CHAPTER ONE

Background to the Study

1.0 Introduction

Diabetes is a long-term medical condition that affects the way the body processes blood sugar

(glucose), which is its primary source of energy. Globally, the burden of diabetes has been on a

steady rise, with alarming statistics reported by the World Health Organization (WHO). In 1980,

approximately 108 million people were living with diabetes, but by 2014, this number had

escalated to 422 million. Among the different types of diabetes, type 2 diabetes is the most

prevalent, affecting a diverse population regardless of age, gender, or socioeconomic

background.

The condition arises when the pancreas produces insufficient amounts of insulin, or when the

body’s cells become resistant to insulin’s effects. Insulin, a hormone produced by the pancreas,

is essential as it acts like a "key" that allows glucose from the bloodstream to enter cells where it

can be used for energy. When this process is disrupted, glucose builds up in the blood, leading to

hyperglycemia (high blood sugar). If left unmanaged, chronic hyperglycemia can result in

severe complications, including cardiovascular diseases, kidney damage, nerve dysfunction, and

eye disorders.

Although diabetes is a chronic condition requiring lifelong management, advancements in

medical science and healthcare practices have provided a variety of treatment options. These

include the use of medications, insulin therapy, and lifestyle interventions such as maintaining a

healthy diet, engaging in regular physical activity, and achieving weight management goals.

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Proper management can enable individuals with diabetes to live healthy lives and minimize the

risk of complications.

It is important to differentiate diabetes mellitus from diabetes insipidus, another rare condition

characterized by excessive thirst and urination but unrelated to blood glucose regulation. While

both share the term "diabetes" due to similar symptoms, their underlying causes and management

strategies are distinct.

1.1 Case Presentation

The focus of this case study is on Mallam Usman Yusuf, a 55-year-old man diagnosed with

type 2 diabetes a decade ago. His medical history includes risk factors such as obesity, a

sedentary lifestyle, and a family history of diabetes. Despite initial efforts to manage his

condition through lifestyle modifications and oral medications, Mallam Usman’s diabetes has

progressed over time, necessitating the use of insulin therapy alongside increased doses of

medications. This case offers an opportunity to explore the challenges faced by individuals living

with diabetes and assess the effectiveness of various management strategies.

1.2 Research Questions

This study is guided by the following research questions:

1. What are the physical and psychological effects of diabetes on Mallam Usman’s overall

quality of life?

2. How effective are current diabetes management strategies in regulating Mallam Usman’s

blood glucose levels and preventing complications?

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 3. To what extent do lifestyle modifications, including diet and physical activity, contribute

to the management of Mallam Usman’s condition?

1.3 Significance of the Study

This study is significant as it seeks to provide a comprehensive understanding of the multifaceted

challenges associated with diabetes management. By closely examining Mallam Usman’s

experiences, the study aims to highlight the importance of personalized treatment approaches

tailored to the unique needs of individual patients. The findings will not only contribute to the

existing body of knowledge on diabetes management but also serve as a valuable resource for

healthcare professionals, patients, and caregivers in improving care practices and patient

outcomes.

1.4 Scope and Limitation of the Study

The study will focus exclusively on the experiences and management strategies of Mallam

Usman over a six-month period. While the scope is limited to a single case, the in-depth nature

of the investigation will provide detailed insights into the challenges and complexities of living

with type 2 diabetes. However, as this is a case study, the findings may not be generalizable to

all individuals with diabetes. Nonetheless, the study aims to extract lessons and

recommendations applicable to similar contexts.

1.5 Description and Location of the Family

Mallam Usman Yusuf resides with his family in the babble community of Jos North Local

Government Area, Plateau State. The family is an extended unit comprising Mallam Usman, his

3
wife, and their five children. The family engages in various economic activities, including

business and skilled trades, which form the basis of their livelihood.

1.6 Family Composition

Table 1.0: The Family Composition.

SN F a m i l y M e m b e r s . S t a t u s . Occupation.

1 M a l l a m u s m a n y u s u f F a t h e r B u s i n e s s

2 H a j i y a H a j a r a Y a k u b M o t h e r B u s i n e s s

3 Y u s u f U s m a n F i r s t c h i l d D i v e r

4 S a l i s U s m a n Second child P l u m b e r

5 Y a k u b U s m a n Third child Fashion Designer

6 S a l e e m a U s m a n Fourth child Fashion designer

7 I s h a q U s m a n Fifth child N i l l

This chapter provides a foundational overview of diabetes and introduces the case study subject,

Mallam Usman Yusuf, whose experiences and management strategies will form the basis of

subsequent chapters. Would you like assistance with the next chapter or further refinements?

4
 CHAPTER TWO

Review of Related Literature

2.0 Pathophysiology of Diabetes

Diabetes mellitus is a multifaceted chronic condition primarily defined by persistent

hyperglycemia due to impairments in insulin production, insulin action, or both. Specifically,

Type 2 diabetes, which is the focus of this study, stems from insulin resistance in the body's

cells combined with a gradual loss of pancreatic beta-cell function. These beta cells, responsible

for producing insulin, fail to meet the body's needs over time. Furthermore, the liver contributes

to the condition by producing excessive glucose, exacerbating the already elevated blood sugar

levels. This intricate pathophysiological process underpins the development and progression of

Type 2 diabetes and its associated complications, necessitating a comprehensive understanding

for effective management.

2.1 Complications of Diabetes

Diabetes leads to numerous complications, which are broadly classified into micro vascular and

macro vascular complications, each affecting different parts of the body.

2.1.1 Micro vascular Complications

Micro vascular complications involve damage to small blood vessels, resulting in:

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  Diabetic Retinopathy: A progressive condition affecting the retina, potentially leading

to vision impairment and blindness if untreated. It is caused by prolonged exposure to

high blood glucose levels damaging the retinal blood vessels.

 Diabetic Nephropathy: A significant cause of kidney failure worldwide, this

complication results from the gradual destruction of the kidney's filtering units

(glomeruli), leading to proteinuria and, eventually, end-stage renal disease.

 Diabetic Neuropathy: This refers to nerve damage caused by chronic hyperglycemia.

Symptoms include numbness, pain, tingling, or weakness, typically affecting the hands

and feet.

2.1.2 Macro vascular Complications

Macro vascular complications involve larger blood vessels, increasing the risk of life-threatening

conditions such as:

 Cardiovascular Disease (CVD): People with diabetes are at a significantly

higher risk of developing heart-related issues, including coronary artery disease,

which can lead to heart attacks.

 Peripheral Arterial Disease (PAD): Characterized by reduced blood flow to the

limbs, PAD can cause pain, ulcers, and, in severe cases, necessitate amputations.

 Stroke: Diabetes increases the risk of cerebrovascular events, such as ischemic or

hemorrhagic strokes, due to vascular damage and hypertension.

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2.2 Current Management Strategies

Managing diabetes effectively requires a holistic approach encompassing lifestyle changes,

medical therapies, and consistent monitoring of blood sugar levels.

2.2.1 Lifestyle Modifications

Lifestyle interventions are fundamental in managing diabetes, focusing on controlling modifiable

risk factors:

 Dietary Management: A well-balanced diet tailored to individual needs forms

the cornerstone of diabetes care. Medical Nutrition Therapy (MNT), carbohydrate

counting, and portion control are essential strategies for maintaining blood sugar

levels within the target range.

 Exercise: Physical activity is critical for enhancing insulin sensitivity. Aerobic

exercises, resistance training, and high-intensity interval training are beneficial in

managing blood glucose levels and promoting overall health.

 Weight Management: Achieving and maintaining a healthy body weight through

diet and exercise significantly reduces insulin resistance and improves glycemic

control.

2.2.2 Pharmacological Interventions

Medications complement lifestyle changes, offering diverse mechanisms to regulate blood

glucose levels effectively:

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  Oral Medications: These include classes such as metformin (which reduces hepatic

glucose production), sulfonylureas (which stimulate insulin secretion), DPP-4 inhibitors

(which enhance incretin activity), and SGLT-2 inhibitors (which promote glucose

excretion through the urine).

 Insulin Therapy: Essential for advanced cases, insulin can be delivered through basal-

bolus regimens, premixed formulations, or continuous subcutaneous infusion via insulin

pumps, ensuring precise blood sugar control.

2.2.3 Glycemic Monitoring and Target Setting

Regular monitoring is vital to evaluate treatment effectiveness and adjust strategies:

 Self-Monitoring of Blood Glucose (SMBG): Using glucometers, patients can track their

blood sugar levels, enabling timely adjustments to diet, activity, or medications.

 Hemoglobin A1C (HbA1c) Testing: This laboratory test provides a three-month average

of blood glucose levels, serving as a benchmark for long-term glycemic management.

 Individualized Glycemic Targets: Recognizing that one size does not fit all, glycemic

targets are personalized based on patient age, comorbidities, and risk of hypoglycemia to

ensure safety and effectiveness.

2.2.4 Gaps in Current Management

Despite advancements in diabetes care, several challenges remain:

1. Lack of Personalization: Treatment plans often fail to address individual patient needs,

including cultural, economic, and psychological factors.

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 2. Adherence Issues: Many patients struggle to maintain lifestyle changes or adhere to

prescribed therapies, undermining long-term outcomes.

3. Inadequate Prevention of Complications: Current strategies need to be more robust to

prevent or effectively manage diabetes-related complications.

2.3 Theoretical Framework

This case study adopts the Self-Care Model of Diabetes Management, which emphasizes the

critical role of patient involvement in achieving optimal outcomes. The framework is built on

three core principles:

 Patient Empowerment: Encouraging individuals to take charge of their diabetes

management through education and active participation.

 Self-Efficacy: Building confidence in the patient's ability to perform necessary tasks,

such as blood glucose monitoring and adherence to dietary plans.

 Collaborative Care: Establishing a partnership between patients, healthcare providers,

and caregivers to create comprehensive and tailored care plans.

By applying this framework, the study aims to understand how self-care practices, supported by

medical interventions and collaborative guidance, influence the overall management and quality

of life for individuals with diabetes, specifically focusing on the experiences of Mallam Usman

Yusuf.

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 CHAPTER THREE

Methodology

3.0 INTRODUCTION

This chapter details the methodology used in the case study, outlining the research design,

participant selection criteria, data collection methods, analytical techniques, and ethical

considerations. A mixed-methods approach was adopted, combining both quantitative and

qualitative methodologies to capture a comprehensive understanding of Mallam Usman Yusuf's

diabetes management journey. This approach integrates measurable health indicators with

personal narratives to provide a holistic perspective.

3.1 Case Study Design

The study employs a mixed-methods case study design, combining numerical data with

qualitative insights to explore the multifaceted challenges and strategies associated with diabetes

management. This design is particularly suited for understanding complex health conditions like

Type 2 diabetes, where clinical outcomes often intertwine with personal and social factors.

3.1.1 Participant Selection

Mallam Usman Yusuf, a 55-year-old man living with Type 2 diabetes, was purposefully

selected as the study participant. The selection criteria ensured the case study focused on an

individual whose experiences could provide meaningful insights into the complexities of

diabetes management. The criteria included:

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  Duration of Condition: Diagnosed with Type 2 diabetes for a minimum of 5 years,

ensuring a substantial period of disease progression and management experience.

 Current Treatment Regimen: Actively undergoing treatment with insulin therapy

and/or oral ant diabetic medications to manage blood glucose levels.

 Management Challenges: Experiencing documented difficulties in maintaining

consistent blood glucose levels, highlighting areas for investigation and potential

improvement.

 Voluntary Participation: Willingness to actively engage in the study by providing

medical data, participating in interviews, and sharing personal experiences.

This targeted selection enabled the study to focus on the real-world challenges faced by

individuals with Type 2 diabetes.

3.2 Data Collection Methods

Data collection was structured to encompass both quantitative and qualitative dimensions,

ensuring a robust and comprehensive understanding of the subject’s condition and management

strategies.

3.2.1 Quantitative Data

Quantitative data were collected to assess objective health metrics and evaluate clinical

outcomes. The following elements were included:

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  Medical History Review: A detailed account of Mallam Usman’s medical history,

including the duration of diabetes, previous complications, and the list of medications

prescribed.

 Blood Glucose Monitoring: Logs of daily blood glucose readings and periodic HbA1c

results were collected to evaluate glycemic control over time and detect patterns of

stability or fluctuation.

 Anthropometric Measurements: Physical health indicators, such as height, weight, and

Body Mass Index (BMI), were recorded to monitor potential complications associated

with obesity and assess overall physical health.

3.2.2 Qualitative Data

Qualitative data collection focused on understanding Mallam Usman’s personal experiences and

behaviors in managing Type 2 diabetes:

 Semi-Structured Interviews: Conducted across 3–4 sessions, these interviews explored

the participant’s perspectives on living with diabetes, challenges encountered, coping

mechanisms, and motivations for adhering to or deviating from management strategies.

 Observational Studies: Observations were made of Mallam Usman’s daily self-care

practices, including glucose monitoring, insulin administration, and adherence to dietary

and exercise regimens. These observations provided practical insights into his day-to-day

management efforts.

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3.3 Method of Data Analysis

Both quantitative and qualitative data were systematically analyzed to ensure a thorough

exploration of the case study objectives.

3.3.1 Quantitative Data Analysis

 Descriptive Statistics: Key health indicators such as blood glucose levels, HbA1c

results, and BMI were analyzed using means, standard deviations, and frequency

distributions to provide a numerical overview of the participant’s health status.

 Trend Analysis: Graphs and charts were used to visually represent changes in blood

glucose levels and other metrics over time, highlighting periods of improvement,

stability, or deterioration.

3.3.2 Qualitative Data Analysis

 Thematic Analysis: Transcripts from semi-structured interviews were reviewed and

coded to identify recurring themes and subthemes related to self-care, emotional

responses, and perceived barriers to effective diabetes management.

 Content Categorization: Observational data were categorized into specific themes, such

as adherence to medication, dietary patterns, and exercise routines, to complement the

themes identified in interviews.

The combination of these analytical methods provided both a numerical evaluation of clinical

outcomes and an in-depth understanding of the participant’s lived experience.

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3.4 Ethical Considerations

Ethical principles were strictly adhered to throughout the study to ensure the rights, safety, and

dignity of the participant. Key ethical considerations included:

 Informed Consent:Mallam Usman provided written informed consent before participation.

The consent process ensured he fully understood the study’s purpose, procedures, potential

benefits, and risks.

 Confidentiality: All data collected were anonymized to protect the participant’s identity.

Data were securely stored and accessed only by authorized researchers.

 Voluntary Participation: The participant had the right to withdraw from the study at any

stage without providing a reason, ensuring autonomy and respect for his decision.

 Non-Maleficence: Care was taken to ensure that the study did not cause any physical,

emotional, or psychological harm to the participant.

Summary

The mixed-methods design employed in this study provided a holistic understanding of Mallam

Usman Yusuf’s experiences with Type 2 diabetes. By integrating quantitative health data with

qualitative insights into his personal journey, the study aims to highlight the complexities of

diabetes management. This approach also identifies potential gaps in care, offering a foundation

for practical recommendations to improve diabetes management strategies.

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 CHAPTER FOUR

Data Analysis, Results, and Conclusion

4.0 INTRODUCTION

This chapter presents a detailed analysis of both quantitative and qualitative data gathered from

the case study, exploring Mallam Usman's experiences with managing Type 2 diabetes and the

results of the interventions implemented over the study period. It provides a comprehensive

review of his health outcomes, identifies the challenges encountered during the management

process, and highlights areas where improvements can be made.

4.1 Quantitative Findings

The quantitative findings provide an objective measure of Mallam Usman's health status and

diabetes management, offering insights into his glycemic control, weight, and other relevant

clinical parameters.

4.1.1 Blood Glucose Levels

 Mean Fasting Blood Glucose:

 Average:195 mg/dL

 Range: 150–220mg/Dl

These results reflect elevated fasting blood glucose levels, which are above the ideal target range

for individuals with Type 2 diabetes, indicating suboptimal control over overnight glucose levels.

 Mean Postprandial Blood Glucose:

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  Average:270 mg/Dl

 Range:200–300mg/dL

Mallam Usman’s postprandial blood glucose readings were consistently high, showing a

significant deviation from the recommended target of <180 mg/dL, which indicates that his

glucose control after meals needs improvement.

4.1.2 HbA1c Results

 Baseline HbA1c:8.8% (reflecting poor long-term glucose control).

 3-Month Follow-Up:8.5% (slight improvement but still above the target).

 6-Month Follow-Up:7.8% (a notable improvement, but still above the recommended

target of <7.0%).

The downward trend in HbA1c levels over the six-month period suggests some improvement in

long-term glucose control, yet the levels still remain higher than the clinical target for good

diabetes management. Continued efforts are needed to achieve and maintain optimal glycemic

control.

4.1.3 Anthropometric Measurements

 Weight:

 Baseline:80 kg

 6-MonthFollow-Up: 75kg

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 This reduction in weight suggests that lifestyle interventions, such as dietary modifications

and increased physical activity, may be having a positive effect on his overall health.

 Body Mass Index (BMI):

 Baseline:35 (Obese)

 6-Month Follow-Up:33 (Obese, but with improvement)

Despite still being classified as obese, the reduction in BMI is a positive

development, indicating progress in addressing weight-related health risks.

However, continued efforts are necessary to achieve a healthier weight.

4.2 Qualitative Findings

The qualitative data, drawn from interviews and observations, reveal the personal experiences,

beliefs, and challenges Mallam Usman faced in managing his diabetes. These insights add depth

to the clinical findings and provide a more holistic view of his diabetes management journey.

4.2.1 Key Themes

1. Challenges with Medication Adherence:

Mallam Usman reported significant difficulty in consistently adhering to his medication

regimen. Issues such as forgetfulness and the complexity of the treatment plan

contributed to missed doses and irregular medication intake.

2. Struggles with Dietary Changes:

Adapting to the dietary changes recommended for diabetes management proved

challenging. Mallam Usman faced difficulties in sticking to meal plans due to emotional

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 eating habits and cultural dietary preferences, making it harder to follow the prescribed

nutrition guidelines.

3. Emotional Burden of Diabetes Management:

Managing diabetes took an emotional toll on Mallam Usman. Feelings of anxiety and

depression were common as he struggled to keep up with the demands of his condition,

which sometimes led to a sense of helplessness and being overwhelmed.

4. Importance of Social Support:

The role of family, friends, and healthcare providers was crucial in Mallam Usman’s

diabetes management. His support network provided encouragement, advice, and

practical help, which were vital in keeping him motivated and engaged with his care plan.

4.2.2 Subthemes

 Medication Adherence:

Issues such as forgetfulness, confusion about medication schedules, and the complexity

of managing multiple medications made it difficult for Mallam Usman to follow his

prescribed regimen consistently.

 Dietary Changes:

Mallam Usman found it hard to adhere to dietary changes due to a mix of personal habits,

cultural influences, and emotional eating triggers. He sometimes found himself reverting

to old eating patterns, which interfered with his diabetes management efforts.

 Emotional Burden:

The constant monitoring of his condition and the perceived pressure to maintain good

control led to emotional stress. Feelings of frustration, sadness, and anxiety were

18
 common, highlighting the need for psychological support in managing chronic illnesses

like diabetes.

 Social Support:

A strong support system, including his family, friends, and healthcare team, helped

Mallam Usman stay focused and encouraged him to continue following his treatment

plan. The role of a supportive community proved to be essential in helping him navigate

the emotional and practical challenges of managing diabetes.

4.3 Case Study Insights

This case study sheds light on the complexities involved in managing Type 2 diabetes,

particularly in individuals who experience multiple barriers to effective self-care. The following

insights were gained from the analysis of both the quantitative and qualitative data:

1. Clinical Indicators:

While Mallam Usman’s blood glucose levels and HbA1c readings have shown some

improvement, the results indicate that there is still significant room for improvement. It is

essential to address factors such as medication adherence, dietary habits, and weight

management to achieve better control over his diabetes.

2. Personal Challenges:

The personal difficulties that Mallam Usman faced, such as the emotional burden of

diabetes management and struggles with medication adherence and dietary changes,

highlight the need for tailored interventions. Addressing these challenges requires a

multifaceted approach that combines medical treatment with psychological support and

behavioral interventions.

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 3. Role of Social Support:

The significant role played by Mallam Usman’s social support network underscores the

importance of a collaborative care approach. This support network, comprising his

family, friends, and healthcare team, provided essential motivation and encouragement,

which positively influenced his diabetes management.

Implications for Diabetes Care:

 Targeted Interventions:

There is a need for more personalized care plans that account for the specific barriers

individuals face, such as medication non-adherence, cultural dietary preferences, and

emotional stress. Tailoring treatment to the unique needs of the patient will likely

improve outcomes.

 Psychosocial Support:

Given the emotional burden associated with chronic conditions like diabetes,

psychological support should be integrated into care plans. This may include counseling

services, support groups, or stress management techniques to address the mental health

challenges associated with managing diabetes.

 Collaborative Care Model:

A team-based approach to diabetes care that includes healthcare providers, family

members, and peer support groups could enhance patient adherence and improve overall

management of the disease.

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Conclusion

This case study provides valuable insights into the experience of living with Type 2 diabetes and

the challenges faced in managing the condition. While Mallam Usman’s clinical outcomes

showed some progress over the six-month period, the qualitative findings reveal significant

barriers to optimal diabetes management, such as medication adherence, dietary changes, and

emotional stress. These barriers emphasize the need for more personalized, holistic approaches

that consider not only the physical aspects of diabetes but also the emotional, psychological, and

social factors. By implementing targeted interventions and enhancing the support system around

individuals with diabetes, healthcare providers can improve both clinical outcomes and the

overall quality of life for patients like Mallam Usman.

Would you like to expand on the recommendations or delve deeper into any aspect of the data

analysis?

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 CHAPTER FIVE

Summary, Recommendations, and Conclusion

5.0 Summary

This study explored the case of Mallam Usman Yusuf, a 55-year-old man with type 2 diabetes,

emphasizing the physical, psychological, and social challenges he faces. Quantitative and

qualitative findings revealed significant gaps in glycemic control and lifestyle adherence, despite

efforts to manage the condition. The results underscore the importance of personalized care,

improved patient education, and robust social support.

5.1 Recommendations

1. Personalized Management Plans: Tailor treatment regimens to align with patients'

unique needs and circumstances.

2. Enhanced Patient Education: Regular workshops on lifestyle modification and

medication adherence.

3. Psychological Support: Include mental health services to address the emotional burden

of living with diabetes.

4. Social Support Systems: Strengthen family and community involvement in diabetes

management.

5. Regular Monitoring: Emphasize the importance of consistent glycemic monitoring and

follow-ups.

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5.2 Conclusion

This case study highlights the intricate challenges of managing type 2 diabetes in a real-life

context. It reinforces the need for holistic approaches that incorporate medical, psychological,

and social dimensions to achieve optimal outcomes. Addressing gaps in current strategies can

significantly enhance the quality of life for individuals living with diabetes, such as Mallam

Usman Yusuf, and contribute to broader improvements in diabetes care practices.

23
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Bergenstal, R. M., & Peterson, L. (2019). Managing type 2 diabetes: Comprehensive guidelines
and treatment options. Journal of Clinical Endocrinology & Metabolism, 104(5), 1482-
1490. https://doi.org/10.1210/jc.2018-02163

International Diabetes Federation. (2023). IDF diabetes atlas (10th ed.). International Diabetes
Federation. https://www.idf.org/our-network/regions-members/africa/members/12-nigeria

Lind, M., &Bursell, S. E. (2019). The role of insulin in type 2 diabetes management: Efficacy
and long-term outcomes. Diabetes & Metabolism, 45(5), 423-432.
https://doi.org/10.1016/j.diabet.2019.03.003

Micha, R., Peñalvo, J. L., Cudhea, F., & Imamura, F. (2017). Association between dietary factors
and mortality from heart disease, stroke, and type 2 diabetes mellitus: A systematic
review and meta-analysis. JAMA, 318(7), 648-660.
https://doi.org/10.1001/jama.2017.10291

World Health Organization. (2016). Global report on diabetes. World Health Organization.
https://www.who.int/diabetes/global-report/en/

Zhang, Y., Li, L., & Wang, J. (2018). Impact of lifestyle interventions on type 2 diabetes
management in adults. Journal of Diabetes Research, 2018, 1-9.
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Micha, R., Peñalvo, J. L., Cudhea, F., & Imamura, F. (2017). Association between dietary factors
and mortality from heart disease, stroke, and type 2 diabetes mellitus: A systematic
review and meta-analysis. JAMA, 318(7), 648-660.
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Müller, G., &Haak, T. (2021). Diabetic neuropathy: Pathogenesis, clinical features, and
management strategies. Diabetologia, 64(4), 701-711. https://doi.org/10.1007/s00125-
021-05425-z

Nolan, J. J., &Dinneen, S. F. (2019). The pathophysiology of type 2 diabetes mellitus: New
insights and approaches to management. Diabetes Research and Clinical Practice, 155,
1068-1077. https://doi.org/10.1016/j.diabres.2019.07.003

World Health Organization. (2016). Global report on diabetes. World Health Organization.
https://www.who.int/diabetes/global-report/en/

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 APPENDICES

Appendix A: Family History of Diabetes

The following table outlines the family history of Mallam Usman Yusuf, focusing on diabetes-

related conditions within his family. This information helps contextualize genetic and lifestyle

factors in his type 2 diabetes diagnosis.

Family Member A G E CONDITION DIAGNOSIS AGE C O M M E N T S

Mallam Usman Yusuf 5 5 Type 2 diabetes 4 5 Diagnosed 10 years ago
HajiyaHajaraYaku b 4 6 No diabetes N / D No diabetes diagnosis
Yusuf Usma n 3 0 No diabetes N / D No diabetes diagnosis
S a l i s U s m a n 2 5 No diabetes N / D No diabetes diagnosis
Yakub Usman 2 0 No diabetes N / D No diabetes diagnosis
Saleema Usman 1 7 No diabetes N / D No diabetes diagnosis
I s h a q U s m a n 1 5 No diabetes N / D No diabetes diagnosis

Source researchers’ field survey 2025

25
Appendix B: Blood Glucose and Insulin Therapy Log

This table tracks Mallam Usman’s blood glucose levels and insulin usage over a 3-month period
to assess the effectiveness of his treatment plan.

D A T E Fasting Blood Glucose (mg/dL) Post-Meal Blood Glucose (mg/dL) Insulin Dosage (Units) Oral Medication s C o m m e n t s
September 1, 2024 1 4 01 8 01 5 Metformin (500mg) Increased blood glucose after meals.
September15, 2024 1 3 01 6 01 8 Metformin (500mg) Insulin dosage increased to 18 units.
October 1, 2024 1 3 51 7 02 0 Metformin (500mg), Glibenclamide (5mg) Blood glucose improving slightly.
October 15, 2024 1 4 51 9 02 2 Metformin (500mg), Glibenclamide (5mg) Blood sugar spikes remain post-meal.
November 1, 2024 1 2 51 6 02 5 Metformin (500mg), Glibenclamide (5mg) Increase in physical activity.
November15, 2024 1 2 01 5 02 5 Metformin (500mg), Glibenclamide (5mg) Continued improvement in glucose control.

Source researchers’ field survey 2025

Appendix C: Lifestyle Modifications and Exercise Log

This log tracks the lifestyle modifications and physical activities that Mallam Usman has

undertaken over the past 6 months as part of his diabetes management plan. It includes exercise

sessions and dietary changes aimed at improving his glycemic control.

Exercise Type Duration Intensity D i e t a r y C h a n g e s C o m m e n t s

Date
November 5, 2024 Walking 30 minutes Moderate Reduced sugar intake, more vegetables Walking three times a week.
November 20, 2024 Jogging 20 minutes H i g h Increased water intake, less processed food Noticeable reduction in appetite.
November 10, 2024 Walking + Jogging 45 minutes Moderate Low-carb diet, small meals throughout the day Lost 2 kg in weight.
November25, 2024 Walking 30 minutes Moderate Focus on whole grains, lean proteins Improved sleep quality.
November10, 2024 Jogging + Cycling 40 minutes H i g h Balanced meals, portion control Increased energy throughout the day.

Source researchers’ field survey 2020

Appendix D: Informed Consent Form

26
This appendix includes the informed consent form signed by Mallam Usman Yusuf, granting
permission for his participation in the case study.

Appendix E: Research Instruments

This appendix includes the research instruments used in the study, such as interview guides or
questionnaires.

Interview Guide for Mallam Usman Yusuf

1. How do you feel about the current management of your diabetes?

2. Have you experienced any challenges in managing your blood sugar levels? If so, what
are they?
3. How has diabetes affected your daily activities and overall quality of life?
4. Can you describe any changes in your diet or physical activity after starting your
treatment plan?
5. What role does your family play in your diabetes management?
6. How do you cope with the psychological aspects of living with diabetes?

Source researchers’ field survey 2Hhhhh

Appendix F: Blood Pressure Monitoring Log

This log tracks Mallam Usman’s blood pressure readings over a 3-month period, as hypertension
is a common comorbidity in individuals with diabetes.

D a t e Morning Blood Pressure (mmHg) Evening Blood Pressure (mmHg) Medication Adjustments C o m m e n t s
November 1, 2024 1 3 5 / 8 5 1 3 0 / 8 0 No changes Blood pressure slightly elevated.
November 15, 2024 1 4 0 / 9 0 1 3 5 / 8 5 Medication increased slightly Monitoring closely.
November 1, 2024 1 3 0 / 8 5 1 2 5 / 8 0 Medication adjusted Blood pressure stabilizing.
November 15, 2024 1 2 5 / 8 0 1 2 0 / 7 5 No changes Blood pressure within normal range.
November 20, 2024 1 2 0 / 8 0 1 1 8 / 7 5 No changes Improved management.

Source researchers’ field survey 2025

This Appendix provides additional context for the case study, illustrating how Mallam Usman’s
lifestyle, treatment plan, and medical monitoring are documented over time.

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