John was diagnosed diabetic at 40, but instead of focusing on the disease, he ignored it. After all, he didn’t feel sick. But gradually, his health was failing.
Today, John, now 60, is a shadow of his old self. Over the last 20 years, he has watched his body slowly disintegrate. A host of circulatory problems arising from his diabetic condition has cost him his vision, as well as nerve and bony damage to his left foot. Worse still, he is concerned about his heart. He has reason to because more than two thirds of people with diabetes die of stroke and other heart-related problems.
Although John is finally getting treatment, his prospects could have been much better if medical intervention had come much earlier. Diabetes is a chronic disease that quietly consumes the human body, to the extent that you cannot walk, you cannot stand, you cannot function and ultimately you cannot live.
There are millions of people like John in Nigeria. Six million Nigerians have diabetes. About half of this number of persons have their cases diagnosed and even less are under treatment. This makes Nigeria the country with the highest number of diabetic patients in Africa. In fact diabetes is the most common chronic illness that is being managed all over the country.
Diabetes is a chronic disease that occurs when the pancreas is no longer able to produce insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy.
The disease may remain undetected for many years and the diagnosis is often made when a complication appears or a routine blood or urine glucose test is done. It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels. People with type 2 diabetes can often initially manage their condition through exercise and diet. However, over time most people will require oral drugs and or insulin.
In Nigeria, an estimated five million people are suffering from diabetes. If this sounds bad, experts warn that the scenario is likely to get even worse as the number of diabetics is expected to double within the next 20 years, to the extent that 63 percent of undiagnosed and many that are diagnosed are not being correctly controlled. As much as 76 percent of deaths due to diabetes occur in people under the age of 60 in Africa. The bad news continues.
That the cost of diabetes management is prohibitive and gradually increasing is equally worrisome. Already, most patients seen at Federal and state teaching and specialist hospitals are often at the late stage when effective treatment is too late and only palliative measures can be administered.
What is the community doing about diabetes? What is it doing to subsidise some of the drugs for its treatment? What about the availability, and education of the public and at community level?
Just last week, some medical experts expressed concern over the burden of diabetic disorders and the rising cost of its management in the country.
Consultant Physician/Endocrinologist, Obafemi Awolowo University, OAU, Ile Ife, Osun State, Prof. Babatope Kolawole, said the magnitude of diabetes in the country is too alarming to be ignored. He noted that according to statistics, the prevalence of diabetes varies. It is a disease of urbanisation and from previous studies, the highest burden is in Lagos which has a prevalence of over 7 percent per population.
Kolawole blamed urbanisation and lifestyle factors as well as physical exercise as factors driving the epidemic and recommends that reliable preventive measures must target these. “Diabetes is a risk factor for so many other problems, and also contributes a lot to disorders such as kidney disease, blindness and amputation of the foot in Nigeria. It can precipitate emergencies that can lead to death and these are the issues related to poorly treated or untreated diabetes and no effort should be spared in instituting preventive measures at all levels of healthcare delivery in the country.”
On his own, the Chief Medical Director, Lagos State University Teaching Hospital, LASUTH, Prof. Adewale Oke, said most diabetes cases seen at the hospital are in the late stage. “The commonest complications I see involve the blood vessels and the heart. It is a common cause of myocardial infarction and can affect the heart muscles. There can be heart failure, and renal failure. When you are passing too much water without any explanation, you should investigate,” he urged.
Oke, an experienced cardiologist noted that Lagos State is thinking of starting a health insurance scheme to cover diabetes. “It has been read at the state House of Reps. but is yet to be passed, and once that is happening there will be better for management of diabetes especially in the area of drugs for management.”
One of the big worries about diabetes, according to Dr. Dorothy Esangbedo, an experienced paediatrician and renowned endocrinologist, is the increasing burden of diabetes in infants and children. Esangbedo, who is also President, Union of National African Paediatric Societies and Associations, UNAPSA, regretted that even infants and children are not spared the burden of diabetes.
“There is increase in diabetes in children. Taking a situation report today, you will find that diabetes in children is lower in Africa than Europe and the Americas, but in terms of trends over time, the rate of increase is even more in sub-Sahara Africa so much so that they are saying to us that in decades to come, diabetes would be one of the major problems we will be facing.”
The signs and symptoms of diabetes in a child are actually the same as in the adult. The only difference is that the child cannot complain so the mother has to be the one to notice these symptoms, so just like the adult will have problem of excessive passing of water so will the child. “The mother can then notice that the child is passing urine too frequently, and she can also notice that the child is too thirsty and babies tend to present with infections as skin lesions and that is when you see frequent occurrence of skin infections in the child or certain effects of pigmentation of the skin.
This is also a sign that the mother needs to complain about that child. They also tend to be weak, they will not grow, will have weight loss and most importantly, the doctor will want to know if there is family history of diabetes because that is a major pointer that diabetes is possible and tests should be done.”
If there is gestational diabetes, Esangbedo notes that it could affect the child in future and it is an indication that both the mother and the child should be closely watched for diabetes. “In the future, It is usually a good pointer because even though the mother recovers from pregnancy, she should still be closely monitored so that she can quickly put in place the lifestyle strategies that would prevent the onset of the disease.”
With the recent introduction of its brand of insulin, Sanofi, a global healthcare leader, describes this as commitment to improving access and ensuring availability to high-quality, efficacious solutions to improve the management of diabetes for patients. In addition to better support patients in the management of the disease, Sanofi is supporting opening of 12 dedicated diabetes and hypertension clinics in partnership with health authorities. The first clinic was recently inaugurated, at LASUTH.
“We believe in Public-Private partnership, that is why we are standing by the State government to fight NCDs as a whole and diabetes in particular,” said Head of Medical and Regulatory, Sanofi, Dr. Inoussa Fiffen. “By doing so, we believe that the management of diabetes should be decentralised and for the meantime, we need to focus on the rural areas so that the journey of the diabetic is smooth.”