World Diabetes Day: Epidemic worsens as cost of drugs hits N100,000 per patient monthly

* Average of seven million Nigerians affected
• New survey shows 10.7% prevalence in Lagos, Ekiti, Osun, Oyo, Kwara; 43% pre-diabetic
• Care facilities squeezed, boast of one endocrinologist to 600,000 people; only two podiatrists nationwide
• Association seeks SSB tax reintroduction, better use of proceeds

As countries mark World Diabetes Day today, the alarming burden of its prevalence in Nigeria, and the anguish of sufferers, and care practitioners alike, have been brought to the fore.

The deadly lifestyle disease is assuming an epidemic proportion nationwide, exceeding the national average of 5.7 to 10.7 per cent in the South-West part of the country, and about 43 per cent of communities are now at risk.

The worst is that the cost of care now ranges between N500,000 to N800,000 per patient, with the estimated cost of medication in excess of N100,000 a month.

Care practitioners told The Guardian that the recent 300 to 400 per cent spike in drugs and consumables has pushed the option of care beyond most diabetics, and almost a death knell on the growing community of sufferers.

They said besides the urgency of tackling mass staff shortage at care facilities, the federal government must take a tougher and more effective stance on the control of processed foods and Sugar-sweetened Beverages (SSBs) – the primary suspect of obesity and diabetes globally.

Sugar-sweetened beverages (SSBs) have become a major public health concern worldwide, particularly in low- and middle-income countries like Nigeria. Stakeholders reckon that most Nigerians practically have a sweet tooth. And while the prices of SSBs have more than doubled due to inflation, Nigerians have increasingly turned to cheaper brands, continuing to consume these drinks due to the lack of healthier alternatives, and heightening the risk of diabetes.

As a result, regular consumption of SSBs cum sedentary lifestyle has been linked to a range of health issues, most notably obesity, type 2 diabetes, and cardiovascular diseases.

Experts estimated that the national prevalence of diabetes has surged to 5.7 per cent, which represents about six to eight million Nigerians and some local studies estimate rates as high as 10.7 per cent in certain regions. This increase is attributed to changing dietary habits amongst other things.

Most worrisome today is the access to diabetes care, especially due to the rising costs of essential medications and devices, such as insulin and glucose meters.

Findings showed that the average monthly cost of drugs is about N100,000. Currently, a vial of insulin costs between N18,000 and N21,000 – about a 400 per cent spike from its previous price of N3,500. Common anti-diabetic drugs like Novorapiad (flexpen) cost N6,500 about two years ago. Now, it sells for N20,000.

A pack of five Lantus insulin, which was N22,000 now costs N58,000. A pack of Diamicron MR (30mg) now sells for N6,500 compared with N2,200 erstwhile sold. Similarly, Galvus (Novartis) 50/1000mg was N2,400, but now sells for N5,200. Glucophage was N900 but currently sells for N5,700; Alphabetic was formerly N4,500, now N10,500.

According to experts, many patients require a combination of insulin, oral medication, and additional drugs for related conditions like hypertension, making treatment prohibitively expensive.

Findings have shown that many Nigerians are now rationing their drug dosages, turning to unregulated alternatives, including herbal remedies and prayer houses, resulting in more diabetes-related complications like blindness, kidney disease, and premature deaths.

Consequently, “many patients are now cutting down on their drug dosages, turning to unregulated alternatives, including herbal remedies and prayer houses, resulting in more diabetes-related complications like blindness, kidney disease, and premature deaths,” a practitioner said.

For instance, a roadside roasted plantain seller, Mrs Kudirat Ojurongbe, consumed at least three bottles of fizzy drinks daily to cope with the pressure of working in the sun. The routine persisted until she was diagnosed with Type 2 diabetes and hypertension last March.

Ojurongbe kept to the treatment programme until the first bill showed N70,000, in less than a month. “But, I barely make as much as N20,000 profit in a month,” she said.

Another patient, John Odey, a resident of Awada, Onitsha, Anambra State, was also addicted to a brand of stout drink that was believed to be healthy until he was diagnosed with diabetes.

As of the time he started his treatment course, a pack of 1000mg of Glucophage was sold for N900, but now, it has increased to N5,000 a sachet. Due to this, Odey now skips his medication as he hardly afford the money to get the drug and recently developed blurry vision.

Already, the Minister of Health, Ali Pate, had expressed fears that the cost of treating diabetes could exceed N1,000,000 by 2030, shifting from an average of N60,000 per person in 2011 and N800,000 in 2021.

But his prediction is fast becoming a reality. The National President, Diabetes Association of Nigeria (DAN), Ejiofor Ugwu, who is also an associate professor of medicine and a consultant endocrinologist, said the cost of treating and managing diabetes in the country has already gone “astronomically expensive” as the average Nigerian can no longer afford their medications, creating room for development of chronic complications of diabetes, including blindness, amputations, kidney diseases and premature deaths.

Ugwu explained that most diabetes patients often suffer from co-morbidities like hypertension, and high cholesterol, so need more than just diabetes medications.

“The glucose meter for monitoring blood sugar was N5,000 but currently costs about N17,000 while the test strip is now about N20,000, so it is very challenging and it’s giving us the practitioners a nightmare,” he lamented.

Speaking on the availability of diabetes specialists in the country, Ugwu said the country currently has one endocrinologist to 600,000 people, and almost the same in other specialities since diabetes management is multi-disciplinary care.

He also emphasised that Nigeria only has two podiatrists (a specialist who manages foot problems that could stem from diabetes complications or other issues) serving over 200 million people, which is grossly inadequate.

“We have gross manpower deficiency in Nigeria when it comes to diabetes treatment, this has been there, but it is getting worse with an increase in brain drain happening in the country, especially in the healthcare sector,” he said.

Ugwu added that something needs to be done to stop brain-drain through remuneration increases for healthcare professionals in the country, as well as encouraging training institutions to produce more specialists.

To slow the trend, specialists also urged the federal government to reintroduce the SSB tax. The body regretted that the SSB taxation was stopped following lobbying by big beverage industries.

More so, since the introduction of the tax in 2021, the funds realised from the tax were misappropriated due to a lack of legislative framework on how to utilise the fund.

Ugwu, therefore, called for a modality or framework for the utilisation of the tax to fight diabetes and its related non-communicable diseases in Nigeria. He explained that the government, the Ministry of Health, and policymakers need to understand there is an epidemic which can be ameliorated temporarily through the subsidy of diabetes medications, especially insulin and glucose-meter.

“For the short-term solution, the government should also consider immediate tax waiver on imported diabetes medications to help reduce the price while in the long term, the government should consider encouraging indigenous manufacturing of these diabetes drugs in the country.”

A former president of DAN, Alkali Muhammed, said the erstwhile average budget for diabetes management was about N40,000 to N50,000 every month, including the glucometer and the test strips.

“But now, it has gone up like up to 10 times. One of the anti-diabetic drugs, an insulin packet of five used to be sold for about N7,000, and this could even last a patient for even more than a month, but the pack now goes for N58,000,” he said.  Muhammed explained that some of the patients are usually on combinations of drugs.  He added that the commonest reasons for amputation in the hospitals now are due to diabetic foot, and no longer road traffic accidents, while that of blindness is also diabetes.

“A patient on Lantus can also be on oral medication. Diabetes patients now, in a month, should be spending a minimum of N150,000 to N200,000. I can tell you that over 70 per cent of Nigerians living with diabetes are indigent, so that will tell you the percentage of patients who are unable to afford their medication.”

He explained that a landmark study carried out in the country showed that 61 per cent of Nigerians, who have diabetes, also have hypertension, and these accompanying medical disorders, according to him, make treatment more expensive.

“The oral medication daily and just like the way they take their anti-diabetic drugs; we place them on anti-hypertensive drugs as well as drugs that protect the heart and the kidneys and all these should be taken regularly along with the anti-diabetic drugs. So, when you add up these things, in a month, I can say that the most conservative estimate would put it at around N150,000 to N200,000 per month.

“How many Nigerians can afford this? And that’s why right at the hospital level, we are seeing patients coming with enormous complications. The complication rate is high due to poor adherence. We see a lot of the patients that come here with terrible complications because they have been doing the wrong thing out of their inability to afford their conventional drugs,” he lamented.

Speaking in the same vein, a consultant endocrinologist and Secretary-General, Endocrine and Metabolism Society of Nigeria (EMSON), Dr Oluwarotimi Bolaji Olopade, said the disease prevalence is about 5.7 per cent of the Nigerian population, however, recent studies have shown that there is an even higher prevalence.

He said the most recent survey carried out in five states including Lagos, Ekiti, Osun, Oyo and Kwara, showed an average prevalence of 10.7 per cent with about 43 per cent incidence of pre-diabetes among the communities.

Olopade regretted that the government has failed to properly control the use of sugary drinks.   He explained people will maintain and continue consuming unhealthy food choices because the foods and fruits, which are supposed to be the alternatives, are still very expensive.

“So, if the government taxed sugary drinks, what is the alternative that has been provided? You can’t tax something and you’re not going to give an alternative. People will still maintain it. So, we’ll advocate and plead with the government to make food easily available for people.

“The alternative that’s supposed to come down is not coming down too. If transportation is reduced, food will go down. If people see food, they will not be taking soft drinks anyhow. So that’s the truth. Yes, we know that soft drinks are contributing to part of the challenges of this increasing prevalence of diabetes mellitus,” he added.

Olopade advocated health insurance schemes across the state to cover those managing diabetes. He also tasked the federal government to help by subsidizing the cost of drugs as well as boosting local manufacturing of these drugs to reduce cost.

WHO AFRO region last month reported that over 24 million people are currently living with diabetes in the African region, with more than half (54 per cent) of cases undiagnosed. It warned that the region is set to register the largest increase in the number of people with diabetes by 2045.

Celebrated every 14th of November, the theme for WDD 2024 is “Diabetes and well-being”. The theme highlights the impact of diabetes on people’s physical and mental health and the importance of well-being in diabetes care. It highlighted the need to expand the scope of care as diabetes care often focuses only on blood sugar, leaving many overwhelmed with the daily challenges of managing their condition at home, work, and school.

A consultant endocrinologist and professor of medicine at the University of Lagos Teaching Hospital, Olufemi Fasanmade, told The Guardian that diabetes is mainly a lifestyle disease. He noted that weight gain, poor sleep patterns, and high-stress levels would only make the disease common.

The don noted that diabetes care has become quite expensive as several people now spend over N100,000 monthly just for medication.  He explained that more than half of his patients can no longer afford healthcare and for this reason, several have resorted to halving their dosages, some skip outright, and others are seeking alternative, complementary or traditional methods of treatment. “It has become quite expensive caring for diabetes with several people spending over N100,000 monthly for just medication,” he said.

Globally, experts have been alarmed about the increasing number of diabetes which they report has tripled in the last two decades to become one of the fastest growing health emergencies of the century.

The World Diabetes Federation (IDF) warned that if action is not taken urgently, these growing numbers could exceed 700 million by 2045. Along with this number, are diabetes-related complications; projected to rise such as diabetic retinopathy, which is one of the most feared and common complications of diabetes.

Published in The Lancet, experts report more future cases as new estimates indicate that more than 1.31 billion people worldwide could be living with diabetes by 2050.

This increase in prevalence is predicted to be driven by increases in Type-2 diabetes, caused by a rise in the prevalence of obesity and demographic shifts.