To curb the rising menace of diabetes
Amidst merry making and consumption going on with the yuletide and the coming new year, reports on rising cases, prevalence and intensity of diabetes is a cause for concern in Nigeria, especially because the most common type 2 of the disease is a direct repercussion of unhealthy lifestyle of which consumption of unwholesome food and drinks is a part. It is worrisome that non-communicable diseases and their implications for mortality and morbidity are on the increase; and available evidence suggests that diabetes kills more than COVID-19, which brought the entire world on its “knees” in the recent past. This much has been confirmed from statistics released during the 2022 World Diabetes Day (WDD).
Data released by World Health Organisation (WHO) show that about 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.Specifically, on Nigeria, the Endocrinology and Metabolism Society of Nigeria (EMSON), says that the burden of diabetes in the country is increasing as over 10 million Nigerians are living with the disease and the numbers are expected to double by 2030, if nothing is done urgently.
According to the President of EMSON and Consultant Endocrinologist/Physician at Lagos University Teaching Hospital (LUTH), Idi-Araba, Prof. Olufemi Fasanmade, “the total number of people in the country with diabetes is the highest in sub-Saharan Africa. Higher than the number of tuberculosis, Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and COVID-19 put together. Diabetes kills more people in Nigeria than COVID-19, tuberculosis, HIV/AIDS and cancer put together,” In particular, the Society is worried over the dearth of endocrinologists in the country available to manage the millions of Nigerians who are diabetic, noting that there are only 150 endocrinologists in a population of more than 220 million to investigate, diagnose and treat diabetes.
Diabetes is a disease of the pancreas and affect other endocrine systems such as the thyroid, pituitary gland and adrenal glands. So, diabetes marks disorders of the endocrine system; and WHO describes it as a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. Hence, it is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
There are two types of diabetes. WHO says that the most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or does not make enough insulin; and in the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. This type of diabetes is largely the result of excess body weight and physical inactivity. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly in children.
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself.
Some of the risk factors fueling increase in the number of diabetic cases are western lifestyle, smoking and drinking. Western lifestyle is very harmful because it encourages sedentary life, consumption of calorie-densed food (fast food and soft drinks) and stress. In addition, lack of exercise and modern-day habit of using cars, cabs, and bikes for even the shortest of distances is leading to increased obesity, which is another risk factor for developing diabetes.
Presently there is no clinically available cure for diabetes; and the solution lies in prevention and management. While diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications; there is inadequate structures and public enlightenment and support for diabetes prevention and care at all levels.
To reverse this ugly trend, WDD provides an opportunity to raise awareness about diabetes as a public health issue and what needs to be done, collectively and individually, for better prevention, diagnosis and management of the condition. Therefore, it is important to Nigeria to strengthen access to quality information on diabetes both for the health team and for people living with diabetes, their caregivers and society in general.
On prevention, Nigeria’s health authorities at both federal and state levels should seize the moment and latch on this year’s theme, ‘Access to Diabetes Education’ which underpins the larger multi-year theme of ‘Access to Care’ to sensitise Nigerians on the need for healthy diet, regular physical activity, maintaining normal body weight and avoiding tobacco in order to prevent or delay the onset of type 2 diabetes.
In addition, it is instructive that the Federal Government’s Sugar-Sweetened Beverage (SSB) tax embedded in the Finance Act of 2021, which levies a ₦10 tax on each litre of all non-alcoholic and sugar-sweetened carbonated drinks, is a fiscal policy introduced to help curb excessive consumption of sugars as is done in Mexico, the implementation appears weak. Since, the SSB tax could have a positive benefit on population health, especially in the prevention of non-communicable diseases (NCD) like diabetes and chronic kidney disease, beyond the potential benefit of revenue generation, International Diabetes Federation for Nigeria, EMSON, other relevant professional health bodies in Nigeria and health focused NGOs should mount pressure on Federal Government to release an action plan on the implementation of the SSB tax and monitor same for optimal result. But tax alone is not enough, it should be backed by adequate public enlightenment campaign.
On the flip side of prevention is management. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. Since there is a globally agreed target to halt the rise in diabetes and obesity by 2025, the Nigerian government should explore the PAHO Strategic Fund meant to help countries increase access to and availability of essential medicines, including insulin and other diabetes medicines and technologies. This is in tandem with the Global Diabetes Compact aimed at supporting countries in the development, implementation and evaluation of cost-effective programmes that reduce the risk of diabetes and guarantee that all people who require it have access to diabetes care that is quality, equitable, comprehensive and affordable.
Also, Nigeria through the Federal Ministry of Health should work with WHO to integrate diabetes into primary care, using the WHO Package of Essential Noncommunicable disease interventions (PEN) toolkit. This technical assistance from WHO will build the capacity of the country’s health team at primary health care level on current trends in the diagnosis and management of type 2 diabetes. It is in line with Resolution on diabetes adopted by WHO Member States to scale-up efforts to prevent and treat diabetes. The WHO Resolution recommends the integration of prevention and treatment of diabetes into primary health services, the development of pathways for a substantial increase in access to insulin, the promotion of convergence and harmonisation of regulatory requirements for diabetes medicines and technologies and improved diabetes monitoring and surveillance.