By Chioma Obinna
It is no longer news that COVID-19 has affected every aspect of health systems across the world. But the worst affected are patients with comorbidities such as diabetes.
For many Nigerian diabetic patients who have difficulties accessing treatment even before the COVID-19 outbreak, the pandemic has yet again widened the gap in treatment and control of the condition.
Diabetes mellitus is one of the largest global health emergencies of the 21st century, largely because of its severe consequences.
It affects virtually all organs of the body, resulting in loss of vision, dental problems, kidney failure, cardiovascular disease, lower limb amputation, and sexual dysfunction among others, especially when not properly controlled.
Sadly, this is the situation many Nigerians living with diabetes are facing presently.
For them, while medical doctors say just a diagnosis of diabetes changes one’s life but it doesn’t need to ruin it.
These Nigerians are becoming hopeless as they fear their lives may be ruined without urgent intervention.
A new preliminary analysis by the World Health Organisation, WHO revealed that Africa’s death rates from COVID-19 infections are significantly higher in patients with diabetes.
Sunday Vanguard examines the plights of patients with diabetes amid COVID-19.
Unarguably, COVID-19 pandemic severely disrupted access to diabetes treatment in Nigeria and across the world.
For instance, lockdowns to limit the spread of COVID-19 impeded access to healthcare and the basic elements of proper disease management, such as routine glucose monitoring and eating a healthy diet.
Findings by Sunday Vanguard showed that in Nigeria, the pandemic caused a lot of problems for patients physiologically and psychologically.
With studies showing that persons with underlying illnesses like diabetes, cancer, HIV, and hypertension are more vulnerable to coronavirus.
It has also escalated challenges of the high cost of drugs, monitoring devices, loss of livelihood, and difficulties accessing treatment.
Little wonder, WHO Regional Director for Africa, Dr. Matshidiso Moeti, said: “COVID-19 is delivering a clear message: fighting the diabetes epidemic in Africa is in many ways as critical as the battle against the current pandemic.”
However, for over 30 years, Christian Osu has lived with diabetes. Unfortunately, life has not been easy for him since he was diagnosed with diabetes. Christian, a father of four children, lost his job during the heat of the first wave of the pandemic.
According to him, his company relieved him of his job due to the downturn in the organization’s economy. Since then, he has been out of the labour market.
Sadly, his wife, a petty trader, can hardly feed the family from the proceeds of sachet water and biscuits she sells in front of their one-room apartment in Ketu, Lagos.
The situation has further worsened Christian’s condition who can no longer afford his treatment. He is forced to eat whatever is available.
Even a nongovernmental organisation that took up his treatment is no longer forthcoming as funding has dwindled due to COVID-19.
“I can only take drugs or buy insulin any time I have money. Some of the drugs I bought a pack for N3, 000 are now N7000. Where will I get the money? Unfortunately, I have also developed a wound by my foot,” he narrated as tears rolled down his cheeks.
Christian is just one out of the estimated 24 million people living with diabetes in Africa in 2021, according to the International Diabetes Federation.
He is also one of the patients who could not reach their doctor for lack of money.
Unlike Christian, for over 25 years, Mr. Samuel has lived with diabetes and has been lucky so far.
According to Samuel, although God has helped him to manage the condition.
“The situation is worse now. I used to buy my insulin between N3, 000 and N3, 500 in 2019. Today, the same insulin is between N6, 000 and N8, 000, depending on where you are buying from.
“To worsen the whole thing, my doctor had to change my insulin and dosage because at one point I lost control. Now, I have to take insulin twice daily which means I need more than what I was taking before.
“You can imagine the cost. Before now, in 2019, monitoring strips to check my blood sugar level, “AccuChek” was between N3, 500 and N5, 000 for a pack of 50 (which could last a month or more depending on usage).
“Now, it costs between N6, 000 and N9,500, depending on where you are buying from,” he lamented.
However, the pandemic forced him to take extra care.
“I had to take extra precaution because I knew I could easily be infected and being diabetic could make it very dangerous and more life-threatening.
“So, I learnt to stay indoors most of the time and sometimes talk to my doctor on the phone. That is not to say everything has been rosy,” he narrated.
According to Samuel, even though he considers himself lucky, with the skyrocketing prices of drugs, monitoring devices, his fortunes and that of other patients may soon change for the worse.
Right now, many Nigerians can no longer afford the cost of managing diabetes. Children are even worse off. For their type 1 diabetes, they must be on insulin which is now beyond the reach of average parents.
Doctors say some parents now cut costs by reducing the dose of their children’s insulin without medical advice while some have simply stopped further treatment.
These and more are the reasons Nigerians living with diabetes say it is time to change the narrative. According to statistics from the Diabetes Association, one in every two people with diabetes in Nigeria is undiagnosed.
Christian and Samuel are among the five million Nigerians living with diabetes.
Diabetes impairs the body’s ability to produce or process insulin, a substance essential to counteracting a dangerous rise in blood sugar.
The disease causes inflammation and poor blood circulation, both of which increase the risk of complications, including death, from COVID-19.
According to medical experts, there are two main types of diabetes: type 1 caused by a condition early in life that damages the pancreas and impairs insulin production, and type two—which is linked to poor diet, obesity, and lack of exercise.
About 90 percent of diabetes cases globally, and the vast majority in Nigeria and Africa, are type two. The rising rates in Africa are attributed to the same poor diets and sedentary lifestyles causing a surge in type two diabetes around the world.
In addition to COVID-19 risks, diabetes can also increase the risk of heart attack, stroke, kidney failure, lower limb amputation, visual impairment, blindness, and nerve damage, including erectile dysfunction.
In a study by researchers in Lagos entitled: ‘’Morbidity and Mortality Outcomes of COVID-19 Patients,” patients with diabetes were found to be 3.69 times more likely to die from the virus.
The researchers, led by Prof. Akin Osibogun, a former Chief Medical Director of LUTH, found that the prevalence of diabetes as number two of the most common comorbidity was diabetes with 7.2 percent. Hypertension is leading with 17.8 percent.
Also, a recent WHO analysis evaluated data from 13 countries on underlying conditions or comorbidities in Africans who tested positive for COVID-19. It revealed a 10.2 percent case fatality rate in patients with diabetes, compared with 2.5 percent for COVID-19 patients overall.
“The case fatality rate for people with diabetes was also twice as high as the fatality rate among patients suffering from any comorbidity. The three most frequent underlying conditions included patients with HIV and hypertension.
For a Consultant Endocrinologist and diabetes expert, Dr. Afoke Isiavwe, diabetes is yet to get the attention it deserves.
Isiavwe, who is also the Medical Director of Rainbow Specialist Medical Centre, Lagos, lamented that many Nigerians are living with undetected diabetes.
“Diabetes is not getting the attention it deserves. There is a bigger problem coming soon and if we don’t get the right attention now, people will continue to die” he said.
Also, in a statement to mark 2021 World Diabetes Day, a non-governmental organisation, Diabetes Control Media Advocacy Initiative (DICOMA) expressed concern over the plight of Nigerians living with diabetes, saying a significant number can no longer control their condition because of the high cost of drugs and monitoring devices.
The trustee Chairperson of the Organisation Dr. Afoke Isiavwe and the Director of Communication Mrs. Yinka Shokunbi, said people living with diabetes are among the worst hit by the current inflation in the country.
“They said many are unable to take their medications or follow necessary guidelines and routines to keep the disease in check.
“The COVID-19 Pandemic and the attendant disruption it created, also contributed negatively to this, as many breadwinners lost jobs with the economic downturn.
“They said in the last six months Insulin which is a vital component of diabetes management has risen by over 40 percent.
“A vial of insulin now costs between N6000 and N12, 000 in different parts of the country, she said.
Citing figures from the International Diabetes Federation (IDF) DICOMA, she noted that more than 463 million adults (1 in 11) are currently living with diabetes globally.
”While countries like Cameroon now provide insulin free of charge to children and other countries in Africa have adopted policies to assist citizens to achieve control of the condition, Nigeria seems to have left people living with diabetes to their fate,’ she added.
In the views of WHO Regional Director for Africa, Dr Matshidiso Moeti, “We can also stop diabetes from claiming more lives by promoting healthy, affordable diets and regular exercise.”
As the world marks this year’s World Diabetes Day, with the theme: “Access to Diabetes Care”, health watchers say Nigeria must act fast to assist people currently living with the disease as a poorly controlled diabetes population epidemic equals diabetes complications epidemic.