20 million Nigerians on verge of developing diabetes —Professor Fasanmade, EMSN’s President

Cases of diabetes, a group of diseases resulting in excessive sugar in the blood, is on the rise in Nigeria. President, Endocrine and Metabolism Society of Nigeria (EMSN), Professor Olufemi Fasanmade, tells SADE OGUNTOLA that nearly everybody is prone to developing diabetes, a disease that has overtaking road accidents as the leading cause of lower limb amputation in Nigeria?.

What is the level of Nigerians awareness of diabetes? Is it at par with the incidence of diabetes in Nigeria?

The level of awareness of Nigerians for non-communicable diseases like diabetes and hypertension is poor mainly because these diseases are often without symptoms. Traditionally most Nigerians respect or only acknowledge conditions with clear and obvious symptoms such as measles, chickenpox, polio, cholera and malaria which they can relate to and can point to. This is why communicable disease like them can be easily related to.

Very few people even realise that diabetes afflicts more people than malaria, HIV/AIDS, tuberculosis put together. There are somewhere between five to six million people in the Nigerian populace suffering from diabetes but 70 to 80 per cent of people who have it don’t even know they have it.

With this large number of afflicted people walking around not knowing they have this disease, result in sudden death or slow debilitating ill-health due to non-awareness. In the majority of cases, therefore, out of the 5 to 6 million people in the country that have it, only 1 to 1.5 million are aware it’s there.

Many screening programmes identify many new cases of diabetes and those with it are often shocked when told they are diabetic as there may be no symptoms or at the most, vague and non-specific symptoms like weakness/tiredness and fatigue.

 

It is said that prediabetes can turn into full-blown diabetes. How many Nigerians are likely to be living with prediabetes?

With regards to the diabetic status of an individual, there are three main categories: normal blood sugar levels when the fasting blood sugars are less than 100mg/dl, diabetes when the blood sugars in the fasting state are persistently higher than 126mg/dl and a group in between which is called prediabetes.

Prediabetes often becomes full-blown diabetes in a few months or years. However, if lifestyle measures like regular exercise, maintaining a normal weight, stopping alcohol and smoking are put in place, this transition to diabetes may be delayed. This country probably has as many as 10 to 20 million people with prediabetes who by the natural course of prediabetes feed the rising the number of diabetes.

 

An expert said Nigeria is the home to the largest burden of diabetes, how true is this?

This is not true because many countries have more burden of diabetes: these include China, India, USA, Egypt, Saudi Arabia, Germany, Russia and Brazil. However, in the Sub Saharan African region, Nigeria has the highest number of people with diabetes followed by South Africa and Ethiopia. Its current prevalence in Nigeria is about five to six per cent of adults. In rural areas, the prevalence is often much lower than in the urban areas.

 

Early detection of the unrecognised diabetes mellitus (DM) and its risk factors in the community is crucial to minimising the burden of DM and associated complications. How good is Nigeria doing on this?

Nigeria is not doing much of early detection through community screening, opportunistic screening and other measures to detect the condition early. In community screening, the government usually conducts grassroots campaign about the condition and thereafter does field testing or home to home tests or assembling members of communities/villages  where blood pressures and blood sugars are tested, results given to patients and newly diagnosed cases of diabetes and or hypertension sent to health centres for treatment and follow up.

We haven’t done much of this as a country, though during the World Diabetes Day celebrations (November 14th yearly), many hospitals and health centres supported by the pharmaceutical industry take on this onerous task. In opportunistic screening, all attendees to hospitals have their blood sugars checked, just as pulse and temperature are checked irrespective of what they are attending a clinic for.  Those with abnormal blood glucose results are flagged and referred to secondary and tertiary centres.

 

What are the common predictors of unrecognised diabetes in Nigerians?

In classical cases of diabetes, there is the passage of plenty of urine, excessive thirst, weight loss despite eating well, blurred vision, abnormal sensations in hands and feet, generalised itching and fatigue. However, individuals that present in this manner are not so much. Diabetes may present insidiously, meaning there are few, vague or no symptoms at all. Such diabetes often goes unnoticed and undiagnosed.

The factors that predict the occurrence of unrecognized diabetes include illiteracy, poverty, HIV/AIDS and hypertension. Unfortunately Nigeria is saddled with these four conditions.  Our adult literacy rate rarely exceeds 50 per cent and between 70 and 80 per cent of the populace is poor. Those with HIV/AIDS develop diabetes rapidly when they are on some particular antiretroviral drugs while people with hypertension often develop diabetes after some years.

 

Emerging evidence suggests that COVID-19 may actually trigger the onset of diabetes in healthy people and also cause severe complications of pre-existing diabetes. Why is this so?

Very true. COVID-19 like any other viral infection can damage the insulin-producing cells leading to low insulin levels which characterise type 1 diabetes mellitus. In other patients, some people with pre-existing prediabetes may by the stress and drugs used to treat COVID-19 be tipped over into diabetes. Also, some known people with diabetes who develop COVID-19 tend to have multiple organ affectation and the development of new-onset diabetes has been reported among quite a several COVID-19 survivors.

 

“I don’t have diabetes. Why should I be concerned?”

You should be concerned because no one is immune to diabetes and anyone can develop it. As we age, all organs age too, including our pancreas which is involved in producing insulin, the hormone that lowers blood sugar. So, it is almost inevitable that as we age, more and more people will.

 

Are there foods that people with diabetes should avoid and why?

Pastries, sugary food, simple sugars, honey and soft drinks should be avoided because they cause a surge in blood sugars. There is nothing wrong with our traditional African cuisine and individuals with diabetes can take garri, semovita, amala but in moderate quantities and with plenty of vegetables.  For a full and comprehensive guide of what to eat and not to eat every person with diabetes mellitus needs to consult a registered dietitian or nutritionist.

 

Complications of diabetes are common. One is amputation. Now, about how many people end up with leg amputation in Nigeria due to diabetes and can it be prevented?

Diabetes has long overtaken road accidents as the leading cause of lower limb amputation. Many patients end up with an amputation but the number cannot be ascertained. Good health awareness, adequate foot protection can prevent limb amputation

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