A professor of medicine and consultant physician/endocrinologist at the Lagos State University Teaching Hospital, Dr. Anthonia Ogbera, talks about diabetes mellitus and how to avoid it.
What is diabetes?
Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin to meet its needs.
With a population of over 170 million people, Nigeria is the largest country in Africa and accounts for one sixth of Africa’s population. Diabetes mellitus is on the increase and assuming pandemic proportions. The latest estimates from IDF Diabetes Atlas indicate that 382 million people are living with diabetes mellitus worldwide and that by 2035, this figure will be doubled. The bad news is that much of this increase in numbers will be documented in the developing countries of the world like Nigeria.
Unfortunately, Nigeria, like most developing countries, is experiencing a rapid epidemiological transition with the burden of non-communicable diseases like diabetes mellitus and hypertension poised to overwhelm the healthcare system that is already overburdened by HIV/AIDS, tuberculosis and malaria. Guestimates indicate that currently, about 15 million Nigerians are living with diabetes mellitus as against two million in 1997. The epidemic has grown in parallel with the worldwide rise in obesity and it is fuelled by rapid urbanisation, nutrition transition, and increasingly sedentary lifestyles.
What are the types of diabetes?
There are two main types of this disease; they are type 1 diabetes mellitus which has its onset in childhood and requiring lifelong insulin injections and type 2 diabetes with its onset in adulthood and often requiring glucose lowering drugs (in tablet form) and sometimes insulin injections . Type 2 diabetes mellitus is the commonly occurring type of diabetes mellitus and it accounts for 95 per cent persons of persons living with diabetes mellitus. Apparently, the type 2 diabetes mellitus is a global public health crisis that threatens the economies of all nations, particularly developing countries including Nigeria. Although type 2 diabetes mellitus has its onset in adults usually above 30 years of age, this form is becoming increasingly common in teenagers and the reasons for this scenario include, intake of calorie dense foods, lack of exercise and overweight or obesity.
Is diabetes life-threatening?
All forms of diabetes mellitus become life- threatening if glucose control is poor. These complications may affect virtually every organ in the body and may give rise to stroke, kidney failure, foot ulcers and amputations, blindness, impotence in men and stillbirths in women to mention a few.
How common is diabetes in Nigeria?
Local Research from Nigeria has shown that 15 out of a 100 people admitted into the medical wards have diabetes and that one in six people hospitalised as a result of diabetes would die. Foot ulcers or wound occurs in two in 10 people with diabetes and 40 per cent of people with diabetic foot ulcers will need surgical intervention which most of the time involves amputation of the affected limb. Six out of 10 persons undergoing dialysis developed kidney failure as a result of diabetes. One of the most feared complications of diabetes mellitus is stroke which often results in reduced quality and quantity of life.
A significant area of concern which healthcare professionals often shy away from is that of sexual dysfunction. Local research from Nigeria indicate that a third of all men with diabetes have erectile dysfunction or suffer impotence while one 1 in 10 people women with diabetes have sexual problems. A resultant effect of this is the influx of unlicensed therapies and false claims by charlatans who have a field day making profit from people’s ignorance and problems.
There seems to be some form of stigma attached to people with diabetes.
An understudied aspect of diabetes complication is the psychological impact. There is some degree of societal stigma that stems from having diabetes and there a few documented cases of people committing suicide as a result of the unending frustrations of living with the complications of diabetes.
What efforts are being made to reduce the number of those battling with this health condition?
In a bid to reduce the burden of diabetes mellitus and its complications, there are heightened efforts worldwide to increase awareness and sensitise the public on this all important non-communicable disease. To this end, World Diabetes Day was created by the International Diabetes Federation. This day is all about serving as advocacy and creating awareness on diabetes.
In Nigeria, the Diabetes Association of Nigeria, a non-governmental and non-profit organisation, made up of volunteers and stakeholders is at the forefront of the advocacy for diabetes. Healthy living does not only have the potential to prevent diabetes from occurring but also improve the glucose control in persons with diabetes. Healthy living embraces healthy eating, increased physical activity and doing away with risky behaviours such as smoking and excessive alcohol intake. My pragmatic submission is that healthy living be introduced at primary school level and should also be part of the school curriculum. If children embrace healthy living then chances are high that they will adhere to these habits when they grow up. The danger with allowing children to indulge in unhealthy living just because of their age is that they run the risk of developing diabetes and hypertension. Type 2 diabetes or the adult form of diabetes is becoming increasingly documented in adolescents and this is attributable to same risk factors as it in adults.
What are some of the challenges about awareness on diabetes?
Challenges abound in detecting and managing diabetes mellitus and foremost of these are deeply entrenched erroneous beliefs on DM and poor funding of the health sector. Although we have a health insurance system in Nigeria, it is weak and tottering on its feet. There is a compelling need as never before for all stakeholders to be in collaboration with the government and the private sector to improve on the detection of DM and the dissemination of information on it. Currently, a non-governmental non-profit organisation, Structured Healthcare Initiatives, at the forefront in the fight to reduce the burden of DM, is presently collaborating with the World Diabetes Foundation to execute a project titled “Improving foot care in DM in Lagos State.”
To this end, they have donated foot ulcer risk factors detecting equipment to 20 hospitals in Lagos State. They have also built and still building capacity amongst healthcare professionals while at the same time raising public awareness and offering free screening of DM.
Tell us more about foot ulcers.
The burden of foot ulcers in Nigeria is particularly high. In the early 90s, a research work published by me and some of my colleagues showed that 50 per cent of all persons admitted as a result of foot ulcers had diabetes and six out of 10 would require surgical intervention which may be in the form of amputations. The number of deaths from DM foot ulcers is also high and sometimes, such people suffer psychological trauma from the loss of limbs, societal stigma and loss of or reduced earnings/income. We therefore emphasise that persons with DM should undergo yearly screening for nerve damage and assessment of blood flow to the lower limbs.
What is your advice to Nigerians about DM?
My pragmatic submission is adopting a healthy life style should be entrenched in our collective psyche as this will, to a large extent, ensure a life free from diseases.