AN ASSESSMENT OF THE THE PREVALENCE OF URINARY TRACT INFECTION IN TYPE 2 DIABETES MELLITUS PATIENT

CHAPTER ONE

INTRODUCTION

Background of the Study

Diabetes is the prevailing endocrine illness of the past century. The disease incidence in emerging countries has been amplified by multiple causes, such as lifestyle modifications (Hu, 2018). Additionally, diabetes can be classified into two primary categories, with type 2 diabetes being more prevalent. Type 2 diabetes is a long-lasting and advancing metabolic condition that includes a diverse range of problems linked to different levels of insulin resistance, insulin secretion dysfunction, insulin generation and persistence, and increased glucose production (Boyko et al.,2018).

Furthermore. the incidence of diabetes mellitus has risen significantly in recent decades and is now reaching epidemic levels. Globally, there are 371 million individuals who have diabetes, and it is projected that by 2030, this figure will increase to 552 million. The extreme situation can be attributed to changes in lifestyle, the ageing population, and the rising prevalence of obesity (Hu, 2018). 

Diabetes ranks among the top 10 leading causes of mortality worldwide [4], and this is a verifiable reality. The incidence rose from 4.3% to 9% in men and from 5% to 7.9% in women (NCD-RisC, 2016). According to Muller, Gorter, Hak, Goudzwaard, Schellevis, Hoepelman, et al (2018),Type 2 diabetes elevates the likelihood of specific ailments, such as cardiovascular illness, ocular complications leading to blindness, lower limb amputation, renal disease, and infectious diseases. Beyond that Type 2 urinary tract infection (UTI) is the most prevalent infectious illness in diabetic people. Approximately 150 million individuals globally experience urinary tract infections annually (Gupta, 2016). On the other hand, a urinary tract infection (UTI) is a microbial infection that affects the urine system. This infection can affect several parts of the urinary system, including the urethra (urethritis), kidneys (pyelonephritis), or bladder (cystitis) (Fu et al., 2016). However, females have a higher susceptibility to having a urinary tract infection (UTI) compared to males. Localized infection within the bladder can cause significant discomfort and irritation. Nevertheless, if a urinary tract infection (UTI) extends to the kidneys, it might lead to significant repercussions. While urinary tract infections in type 2 diabetic patients can be caused by factors such as immune system problems, weakened white blood cells, inadequate blood supply, bladder dysfunction owing to nephropathy, and glucosuria (Fünfstück, 2017). Dysuria, a symptom characterized by painful urination, is a complication that arises in diabetes individuals who have urinary tract infections. This consequence occurs as a result of organ damage and can even lead to death, particularly in cases of pyelonephritis, a severe infection of the kidneys. Additionally, these patients suffer from nocturnal urine retention, urgency, and incontinence as a result of increased urination to eliminate excessive glucose (Bennett et al., 2018). Urinary tract infections are more common in women compared to men, possibly because of the unique anatomy of the shorter urinary tract, the shorter length of the urethra, and its close proximity to the anus in women (Nitzan, 2015). 

Urinary tract infections in diabetic patients hinder the ability to regulate blood sugar levels, leading to an increased requirement for blood sugar monitoring. This not only diminishes the quality of life but also imposes substantial treatment expenses on the patient (Gorter, 2019).  Moreover, statistics from multiple studies reveal variation in the reported prevalence of urinary tract infections (UTIs) among individuals with type 2 diabetes. This suggests inconsistency and uncertainty regarding the frequency of UTIs in this patient population. Thus, in order to effectively decrease the occurrence of urinary tract infections (UTIs) in individuals with type 2 diabetes, intervention studies necessitate precise and consistent information to mitigate the potential problems associated with UTIs.Therefore, a survey will be conducted in order to assess the prevalence of urinary tract infection in type 2 diabetes mellitus patient.

1.2 Statement of the Problem

As the number of individuals with diabetes continues to rise, so too will the occurrence of urinary tract infections. However, other variables, such as recurrent bouts of acute kidney injury caused by infections, medications, or nephrotoxins, can also contribute to its advancement. It is widely acknowledged that infections are common causes of illness and death in individuals with diabetes (Muller et al., 2018). Immunological deficiencies, such as poor neutrophil function, low levels of prostaglandin E, thromboxane B2, and leukotriene B4, as well as a diminished T cell-mediated immunological response, lead to an elevated risk of infection (Shah, 2018). Shah (2018)further assert that urinary colonization by microorganisms can occur due to diseases such as autonomic neuropathy causing incomplete bladder emptying and excessive glucose concentration in the urine  Research indicates that individuals with diabetes are more prone to developing silent bacteriuria and urinary tract infections (UTIs). UTIs are particularly prevalent among diabetic patients, constituting the most frequent bacterial illnesses (Ellenberg , 2018). Furthermore, it is crucial to acknowledge and address urinary tract infections (UTIs) in diabetes patients due to the potential for serious consequences, such as bacteremia, renal abscess, and renal papillary necrosis.  According to Ellenberg & Weber (2019) managing urinary tract infections (UTIs) in individuals with diabetes poses challenges due to their high likelihood of recurring, resulting in increased financial burdens for both the healthcare system and the patient. Hence, it is in the light of these that the study seeks to assess the prevalence of urinary tract infection in type 2 diabetes mellitus patient.

 1.3  Objectives of the Study

The main purpose of this study is to assess the prevalence of urinary tract infection in type 2 diabetes mellitus patient. Specifically, the study will;

Determine the prevalence rate of urinary tract infections (UTIs) among patients diagnosed with Type 2 Diabetes Mellitus (T2DM).

Investigate the factors contributing to the increased prevalence of UTIs in T2DM patients.

Evaluate the effectiveness of various preventive strategies for reducing the prevalence of UTIs in T2DM patients.

1.4  Research Questions

The following questions have been prepared for the study:

What is the prevalence rate of urinary tract infections (UTIs) among patients diagnosed with Type 2 Diabetes Mellitus (T2DM)?

What factors contribute to the increased prevalence of UTIs in patients with T2DM?

How effective are various preventive strategies in reducing the prevalence of UTIs in patients with T2DM?

1.5 Research Hypotheses

H0: There is no significant difference in the prevalence of urinary tract infections between type 2 diabetes mellitus patients and the general population.

Ha: There is a significant difference in the prevalence of urinary tract infections between type 2 diabetes mellitus patients and the general population.

1.6 Significance of the Study

Specialists who manage diabetes will benefit from insights into the increased risk of UTIs among their patients, allowing them to incorporate preventive measures into diabetes management plans.Furthermore, the study findings will help patients become more aware of their susceptibility to UTIs and manage their condition more effectively, potentially reducing the incidence of UTIs and improving overall health. Likewise, the findings will inform public health campaigns aimed at educating diabetic patients about the risks of UTIs and promoting preventive measures.Moreover, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the prevalence of urinary tract infection in type 2 diabetes mellitus patient.

1.6 Scope of the study   

The scope of this study is boarded on the prevalence of urinary tract infection in type 2 diabetes mellitus patient. Empirically, this study will determine the prevalence rate of urinary tract infections (UTIs) among patients diagnosed with Type 2 Diabetes Mellitus (T2DM), investigate the factors contributing to the increased prevalence of UTIs in T2DM patients and evaluate the effectiveness of various preventive strategies for reducing the prevalence of UTIs in T2DM patients.

Geographically, the study will be delimited to healthcare professionals in Cameroon.

1.7 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Urinary Tract Infection (UTI):an infection in any part of the urinary system, including the kidneys, ureters, bladder, and urethra.

Type 2 Diabetes Mellitus (T2DM): a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency, leading to hyperglycemia.