The Endocrinology and Metabolism Society of Nigeria (EMSON) has issued a caution as Nigerians participate with the global community in observing World Diabetes Day (WDD), highlighting that over 10 million Nigerians currently live with the condition, with projections indicating that this figure could double by 2030 unless prompt measures are undertaken.
The Society also expressed concern regarding the scarcity of endocrinologists, noting that there are merely 150 professionals available to address this health issue within a populace exceeding 220 million individuals. They pointed out that diabetes significantly contributes to kidney failures, heart attacks, strokes, limb amputations, blindness, and various other ailments.
Endocrinologists and diabetologists are tasked with diagnosing, recognizing, and managing disorders of the endocrine system, making the distressing lack of such specialists alarming. Diabetes, a pancreatic ailment, along with disorders of the thyroid, pituitary gland, and adrenal glands, falls under the care of endocrinologists.
WDD serves as an opportunity to elevate public understanding of diabetes as a worldwide public health concern and the steps that should be taken, both individually and collectively, to enhance diabetes prevention, identification, and treatment.
This year’s theme, “Access to Diabetes Education,” is underpinned by the broader multi-year focus on “Access to Care.” Type 2 diabetes, linked to lifestyle choices such as obesity and unhealthy habits, accounts for 90% of diabetes cases. The Type 1 variant, which begins in childhood, is an incurable autoimmune disorder.
Prof. Olufemi Fasanmade, President of EMSN and Consultant Endocrinologist/Physician at Lagos University Teaching Hospital (LUTH), Idi-Araba, stated that the occurrence of diabetes mellitus in Nigeria is increasing.
“In the 1960s to 1970s, diabetes was present in only 0.5-1 percent of adults in Nigeria. By the 1980s to 1990s, this figure climbed to 1.4-2.2 percent of adults. Presently, approximately 5.7 percent of adults are affected by diabetes, and about 10 to 15 percent are diagnosed with pre-diabetes.
“In Nigeria’s urban areas, one in ten adults is living with diabetes, and we have close to 90 to 100 million adult residents. Nearly 10 million individuals in Nigeria are afflicted by diabetes, while 30 percent of individuals with hypertension are also diabetic.
“The overall figure of people diagnosed with diabetes in Nigeria is the highest within sub-Saharan Africa. This surpasses the combined total of tuberculosis, Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), and COVID-19. Diabetes results in a greater fatality rate in Nigeria than COVID-19, tuberculosis, HIV/AIDS, and cancer combined,” he noted.
According to Fasanmade, diabetes is the leading cause of lower limb amputations and chronic kidney conditions. He mentioned that only 150 endocrinologists practice in Nigeria, translating to about 1 for every 100,000 people.
Fasanmade commented on the financial implications of managing diabetes: “Diabetes is an expensive condition. A typical patient in Nigeria spends between N20,000 and N30,000 monthly to keep the disease in check. This is the minimum cost, covering prescription medications, blood tests, and consultation fees. Some patients may need to allocate between N100,000 and N150,000 monthly when complications like kidney diseases arise.
“In the United States, diabetes costs around $300 billion each year. The total expenses related to diabetes in Nigeria remain uncertain. A vial of insulin ranges from N6,000 to N10,000, with patients requiring one or two vials monthly.
“A box of strips for blood sugar testing is approximately N6,000, with a need for one or two boxes each month. Some tablets are priced as low as N2,000 monthly while others can rise to N30,000 monthly. Generally, patients are prescribed two to three different medications.”
Fasanmade identified western lifestyle, tobacco use, and alcohol consumption as contributors to the rising incidence of diabetes cases.
“The western lifestyle poses significant risks by promoting a sedentary existence, the consumption of calorie-dense foods (fast food and sugary drinks), and increased stress levels. Unfortunately, people are engaging in less physical exercise these days and are opting for cars, taxis, and motorcycles even for short distances, resulting in escalating obesity, which further heightens the risk of developing diabetes,” Fasanmade commented.
While acknowledging the absence of clinically effective treatments for diabetes, the endocrinologist noted that there have been only a few reports of experimental approaches that tend to be impractical, such as whole pancreas or islet cell transplants. “However, acquiring a pancreas is challenging, and the procedure involves its own risks,” he stated.
He asserted that diabetes is a chronic or degenerative illness requiring ongoing management as it is a lifelong condition similar to hypertension and many other non-communicable diseases. However, he added, “There may be a potential cure in the future, but none exists at present.”
Fasanmade observed that the last reliable national prevalence of diabetes was documented at 2.24 percent in 1992, lamenting the absence of a population-based estimate over the past two decades to assist with national health frameworks, policies, and funding. Furthermore, over time, the International Diabetes Federation has predominantly provided prevalence estimates for Nigeria based on extrapolated data from other countries with similar sociodemographic profiles.
“Currently, there is a significant shortage of qualified diabetes specialists throughout the country,” he stated, emphasizing that diabetes research in Nigeria is inadequately financed, and there is a lack of public awareness and support for diabetes prevention and care at all levels.
WHO facts on Diabetes
The World Health Organization (WHO) Fact Sheet on Diabetes indicates that 8.5% of adults aged 18 years or older had diabetes in 2014. In 2019, there were 1.5 million fatalities directly linked to diabetes, with 48% of these deaths occurring in individuals under 70. Diabetes was also responsible for an additional 460,000 deaths caused by kidney diseases, and elevated blood sugar levels contributed to 20% of cardiovascular deaths.
“From 2000 to 2019, there was a 3 percent rise in age-standardized mortality rates due to diabetes. In lower-middle-income nations, this mortality rate increased by 13 percent.
“Conversely, the likelihood of dying from any of the four principal non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory conditions, or diabetes) between the ages of 30 and 70 declined by 22 percent globally between 2000 and 2019.
“Adopting a wholesome diet, engaging in regular physical activity, maintaining a healthy body weight, and refraining from tobacco use are effective strategies to prevent or delay the onset of type 2 diabetes.
“Diabetes can be managed, and its complications can be avoided or postponed through a combination of diet, physical activity, medication, and consistent monitoring and treatment for any associated issues.”
The body’s ineffective utilization of insulin leads to type 2 diabetes, often referred to as non-insulin-dependent or adult-onset diabetes. This type affects more than 95% of individuals diagnosed with diabetes and is primarily driven by excessive body weight and sedentary lifestyles.
Initially, this type of diabetes was observed solely among adults, yet it is increasingly being diagnosed in children.
A hallmark of type 1 diabetes, which is also known as insulin-dependent, juvenile, or childhood-onset diabetes, is inadequate insulin production, necessitating daily insulin injections. In 2017, nine million individuals worldwide had type 1 diabetes, with the majority residing in affluent countries. The causes and preventive methods for this condition remain unknown.
