ADDRESSING DIABETES EDUCATION NEEDS USING THE POWER OF MOTION PICTURES.

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With the increasing prevalence and incidence of diabetes globally, it is pertinent that diabetes education be incorporated into school curricula. However, for those who are out of school or not opportune to enjoy formal education, it becomes a challenge towards meeting their educational needs.
Majority of the problems of diabetes is fueled by ignorance. It is eminent across board both in on the part of health professionals and persons living with diabetes.
With the outcome of motion pictures, new revolution evolves on how stories and information are passed across to different class of the population. With the introduction of home videos in Nigeria in the 90’s, Africans all over the world got new ways of listening, seeing and feeling the challenges of Africans as told by Africans. These medium has been used to address challenges of female genital mutilation, the problems and ways of preventing vesico vaginal fistula. These medium is equally being exploited to send home the message of HIV infection prevention. This medium is also useful if properly organized by professionals to address the paucity of information and ignorance surrounding diabetes prevention strategies.
As we celebrate this year’s World diabetes day 2010, with a theme of “Diabetes Education and Prevention”, the motion picture as a tool for diabetes education should be considered using local languages like Hausa, Swahili, French, and English. This will help fight ignorance which is fueling the increase incidence of diabetes and other non communicable diseases.

Congressional Briefing by Global Diabetes Initiative to US Congress - Expectations

Following the discussion held at the UN summit on Millennium Development goals assessment, the world has began to retrace its steps to look inwards on neglected concerns. I recently did a write up on Millennium development goals and Diabetes, it was quite alarming at what the statistics are saying concerning the prevalence and incidence rate of diabetes, cancer amongst others.
On September 27th, 2010, Researchers from Albert Einstein College of Medicine of Yeshiva University held a Congressional briefing in Washington D.C, focusing attention on the alarming Global diabetes epidemic.
It is no longer news that incidence of diabetes is increasing worldwide at a rate that exceeds most other diseases. The WHO estimates that by the year 2030, more than 366million people will be suffering from diabetes, a figure far higher than number of persons living with HIV/Aids. Unfortunately majority of this figure about 298million will live in developing Countries especially sub Saharan Africa.
This Congressional briefing is a welcome development and I strongly subscribe to publication of the outcome of such briefing for the consumption of other Legislatures and parliaments across the World.
Like the Words of Wisdom by Ban Ki Moon “Diabetes and other NCDs are public health emergency in slow motion”

DIABETES AND WEIGHT MANAGEMENT STRATEGIES

Weight loss is one way to lower blood glucose and to reduce risks for heart and blood vessel disease. Being overweight is a risk factor for developing diabetes even if one is healthy and not yet diabetic, being overweight could predispose an individual to insulin resistance.
Persons with insulin resistance lack the ability to utilize insulin properly. It is difficult to lose weight for most people. Losing 10 to 20% of weight can have a big impact on an individual’s blood glucose levels.
Losing weight too quickly often results in rebound, hence it is important that it should be slow and steady process. The body weight is determined by the following factors:
- The type of food we eat.
- Physical activity level
- Body build and heredity
- Body chemistry
- Medicines.
Physical activity helps the body to respond better to insulin. If you are overweight, losing weight and maintaining a healthy weight also helps the body respond better to insulin.
The Body Mass Index (BMI) is a relationship of the body weight to height. The internationally accepted standard adopted by National Institutes of Health, National Heart, Lung and Blood Institutes, Clinical Guidelines on the Identification, evaluation and treatment of Overweight and Obesity in adults, the evidence report states that:
Underweight (BMI <18.5)
Normal (BMI 18.5 – 24.9)
Overweight (BMI 25.0 – 29.9)
Obesity Class 1 (BMI 30 – 34.9)
Obesity Class 2 (BMI 35 – 39.9)
Obesity Class 3 (BMI ≥ 40).
A calorie is a measure of stored energy. Eating fewer calories is one way to lose weight. The minimum recommended calories to obtain needed vitamins and minerals is 1200 for adult females and 1500 for adult males. Fad diets and quick weight loss plans can harm health and interfere with diabetes management weight loss of no more than one ib per week is recommended. Awareness of the calorie content of food can also help one choose foods to gain weight or avoid weight loss.
It is important to note that carbohydrates, protein and fat all contribute calories when digested. Hence the teaching by health care providers especially in Africa that people living with diabetes should only eat proteinous foods should be condemned. Fat provides more calories per gram than carbohydrate or protein and is most easily changed into body fat.
Foods high in water and or fiber have fewer calories per bite. Fresh fruits, vegetables and whole grains heave the lowest calorie per bite. These foods tend to require more chewing, take longer to eat and help you feel full and satisfied without lot of calories.
Exercise helps with weight management by burning calories, relieving stress, and maintaining muscle mass. Exercise helps persons with type 2 diabetes improve blood glucose levels by improving insulin sensitivity and decreasing glucose output from the liver.
In some parts of Africa, weight gain is a sign of affluence and well being hence people spend so much money to gain weight but with education and awareness on the dangers of overweight and obesity keeping moderate weight should be encouraged

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.