1.1 Background to the Study

Diabetes mellitus (DM) is a metabolic disease in which glucose level in the blood is high over extended periods (World Health Organization, 2014). DM results when the pancreas is unable to produce insulin or cell of the body is not responding to insulin produced  (Shoback, 2011). In 2013 alone 4.6 million people died of DM (Aschner, Beck-Nielsen, Bennett, Boulton, & Colagiuri, 2013). Low and middle-income countries of the world is being affected by DM, there are more than 77 % morbidity and 88 % mortality (International Diabetes Federation, 2013). Type 2 diabetes mellitus (T2DM) is the commonest form of DM and it account for 90 % of disease (Aschner et al., 2013).

13.2% is the prevalence rate of DM with registered 4,600 people (International Diabetes Federation, 2014). Estimate of the World Health Organization (WHO) states that DM prevalence among adults in 2014 was 9%, a prediction of at least 350 million people with T2DM by 2030 (WHO, 2015). In accordance with a national survey carried out, the prevalence of diabetes mellitus in Nigeria increased from 2.2% to 5.0% by 2013 estimates of the International Diabetes Federation (IDF). Complications of diabetes are common at the time of presentation in Nigeria: neuropathy 56%, erectile dysfunction 36%, nephropathy 9%, and retinopathy 7% (Chinenye & Ofoegbu, 2013). This is partly because diabetes is a progressive illness with an initial asymptomatic phase associated with on-going tissue damage and decline in pancreatic beta cell mass and function.

Ali, Barke, Bullard, Gregg, and Imperatore, (2012) reported that glycemic control at the suboptimal level likely cost diabetic patients increased care requirement, complications and related health care costs. Improper glycemic control has a link with an increased risk of visual impairment, kidney failure and cardiovascular disease (Balkau, Borch-Johnsen, Colagiuri, Lee, Shaw &Wong, 2011). The possible reasons for poor glycemic control includes poor adherence and awareness, manpower insufficiency, time constraint, lack of appropriate guidelines on diabetic education for health practitioners and diabetic patients (Amade, Gudina, Ram, & Tesfamichael, 2011).

Because of lack of awareness, patients with DM suffer from its complications (Gul, 2010). The way to self-management includes testing the blood glucose, adequate diet, regular examination of the foot and eye, all this have shown to reduce complications from DM (Aschner et al., 2013; Biswas, Ferrari, Islam, Islam, Lechner &Niessen, et al., 2015).Therefore, proper blood glucose control among Diabetes Mellitus patients prevents short and long-term complications and reduce cost and long hospital stay.

The aim of self-management of DM is to ensure that the blood glucose level is at a normal range and to reduce the risk of complications. There are seven self-care behavior people having DM must ensure to keep their glucose level normal: they include eating healthy, physically active, self-monitoring of glucose content, compliance with medication, risk-reduction behaviors, good problem-solving and healthy coping skill (American Association of Diabetes Educators, 2010). This measures are useful for physicians managing diabetic patients and it has impacted positively on glycemic control, complication reductions and improvement in quality of life (American Diabetes Association, 2009). Self-management goals and its implementation are written in collaboration with the diabetic patient and health care professionals, it promotes patient self-management, decrease the prevalence of DM and its complications (Ahola & Groop, 2013).

Haidet, Naik, Rodriguez and Teal (2011), also emphasized the importance of patient education for better outcomes of self-management of diabetes, stated that patient education is necessary because it promote high quality diabetic care. Diabetic education programmes stress the importance of patients comprehending the practical approach to self-manage their disease condition. Knowledge and understanding are important in helping patients towards better self-management of diabetes mellitus.

Education help people having DM initiate good self-management and coping skill. Continuous DM education help people having the disease care for themselves.(American Diabetes Association, 2014).There is good report when intervention is long term, it includes follow-up and patients care is individualized. Intervention which promotes behavioral changes improves clinical outcome (Haidet, Naik, Rodriguez &Teal, 2011).Anderson and Funnell (2013), said that self-management education is a process of facilitating knowledge, skill and ability, is an important component of an effective diabetic management. Self-Management place patients at center of care, empowering patients to make decision that will improve clinical outcome.