The Prevalence of Diabetes mellitus in Nigeria updates and challenges

Diabetes mellitus is a metabolic disorder that affects the way the body handles basic food components like carbohydrates, protein and fats. This is mostly due to lack or abnormaly in action or effect of the hormone insulin.
Diabetes mellitus is old with man. Globally, there are different prevalent levels varying from country to country, race and ethnic groups. The International Diabetes Federation in its recent publication came up with prevalence and incidence values around different regions and countries of the World.
Nigeria with over 250 tribes and different culture and food values, the prevalence values has not been uniform though the International Diabetes Federation recorded 3.9% in its current Diabetes Atlas.
Over the past 30years the prevalence of Diabetes has been increasing steadily. In 1971, a hospital survey by Osuntokun et al in Ibadan estimated a prevalence of 0.4%; In 1989, while screening for Diabetes during a World Diabetes Day(November 14) in Lagos metropolis, Ohwovoriole et al found a prevalence of undiscovered Diabetes of 1.6%; A national survey in 1992 by the Non-communicable Disease Expert Committee of the FMOH recorded a prevalence of 2.2% (National)- Lowest 0.5% in Mangu, Plateau State and highest 7% in Lagos Island; A survey by Puepet 1994, in urban adults in Jos metropolis discovered a prevalence of undiscovered Diabetes to be 3.1%; by 2004, a second survey in Jos recorded a prevalence of 10.3%.
The progressive increase in the prevalence rates of Diabetes is associated with lifestyle changes; overweight and obesity, physical inactivity, alcohol consumption, dietary changes and cigarette smoking- factors that are potentially modifiable.
So much attention is being given even recently to Communicable diseases like HIV, Tuberculosis and Malaria at the detriment of the emerging epidemic of Non-Communicable disease like Diabetes, hypertension and heart disease. Over 30% of our elite population including decision-makers is Diabetic. More painfully so, the majority of the Nigerian Diabetic population cannot afford meaningful treatment; and over 80% of the healthy population are ignorant about Diabetes.
There is a need for more sponsored independent studies on prevalence and incidence rates around the different states of the Federation or geopolitical zones in collaboration with the Federal Ministry of Health, to ensure proper documentation for future references and to provide proper policy framework and guidelines for legislators. This is to help formulate appropriate health policies towards prevention and care for people living with diabetes and also to regularize and standardize the treatment guidelines. This is important and urgent because presently there is no nationally accepted guideline for management of diabetes in Nigeria like we have for malaria or Hiv infection.
These standards will help the patients because presently there are pools of information and misinformation even among health care professionals who have not been in touch with current realities and publications on diabetes management.
In some parts of this great country Nigeria, some health care professionals still advice persons living with diabetes not to eat any carbohydrate but only proteins when current research findings advocates use of complex carbohydrates and other food groups in moderate quantity.
The Federal government of Nigeria through the Federal Ministry of Health needs to quickly act through the Diabetes Association of Nigeria which have chapters in many states of the Federation and other stake holders associations and non governmental organizations to ensure uniformity of standards of care and practice.

CONTINUOUS GLUCOSE MONITORING DEVICES, HOW USEFUL, HOW COMMON?

Continuous Glucose monitoring Devices are recent phenomenon in diabetes management (CGMD). This devices are products of painstaking research effort towards improved glucose control in people living with diabetes.
They come in different shapes, sizes and functions but the entire goal is the same. It enable an individual knows what happens to the glucose in 24 hours of the day and there are graphic displays to further help enumerate the situation and most have alarm installed for hypoglycaemic situation and hyperglycaemic situation as well.
Persons living with diabetes are able to eat freely and yet be in control, since they can estimate their calorie needs in the day.
The challenges associated with use of this devices entails what happens when an individual goes to an environment where the devices are not available or some components like insulin differ in brand or type. The device could malfunction or get soaked in water. This situations may pose a big issue if the occur, hence it is good to always have the contact of your doctor, go with spare device and the manufacturer of such devices should ensure even distribution around the world since the World is already a global village at affordable cost with ease of access.
These devices are being improved upon almost on yearly bases yet there are many countries of this world, where this continuous glucose monitoring are mere imagination and television displays. The manufacturers of this products should do more to get this products to end users because I believe that is when the chain of production is fully complete.

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PUBLIC PRIVATE PARTNERSHIP SCHEME AND DIABETES CARE POSSIBLE APPROACH BY COUNTRIES OF AFRICA.

The management of Diabetes is quite expensive especially in the developing World. It is more expensive if not managed hence there is no limit to the cost until the final knock of death. The hope however is that early actions in terms of management and care always bring about notable change in outcome measures in a diabetic well being. Ideally, resources should be made available to ensure that people diagnosed with diabetes carry out blood glucose self monitoring, receive appropriate meters, strips and education free of charge. Unfortunately at this stage, such a goal is unrealistic in many Countries even though possible due to competing priorities for very limited health budgets particularly in the context of the HIV/AIDs and TB epidemics sweeping across Sub Saharan Africa.
Through public private partnership scheme, the following can be achieved:
- Provision of free glucometers and test strips and drugs for Children and Pregnant women with diabetes this will aid the fight against the upsurge in Child Maternal Mortality rate.
- Arrangement can be made with Manufacturers whereby the meters are provided free to the patient while the test strips are paid for at subsidized rate.
- In areas or institutions where meters are available, information on the importance of blood glucose self monitoring needs to be explained in a culturally appropriate manner using local languages that people can understand.
- The media should foster dialogue and initiate discuss among stake holders, interest groups and policy makers towards engineering change to best practices.

WORLD DIABETES DAY 2010 CELEBRATION A CALL TO ACTION PART 1

World Diabetes Day – a day set aside by the United Nations following resolution 61/225 on Dec 20th 2006 in conjunction with International Diabetes Federation for Diabetes Advocacy, awareness, support and care for persons Living with Diabetes and those at risk of diabetes. The beauty of this years’ celebration is that it coincides with the UN Summit year on Non communicable diseases of which diabetes mellitus is a major stateholder. It is my fervent prayers along with many other concerned persons and institutions am sure for a Global Fund to be set aside for the purpose of diabetes awareness, research, support and care to help check Diabetes edpidemic and other non communicable diseases like cancer and others.
Going through the website of International Diabetes Federation, a number of activities has been lined up to celebrate this occasion. These ranges from Walk shows, concerts, blue lighting festivities amongst others. The theme of this year’s celebration is Diabetes Education and Prevention. It is important that as we carry out our activities in line with this theme, we need not only educate people about healthy living style alone but also Education about the need for everyone to be committed to do something about Diabetes. People in Government need to make definite commitment regarding appropriate Legislation concerning sales of fast foods and beverages around junior and high grade schools ,introduction of healthy living as a subject in school curricula. Above all provision of support to persons living with Diabetes especially orphans and widows in area of procurement of drugs especially insulin and other accessories like glucometers amongst others to relieve the pressure and encourage people living with Diabetes.

ARTIFICIAL PANCREAS

The Pancreas is an organ in the body that is responsible for production of hormones particularly insulin which is important for metabolism of glucose and other food groups. Artificial Pancreas is a term widely referred to in the old as theoretical. Thanks to modern technology, it is a reality. However, I do wonder about the durability of this product. Considering the experimental work of Prof Taylor et al who developed the device from De Montfort University, Leicester, it could put an end to the daily injections people living with diabetes have to endure to regulate their blood glucose levels.
The new artificial pancreas, invented and patented by Prof Taylor, is made of a metal casing containing a supply of insulin kept in place by a gel barrier. When the body’s glucose levels drop, the gel barrier starts to liquefy and lets insulin out. The insulin feeds into the veins around the gut then into the vein to the liver, mimicking the normal process for a person with a healthy pancreas. As the insulin lowers the glucose level in the body, the gel reacts by hardening again and stopping the supply.
When Insulin came up in 1921, There was a lot of mixed feelings as regards the reliability, quality and availability. Such fears were later fixed, thanks to the commercialization of this whole process. When the Artificial pancreas eventually came to be, will it only benefit those living with type 1 diabetes or could it be modified to handle those with insulin resistance which is the case with most persons living with type 2 diabetes.

Diabetes a Burning Issue on the Global Agenda, Not limited to Global health Agenda.

Incidence of diabetes is increasing Worldwide at a rate that eclipses most other diseases. The WHO estimates that by the year 2030, more than 366 million people will be living with diabetes, this is ten times the number affected by Hiv/Aids. It is even more devastating in that of this figure, more than 298 million people will be living in developing Countries, where the World is currently battling poverty and hunger amongst other challenges.
The major point is this, who will take up this diabetes challenge, why do we all seem not concerned about this epidemic yet we all are either directly or indirectly being affected by diabetes? This is a question I want to pose to every human living currently on planet earth.
As we prepare to celebrate this years’ World Diabetes Day come November 14th , with a theme ‘Diabetes Education and Prevention’, let us strife to know more about diabetes. Research has shown that with Education, Glycaemic control is improved and frank diabetes preventable.

Blood Glucose control and Meal Planning

It is quite challenging and interesting to note that many persons living with diabetes mostly consider being in charge of diabetes only when the engage in use of their drugs as recommended by the doctor. However, they are careless about what happens with their meal planning, exercise and education which are cardinal incredients in the business of blood glucose control.
Meal planning is beyond what is on the table. It is a mixture of meal timing, portion size and food composition.
Without the proper integration of this rudimen, the blood glucose will definately go up and down and the eventual stress that comes with poor glucose readings follows and if not quickly checked depression may follow.
As we engage in the business of blood glucose control today and always, let us inculcate the need for adequate and appropriate meal planning.

TOAST TO THE THIRTY THREE TRAPPED MINERS IN CHILE CENTRAL AMERICA

The Will to be alive has kept you all these 65 plus days despite being in the custody of the Earth which is not satisfied with taking life.
When I take a critical look at the mystery of these men being alive and keeping on, it points to the fact that when there is unity and comradeship, sky is the limit to which we can achieve anything we so desire. It so happens that someone among the thirty three persons is living with diabetes.
There are so many lessons to be learnt from these men who are instantly heroes .When they where going down the mine no body among them new this fate is coming their way. Had they been opportune to know, many would have turn down the offer to be a hero.
The spirit of survival both from families and Government and indeed the international community has been fully in operation since these days. As you come into this world, I wish to welcome you and encourage you to continue to build comradeship amongst your colleagues and other workers in your company. I wish to urge you not to fear anything in the near future and I wish you good health and happy stay with your family here on Earth.

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THE MUCH EXPECTED,AWAITED AND BELATED UN SUMMIT ON DIABETES AND OTHER NON COMMUNICABLE DISEASES SCHEDULED FOR 2011, EXPECTATIONS.

That Diabetes is a current global epidemic is no longer news. Ban ki Moon, the UN Secretary General sum it all with his statement “Diabetes and other NCDs are global epidemic of public health concern in slow motion”, I beg to differ from his position, am of the view that it is already in quick motion.
The current WHO,IDF, ADA abridged statistics shows that over 285 million persons are living with diabetes and a quarter of this figure are unknown. Where has the World been, when this figure got to this, and as am writing this piece, many more are being diagnosed.
This premises announce the global expectation of the summit of the UN. Following Resolution 61/225 adopted in December, 2006, diabetes has eventually gotten the World attention.
This summit is a first step in ensuring World leaders make the prevention and treatment of NCDs are urgent priority both globally and nationally.
Recently in South Africa there was a leadership summit organized to fine tune framework and position statement toward this much awaited summit, an alliance of all sectors of society will be needed to turn around this global epidemic. It is of prime importance and crucial that we keep up to date and informed in the lead up to the summit.
The UN Summit on NCDs is our biggest and best opportunity to get the action needed to achieve the IDF vision of a World without Diabetes.
It is hoped that a global fund to assist the numerous challenges posed by Diabetes is set up and I want to appeal to member nations of the UN to contribute generously towards this cause.
Some immediate challenges faced by Diabetes around the globe revolves around the following though more prevalent in sub-Saharan Africa and other developing economies
- There is a poorly developed healthcare infrastructure to support chronic and acute treatment.
- Lack of coordinated healthcare policy that would ensure screening, treatment and prevention are accorded priority.
- A lack or inadequate knowledge by healthcare providers on how to treat or manage the disease.
- Ignorance on the part of the general population about diabetes prevention strategies.
The much expected, awaited and belated UN summit on Diabetes and other non communicable diseases scheduled for 2011, expectations are high, it can be achieved and surpassed if we work as a team and family.
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