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BIAKA UNIVERSITY INSTITUTE OF BUEA

SCHOOL OF HEALTH SCIENCES DEPARTMENT OF NURSING

DIABETES MELLITUS: A PREVENTABLE

SILENT KILLER

By

THELSY XXX XXXX

(HSXXBNXXX)

A seminar paper submitted to the Department of Nursing, School of Health

Sciences of the Biaka University Institute of Buea, in Partial

Fulfilment of the requirements for the award of

Bachelor of Science (BSc) Degree

in Nursing.

JUNE, 2025.
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CERTIFICATION

BIAKA UNIVERSITY INSTITUTE OF BUEA

SCHOOL OF HEALTH SCIENCES DEPARTMENT OF NURSING

This is to certify that the seminar paper entitled ‘‘DIABETES MELLITUS: A

PREVENTABLE SILENT KILLER’’Submitted to the department of nursing, school of

health sciences of the Biaka University Institute of Buea, in partial fulfilment of the

requirements for the award of a degree in Nursing Sciences is a genuine work carried out by

THELSY XXX XXX (HSXXBNXXX).

Course Instructor (1)

MADAM UKUM SUSAN

Signature……………………… Date………………….

Course Instructor (2)

MADAM CHUNG CLEMENTINE

Signature……………………… Date ……………………….

H.O.D

SALLY EKOLI

Signature………………………… Date ……………………

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ACKNOWLEDGEMENTS

My sincere gratitude to the course instructors Mme Ukum Susan and Mme Chung Clementine

for their contribution, collaboration, patients and above all the motivation they gave me

throughout this study.

Big thanks to Biaka University Institute of Buea and the entire administration for giving me

the opportunity to enrol in BUIB and for proving a wonderful and excellent study facilities.

I am extremely grateful to my sponsor XXX XXXXXX XXX for his financial and moral

support.

Special thanks to my class mate for the support they gave me in the successful completion of

this seminar.

I will also use this opportunity to express a deep sense of gratitude to my entire family for

their moral, spiritual and financial support they gave me throughout this study.

And lastly, am grateful to GOD for His guidance and protection, and for giving me the

strength to successfully carry out this work.

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TABLE OF CONTENTS

CERTIFICATION....................................................................................................................i

ACKNOWLEDGEMENTS...................................................................................................iii

SUMMARY...........................................................................................................................iv

LIST OF FIGURES..............................................................................................................vii

LIST OF ABBREVIATIONS AND ACRONYMS................................................................viii

SECTION ONE

INTRODUCTION

1.1Background........................................................................................................................1

1.2 Objectives..........................................................................................................................3

1.2.1 General objective............................................................................................................3

1.2.2 Specific objectives..........................................................................................................3

1.3 Structure of the Paper........................................................................................................4

SECTION TWO

DEFINITION AND TYPES OF DIABETES MELLITUS

2.1 Definition and description of key concepts.......................................................................5

2.2 Type 1 Diabetes.................................................................................................................6

2.3 Type 2 Diabetes.................................................................................................................8

2.4 Gestational Diabetes........................................................................................................10

2.5 Pre-diabetes.....................................................................................................................11
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2.6. Other Type of Diabetes..................................................................................................11

SECTION THREE

PREVENTION OF DIABETES MELLITUS

3.1 Primary prevention..........................................................................................................13

3.2 Secondary prevention......................................................................................................16

3.3 Tertiary prevention..........................................................................................................16

3.4 Pharmacotherapy for Prevention.....................................................................................17

SECTION FOUR

CONCLUSION & RECOMMENDATION

4.1 Conclusion.......................................................................................................................19

4.2 Recommendations...........................................................................................................19

REFERENCES......................................................................................................................21
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LIST OF FIGURES

Figure 1: Signs and Symptoms, Complication and prevention of diabetes Mellitus..............3

Figure 2: Prevention of Diabetes Miletus............................................................................. 14

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LIST OF ABBREVIATIONS AND ACRONYMS

BG Blood Glucose

CVCs Cardiovascular Complications

DM Diabètes Mellites

DN Diabetic Nephropathy

DKA Diabetic Keto- Acidosis

GDM Gestational Diabetes Mellitus

IDDM Insulin-dependent Diabetes Mellitus

IFG Impaired Fasting Glycaemia

IGT Impaired Glucose tolerance

NCD Non-communicable diseases

T1DM Type 1 Diabetes

T2DM Type 2 Diabetes

WHO World Health Organization

β – Cell Beta cells

 1

SECTION ONE

INTRODUCTION

1.1Background

Diabetes mellitus is a global public health problem with serious complication for health and

wellbeing. It is predicted to be the world’s most disabler and killer diseases of the working

age group, and one of the most prevalent non- communicable diseases associated with

increased morbidity and mortality (Roglic, 2024). It is a metabolic disorder of multiple

etiology characterized by sustained hyperglycemia with disturbances of carbohydrate, fat, and

protein homeostasis resulting from defects in insulin secretion, insulin action, or both (WHO,

2023). The defects in insulin secretion are the result of inappropriate functioning of the β cells

of the pancreas while those in insulin action are generally associated with resistance of the

peripheral tissues to insulin. In all cases, the end-result is a defective availability of insulin

(Gholap, 2016).

There are primarily two types of diabetes. Type 1 diabetes is an autoimmune disease in which

the pancreas can no longer produce insulin. As a result, the body cannot control blood sugar

levels. The key characteristics of type 1 diabetes are its onset mostly in young people and the

extremely wide global variation in the incidence of the disease (Kahn, 2021). Type 1 diabetes

appears to be on the increase in almost all populations. In Europe, the incidence of (childhood

onset) type1 diabetes continues to rise but the increase is not necessarily uniform. This pattern

of change suggests that key risk exposures differ over time in different European countries

(Patterson, 2017). Type 2 diabetes (previously called adult onset) is a metabolic disorder in

which the body gradually becomes insensitive to the action of insulin with decreased beta cell

mass and progressive beta cell failure so that blood sugar control is also compromised(Wild,

2018). Overall, the prevalence of type 2 diabetes dominates the total diabetes burden. In
 2

developed countries, most people with diabetes are aged over 60 years, while in developing

countries the disease mainly affects people of working age (40 to 60 years) (Patterson, 2017).

Diabetes mellitus may present characteristic symptoms including, polyuria, polydypsia,

polyphagia, blurry vision, as well as weight loss, and when not treated adequately.

Ketoacidosis or a non-ketotic hyperosmotic state may lead to stupor, coma, and eventually

death. However, in most cases these symptoms are not severe or may even be absent. As a

result, potentially critical hyperglycemia may be present long before the diagnosis is made (Al

Rashed, 2021). In the long-term, the effects of diabetes mellitus include retinopathy and

potential blindness, nephropathy that may lead to renal failure, and/or neuropathy with the

risk of foot ulcers, amputation, and features of autonomic dysfunction including sexual

dysfunction(Kahn, 2011).

According to Kahn (2011), diabetes mellitus influence on all kind of socio-economic

countries but the low-income countries are more influenced. In low and middle-income

countries, the number of diabetic patients in urban areas is 186.2 million while 126.7 million

live in rural areas (Kahn, 2021).In Cameroon, the prevalence of diabetes in adults in urban

areas is currently estimated as 6%-8% with as much as 80% of people living with diabetes

who are currently undiagnosed in the population (Mbakwa, 2018). People tend to use more

high sugar food and do sedentary work with the changing lifestyles, as a result of

globalization and industrialization. With that, Diabetes Mellitus has increased (Kolb and

Mandrup-Poulsen, 2010).

According to Begicet al., (2016), diabetes mellitus has some risk factors including

hyperglycemia, irregular fat profiles, and changes in seditious mediators and clotting. A study

done in India stated that hypertension, overweight; obesity, smoking, tobacco use, alcohol

consumption, genetics and exercise pattern are main risk factors of diabetes mellitus

(Venugopal and Iyer, 2020). Unfortunately, there is no cure for diabetes yet but by controlling
 3

blood sugar levels through a healthy diet, exercise and medication the risk of long-term

diabetes complications can be decreased(WHO, 2016). In order to reduce the prevalence of

diabetes mellitus, at first we should be able to understand the disease condition, its risks

factors and know about its prevention.

Figure 1: Signs and Symptoms, Complication and prevention of diabetes Mellitus

1.2 Objectives

1.2.1 General objective

At the end of this presentation, participants should be able to discuss concepts related to

diabetes mellitus.

1.2.2 Specific objectives

At the end of this presentation, participants should be able to;

1. Define and explain the various types of diabetes mellitus

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2. Enumerate the preventive measures towards diabetes mellitus

1.3 Structure of the Paper

This seminar book is divided in to four sections. Section one covers the background

information, objectives and the structure of the paper. Section two and three covers the review

of the various objectives respectively. Section four entails the conclusion and provides

recommendations. The list of references and appendices follows these chapters.

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SECTION TWO

DEFINITION AND TYPES OF DIABETES MELLITUS

2.1 Definition and description of key concepts

Diabetes mellitus is a global public health problem with serious complication for health and

wellbeing. It is predicted to be the world’s most disabler and killer diseases of the working

age group, and one of the most prevalent non- communicable diseases associated with

increased morbidity and mortality (Roglic, 2024). It is a metabolic disorder of multiple

etiology characterized by sustained hyperglycemia with disturbances of carbohydrate, fat, and

protein homeostasis resulting from defects in insulin secretion, insulin action, or both (WHO,

2023).It can represent an absolute insulin deficiency, impaired release of insulin by the

pancreatic beta cells, inadequate or defective insulin receptors, or the production of inactive

insulin or insulin that is destroyed before it can carry out its action (Kolb and Mandrup-

Poulsen, 2020). Normally a certain amount of glucose circulates in the blood. The major

sources of this glucose are absorption of ingested food in the gastrointestinal (GI) tract and

formation of glucose by the liver from food substances. A person with uncontrolled diabetes

is unable to transport glucose into fat and muscle cells; as a result, the body cells are starved,

and the breakdown of fat and protein is increased (Kahn, 2021).

The cause of diabetes mellitus (DM) is not known, but genetic, autoimmune, viral,

environmental, and socioeconomic factors have all been implicated in the development of the

disease (Gholap, 2016).

Diabetes is a significant risk factor in coronary heart disease and stroke, and it is the leading

cause of blindness and end-stage renal disease, as well as a major contributor to lower

extremity amputations (Patterson, 2017). Diabetic patients also have nerve damage

(neuropathy) that can affect the peripheral nerves, resulting in numbness and pain of the hands

or feet. Because diabetic patients are hyperglycemic, they are at higher risk for infection
 6

because an elevated glucose encourages bacterial growth (Schwarz and Lindstrom, 2019). The

combination of peripheral neuropathies with numbness of the extremities, peripheral vascular

disease leading to poor tissue perfusion, and the risk for infection makes the diabetic patient

prone to feet and leg ulcers (Riddle and Karl, 2022).

The primary goals of treatment for patients with diabetes include controlling blood glucose

levels and preventing acute and long-term complications. Thus, the nurse who cares for

diabetic patients should assist them to develop self-care management skills. With good

education and self-care, patients with diabetes can prevent or delay these complications and

lead full, productive lives (WHO, 2023)

There are several different types of diabetes mellitus; they may differ in cause, clinical course,

and treatment (Gholap, 2016). The major classifications of diabetes are:

 Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)

 Type 2 diabetes (previously referred to as non-insulin-dependent diabetes mellitus)

 Gestational diabetes mellitus

 Diabetes mellitus associated with other conditions or syndromes

The terms “insulin-dependent diabetes” and “non-insulin-dependent diabetes” and their

acronyms (IDDM and NIDDM, respectively) are no longer used because they have resulted in

classification of patients on the basis of the treatment of their diabetes rather than the

underlying etiology. Use of Roman numerals (type I and type II) to distinguish between the

two types has been changed to type 1 and type 2 to reduce confusion (WHO, 2016).

2.2 Type 1 Diabetes

Type 1 diabetes is characterized by an acute onset, usually before age 30. It is characterized

by destruction of the pancreatic beta cells (Gholap, 2016). Type1 diabetes is subdivided into

two types: Type 1A, immune-mediated diabetes, and Type 1B, idiopathic diabetes.
 7

2.3 Type 2 Diabetes

The two main problems related to insulin in type 2 diabetes are insulin resistance and

impaired insulin secretion (Venugopal and Iyer, 2020). Insulin resistance refers to decreased

tissue sensitivity to insulin. Normally, insulin binds to special receptors on cell surfaces and

initiates a series of reactions involved in glucose metabolism. In type 2 diabetes, these

intracellular reactions are diminished, thus rendering insulin less effective at stimulating

glucose uptake by the tissues and at regulating glucose release by the liver(Patterson, 2017).

The exact mechanisms that lead to insulin resistance and impaired insulin secretion in type 2

diabetes are unknown, although genetic factors are thought to play a role. To overcome

insulin resistance and to prevent the build-up of glucose in the blood, increased amounts of

insulin must be secreted to maintain the glucose level at a normal or slightly elevated level.

However, if the beta cells cannot keep up with the increased demand for insulin, the glucose

level rises, and type2 diabetes develops (Schwarz and Lindstrom, 2019).

Despite the impaired insulin secretion that is characteristic of type 2 diabetes, there is enough

insulin present to prevent the breakdown of fat and the accompanying production of ketone

bodies. Therefore, DKA does not typically occur in type 2 diabetes. Uncontrolled type2

diabetes may, however, lead to another acute problem, HHNS (Dandona and Dhindsa, 2020).

Type 2 diabetes occurs most commonly in people older than 30 years who are obese, although

its incidence is increasing in younger adults. Because it is associated with a slow (over years),

progressive glucose intolerance, the onset of type 2 diabetes may go undetected for many

years (Dandona and Dhindsa, 2020). If symptoms are experienced, they are frequently mild

and may include fatigue, irritability, polyuria, polydipsia, skin wounds that heal poorly,

vaginal infections, or blurred vision (if glucose levels are very high). For most patients

(approximately 75%), type 2 diabetes is detected incidentally (e.g., when routine laboratory

tests or ophthalmoscopic examinations are performed) (Kolb and Mandrup-Poulsen, 2020).

 8

One consequence of undetected diabetes is that long-term diabetes complications (e.g., eye

disease, peripheral neuropathy, and peripheral vascular disease) may have developed before

the actual diagnosis of diabetes is made(Dandona and Dhindsa, 2020).

Because insulin resistance is associated with obesity, the primary treatment of type 2 diabetes

is weight loss. Exercise is also important in enhancing the effectiveness of insulin. Oral anti-

diabetic agents may be added if diet and exercise are not successful in controlling blood

glucose levels(WHO, 2016). Insulin may be added to oral agent therapy, or patients may

move to insulin therapy entirely. Some patients require insulin on an ongoing basis, and

others may require insulin on a temporary basis during periods of acute physiologic stress,

such as illness or surgery (WHO, 2023).

2.4 Gestational Diabetes

Gestational diabetes is any degree of glucose intolerance with its onset during pregnancy.

Hyperglycemia develops during pregnancy because of the secretion of placental hormones,

which causes insulin resistance (Kolb and Mandrup-Poulsen, 2020). It most frequently affects

women with a family history of diabetes; with glycosuria; with a history of stillbirth or

spontaneous abortion, fata anomalies in a previous pregnancy, or a previous large- or heavy-

for-date baby; and who are obese, of advanced maternal age, or have had five or more

pregnancies (Kolb and Mandrup-Poulsen, 2020).

All pregnant women should undergo risk assessment for diabetes during their first prenatal

visit. Those with significant risk should undergo plasma glucose testing as soon as feasible. If

they are found not found to have GDM at the initial screening, they should be retested

between 24 and 28 weeks of gestation (WHO, 2023). Women with average risk should be

tested at 24 to 28 weeks of gestation. Diagnosis and careful medical management are essential

because women with GDM are at higher risk for complications of pregnancy, mortality, and
 9

fetal abnormalities. Fetal abnormalities include macrosomia (i.e., large body size),

hypoglycaemia, hypocalcaemia, polycythaemia, and hyperbilirubinemia (Wild, 2018).

Initial management includes dietary modification and blood glucose monitoring. If

hyperglycemia persists, insulin is prescribed. Oral anti-diabetic agents should not be used

during pregnancy. Goals for blood glucose levels during pregnancy are 105 mg/dL (5.8

mmol/L) or less before meals and 120 mg/dL (6.7 mmol/L) or less 2 hours after meals (Kahn,

2021). After delivery of the infant, blood glucose levels in the woman with gestational

diabetes return to normal. However, many women who have had gestational diabetes develop

type 2 diabetes later in life. Therefore, all women who have had gestational diabetes should be

counselled to maintain their ideal body weight and to exercise regularly to reduce their risk

for type 2 diabetes (WHO, 2016).

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SECTION THREE

PREVENTION OF DIABETES MELLITUS

With no cure in sight for diabetes, it is imperative that one makes efforts to prevent diabetes.

While there is not yet conclusive evidence to suggest that type 1 diabetes mellitus can be

prevented, there are ways to prevent type 2 diabetes (Kolb and Mandrup-Poulsen, 2020).

From an epidemiological perspective, prevention of diabetes can be done at various levels

a. Primary prevention of Diabetes- Prevention of onset of diabetes in an individual.

b. Secondary prevention- Prevention of progression of diabetes and prevention of onset

of complications.

c. Tertiary prevention- Prevention of progression of diabetes-related complications and

their prompt management including rehabilitation.

Primordial prevention is promotion of a healthy life-style and is aimed at controlling the risk

factors for development of diabetes, thus preventing the development of diabetes at the

community level. By promoting a healthy-lifestyle and controlling the risk factors, as part of

primordial prevention, we can prevent onset of a number of other lifestyle diseases too, viz.

hypertension, obesity, coronary artery disease, etc (WHO, 2016).

Type 1 diabetes mellitus (T1DM) offers limited scope for prevention in view of an incomplete

understanding of the disease pathogenesis and heterogeneity, and the risk factors are also

largely unknown, besides validated biomarkers for precise staging of the disease are lacking.

Moreover, type 1 diabetes contributes to only 5% of the total diabetes pool. Primary

prevention of T1DM should target the general childhood population with vaccines (viral or

tolerogenic) or by altering microbiota-induced immunoregulation (Kolb and Mandrup-

Poulsen, 2020).
 11

3.1 Primary prevention

Nutrition

In the prospective Nurses’ Health Study conducted in 1941 female nurses followed for 16

years, a series of risk factors related to dietary behaviour, physical activity, weight and

cigarette smoking were identified and targeted, and this was associated with a remarkable

91% reduction in the risk of developing diabetes(Riddle and Karl, 2022). Even with a family

history of diabetes the risk reduction was 88%. In theory, therefore, diabetes can be

prevented, largely by lifestyle changes irrespective of genetic background. Some pioneering

studies showed that this is feasible. In case of over-weight individuals reduction of weight by

restricting calories and increasing exercise is of vital importance. However it has been

observed that it is not necessary to reduce the weight to the level of ideal body weight; but a

reduction of about 5-10% in the body weight gives substantially good results(Riddle and Karl,

2022).

Physical Activity

Physical activity is important both in the prevention as well as the management of diabetes in

all its stages. It is recommended that around 30-40 minutes of aerobic activity like brisk

walking should be encouraged for at least 5 days a week and preferably for all 7 days

(equivalent to 150 minutes/week) (Venugopal and Iyer, 2020). The beneficial effects of

physical activity are manifold viz. improved insulin sensitivity, reduction in overall adiposity

and central obesity, improved glucose tolerance, and increased vitality. It is universally

accepted that sticking to an exercise schedule over the years is difficult. However, a

combination of dietary modification and physical activity is considered the best bet for

prevention of diabetes and for health promotion(Venugopal and Iyer, 2020).

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Lifestyle Interventions

Lifestyle measures which include medical nutrition therapy and physical activity aim to

address the issue of overweight and obesity, improve insulin sensitivity, prevent progression

of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) to overt diabetes and

control inflammation. The Swedish Malmo study was one of the earliest lifestyle intervention

studies for the prevention of type 2 diabetes and was conducted in male subjects aged 47-49

years. Men who participated in the lifestyle intervention had a lower incidence of type 2

diabetes and a greater reversal of glucose intolerance compared to those men who received

usual care. At the end of 12 years, the IGT men who underwent lifestyle intervention had

similar mortality as compared to normal glucose tolerance men, but had less than half the

mortality rate when compared to IGT men who received usual care (Kolb and Mandrup-

Poulsen, 2020).

Although the results of these lifestyle intervention programmes look impressive, but in routine

day-to-day practice, lifestyle management is not easy to execute, as these interventions are

labour intensive, and moreover, the results may not be as replicable as to a research setting,

even in well-funded healthcare systems.

3.2 Secondary prevention

The primary purpose of secondary prevention activities such as screening is to identify

individuals without symptoms who already have the disease, are at high risk of developing

complications related to the primary disease, and where intervention could have a beneficial

effect. Secondary prevention is the key to reducing the risk of costly and disabling diabetic
 13

complications. There is now conclusive evidence that good control of blood glucose levels

can substantially reduce these complications (Schwarz and Lindstrom, 2019).

3.3 Tertiary prevention

Tertiary prevention of diabetes includes every action taken to prevent or delay the

consequences of diabetic complications, such as blindness, foot amputation and adverse

pregnancy outcomes (Patterson, 2017). Strategies for tertiary prevention involve prevention of

the development of complications by strict metabolic control, education and effective

treatment (Schwarz and Lindstrom, 2019). They also involve screening for early stages of

complications, when intervention and treatment are generally more effective. Such screening

for complications aimed at early intervention and treatment has proved successful and may be

even more effective than strategies aimed at preventing the development of complications

(Schwarz and Lindstrom, 2019). As an example, the introduction of laser photocoagulation in

the treatment of retinopathy has led to a dramatic decrease in diabetes-related blindness.

Rehabilitation of persons with diabetic complications is essential since many individuals with

diabetes may develop disabling complications with high associated costs (Schwarz and

Lindstrom, 2019).

3.4 Pharmacotherapy for Prevention

Considerable interest has been focused on the prevention of diabetes with the use of drugs

which are used for the treatment of diabetes as well. For instance, the Diabetes Prevention

Programme Research Group study found a 31% reduction in the incidence of diabetes with

metformin (at 2.8 years) (WHO, 2016). Previously troglitazone was shown to be effective in

controlling blood sugar levels but had to be withdrawn because of serious liver toxicity during

the TRIPOD (TRoglitazone in Prevention of Diabetes) study. In people with obesity, orlistat
 14

(pancreatic lipase inhibitor) has been shown to reduce the risk of diabetes by 37% when

compared with placebo (WHO, 2016).

Figure 2: Prevention of Diabetes Miletus

 15

SECTION FOUR

CONCLUSION AND RECOMMENDATION

4.1 Conclusion

Diabetes has become one of the largest public health problems to date. Decreased physical

activity, over nutrition, and nutrition transitions caused by changes in lifestyle contribute to

the increasing incidence of chronic metabolic diseases as well as deaths related to them. The

shift from undernutrition to over nutrition indicates that chronic diseases of affluence have

become a public health problem; hence, sustainable health-related goals have been developed

for the prevention of these diseases. Environmental factors and the gut micro biota influence

metabolism in the human body. Several studies have proven that lifestyle interventions can

effectively deter the progression of diabetes in individuals with impaired glucose tolerance. If

the window of prevention is shifted back, diabetes may become a fortuitous event.

4.2 Recommendations

1. Exercise and Nutrition counselling in office visits, at-society level, at the level of

school children and college students will go a long way in promoting healthy lifestyle

and preventing diabetes mellitus.

2. The government should take measures to aware the public about diabetes mellitus and

its impact on the economy and the health (as a person and as a whole). As well as

government should aware the public about the-correct managing styles diabetes

mellitus such as self-monitoring and periodic check-up for the disease.

3. All pregnant women should be screened for diabetes during the first antenatal visit by

testing for glycosuria. A positive test is an indication for further assessment by a 75 g

oral glucose tolerance test.

 16

4. During pregnancy, frequent follow-up is needed to ensure that therapy targets are met

without significant hypoglycaemia. Review every two to four weeks is generally

recommended but should be more frequent if required.

5. Intensive education and management of the woman with diabetes should start several

months before conception to ensure strict control during the early weeks of pregnancy.

Pregnancy may have to be deferred until optimal control is achieved. Large, long-term

intervention studies are needed to identify effective strategies for reducing barriers to

diabetes care and improving adherence to treatment and management regimens.

6. Although effective preventive strategies exist for type 2 diabetes, the susceptibility

genes identified so far do not provide predictive abilities strong enough to warrant

genetic screening. Therefore, continued research into genetic screening is needed.

 17

REFERENCES

Alberti, K., George, M. M., Paul Zimmet, and Johnathon Shaw. “International Diabetes Federation: A

consensus on Type 2 diabetes prevention.” Diabetic Medicine, 24.5 (2017): 451-463.

Al Rashed, A., 2021. Pattern of presentation in type 1 diabetic patients at the diabetes center

of a university hospital. Annals of Saudi Medicine, Volume 31, pp. 243-249.

Begic, E., Begic, E., Arnautovic, A., &Masic, I. (2016). Assessment of Risk Factors for

Diabetes Mellitus Type 2. Diabetes, pp. 1–5.

https://doi.org/10.5455/msm.2016.28.187-190

Bi, Y., Wang, T., Xu, M., Xu, Y., Li, M., Lu, J., … Ning, G. (2022). Advanced research on

risk factors of type 2 diabetes. Diabetes/Metabolism Research and Reviews, 28, 32–

39. https://doi.org/10.1002/dmrr.2352

Dandona, P. &Dhindsa, S., 2020. Hypogonadotropichypogonadism in type 2 diabetes and

obesity..Journal of Clinical Endocrinology and Metabolism, Volume 96, pp. 2643-

2651..

Gholap, N., 2016. Type 2 diabetes and cardiovascular disease in South Asians..Prim. Care

Diabetes, Volume 5, p. 45–56..

Kahn, S., 2011. Beta cell failure: causes and consequences..International Journal of Clinical

Practice Supplement, pp. 13-18.

Hu, M., Wan, Y., Yu, L., Yuan, J., Ma, Y., Hou, B., … Shang, L. (2017). Prevalence,

Awareness and Associated Risk Factors of Diabetes among Adults in Xi’an, China.

Scientific Reports, 7(1), 10472. https://doi.org/10.1038/s41598-017-10797-x

Kolb, H. &Mandrup-Poulsen, T., 2010. The global diabetes epidemic as a consequence of

lifestyle-induced low-grade inflammation..Diabetologia, 53(1), p. 10–20..

 18

Patterson, C., 2017. Trends in childhood type 1 diabetes incidence in Europe during 1989-

2008: evidence of non-uniformity over time in rates of increase..Diabetologia, 55(8),

pp. 2142-7.

Ramachandran, A., Ma, R. C. W., &Snehalatha, C. (2010). Diabetes in Asia. Lancet (London,

England), 375(9712), pp408–18. https://doi.org/10.1016/S0140-6736(09)60937-5

Riddle, M. & Karl, D., 2012. Individualizing Targets and Tactics for High-Risk Patients With

Type 2 Diabetes Practical lessons from ACCORD and other cardiovascular

trials..Diabetes Care, 35(10), pp. 2100-2107.

Schwarz, P. & Lindstrom, J., 2019. From evidence to practice-the IMAGE project-new

standards in the prevention of type 2 diabetes..Diabetes Res and ClinPract, Volume

91, pp. 138-140..

Shaikh, Z., Akhund, S., Ali, M., & Khan, M. (2013). Type 2 diabetes, Effects of socio-

demographic factors among patients. Professional Med J, 20(2), 244–249.

Venugopal, S. &Iyer, U. M., 2010. Risk factor analysis and trends of dyslipidemia in type 2

diabetes mellitus subjects of an industrial population..Biomedical Research, 21(4), p.

371–375..

WHO, 2013. Screening for Type 2 Diabetes. Report of a World Health Organization and

International Diabetes Federation meeting.,Geneva: World Health Organization.

WHO, 2016. Global Report on Diabetes, Geneva: World Health Organization.

Wild, S., 2018. Global prevalence of diabetes: estimates for the year 2000 and projections for

2030..Diabetes Care, 27(5), p. 1047–1053.

 19

RADIO ADVERT

The station manager

CRTV Buea.

Dear sir,

RADIO ADVERT

It an honour er to be at your radio station today, I am THELSY xxx xxx, Top Up

Bsc Nursing student of Biaka University Institute of Buea carrying out a seminar
on the theme " DIABETES MELLITUS: A PREVENTABLE SILENT KILLER. ". Please
kindly pass this Announcement over your Radio station.

Seminar theme: DIABETES MELLITUS: A PREVENTABLE SILENT KILLER.

Venue: Muea sub-divisional hospital

Date: Thursday 19th June 2025

Time: 10am to 2pm

Announcement, Announcement, Announcement......

Dear listeners of the national radio station, we are glad to have you all connected today.
Tory dey, news dey, hear fine and share with your neighbours them wey na nurses dem.
A seminar on DIABETES MELLITUS: A PREVENTABLE SILENT KILLER It will be held
at Muea sub-divisional hospital on Thursday 9th June 2025 at exactly 10am.
Free entry, free entry. Come one, come all.
Thank you
 20

BIAKA UNIVERSITY INSTITUTE OF BUEA,

SCHOOL OF HEALTH SCIENCE,

DEPARTMENT OF NURSING,
THELSY XXX XXX,
+237 6 XXX XXXX,
MAY, 31st, 2025.
 21

To Director of the Muea

Sub-Divisional Hospital

Dear sir;

A request to use the conference hall of the Muea Sub-Divisional Hospital for a health
seminar

I hope this message finds you well. I wish to get your permission to use the conference hall of

the Muea Sub-Divisional Hospital to organise a health seminar on the topic ‘‘DIABETES

MELLITUS: A PREVENTABLE SILENT KILLER.’’ Taking place on June 9th 2025. We

promise to keep the hall clean and respect all standards set by the hospital administration.

Yours faithfully,

THELSY XXX XXXXX XXX

 22

THELSY XXXX XXXXXX,

BIAKA UNIVERSITY INSTITUTE OF BUEA,
SCHOOL OF HEALTH SCIENCE,
DEPARTMENT OF NURSING,
XXXXX@yahooo.com,
+237 6XX XXXX,
MAY, 31st, 2025.

To Dr. Ako Simon

Dear Sir,

A Letter of Appeal

With immense pleasure. We would like to inform you that we are holding a seminar on the 9 th

of June 2025 at the Muea Sub-Divisional Hospital. The theme of the seminar titled

‘‘DIABETES MELLITUS: A PREVENTABLE SILENT KILLER.’’ is to create awareness

on the prevention and management of diabetes mellitus.

We assure you that your generous sponsorship will contribute towards the effective reduction

of the occurrence of such conditions in our communities. We are putting effort to make this

seminar a well-attended seminar and also looking forward for your favorable response.

Profound regards

THELSKY xxxx xxxxxx.

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BIAKA UNIVERSITY INSTITUTE OF BUEA,

SCHOOL OF HEALTH SCIENCE,

DEPARTMENT OF NURSING,
THELSY XXX XXX,
+237 6XX XXXX,
MAY, 31st, 2025.

To Mme Ukum Susan, lecturer at

The Biaka University Institute of

Buea

Dear Madame;

A request as a Guest speaker

Warmest greetings!

I hope this message finds you well. I am honoured to invite you to speak at our seminar, an

independently organised event on the topic ‘‘DIABETES MELLITUS: A PREVENTABLE

SILENT KILLER’’ happening in June 9th 2025 at Muea Sub-Divisional Hospital. I am a

huge fan of your work and the way you are impressive at the things you do and we will be so

excited if you join us.

We believe your voice would be a critical addition to the fight against this prevalent condition

adults with devastating effects.

Thank you for reading, and we very much look forward to hearing from you.

Yours faithfully,

THELSY XXX XXXXX XXX.

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BUDGET

VARIABLES PRICE (in FRS CFA)

Guest speakers 100,000

Transportation 50,000

Radio announcement 10,000

Decoration 50,000

Posters 30,000

Coffee and snacks 100,000

Hand-out materials 50,000

Video and photographing 100,000

Miscellaneous 100,000

Telephone calls 30,000

Technical equipment 150,000

Standby generator 100,000

Typing and printing of certificates of participants 50,000

Board markers 8,000

Folders 1,000

Pens 1,000

Total 1, 130,000FRS CFA