Diabetes, described by the World Health Organisation as an important cause of premature death and disability, is mushrooming in Nigeria, but without the knowledge of many sufferers. A recent claim that over 50 per cent of diabetics do not know their status should be a cause for grave concern for health officials in a country that is serious about maintaining a healthy population. It is also a damning indictment of Nigeria’s health system that has failed to come up with a policy of early detection and treatment of deadly diseases generally.
For a disease like diabetes, medical experts believe that prevention is always the best option, since it is one of those conditions deemed to be without a cure. But when diabetes occurs, it is even better to be aware so that the right steps can be taken to provide the care needed to make the patient live longer and free of the various complications associated with it.
This is why Alkali Mohammed, the Chief Medical Director of the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, speaking at a workshop in Lagos recently on the challenges of living with diabetes, advocated a policy of early detection and management of the condition. He said, “Diabetes mellitus-related foot disease is responsible for up to 80 per cent of foot and limb amputations that did not occur as a result of traumatic events like accidents in Nigeria.” (The foot disease is one of the complications associated with diabetes.)
This is just an aspect of the alarming statistics that come with diabetes, whether in Nigeria or globally. According to WHO, which was able to produce its first “Global Report on Diabetes” last year, there were 422 million diabetics all over the world as of 2016, up from 108 million recorded in 1980. This is an obvious indication of the alarming rate of increase in diabetic cases. In Nigeria, the figure comes down to 1.7 million people, undoubtedly the highest prevalence in Africa.
In its awareness campaign last year, the Nigerian Medical Association stated that the disease claimed about 40,000 lives in 2015 alone. These were lives that could have been saved if a series of cost-effective interventions necessary for the management of the disease had been adopted. Such interventions, as a matter of necessity, are expected from both the government and individuals, especially at the lifestyle level.
Diabetes is defined by WHO as a chronic disease that occurs when the pancreas does not produce enough insulin to regulate the blood sugar (or glucose) in the body or when the insulin produced cannot be effectively utilised. As the hormone that regulates sugar level in the blood and helps cells to take in the glucose converted to energy, when insulin fails to perform its functions, the excess sugar that is not absorbed builds up in the blood, creating some harmful effects in the body.
Of the two main types of diabetes, the Type 2, which constitutes about 90 per cent of all cases, is by far the most prevalent. While Type 1 whose causes are not quite known requires those living with it to be on a daily insulin administration for survival, Type 2 is typically as a result of excess body weight and lack of adequate physical activity. Although only limited to adults at a time, Type 2 diabetes is increasingly being noticed among children. A third type known as Gestational diabetes is a temporary condition associated with pregnancy but carries long-time risk of Type 2 diabetes.
Symptoms of the disease, according to the American Diabetes Association, include frequent urination, feeling very thirsty, feeling very hungry despite eating well, blurry vision and extreme fatigue. Others include weight loss, even when one is eating more, and tingling pain and numbness in the hands and feet. But in many cases, the symptoms could be so mild that they escape detection.
Although recent figures are not readily available, it is estimated that 1.5 million people died of diabetes globally in 2012. WHO says that “higher-than optimal blood glucose caused an additional 2.2 million deaths,” bringing the total to 3.7 million. More than 40 per cent of the deaths, according to the global health agency, occurred prematurely, before the age of 70. It is said to be one of the four main non-communicable diseases — that kill 16 million people annually — taking the attention of the global agency. This was why WHO made diabetes the focus of last year’s celebration of the World Health Day.
If not properly managed, diabetes can result in complications such as heart attack, stroke, kidney failure, nerve damage, vision loss and leg amputation. Diabetes also has a cost burden on both the individual and the society. The Lancet, a leading medical journal for global health, described the cost of managing diabetes as “catastrophic medical expenditure.” The WHO Global Report says “it has been estimated that the direct annual cost of diabetes to the world is more than $827 billion.”
The government owes it to Nigerians to create awareness as well as provide the necessary health facilities for the early detection and management of the disease, in line with its commitment to the United Nations Sustainable Development Goals to reduce NCD premature deaths by one-third by 2030. In this case, the detection of a disease such as diabetes can be inculcated in the primary health care, if properly strengthened, so that only referral cases can go to the secondary and tertiary levels.
Care should also be taken to ensure that citizens cultivate healthy eating habits. Since overweight and obesity have been implicated in a substantial proportion of global diabetes, there should be a high level of campaign for Nigerians to live a more physically active life and to ensure regular and periodic examinations at the hospitals. These habits will not only reduce the prevalence of diabetes, they will delay the onset of its complications.
