Open Journal of Pathology, 2013, 3, 139-143
Published Online October 2013 (http://www.scirp.org/journal/ojpathology)
http://dx.doi.org/10.4236/ojpathology.2013.34026
Copyright © 2013 SciRes. OJPathology
139
Socio-Economic Status and Hemoglobin Concentration of
Type 2 Diabetes Mellitus Patients Attending Diabetic
Clinic in Benin City, Nigeria
Alfred Friday Ehiaghe1,2,3, Joy Imuetinyan Ehiaghe2,3, Ositadinma Martin Ifeanyichukwu3,
Ikusemoro Augustina Isioma1, Justus A. Ize-Iyamu4, Lily O. Ize-Iyamu4
1Department of Hematology, College of Health Sciences, Igbinedion University, Okada, Nigeria; 2Lahor Research and Medical Cen-
tre, Benin City, Nigeria; 3Department of Medical Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria; 4Pathology De-
partment, Central Hospital, Benin City, Nigeria.
Email: fredleo2547@yahoo.com, Ehiaghejoy@yahoo.com, ositadinma@yahoo.com, isiotyn@yahoo.com,
justize4ever09@yahoo.com, lijiggs@gmail.com
Received July 13th, 2013; revised August 13th, 2013; accepted August 31st, 2013
Copyright © 2013 Alfred Friday Ehiaghe et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
The aim of this study is to determine the Socio Economic Status and Red Blood Cell Hemoglobin concentration altera-
tion in type 2 Diabetes mellitus patients attending Diabetic Clinic in Benin City, Nigeria. The sample population con-
sists of 142 subjects, 71 of patients were known in Type 2 Diabetes mellitus already on drugs and were confirmed to be
Diabetic using Glucose oxidase method while the other 71 subjects were age matched apparently healthy control subject
on routine check up, they were confirmed to be non Diabetic using the Glucose oxidase method. Hemoglobin concen-
trations were done using the Cyanmethemoglobin method. Those under the low income Socio-Economic status had the
highest incidence of type 2 Diabetes mellitus (49%) of the Diabetic population, closely followed by the middle income
Socio-Economic status (35%) of the Diabetic populations. The Mean ± S.D of Hemoglobin concentration of control
subjects against Mean ± S.D of Hemoglobin concentration of the various Socio-Economic status of Males and Fe-
males type 2 Diabetes mellitus patient show a statistically significant decrease (P < 0.05). Type 2 Diabetes mellitus is
associated with Anemia irrespective of Socio-Economic status. Prevention of the Global Diabetes epidemic must in-
clude regular national surveys, introduction of Diabetes health education in schools, emphasis on balance diet, regular
exercise and abstention from tobacco smoking.
Keywords: Anemia; Hemoglobin Concentration; Ascaris Lumbricoides; Hookworm; Cyanmethaemoglobin Method
1. Introduction
The prevalence of type 2 Diabetes mellitus has been rap-
idly rising worldwide. It is caused by either deficiency of
insulin secretion or reduction in the biology effectiveness
of insulin [1]. The International Diabetes Federation
(IDF) estimated in 2011 that 366 million adults, aged 20
- 79 years, of the world’s 7 billion population have Dia-
betes mellitus. This gives a comparative prevalence of
8.5%. Since more than 90% of the global cases of Diabe-
tes are type 2, it is evident that the epidemic is mainly
due to the escalation of causes of type 2 Diabetes melli-
tus [2-6]. Significant socio-economic gradients have been
shown in the prevalence of several cardiovascular disease
risk factors, including diabetes mellitus. Diabetes may be
up to two times more prevalent in low income population.
According to the current definition, two fasting glucose
measurement above 126 mg/dl [7.0 mmol/l) is consid-
ered diagnostic for Diabetes mellitus or Glycated hemo-
globin [HbA1C) above 6.5% [7,8]. Nigeria with less than
5% health insurance presents a difficult picture for its 3.1
million people with Diabetes, the highest in Africa [9,10].
The country has a population of about 150 million, of
which 76 million are adults. Diabetes related death in
Nigeria in 2011 accounted for 63,340 people [11]. The
classical symptoms of Diabetes are polydipsia, polyuria
and weight loss, and the causes of most type of diabetes
are multi-fictional environmental, lifestyle and genetic
factors are involved [2,3,12].
Anemia is relatively common in patients with Diabetes
mellitus, it contributes to many clinical aspects of Dia-
betes mellitus including cardiovascular mortality and
chronic kidney disease [13]. Anemia is defined by the
Socio-Economic Status and Hemoglobin Concentration of Type 2 Diabetes
Mellitus Patients Attending Diabetic Clinic in Benin City, Nigeria
140
World Health Organization as a hemoglobin concentra-
tion below the following threshold, children (5 - 12 years)
<11.5 g/dl, teens (12 - 15 years) <12.0 g/dl, Women (>15
years) <12.0 g/dl and Men (>15 years) <13 g/dl.
Generally, Anemia in chronic disease like Diabetes
mellitus and Tuberculosis are normocytic normochro-
matic type, although in a few cases, microcytosis and hy-
pochromia also occur [14].
This study was conducted to determine the Socio Eco-
nomic status and Red blood cell hemoglobin concentra-
tion alteration in type 2 Diabetes mellitus patients at-
tending a Diabetic clinic in Benin City, Nigeria.
2. Materials and Methods
2.1. Study Design
A cross sectional laboratory based, analytical survey was
adopted for this research.
2.2. Study Area
This study was carried out in Benin City, Edo State, Ni-
geria. The two Hospital used were Orobosa Medical
Centre and Lahor Medical Centre in Benin City.
2.3. Sample Size Determination
The sample size were determined using the formula [15].
N = Z2 × P (1 P)/d2.
d = desired level of significance (0.05).
Z = Confidence internal (1.96).
P = prevalence rate (4.9%) [11].
Using this formula, the minimum number of sample
will be 71 subjects.
2.4. Subjects
The sample population consists of 142 subjects. 71 of pa-
tient were known Type 2 Diabetes mellitus already on drugs
and were confirmed to be Diabetic using glucose oxidase
method [16]. While the other 71 were age matched appar-
ently healthy control subject on routine checkup, they
were confirmed to be non diabetic using the glucose oxi-
dase method. Approval and patient consent was obtained
from the two centers. Those that have access to better die-
tary habits, health conditions, improved education and in-
come were classified as high Socio-Economic status, while
the middle and low socio-economic status were classified
with the absence of one or more criteria as listed above.
2.5. Inclusion Criteria
Both males and females were included in this study.
2.6. Exclusion Criteria
Subjects diagnosed with other systemic diseases will be
excluded from this study.
2.7. Collection of Blood Samples
10 ml of venous blood was collected from the medial
cubital vein using vacutainer and needle from each of the
subjects and shared equally into an Ethylene Diamine
tetra acetic acid (EDTA) container and Sodium Fluoride-
Potassium Oxalate container.
2.8. Blood Sample Processing
Sample Preparation and test performance for Hemoglo-
bin concentrations were done using the Cyanmethemo-
globin method described by [17]. 20 μl of blood was di-
luted in a 5 ml buffered solution of potassium Cyanide to
yield the stable hemoglobin derivative cyanmethemoglo-
bin. The potassium ferricyanide converts the Hemoglobin
to methemoglobin by the action of potassium cyanide.
This must be allowed to stand for at least three minutes,
to allow for complete conversion of Hemoglobin to cyan-
methemoglobin, before the absorbance is measured against
a Reagents blank at a wavelength of 540 mm using a
spectrophotometer.
2.9. Blood Glucose Determination
2.9.1. Reagent C ompositi on
R1a (Buffer)
Phosphate Buffer 0.1 mol/l, pH 7.0
Phenol 11 mmol/l
R1b (GOD-PAP Reagent)
4 aminophenazone 0.77 mmol/l
Glucose Oxidase >1.5 kU/l
Peroxidase >1.5 kU/l
Preparation of working Reagent (Reagent 1).
Reconstitute the content of one vial of reagent R1b
with the entire portion of Buffer R1a. The working re-
agent is stable for 3 months at +2˚C to +8˚C.
2.9.2. Proce dure (Semi Micro Met ho d )
10 μl of the standard or test sample was added to 1000 μl
of Reagent 1, mixed and incubated for 25 minutes at
15˚C - 20˚C. The absorbance of the standard and the
sample was measured against the Reagent blank within
60 minutes at a wavelength of 540 mm using a Spectro-
photometer.
2.9.3. Study Dura ti on
Sample collection and processing was from March 2010
to June 2010.
3. Limitation of the Study
Subject compliance to Blood samples collection was the
limitation to this study.
Copyright © 2013 SciRes. OJPathology
Socio-Economic Status and Hemoglobin Concentration of Type 2 Diabetes
Mellitus Patients Attending Diabetic Clinic in Benin City, Nigeria
141
3.1. Data Collection
Data was collected using self administered semi structure
questionnaire.
3.2. Statistical Analysis
All numerical results were collated from the four groups.
Data were presented as Mean ± Standard Deviation (S.D)
and analyzed using one way analysis of variance
(ANOVA). Using SPSS version 18.0 P values < 0.05
were considered significant.
4. Results
Of the 142 subject enlisted for the study, 80 (56%) were
Males and 62 (44%) were Females. The age group that
has the highest number of type 2 Diabetes mellitus was
41 - 50 (64% of Males and 36% of the Females). Closely
followed by 31 - 40 (50% of the Males and 50% of the
Females), Table 1.
Those under the low income Socio-Economic status
had the highest incidence of type 2 Diabetes mellitus
(49%) of the Diabetic population, closely followed by the
middle income Socio-Economic status (35%) of the
Diabetic populations, Tables 2 and 3.
Table 4 shows the Mean ± S.D of Blood Glucose level
of control subjects against Mean ± S.D of Blood Glucose
level of the various Socio-Economic statuses of males
and female control patient, showing a statistically sig-
nificant increase (P < 0.05).
Table 5 shows the Mean ± S.D of Hemoglobin con-
centration of control subjects against Mean ± S.D of
Hemoglobin concentration of the various Socio-Eco-
nomic statuses of males and female type 2 Diabetic mel-
litus patient, showing a statistically significant decrease
(P < 0.05).
5. Discussion
Our study revealed that age group that had the highest
number of type 2 Diabetes mellitus was 41% - 51% of
Table 1. Age, sex and type 2 diabetes mellitus (Dm) distri-
bution.
Age
range
(yrs) Subjects Males FemalesType 2
Dm
Type 2
Dm male
(%)
Type 2
Dm Female
(%)
15 - 20 10 6 4 5 3 (60) 2 (40)
21 - 30 32 15 17 11 5 (45) 6 (55)
31 - 40 30 16 14 8 4 (50) 4 (50)
41 - 50 40 25 15 28 18 (64) 10 (36)
>50 30 18 12 19 10 (53) 9 (47)
Total 142 80 (56) 62 (44)71 40 (56) 31 (44)
Table 2. Shows socio-economic status of type 2 Diabetes
mellitus subjects.
Socio-economic status Diabetes mellitus population (%)
PHigh income status 11 (16)
QMiddle income status 15 (21)
RLow income status 45 (63)
Total 71
Table 3. Shows socio-economic status of control subjects.
Socio-economic status Control subject (%)
PHigh income status 15 (21)
QMiddle income status 20 (28)
RLow income status 36 (51)
Total 71
the Males and 36% of the Females, Closely followed by
31 - 40 (50% of the Males and 50% of the Females), Ta-
ble 1. These may be due to that type 2 Diabetes mellitus
is common among the age bracket. These have been re-
ported by these Authors. The International Diabetes Fed-
eration (IDF) estimated in 2011 that 366 million adult’s
age 20 - 79 years, of the world’s 7 billion population
have Diabetes mellitus. This gives a comparative preva-
lence of 8.5%. Since more than 90% of the global cases
of diabetes are type 2, it is evident that the epidemic is
mainly due to the escalation of the cases of type 2 Dia-
betes mellitus and up to 50% of cases of Gestational dia-
betes may end up as type 2 diabetes [2-6].
Those under the low and middle socio-economic status
that the highest incidence of type 2 Diabetes mellitus,
49% and 35% respectively, Table 2. This group of sub-
jects falls under the low income earner. Majority of them
may be poor and under nourished. This is in line with
these findings. Diabetes mellitus has been linked to Tu-
berculosis, HIV/AIDS, Malaria, Poverty, Malnutrition,
Cancer, Chronic respiratory diseases and cardiovascular
disease. It is very significant that the UN has accorded
Diabetes mellitus a right of place as a global jeopardy
and chronic killer [18,19].
Table 5, revealed that irrespective of Socio-Economic
status, type 2 Diabetes mellitus is associated with a low
Hemoglobin concentration (P < 0.05). A decrease in
Hemoglobin concentration may be due to the increase in
cytokine production occasioned by increased Suscepti-
bility to infection, decrease Erythropoietin (Epo) produc-
tion associated with increase susceptibility of the kidney
to nephropathy seen in type 2 Diabetes mellitus subject
and increased generation of free radical occasioned by
the Hyperglycemia present in type 2 Diabetes mellitus
Copyright © 2013 SciRes. OJPathology
Socio-Economic Status and Hemoglobin Concentration of Type 2 Diabetes
Mellitus Patients Attending Diabetic Clinic in Benin City, Nigeria
Copyright © 2013 SciRes. OJPathology
142
Table 4. Shows the mean ± S.D of blood glucose level of control subjects against various socio-economic status (P, Q and R) of
patients with type 2 diabetes mellitus.
Socio-economic status
Subjects Controls P Q R
(Mean ± S.D)
(g/dl)
n = 71
(Mean ± S.D)
(g/dl)
n = 11
(Mean ± S.D)
(g/dl)
n = 15
(Mean ± S.D)
(g/dl)
n = 45
Males 83 ± 0.03 129 ± 0.02x 128 ± 0.05x 129 ± 0.03x
Females 80 ± 0.04 130 ± 0.03x 132 ± 0.03x 142 ± 0.02x
P = High income status, Q = Middle income status. R = Low income status. All numerical result was collated from the four groups. Data is presented as. Mean
± Standard Deviation (S.D) and analyzed using one way analysis of variance (ANOVA). Using SPSS version 18.0 P values < 0.05 were considered significant.
(x = P < 0.05).
Table 5. Shows the mean ± S.D of hemoglobin concentration of control subjects against various socio-economic status (P, Q
and R) of patients with type 2 diabetes me llitus.
Socio-economic status
Subjects Controls P Q R
(Mean ± S.D)
(g/dl)
n = 71
(Mean ± S.D)
(g/dl)
n = 11
(Mean ± S.D)
(g/dl)
n = 15
(Mean ± S.D)
(g/dl)
n = 45
Males 15 ± 0.04 9.5 ± 0.02x 9.3 ± 0.01x 9.1 ± 0.02x
Females 14 ± 0.01 8.5 ± 0.01x 8.3 ± 0.01x 8.0 ± 0.02x
All numerical result was collated from the four groups. Data is presented as mean ± standard deviation (S.D) and analyzed using one way analysis of variance
(ANOVA). Using SPSS version 18.0 P values < 0.05 were considered significant (x = P < 0.05).
patient. This is in accordance with these findings. Ane-
mia is relatively common in patients with type 2 Diabetes
mellitus and the low hemoglobin concentration contrib-
ute to many clinical complication of Diabetes mellitus
and is associated with a more rapid decline in Glomerular
filtration [20]. Diabetic nephropathy and diabetic reti-
nopathy result in increased susceptibility to low hemo-
globin level [21]. A low hemoglobin level is associated
with cardiovascular mortality and chronic kidney disease
(CKD) in patients with Diabetes mellitus [22]. One of the
most potent causes of suboptimal response to Epo is
chronic and overt inflammation associated with an in-
creased production of cytokines, such as tumor necrosis
factor alpha, interleukin one and interferon gamma which
might suppress erythrocyte stem cell proliferation [23-26].
Early Epo deficiency occurs in both type 1 and type 2
Diabetics, although, the prevalence is higher in type 2
diabetes mellitus [27]. The onset of anemia in patients
with Diabetes mellitus is caused by severe symptomatic
autonomic neuropathy causing efferent sympathetic den-
ervation of the Kidney and loss of appropriate erythro-
poietin (Epo) production due to damage to the renal in-
terstitial. It has been shown that a Normochromic, Nor-
mocytic anemia can occur before evidence of renal im-
pairment [28,29].
6. Conclusion
Type 2 Diabetes mellitus is associated with anemia irre-
spective of socio-Economic status. Prevention of the
global Diabetes epidemic must include regular national
surveys, introduction of Diabetes health education in
schools, emphasis on balance diet, regular exercise and
abstention from tobacco smoking. This should be ac-
companied by regular Blood pressure check, Serum lip-
ids and Renal function test monitoring.
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