study from the private facilities was used for this review. Metformin was the most prescribed monotherapy while metformin plus glibenclamide was the most prescribed combination therapy. Insulin was also used in dual or triple combination therapy with other oral hypoglycaemic drugs. Prevalence of Type 2 diabetes mellitus is on the increase in Nigeria, especially in the urban settings, among the higher socioeconomic class, and the higher age groups. Treatment of diabetes is in line with most areas of the clinical guidelines except in the area of use of glibenclamide as combination or add-on therapy and with the use of insulin as dual combination therapy. Keywords: Systematic, prevalence, treatment, diabetes, Nigeria. INTRODUCTION Life of man for all times and ages has Mellitus constitute one of the most been characterized pathologically by chronic human infirmities of all times. As diseased conditions of which Diabetes a disease of prehistoric era through 124 IDOSR JOURNAL OF BIOLOGY, CHEMISTRY AND PHARMACY 3(1) 124-146, 2019 www.idosr.org Offu antiquity, medieval, modern, and often perceived as mysterious, curse, rare contemporary times, diabetes ravaged disease or evil. Ancient Graeco-Roman humanity for over millennia though medical practices, oriental Chinese and perceived by different ages and peoples Indian traditional medicine, Afro- in diverse ways – at one time as Egyptians papyrus, as well as the peoples mysterious, other times as socio-cultural of Ancient Near East and the Arabian omen, or human affliction. Its impact Peninsula medical civilizations more often emanates from its debilitating characterized the incidence of diabetes pathophysiological effects which have mellitus in one way or the other. Ancient generated over time intense characteristic Indian physicians referred to it as and/or pathological research to unravel madhumeha („honey urine‟) because it and treat the dreaded inferno. attracted ants. Historical Background of Diabetes Around 131-201 CE, Greek physician, Mellitus Galen of Pergamum, theorized diabetes as The term diabetes mellitus etymologically grave affliction of the kidneys. Avicenna derives from the Greek word diabetes (980-1037), a renowned Persian polymath which means to pass through or simply to and physician published “The Canon of siphon while mellitus on the other hand, Medicine” in 1025 in which he provided comes from the Latin word mellitus which unique characterization of diabetes translates to sweet or honey. The literal mellitus as sweet urine, abnormal definition as such is a diseased condition appetite, diabetic gangrene, sexual in humans that cause the siphon or excess dysfunction and frequent urination. He passage of sugar from the body. The also concocted a mixture of seeds (lupin, coinage of the term implicates a medical fenugreek, zedoary) as a panacea to its condition where excess sugar is found in debilitating effects [4]. the blood and in the urine. Literary Other features of diabetes mellitus that accounts differ as to the first scientist pervaded down to medieval age include who coined and used the term. While urine colour, taste, sediment and odour. some accounts refer the initial coinage of This process of disease identification and the term diabetes to Apollonius of examination was referred to as Memphis around 250 BC (Diabetes „uroscopy‟. This was common around the History, 2018); other accounts according 11-12th centuries. Nevertheless, around to [1] “recorded history attributes the first 400–500 A.D., the quest for efficient complete descriptions in the first century diagnostic and pathological knowledge of A.D. to Aretaeus the Cappadocian, who the diabetes mellitus led two great indian coined the word diabetes (Greek, „siphon‟) medical scientists – Sushruta, a physician and dramatically stated “… no essential and Charaka, a surgeon after series of part of the drink is absorbed by the body rigorous scientific studies identified two while great masses of the flesh are types of diabetes – Type 1 and Type 2. liquefied into urine”. [2] On the other However in 1936, Harold Percival hand, the term mellitus was coined by the Himsworth substantially differentiated British Surgeon-General, John Rollo in Type 1 and Type 2 diabetes as unique 1798, in recognition of its sugar-like taste entities as are currently referred in and to differentiate it from diabetes medical science [5]. Further analysis of (insipidus) with tasteless urine [3]. scholarly perspective on diabetes is x- Throughout Antiquity around the 1500 BC rayed in the literature review. and Medieval era, diabetes mellitus was LITERATURE REVIEW The review of extant literature, systematically review topical but relevant perspectives, and scholarly horizons on literature, primary reports and data that the subject of Diabetes Mellitus is focused on the issue. Such reviews aim to important. One of the practical broaden the horizon of knowledge on approaches to deal with the critical issues subject matter, share subjective and of Diabetes is to critically and objective experiences on related issues, 125 IDOSR JOURNAL OF BIOLOGY, CHEMISTRY AND PHARMACY 3(1) 124-146, 2019. www.idosr.org Offu investigate and expound the historical diabetes was chronic in some people, it space for evaluating needed facts and was fatal in others; thereby depicting first data. As such, it creates the hypothetical instance of clinical difference among modules for priming and galvanizing our diabetic patients. systematic discourse on Diabetes. However, in 1936 Sir Harold Percival Diabetes – what it is: (Harry) Himsworth characteristically Diabetes is a chronic non communicable distinguished diabetes as type 1 and type disease that occurs either when the 2 as published in his scientific discourse pancreas does not produce enough of the on diabetes. He strongly argued that hormone responsible for regulating the insulin resistance in conjunction with blood sugar in the body and/or a impaired beta-cell function proved the condition where the body cannot major causal factor of type 2 than insulin effectively utilize the hormone referred to deficiency as noted in type 1 diabetes [9]. as insulin. Hyperglycaemia, or raised Type 1 Diabetes Type 1 diabetes known blood sugar, is a common effect of as insulin-dependent, occurs more in uncontrolled diabetes and over time leads children and was often referred to as to serious damage to many of the body‟s juvenile diabetes. Unlike type 2, there is systems, organs and tissues, especially complete insulin deficiency among the nerves and blood vessels [6]. The patients with type 1 and as such are main symptoms of diabetes are three – completely dependent on injection of polydipsia, polyphagia and polyuria – hormone insulin