By Sola Ogundipe
The growing number of people living with diabetes mellitus in Nigeria is worrisome and an explosion in the number of diabetic patients may be imminent if urgent measures are not taken to address the trend.
The World Health Organisation, WHO, estimates for Nigeria, show that 4 million Nigerians are diabetic, and nearly 4 – 11 per cent of the population lives with diabetes.
Experts say it is getting commoner worldwide with the number of affected people rising yearly with projections showing that Africa and Nigeria in particular, is likely to experience the highest increase in the near future. The International Diabetes Federation estimates that by 2040, the global prevalence of diabetes is likely to affect 10 per cent of humanity.
Currently, diabetes care is poorly coordinated, especially at the primary and secondary public health care centres.
Many Nigerians are living with undetected diabetes and even for those that have been diagnosed, just a fraction is receiving proper care and treatment.
A recent study showed that pooled prevalence of diabetes mellitus in the six geopolitical zones were 3.0 percent in the northwest, 5.9 per cent in the northeast, 3.8 percent in the north-central zone, 5.5 percent in the southwest, 4.6 percent, in the south-east, and 9.8 percent in south-south zone.
Findings by Good Health Weekly reveal diabetes screening programmes are few across the States and have limited impact.
The steady increase of diabetic foot, a major complication of diabetes mellitus is equally worrisome.
Many people living with diabetes lack basic knowledge and information about diabetes foot care even as reliable support for diabetic foot care programmes are largely unavailable, leading to poor outcomes for the patient.
Nigeria is currently the most affected country in Africa. It is estimated that over four million Nigerians are living with either the type 1 or type 2 diabetes and findings show that more than 50 per cent the persons with diabetes in the country are unaware that they have the disease.
More than 1 in 3 people with diabetes will develop”a complication of the eyes known as diabetic retinopathy. There is also high prevalence of complications such as diabetic foot among diabetics who risk suffering nerve damage and end up losing their limbs from amputation.
Findings by Good Health Weekly show that patients with diabetes are 25 times more likely to have amputations than people without diabetes.
The amputations, unfortunately often do not only result in the loss of the limb but in the loss of life of the patient. Worse still, treatment for diabetic foot complications is the most expensive part of diabetes care even though there is no guarantee that the leg or the life of the patient will be saved.
“Diabetic foot is one of the commonest reasons for prolonged hospitalisation in tertiary hospitals. The patient suffers nerve damage to the affected limb even as the tissues develop ulcers, infection sets in and it begins to decay (gangrene),.
With the majority of patients financing their medical bills out of pocket, several diabetic patients fail to adhere to their medications and tests. Only 1 in 5 of the patients perform self–blood glucose monitoring among other tests. Several patients even resort to traditional treatment and complementary alternative medicine options.
Today, many Nigerians have become victims of foot amputation, stroke, blindness, kidney failure, heart attack, among other serious conditions, all linked to diabetes.
Already, the rate of amputation among Nigerians living with diabetes is as high as 53.2 per cent of the number of people with foot ulcers in some centres across the country, making diabetic foot the most common cause of non-traumatic amputation in the lower extremities in the country.
“Diabetes places an extra burden on the individuals and families affected, especially for the majority of patients unable to access quality health care,” said Prof Femi Fasanmade. an endocrinologist at the Lagos University Teaching Hospital, LUTH.
Many patients report late to the health care centre when they have developed advanced disease making treatment and care difficult.
A Consultant Endocrinologist and diabetes expert, Dr Afoke Isiavwe, who is the Medical Director of Rainbow Specialist Medical Centre, Lagos, said diabetes is not getting the attention it deserves even as she decried the current situation whereby a lot of Nigerians are living with undetected diabetes.
“Diabetes is not getting the attention it deserves. There is a bigger problem coming in the near future and if we don’t get the right attention now, people will continue to die.
“We need to address the situation urgently. It is affecting the poor, the rich, the young and the old. What we need to do is set up centres that offer free screening and care for diabetes,” she argued.
An examination of the diabetes burden within sub-Sahara Africa showed that the region has the highest potential by an estimated 156 per cent increase by 2045.
“By 2040, 642 million will be diabetic. Diabetes kills more than HIV, TB and malaria combined and this is made worse by the fact that there are no dedicated diabetes centre in Nigeria. Worse still, mortality rate following diabetic foot amputation is higher than for breast cancer.
Among the main reasons for the expected rise are ageing population, increasing urbanization, (sedentary lifestyle) reducing physical activity and increasing obesity.
Noting that it is long overdue for the all States of the Federation to have dedicated diabetes Centres, Isiavwe said there are currently 16 million persons affected by diabetes but the figure will rise in coming years.
“There is a very urgent need for all hands and voices involved in the diabetes circle – persons living with diabetes, advocacy groups and associations, diabetes care providers, Diabetes Health Care Trainers, policymakers, etc., to be united to birth the right atmosphere for both primary and secondary prevention of diabetes mellitus in Nigeria.
In her research on diabetes foot in Nigeria, Prof Anthonia Ogbera, an Endocrinologist and Consultant at the Lagos State University Teaching Hospital documented the financial burden of diabetic foot problem in the country.
The research published in 2005 showed that the direct costs of treating the diabetic foot ulcer were about 1000 Euros (N400,000), whereas the average monthly wage was about 46 Euros (N18,000).
Findings reveal that today, even the proposed average monthly wage of N30,000 would be inadequate.
“The accompanying social, emotional, and psychological implications of diabetes foot ulcers and amputations are severe, with high mortality rates. A foot care programme including education about foot care should be directed at patients and also at health-care providers.
“All health professionals should have the knowledge and skills to help individuals and families manage diabetes. It is important that every clinic is set up to provide appropriate care and to know when to refer patients to the Endocrinologist/diabetes specialist.”
Isaiavwe said training in Podiatry, a branch of medicine dedicated to the study, diagnosis, medical and surgical treatment of disorders of the foot, ankle and lower extremities, should be part of the package.
Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar Treatment
Treatment involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels.
Maintainance of blood glucose control, particularly for people with type 1 diabetes who require insulin. People with type 2 diabetes can be treated with oral medication, but may also require insulin.
Maintain blood pressure control and foot care.
Adopt simple lifestyle measures such as maintaining healthy body weight, being physically active eating a healthy diet, avoiding sugar and saturated fats intake and avoiding tobacco use. Go for regular screening for early signs of diabetes-related kidney disease and treatment.