The Endocrinology and Metabolism Society of Nigeria (EMSON) has issued a warning as Nigerians join the rest of the world in commemorating World Diabetes Day (WDD), noting that over 10 million Nigerians currently have the disease, with the number expected to double by 2030 if urgent action is not taken.
The Society also lamented the fact that there are only 150 endocrinologists available to treat the condition in a population of over 220 million people, noting that diabetes is a significant contributor to kidney failure, heart attacks, strokes, lower limb amputation, blindness, and other conditions.
Endocrinologists and diabetologists investigate, identify, and treat endocrine system disorders, so the alarming shortage of them is concerning. Diabetes, a pancreatic disease, and illnesses affecting the thyroid, pituitary gland, and adrenal glands are all conditions that endocrinologists treat.
WDD offers a chance to increase public awareness of diabetes as a global public health issue and what needs to be done, both individually and collectively, for better diabetes prevention, diagnosis, and management.
The larger multi-year theme of “Access to Care” is supported by this year’s theme, “Access to Diabetes Education.” Type 2 diabetes, a lifestyle disease associated with obesity and unhealthy behavior, affects 90% of diabetics. The childhood-onset Type 1 variant is an incurable autoimmune disease.
According to Prof. Olufemi Fasanmade, President of EMSN and Consultant Endocrinologist/Physician at Lagos University Teaching Hospital (LUTH), Idi-Araba, the prevalence of diabetes mellitus in Nigeria is rising.
“In the 1960s to 1970s, diabetes was found in only 0.5-1 per cent of adults in Nigeria. In the 1980s to1990s, the figures rose to 1.4-2.2 per cent of adults. Currently, there is about 5.7 per cent of adults affected with diabetes and 10 to 15 per cent with pre-diabetes.
“In urban towns and cities in Nigeria, one in 10 adults have diabetes and we have just 90 to 100 million adults in Nigeria. Almost 10 million people in Nigeria have diabetes, while 30 per cent of people with hypertension also have diabetes.
“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,” he said.
The most frequent cause of lower limb amputation and chronic kidney disease, according to Fasanmade, is diabetes. Only 150 endocrinologists are currently in practice in Nigeria, or about 1 in 100,000, he claimed.
Fasanmade made the following statement regarding the expense of having diabetes: “Diabetes is a very costly condition. A typical patient with it in Nigeria will spend between N20,000 and N30,000 to keep it under control. This is the bare minimum and includes prescription drugs, blood tests, and clinic visits. Some patients must spend between N100,000 and N150,000 per month when complications like kidney disease are present.
“In the United States, up to $300 billion is spent on diabetes per annum. The figures for total diabetes expenditures in Nigeria are uncertain. One vial of insulin is N6,000 to N10,000 and patients use one or two per month.
“A box of strips for testing blood sugar is about N6,000 and patients need one or two per month. Some tablets are as cheap as N2,000 per month and others as high as N30,000 monthly. Usually, patients are on two to three of the drugs.”
Fasanmade cited western lifestyle, smoking, and alcohol consumption as risk factors for the rise in the number of diabetic cases.
“Western lifestyle is very harmful in that it encourages sedentary life, consumption of calorie-densed food (fast food and soft drinks) and stress. Unfortunately, people exercise less nowadays and they resort to cars, cabs, and bikes for even the shortest of distances leading to increasing obesity, which is another risk factor for developing diabetes,” Fasanmade said.
While acknowledging that there is no clinically effective treatment for diabetes, the endocrinologist also stated that there have only been a few reports of experimental treatments that are largely impractical, such as transplants of the entire pancreas or islet cells from the pancreas to humans. “But getting a pancreas is not easy and the operation comes with its own challenges,” he said.
He emphasized that diabetes is a degenerative or chronic disease that requires management because it is a lifelong condition, just like hypertension and many other non-communicable diseases. However, he added, “In future, however, there may be a cure, but presently there is none.”
Fasanmade noted that the last accurate national prevalence of diabetes was 2.24 percent, which was reported in 1992, and expressed regret that there hasn’t been a population-based estimate in the last 20 years to help with national health planning, policies, and funding. Additionally, over the years, the International Diabetes Federation has provided prevalence estimates for Nigeria that have primarily been based on data extrapolated from other nations with comparable sociodemographic characteristics to Nigeria.
“Right now, there is a serious dearth of skilled diabetes personnel across the country,” he said, adding that diabetes research is currently inadequately funded in Nigeria and there is inadequate public enlightenment and support for diabetes prevention and care at all levels.
WHO facts on Diabetes
The World Health Organization (WHO) Fact Sheet on Diabetes states that 8.5% of adults who are 18 years of age and older had diabetes in 2014. A total of 1.5 million deaths were directly related to diabetes in 2019, and 48% of these deaths occurred in people under the age of 70. Diabetes contributed to an additional 460,000 kidney disease deaths, and elevated blood glucose is responsible for 20% of cardiovascular deaths.
“Between 2000 and 2019, there was a three per cent increase in age-standardised mortality rates from diabetes. In lower-middle-income countries, the mortality rate due to diabetes increased 13 per cent.
“By contrast, the probability of dying from any one of the four main non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between the ages of 30 and 70 decreased by 22 per cent globally between 2000 and 2019.
“A healthy diet, regular physical activity, maintaining normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
“Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.”
The body’s inefficient use of insulin causes type 2 diabetes, also known as non-insulin-dependent or adult-onset. Type 2 diabetes affects more than 95% of those who have the disease. This particular type of diabetes is primarily brought on by excess body weight and inactivity.
This type of diabetes was previously only seen in adults, but it is now increasingly present in children.
Deficient insulin production is the hallmark of type 1 diabetes, also referred to as insulin-dependent, juvenile, or childhood-onset, which necessitates daily insulin administration. Nine million people worldwide had type 1 diabetes in 2017, with the majority residing in high-income nations. Its cause and methods of prevention are unknown.