As Nigerians join the rest of the world today, to observe World Diabetes Day (WDD), the Endocrinology and Metabolism Society of Nigeria (EMSON) has warned that over 10 million Nigerians are living with the disease and the numbers are expected to double by 2030, if nothing is done urgently.

The Society also decried a situation where there are only 150 endocrinologists in a population of more than 220 million to manage the condition, adding that diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.

The alarming dearth of endocrinologists is worrisome, as these specialists and diabetologists investigate, diagnose and treat disorders of the endocrine system. Endocrinologists treat diabetes, a disease of the pancreas and diseases that affect other endocrine systems such as the thyroid, pituitary gland and adrenal glands.

WDD provides an opportunity to raise awareness about diabetes as a global public health issue and what needs to be done, collectively and individually, for better prevention, diagnosis and management of the condition.

This year’s theme, ‘Access to Diabetes Education’, underpins the larger multi-year theme of ‘Access to Care’. Nine in 10 of diabetics have the Type 2 variant, a lifestyle disease linked to obesity and unhealthy living. The Type 1 variant is an unpreventable autoimmune disease that develops in childhood.

President of EMSN and Consultant Endocrinologist/Physician at Lagos University Teaching Hospital (LUTH), Idi-Araba, Prof. Olufemi Fasanmade, told The Guardian that the burden of diabetes mellitus in Nigeria is increasing.

“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.

Fasanmade added that diabetes remains the commonest cause of lower limb amputation and chronic kidney disease. “There are only 150 practicing endocrinologists in Nigeria, which is about 1:1,000,000,” he said.

Commenting on the cost of living with diabetes, Fasanmade said: “Diabetes is a very costly condition. In Nigeria, a typical patient with it will spend N20,000 to N30,000 to properly control it. This is the minimum and covers medications, blood tests and clinic attendance. When complications like kidney disease come into the picture, some patients have a monthly expenditure of N100,000 to N150,000.

“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.”

On factors fueling an increase in the number of diabetic cases, Fasanmade said western lifestyle, smoking and drinking are risk factors.

“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.

The endocrinologist, while admitting that there is no clinically available cure for diabetes, added that there are just a few reports of largely impracticable experimental cures such as transplants of the whole pancreas, or islet cells of pancreas to people. “But getting a pancreas is not easy and the operation comes with its own challenges,” he said.

He stressed that diabetes, like hypertension and many other non-communicable diseases, are degenerative or chronic diseases, which have to be managed since they are lifelong conditions. “In future, however, there may be a cure, but presently there is none,” he said.

While regretting the absence of a current population-based national prevalence figure for diabetes in the last 20 years to aid national health planning, policies and financing, Fasanmade said the last true national prevalence of diabetes was given in 1992 as 2.24 per cent. And the prevalence estimates given by the International Diabetes Federation for Nigeria over the years have relied mainly on data extrapolated from other countries with similar socio-demographic characteristics as 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.

According to the World Health Organisation (WHO) Fact Sheet on Diabetes, “in 2014, 8.5 per cent of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48 per cent of all deaths due to diabetes occurred before the age of 70 years. Another 460,000 kidney disease deaths were caused by diabetes, and raised blood glucose causes around 20 per cent 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.”

Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. More than 95 per cent of people with diabetes have type 2 diabetes. This type of diabetes is largely the result of excess body weight and physical inactivity.

Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly in children.

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterised by deficient insulin production and requires daily administration of insulin. In 2017 there were nine million people with type 1 diabetes; the majority of them live in high-income countries. Neither its cause nor the means to prevent it are known.

Last year, the Federal Government introduced a Sugar-Sweetened Beverage (SSB) tax embedded in the Finance Act of 2021, which levies a ₦10 tax on each litre of all non-alcoholic and sugar-sweetened carbonated drinks. The fiscal policy was introduced to help curb excessive consumption of sugars as is done in Mexico, which could have a positive benefit on population health, especially in the prevention of non-communicable diseases (NCD) like diabetes and chronic kidney disease, beyond the potential benefit of revenue generation.

Chief Superintendent of Customs, Department of Excise, Free Trade Zone and Industrial Incentives, Mr Dennis Ituma, disclosed that government had started the implementation of the N10 taxation per litre of SSBs. According to Ituma, customs had started the implementation of taxing all companies producing SSBs on June 1, 2022.

At a recent roundtable on the policy by PharmAccess Foundation, stakeholders lamented that the SSB tax enforcement structure and the timeline for implementation are yet to be determined.

Some of the action plans proposed by the stakeholders include: The SSB and other pro-health taxes should be allocated to the health sector to fund the prevention and treatment of non-communicable diseases (NCDs) and provide financial protection for Nigerians; the Finance Act should be improved to address how the generated SSB tax will be utilised; advocacy should go beyond SSBs to focus on the entire pro-health taxes, which include alcohol and tobacco.

They noted that the SSB tax is too low to achieve deterrence from consumption of unhealthy products, so, the percentage should be increased to effectively reduce consumption of SSBs and Federal Government should design a robust framework for the utilisation of the earmarked funds from SSB tax at the national and sub-national level and monitor state governments to ensure value for money and adherence to the guidelines.

A NEW study finds that an eight-week exercise programme consisting of one hour of exercise three times a week can restore brain insulin sensitivity in individuals with obesity.

The link between brain insulin insensitivity and diabetes is well-established, but the exact nature of that connection is still being studied.

New research from researchers at the German Center for Diabetes Research, Tübingen University Hospital, and Helmholtz Munich in Munich, Germany, explores the effect of exercise on brain insulin sensitivity.

The study found that healthy levels of brain insulin sensitivity were restored in participants after an 8-week exercise programme. The findings were recently published in JCI Insight.

Also, another study found exercising later in the day may reduce insulin resistance, control blood sugar. Researchers in Europe analysed data to see if breaks in sedentary activity can impact insulin resistance.

The researchers found no connection between breaks in sedentary activity and reduced insulin resistance but did find a possible connection between the timing of exercise and insulin resistance.

While exercising in the morning did not reduce insulin resistance, the researchers found that exercising in the afternoon or evening may be beneficial.

According to WHO, obesity rates have tripled worldwide since 1975. The connection between obesity and insulin resistance is bidirectional. Insulin resistance often develops due to being overweight or obese, which can lead to type 2 diabetes.