Diabetes Prevalence
Diabetes mellitus is a chronic, incurable metabolic disease defined by elevated levels of blood glucose over time (WHO, 2024). Approximately 537 million adults aged 20-79 years live with diabetes, consequently resulting in an annual death rate of 1.5 million people. In less than a decade, the global burden of the disease has risen by 13.2% with the majority of affected individuals situated in low-and-middle-income countries (IDF, 2024). Across Africa, approximately 24 million adults are diagnosed with diabetes, and without effective interventions, this number is expected to rise to 55 million by 2045. Diabetes therefore posesa critical public health issue, necessitating commitments to bridge the gaps and break barriers to effective care and prevention. Â
The Nigerian Context
With Nigeria being the most populous African nation, accounting for one-sixth of the diabetes burden in the continent (IDF, 2024), implementing comprehensive care for diabetes management portends significant benefits for facilitating the achievement of Sustainable Goal (SDG) 3. Consequently, the National Guideline on Prevention, Control, and Management of Diabetes Mellitus helps to ensure standardized care for preventing patient complications. Similarly, the National Framework and Policy on Diabetes (prevention, management, and control) was developed with the overarching objective of improving health outcomes and decreasing the national diabetes burden (Chelo, 2019).
However, these efforts have not been met by a commensurate reduction in diabetes burden as Nigeria still records an over 3% increase in the prevalence rate in the last 10 years with the majority of affected individuals resident in the south-south geopolitical zone (Uloko et al., 2018). This is a critical challenge as the increasing diabetes prevalence further heightens the rates of microvascular complications such as blindness and kidney failure. In Nigerian hospitals, more than 30% of lower-limb amputations are related to diabetic complications. Additionally, diabetes is underpinned as the underlying cause of a number of serious and expensive health issues majorly financed by out-of-pocket payments (Ugwu et al., 2019). These health and economic challenges associated with diabetes underscore the urgent need for measures to ensure that all who are diagnosed with diabetes have access to equitable, comprehensive, affordable, and quality care while also reducing public health risks.
Bridging the Gaps
The commitment to bridge the gaps in diabetes care and prevention starts with a collective and individual imperative. While governments, regional bodies, healthcare professionals, and other relevant stakeholders are implementing measures to support diabetes care, it is also critical for individuals tomake informed decisions about self-management or reduce their predisposition to the disease.
Diabetes could either be type 1, type 2, or gestational. While type 1 diabetes is more common in children and adolescents, over 90% of people with diabetes in Nigeria have type 2 diabetes. This variant of the disease is thought to affect middle-aged and older adults who have prolonged hyperglycemia due to poor lifestyles, driven by socioeconomic, demographic, environmental, and genetic factors (IDF, 2024). The most predominant risk factors for diabetes in Nigeria are family history, urban dwellings, unhealthy dietary habits, cigarette smoking, older age, physical inactivity, and obesity (Uloko et al., 2018). However, noteworthy among these factors is the poor public knowledge of their diabetes diagnosis. A substantial proportion of the population live with undiagnosed diabetes, impaired fasting glucose, and impaired glucose tolerance, leading to poor glycemic control and a consequent high incidence of end-stage diseases (Ajayi et al., 2023). Additionally, the majority of people living with undiagnosed diabetes are unaware of the risks and vulnerabilities to help protect themselves or others.
Despite these criticalities, interventions in the country have primarily focused on population-level diabetes management education without first addressing the need for screening among individuals. With early diagnosis of chronic conditions as an emphasis for achieving SDG 3, enhancing population-level awareness of the need for diagnostic screening is arguably the most fundamental need for bridging the gaps in diabetes management. This could be done by adopting health screening policies and interventions implementable within the tertiary, secondary, and primary healthcare sectors. The adoption and enforcement of surveillance and evaluation systems to coordinate the multi-sectoral approach towards the prevention and control of diabetes is also recommended. This will enhance the participation of individuals in reducing diabetic complications, empowering them to play proactive roles in self-care and community-wide support for diabetes care.Further, this will facilitate social support and networks and fewer psychosocial problems associated with the health, social, and financial burden of the disease.
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References:
Ajayi IO, Balogun WO, Olopade OB, Ajani GO, Soyoye DO, Bolarinwa OA, et al. Prevalence of haemoglobin A1c based dysglycaemia among adult community dwellers in selected states in Nigeria: a descriptive cross-sectional study. Front Endocrinol (Lausanne). 2023;14:1192491. http://doi.org/10.3389/fendo.2023.1192491.
Chelo (2022). Addressing the Diabetes Burden in Nigeria through Policy and Health Education. Available at: https://cheld.org/addressing-the-diabetes-burden-in-nigeria-through-policy-and-health-education/ (Accessed November 14, 2024)
International Diabetes Federation (2024). Diabetes: Facts and figures. Available at: https://idf.org/about-diabetes/diabetes-facts-figures/ (Accessed November 13, 2024).Â
Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria. World J Diabetes. 2019;10(3):200-211. https://doi.org/10.4239/wjd.v10.i3.200.
Uloko AE, Musa BM, Ramalan MA, Gezawa ID, Puepet FH, Uloko AT, et al. Prevalence and Risk Factors for Diabetes Mellitus in Nigeria: A Systematic Review and Meta-Analysis. Diabetes Ther. 2018;9(3):1307-1316. Htps://doi.org/10.1007/s13300-018-0441-1.
World Health Organization (2024). Diabetes. Available at: https://www.who.int/health-topics/diabetes (Accessed November 13, 2024).