How lifestyle, late detection fuel diabetes crisis in Nigeria

How lifestyle, late detection fuel diabetes crisis in Nigeria

As Nigeria joins the rest of the world to commemorate World Diabetes Day(WDD), marked annually on Nov. 14, health experts have warned that changing lifestyles and late detection are fuelling a diabetes crisis in the country.

The Voice Media Trust (VMT NEWS) reports that WDD is commemorated to raise awareness on prevention, early detection and care.

Diabetes mellitus, a chronic metabolic condition characterised by elevated blood sugar due to inability of the pancreas to produce enough insulin or impaired insulin action, has become a major public health concern, with complications including blindness, kidney failure, heart failure, stroke and limb amputation.

According to the International Diabetes Federation (IDF) Diabetes Atlas, globally about 589 million adults live with diabetes, with 24.6 million in Africa.

About 11 million adults live with the condition in Nigeria, with many unaware of their status.

The experts spoke in separate interviews with NAN in Ibadan, in commemoration of World Diabetes Day.

They remarked that the disease, which can remain undetected for years without symptoms, is now killing more Nigerians than malaria, HIV and tuberculosis combined.

An Endocrinologist, Prof. Michael Olamoyegun said diabetes kills more Nigerians than malaria, HIV and tuberculosis combined.

Olamoyegun is Professor of Medicine and Endocrinology at Ladoke Akintola University of Technology and also Consultant Physician and Endocrinologist at LAUTECH Teaching Hospital, Ogbomoso, Oyo State.

He said diabetes is a metabolic disorder of carbohydrates, fats and protein.

He added that it is characterized by elevated blood sugar due to inability of pancreas to produce enough insulin.

According to him, diabetes also occurs if insulin action is impaired.

He said there are many variants but three main types exist.

He listed Type 1 diabetes which occurs due to absolute deficiency of insulin.

Olamoyegun said it is seen mainly in younger age group, usually less than 30 years, although occasionally in adulthood.

He said it is found in about five to ten per cent of all individuals with diabetes.

He said this group are managed with insulin injections since body no longer produces insulin.

The Endocrinologist said Type 2 diabetes represents 90 to 95 per cent of individuals with diabetes, stressing it occurs when insulin is not able to function well in the body.

According to him, this usually occurs in older individuals who have family history in first-degree relatives.

Olamoyegun, also the Secretary General, Association of Clinical Endocrinologists of Nigeria (ACEN) added hypertension, overweight or obese and sedentary lifestyles as risk factors.

He said it is usually managed with oral medications, dietary control and occasionally with insulin.

The Endocrinologist emphasised that Gestational Diabetes Mellitus is diabetes first detected in pregnancy, saying it complicates about 7.5 to 12 per cent of all pregnancies.

He explained that diabetes in pregnancy makes it high risk as it can worsen outcomes for mother and foetus.

On prevalence, he said number of people living with diabetes had increased worldwide and in Nigeria.

Globally, more than 600 million people are living with diabetes, 25 million in Africa, while 7 per cent, that is 11 million adults older than 18 years, in Nigeria have diabetes.

He noted that most people with diabetes are unaware of their status, emphasising that the number of Nigerians living with diabetes increased by more than 21 per cent in last five to six years.

“In Nigeria, most individuals with diabetes are aged 45 to 59 years (mostly productive years).

“At least 15 to 20 per cent of people admitted into medical wards in most tertiary hospitals in Nigeria have diabetes and they usually have one complication or another.

“Globally, diabetes kills one person every five to six seconds, every 30 seconds, someone’s leg is amputated due to diabetes.

“Nigeria has one of highest rates of amputation due to diabetes in the world and most amputations are major amputations, below or above the knee,” he said.

On signs, Olamoyegun said diabetes might present in three different ways.

“Firstly, with symptoms like excessive urination, excessive thirst, increased hunger, numbness, weight loss and tiredness.

“Secondly, it may be without symptoms, (asymptomatic), that is absent of specific symptoms, which can lead to delay in diagnosis as individuals may not see need for screening.

“Type 2 diabetes may be present for 5 to 10 years before diagnosis is made.

“The third may be with diabetes-related complications like erectile dysfunction, impaired vision and delayed wound healing leading to amputation,” he said.

Olamoyegun also listed stroke and kidney failure.

The Endocrinologist further explained that diabetes is commonest cause of adult-onset blindness and leading cause of kidney failure.

He added that it is also the commonest cause of non-traumatic amputation.

According to him, diabetes is also a risk factor for heart failure, stroke and dementia, (that is loss of memory).

On biggest complications, he said there are many complications including diabetic foot ulcers and blindness.

He also listed kidney failure, heart failure, dementia and sexual dysfunctions in male and female.

Olamoyegun further remarked that at least one in three patients with diabetic foot ulcers admitted into hospitals in Nigeria end up with amputation.

He added that approximately one in five individuals with diabetic foot ulcers die during hospital admission.

“Recent findings showed diabetes ranks as commonest cause of kidney failure in some tertiary hospitals in Nigeria,” he said.

On solutions, Olamoyegun urged Nigerian government to expand health insurance coverage for diabetes medicines, saying coverage should include insulin, glucose monitoring and complication screening.

He called on government to strengthen primary healthcare through trained personnel and reliable supplies, as well as early diagnosis and referral.

The consultant urged government to support healthier school meals and affordable nutritious foods.

Olamoyegun further advised for establishment of national diabetes register to monitor care and outcomes and establishment of Nigeria Diabetes Centre in each of six geopolitical zones.

He said government should improve research funding for diabetes and other non-communicable diseases.

The consultant endocrinologist also advised individuals to maintain healthy weight and exercise regularly.

Olamoyegun urged people to always eat vegetables, beans and whole grains and limit sugary drinks.

“People should learn to seek risk-based diabetes testing, especially with obesity or family history, they should take prescribed medicines consistently, monitor glucose and attend appointments.

“Obtain regular eye, kidney and foot assessments; avoid tobacco and unverified cures,” the consultant endocrinologist advises.

Nigeria carries highest burden of diabetes in sub-Saharan Africa, says Dr Roseline Akande, Public Health Physician, LAUTECH Teaching Hospital, Ogbomoso.

According to her, diabetes mellitus contributes to global burden of disease with life-threatening complications.

She cited 2024 systematic review and meta-analysis published in Cardiovascular Diabetology, drawing on 60 studies and 124,876 participants.

“Drawing on 60 studies across all six Nigerian geopolitical zones and 124,876 participants, the true prevalence of Type 2 diabetes in Nigeria is 7.0%,” she said.

She noted this translates to estimated 8.02 million Nigerians, or roughly one in every 14 adults.

The public health physician said figure is nearly double what International Diabetes Federation previously reported and could nearly double by 2045.

On Oyo State, Akande cited 2017 study in Oke-Ogun region.

She said it reported 4.6 per cent prevalence and pre-diabetes values of 6.0 per cent, with females more affected in Oyo State.

On why cases are rising, she attributed it to globalization and urbanization.

“The effects of globalization, urbanization with the attendant industrial explosion, family history of diabetes, the consequences of life style modification and nutrition, has further increased the prevalence rate of diabetes in our society,” she noted.

Akande further listed sedentary lifestyle and poor eating habits as main risk factors.

“The risk of T2DM is greatly increased by the increased use of processed foods, sugary drinks, and high-calorie meals among Nigerians who migrate to cities,” she explained.

She added that transition from traditional diets high in fruits, vegetables and whole grains to Westernized diets worsens issue.

According to her, poor health seeking behaviour among young adults especially accessing preventive services is contributory.

On screening programme, Akande confirmed Project 10 Million was organized across Nigeria including Oyo State.

She said state-wide campaign launched by Oyo State Government targeting hundreds of thousands for free blood pressure and blood sugar checks.

She noted screening facilities are available in both public and private health facilities in Oyo State.

On solution, the public health physician said improved knowledge could encourage preventive measures.

She noted most studies on knowledge were hospital-based among diabetic patients, very few among community members.

According to her, National framework on diabetes embodied in NHSDP II, SDGs, National Policy on NCDs and Multi-Sectoral Action Plan are relevant policies to reduce burden.

Diabetes damages heart muscles and vessels via persistent chronic inflammatory states leading to* atherosclerotic changes, says Dr Temilade Adeyanju, Consultant Cardiologist, UCH, Ibadan.

“Diabetes mellitus presents a chronic inflammatory state, that can directly affect the heart muscles and vessels leading to atherosclerotic changes and fibrosis,” she said.

She noted autonomic damage affects neural transmission.

“It causes autonomic damage, which can affect neural inputs transmission to the heart causing neural dysfunction, arrthythmias and other cardiovascular complications including heart failure etc.

“The persistent high blood sugar known with DM creates a pathophysiological dysfunction at the cardiac cellular level, causing metabolic and microvascular disruption in cardiac muscle cellular exchanges.

“This can lead to scarring – fibrosis continuum,” she explained.

On stroke and heart failure, the consultant said majority are caused by systemic hypertension but diabetes increases risk.

” Compared to Hypertension, Fewer stroke patients had diabetes alone first, before their stroke” she said.

On prevention, Adeyanju advised early screening to prevent failure.

“From the first day at diagnosis, other risks factors should be screened for, and re checked at least once per annum,” she stated.

Diabetes can remain undetected for years without obvious symptoms, says Dr Muyiwa Oguntunde, Family Physician, O.L.A Catholic Hospital, Ibadan.

“In Family Medicine, we do not focus only on the presenting complaint; we look at the patient as a whole,” he said.

He said patient may present with fever and assume malaria, but symptoms like excessive urination at night, excessive thirst and unexplained weight loss should make us consider diabetes.

“One important point is that not every fever is malaria or typhoid,” he noted.

On yearly test, he said simple test is blood glucose test.

He described fasting blood glucose as practical and relatively affordable screening option.

According to him, HbA1c gives indication of average blood glucose over approximately three months and does not require fasting.

He encouraged adults aged 35 years and above, overweight persons and those with family history to undergo screening.

On herbal mixtures, the physician said patients believe herbal preparations are safer simply because natural.

“Diabetes is not a condition that should be treated by trial and error,” he said.

Global data shows 43 per cent of adults with diabetes (252 million) are undiagnosed, which contributes to late presentation and complications like amputation and blindness.

Oguntunde warned of delayed diagnosis, unpredictable ingredients, drug interactions, kidney and liver injury and progression of complications.

On first-step management, Oguntunde said management can begin at primary-care level without waiting for specialist.

He listed affordable lifestyle modification, including reducing sugary drinks and encouraging balanced meals with locally available foods.

He said metformin is often affordable first-line option provided renal function adequate.

He added that initial assessment should check blood pressure, kidney function, foot sensation and eye assessment, and urgent referral for vomiting, deep breathing or altered consciousness.

No single food automatically worsens diabetes, says Abdulsalami Olayinka, Assistant Director of Dietetics, UCH, Ibadan.

According to him, what matters is type of food, quantity consumed, frequency and how it is combined.

The Dietician explained that some foods have greater potential to cause rapid increases in blood glucose when consumed excessively.

Olayinka described sugary drinks as among the most problematic, including fizzy drinks, sweetened fruit juices and energy drinks.

He said they contain large amounts of rapidly absorbed sugars and can cause sharp increases in blood glucose.

He said white rice is refined carbohydrate with relatively low fibre and large portions without vegetables and protein can increase blood glucose.

Olayinka added that white bread is another refined carbohydrate that is quickly digested and frequent consumption without protein makes management difficult.

The dietitian noted that amala and lafun are carbohydrate-rich foods commonly consumed in southwestern Nigeria and can be included in meal plan.

He said excessive portions can increase blood glucose depending on flour used, preparation method and accompanying soup.

Olayinka recommended not to completely prohibit culturally important foods but educate patients on moderation, appropriate portions and healthier combinations.

On garri, he said it is scientifically incorrect to say garri directly causes diabetes.

He explained that garri is from cassava and eating garri does not automatically make someone diabetic.

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He described diabetes as complex condition influenced by genetic susceptibility, insulin resistance, lifestyle and body weight.

He said because garri is rich in carbohydrates, excessive consumption can significantly increase blood glucose in people already living with diabetes.

Olayinka recommended diabetes plate method for portion control.

He said half of plate should be non-starchy vegetables such as ugu, ewedu, okro, cabbage, spinach and green beans.

He said one-quarter should be protein such as fish, eggs, chicken, beans or lean meat and one-quarter carbohydrate such as amala, garri and rice.

For household measurement, he said cooked rice should be approximately half to one standard measuring cup per meal.

Olayinka advised amala should be one small, fist-sized portion and soaked garri should be half cup of dry garri before soaking.

He said bread should be approximately two thin slices, preferably whole-grain, noting these are general starting points, not universal prescriptions.

According to him, portion requirements should be individualised according to blood glucose levels, body weight, physical activity, medication and nutritional needs.

On cost, Olayinka said eating healthily does not necessarily mean buying expensive imported foods or special diabetic products.

This is important as the 2024 Nigeria Demographic and Health Survey shows 41 per cent of children aged 6 to 23 months consume sugary drinks.

Nearly 80 per cent of Nigerians could not afford a healthy diet in 2022 according to Global Food Policy Report.

The Dietician recommended three practical swaps using affordable Nigerian foods.

“First, instead of soft drinks and sweetened zobo, encourage water and unsweetened zobo to reduce sugar consumption.

“Second, instead of large plate of white rice or large ball of amala, reduce carbohydrate and increase vegetables like ugu, ewedu, okro and cabbage.

“Also, beans and cowpeas are excellent affordable sources of plant protein and dietary fibre.

“Third, instead of biscuits, cakes and sugary pastries, encourage boiled eggs, boiled groundnuts in moderate portions and fresh oranges,” he said.

The Dietician also listed garden eggs, cucumber and small portions of pawpaw as options that provide fibre and protein.

He emphasized that healthy eating should be based on locally available, affordable and culturally acceptable foods.

Olayinka said diabetic meal plan should be adequate, affordable, practical and based on foods readily available within community.

He gave example of breakfast as two slices whole-wheat bread, one boiled egg, cucumber and unsweetened tea.

He listed lunch as one small portion of amala, ewedu and okra soup with moderate palm oil and moderate portion of fish.

He listed dinner as two serving spoons of cooked beans, small portion of boiled plantain and cabbage or ugu.

“Beverage throughout day should be adequate clean drinking water and avoid soft drinks and added sugar.

“Also, patients using insulin or certain diabetes medications should avoid skipping meals because of risk of hypoglycaemia,” he said.

Olayinka concluded that diabetes is not a death sentence and does not mean abandoning all foods enjoyed.

He said problem is often not Nigerian food itself but inappropriate timing, excessive portions, poor combinations and frequent sugary drinks.

He added physical inactivity and inadequate nutritional education.

He stressed that people should receive regular nutritional counselling from qualified Registered Dietitians and work closely with healthcare teams.

He said diabetes management is not achieved through medication alone but through nutrition, physical activity, medication adherence and regular monitoring.

The Dietician maintained that healthy eating should not be privilege for wealthy but achievable lifestyle for every Nigerian family.

The Deputy Director of Pharmaceutical Services at UCH, Ibadan, Dr Moses Ajayi, identified major challenges affecting diabetes management.

According to him, the major challenges are high cost, out-of-stock and challenges in maintaining cold chain in the face of erratic power supply.

He listed drugs used by an average person to include Metformin + glimepiride, Metformin + vildagliptin or linagliptin or sitagliptin, or metformin and dapaglifloxin or empaglifloxin.

“Metformin 1g is N480 per sachet, Metformin 500mg is N450 per sachet, Linagliptin is N4,920, Dapaglifloxin is N4,800 per sachet while Empaglifloxin is N6,100 to N9,650 per sachet.

“Humulin 70/30 costs N23,914 for patients paying out of pocket while patients on National Health Insurance Authority (NHIA) pay N13,400.

“Injection Insulin Glargine costs N14,230 for patients paying out of pocket while patients on NHIA pay N8,888,” he said.

Ajayi said in their units, insulins basically 70/30 and soluble insulins are available, noting that for the test strips, medical store or Diabetes Association of Nigeria deals with that.

He said the challenges include out of stock, maintaining cold chain in the face of erratic power supply and accessibility to NHIA by patients.

Ajayi added that the cost of an average insulin is more than the approved NHIA price, so patients on NHIA need to pay more to get the insulin.

He said complications seen due to uncontrolled blood glucose in diabetic patients include retinopathy and nephropathy.

On solutions, Ajayi called for awareness on the dangers associated with uncontrolled diabetes, making drugs readily available for diabetes and review of NHIA tariff so as to accommodate antidiabetics and diabetic medications.

While the crisis appears daunting, experts insist that beyond medication, solutions also lie in lifestyle and early action.

For individuals, this means maintaining healthy weight, regular exercise, eating more vegetables, beans and whole grains, practising portion control with the diabetes plate method — half plate vegetables, quarter protein, quarter carbohydrate — limiting sugary drinks.

Also Paramount is avoiding tobacco and unverified herbal mixtures, and seeking risk-based screening especially for adults above 35 years, overweight persons and those with family history.

For government, they advocate expanding NHIA coverage to include insulin, glucose monitoring and complication screening, reviewing NHIA tariffs to accommodate anti-diabetic medications.

They also advocate strengthening primary healthcare for early diagnosis and referral, supporting affordable nutritious foods and healthier school meals.

Also necessary is establishing a national diabetes register and Diabetes Centres in the six geopolitical zones, ensuring availability of drugs and cold chain for insulin, and increasing funding for research on non-communicable diseases.

For healthcare systems, this includes regular eye, kidney and foot assessments from first day of diagnosis and rechecking annually, taking prescribed medicines consistently.

Also included is monitoring glucose and attending appointments; receiving nutritional counselling from registered dietitians.

As observed during the interviews, diabetes is not a death sentence, but late detection, poor diet and sedentary lifestyle remain major drivers.

With early screening, affordable care and healthy living, Nigeria can curb the growing burden and prevent avoidable deaths, blindness, kidney failure and amputations.