In this interview by SADE OGUNTOLA, a diabetes expert, Dr Williams Balogun, said Nigerians should be diabetes-conscious, eat healthily and exercise to avoid falling prey to diabetes because it is on the rise in Nigeria.
H OW is Nigeria’s 10 per cent sugar tax on sweetened beverages likely to impart incidence of health problems like diabetes, tooth decay and obesity?
It is a step in the right direction because there is a rise in the burden of diabetes and its complications in Nigeria and other developing countries. We have imbibed the Western lifestyle, their diet and way of life, which were not part of our traditional culture.
Consuming sweetened beverages and sugar makes people gain weight and this can lead to diabetes. Gaining weight and becoming obese are strong risk factors to develop Type 2 diabetes. The policy will make these drinks more expensive; it does not say people should not take them.
So, an individual has a choice to make. If you want to consume much of it, then you should also be prepared to pay much more to be able to get it. It is to force you to think twice and discourage you from buying as much as you would have wanted to buy. Addressing diseases that develop as a result of a change in lifestyle will also require another change of lifestyle and a lot of self-discipline.
A school of thought is that the Sugar tax should also be extended to alcoholic drinks, being also sources of extra calories and its deleterious effect on the human body when taken in large amounts. What is your opinion on this?
I agree that alcoholic drinks and tobacco because they could jeopardize health should attract similar legislation to discourage taking them recklessly. But you cannot legislate that people should stop taking alcohol. Medically, there is a quantity of alcohol use that will not jeopardize the health and people are allowed to take that. However, the problem is, how do you draw the line since these things have additive components that make you want to take beyond what you should have taken?
How much is too much when it comes to the intake of sweetened beverages?
It is difficult to put a cut-off limit for sweetened beverages and sugar intake for the general population. For instance, the amount someone on the way to having diabetes could take will differ from someone who is not genetically predisposed to develop diabetes and maintain a good lifestyle. It varies from one person to another, to a great extent, unlike alcohol where there are general recommendations on what men and women can take per week.
Diabetes runs in some individuals’ family trees; so is it possible to prevent it?
Diabetes is of different types. Type 2 diabetes, which is the commonest type, occurs in seven or eight of every 10 people with diabetes. The good news is that Type 2 diabetes is highly preventable, even in those with a family history of diabetes: by cultivating a healthy eating habit, exercising and going for periodic screening.
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Can fever, malaise or feeling of unwell be a sign of diabetes in some instances?
A classical feature of diabetes is feeling weak and unwell that many in our environment easily attribute to malaria, given that Nigeria is in a malaria-endemic area. They are unable to distinguish a malaise due to malaria or COVID-19 from that due to diabetes because in the past when they were treated with malaria medicine they got better. They just assume that malaria is back. People should have the habit of checking, if after taking malaria medicine, they are still not well, they should also have a blood sugar check to rule out diabetes.
How true is it that there is a looming epidemic of diabetes in Nigeria?
It is true that there is a looming epidemic of diabetes in Nigeria. We have started seeing an upsurge in cases and it’s very frightening. In the early 60s, researchers and health practitioners reported that it was difficult to even say we have diabetes in Nigeria. The percentage of the population that reported having diabetes was less than one per cent. Now, it is much higher, with variations from one part of the country to another.
Currently, we are thinking that between five to seven per cent of our population has diabetes. Considering that Nigeria has a population of about 200 million, that’s a lot! Tracking its trajectory, you can see a steady rise. And this is partly because we are imbibing Western and sedentary lifestyles. Technology has really revolutionized a lot of things; including house chores and people hardly walk. And we’ve also seen that when people migrate from rural to urban areas, there is a higher chance of developing diabetes.
Is diabetes a disease that is biased for a particular gender or age group?
Diabetes tends to occur with ageing. However, that diabetes has a bias for a particular gender is not something that is settled. Diabetes affects all gender almost equally. In Nigeria, it is difficult to say that diabetes is biased for a particular gender. Nigerians don’t have the habit of periodic medical screening and the health-seeking behaviour of the two genders differ.
Many healthcare practitioners have reported that women with diabetes are a little bit more than men. But that could be because the health-seeking behaviour of women in the country is better than that of men. What a woman will consider and quickly come to the hospital to report, a man may still put up a ‘macho’ face and refuse to seek help. In developed countries, people don’t have to wait till they have a disease. They have a periodic habit of going to do what we call check-ups or medical screening.
Is Nigeria doing enough, both in the prevention and treatment of diabetes?
No, we’re not doing enough; we have not given health the kind of priority it deserves, even compared to some African countries. Our health system is still crawling; budgetary allocation to health is below WHO recommendation. A lot still needs to be done to re-orientate or educate the public because cultural beliefs and misconceptions about what is responsible for diabetes are rife. Some believe it is due to a spiritual attack.
Unfortunately, we haven’t really done much on non-communicable diseases, perhaps because it takes time to develop. And while it is developing in the body, it has already started to cause havoc. Type 2 diabetes, for example, is not when you see clinical signs and symptoms that it actually started in the body. Many times, it’s already in the body for months and years. So, it is not uncommon to see that when people with diabetes present to the hospital, they already have complications. That is why a lot needs to be done on educating our people to ensure that they imbibe the good practice of diabetes screening to be sure their blood sugar level is within the normal range.
A lot of people with diabetes have amputated limbs, what is responsible for this? Can this be prevented?
This is a sad picture that we see with diabetes; it’s terrible to see the legs of individuals who could still fend for their family and contribute to society cut off! They had wounds that refused to heal because of diabetes. Sometimes, people don’t know that they have diabetes. The first thing that will bring them to the hospital is a wound that refused to heal because diabetes is already in their bodies. Some with known diabetes end up with a wound that refused to heal because they have not really taken the treatment and care of their diabetes seriously. They don’t comply with all the instructions, eating appropriately, being physically active, buying and taking their medications regularly; and coming to the hospital for their medical appointments and checkup because they think that they are fine. The fact that they are able to go out and be involved in their normal activities without taking their drugs and complying with other instructions will only be for a while. A lot of people had fallen into that trap. Meanwhile, the disease is still doing havoc, destroying blood vessels and vital body organs gradually.
Before you know it, they have a wound that is not healing. Some again make the mistake of still keeping it at home, thinking that when they use herbal or traditional means it will heal. Usually, by the time they come to the hospital, it is too late. The blood vessels supplying the limbs would have been damaged, and there is nothing that can be done to salvage it. So it’s one of those saddest ways by which diabetes render human life useless.
How common is limp amputation due to diabetes?
Limb amputation among persons with diabetes is quite common. For instance, at the UCH, about four or five out of ten individuals admitted into the diabetes ward at a time would have a problem with a foot ulcer. So, quite a number of them on admission have foot ulcers that may require limb amputation invariably, if care is not taken.
This is an area that the government needs to accord higher priority. Diabetes is a disease that is very expensive to treat, especially when the complications set in. Diabetes prevention is still the best approach.