AN EVALUATION OF THE PREVALENCE OF URINARY TRACT INFECTIONS AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Diabetes mellitus stands as the most prevalent endocrine disorder of the modern era. Its rising incidence in developing nations has been attributed to a variety of factors, including significant changes in lifestyle (Hu, 2018). Diabetes is broadly categorized into two main types, with Type 2 diabetes mellitus (T2DM) being the more widespread. T2DM is a chronic and progressive metabolic disorder marked by a complex interplay of insulin resistance, impaired insulin secretion, reduced insulin effectiveness, and excessive glucose production (Boyko et al., 2018). Over recent decades, the global incidence of diabetes has increased dramatically, reaching levels that some describe as epidemic. Current statistics indicate that approximately 371 million individuals are affected by the disease worldwide, and projections suggest this number will escalate to 552 million by the year 2030. This upward trend is largely influenced by population ageing, sedentary lifestyles, and a surge in obesity rates (Hu, 2018). Globally, diabetes is ranked among the top ten causes of mortality. Between 1980 and 2016, prevalence rates rose from 4.3% to 9% in men and from 5% to 7.9% in women (NCD-RisC, 2016). As noted by Muller et al. (2018), individuals living with Type 2 diabetes are at greater risk for a wide range of complications, including cardiovascular disease, vision loss due to ocular complications, limb amputations, kidney disorders, and increased susceptibility to infections. Among these, urinary tract infections (UTIs) are the most commonly observed infections in diabetic individuals. Each year, around 150 million people globally are affected by UTIs (Gupta, 2016). A urinary tract infection is an infection caused by microbial invasion of the urinary system. It may affect different sections of the system, including the urethra (urethritis), bladder (cystitis), or kidneys (pyelonephritis) (Fu et al., 2016). Women are particularly susceptible to UTIs due to anatomical factors such as a shorter urethra and its proximity to the anus. Although a localized bladder infection may cause irritation and discomfort, a UTI that ascends to the kidneys can lead to severe health complications. In individuals with Type 2 diabetes, several physiological factors contribute to the heightened risk of UTIs. These include immune suppression, compromised white blood cell function, poor circulation, diabetic neuropathy leading to bladder dysfunction, and glucosuria (Fünfstück, 2017). Symptoms such as dysuria (painful urination) are common and can result from organ damage. Severe infections like pyelonephritis can be fatal. Patients often experience urinary urgency, nocturia, and incontinence, caused by frequent urination to excrete excess glucose (Bennett et al., 2018). The increased UTI susceptibility in women can also be explained by their unique anatomy, such as the shorter length of the urethra and its closeness to the anal region (Nitzan, 2015). Furthermore, UTIs complicate glycemic control in diabetic patients, necessitating increased monitoring and treatment efforts. This not only affects the quality of life but also imposes financial burdens on patients (Gorter, 2019). Numerous studies have reported varying prevalence rates of UTIs among individuals with Type 2 diabetes, pointing to inconsistencies in available data. These variations underscore the need for accurate and comprehensive information to guide preventive and management strategies. Thus, to inform effective interventions and reduce the occurrence of UTIs in diabetic patients, this study seeks to assess the prevalence of urinary tract infections among individuals with Type 2 diabetes mellitus. 1.2 Statement of the Problem As the global prevalence of diabetes rises, so does the incidence of associated complications such as urinary tract infections. While acute kidney injuries from infections, drugs, or nephrotoxins also contribute to this increase, infections remain a leading cause of morbidity and mortality among diabetic patients (Muller et al., 2018). The increased infection risk in diabetic individuals is largely due to immune system impairments, including dysfunctional neutrophil activity, low levels of inflammatory mediators such as prostaglandin E and thromboxane B2, and weakened T-cell mediated immunity (Shah, 2018). Shah (2018) further explains that autonomic neuropathy and glucosuria contribute to microbial colonization of the urinary tract in diabetes patients. Research has consistently shown that individuals with diabetes are more prone to developing asymptomatic bacteriuria and symptomatic UTIs. Among bacterial infections, UTIs are the most common in diabetic populations (Ellenberg, 2018). If left untreated, these infections can escalate into serious complications such as bacteremia, renal abscesses, and renal papillary necrosis, all of which can severely impact patient outcomes. As Ellenberg and Weber (2019) have emphasized, the management of UTIs in diabetic patients is particularly challenging due to their recurrent nature, which increases healthcare costs and financial burdens on patients. Given these clinical and economic implications, it is crucial to conduct focused research on this issue. Therefore, this study aims to assess the prevalence of urinary tract infections among patients with Type 2 diabetes mellitus.  1.3  Objectives of the Study The main purpose of this study is to evaluate the Prevalence of Urinary Tract Infections Among Patients with Type 2 Diabetes Mellitus. Specifically, the study will; i.Determine the prevalence rate of urinary tract infections (UTIs) among patients diagnosed with Type 2 Diabetes Mellitus (T2DM). ii.Investigate the factors contributing to the increased prevalence of UTIs in T2DM patients. iii.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: i.What is the prevalence rate of urinary tract infections (UTIs) among patients diagnosed with Type 2 Diabetes Mellitus (T2DM)? ii.What factors contribute to the increased prevalence of UTIs in patients with T2DM? iii.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. 1.7 Scope of the study    The scope of this study is boarded on the Prevalence of Urinary Tract Infections Among Patients with Type 2 Diabetes Mellitus. 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. 1.8 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.