Fred, a 65-year-old retired civil servant is diabetic, but he has been living with the condition without complications for more than two decades.
“I am on insulin and some other tablets and I don’t miss a dose. I ensure I check my blood sugar level every morning and I know what to do and act promptly if my blood sugar level is high or too low,” he disclosed in an encouter.
Fred considers himself privileged that he can afford his medications, monitoring devices, and also have access to an experienced endocrinologist.
“I can tell from my personal experience that diabetes management in Nigeria is becoming a serious problem. Not everyone with diabetes can be so lucky. But all these may change soon going by the rising cost of drugs and dwindling economic fortunes and rising inflation.”
Yewande, a Lagos busineswoman told Saturday Vanguard that even though her diabetic husband manages to keep his blood sugar manageable, it has been really challenging.
“My husband who has been diabetic for almost a decade, is effectively managing his blood sugar issue. His father who lived with diabetic for nearly 40 years before he passed on also managed the condition.
“Getting medical attention can be hectic really for those who do not have the resources. If one happens to suffer some other accompanying conditions such as renal issue, then matters would really be rough! Nigerian healthcare is just made complex by ineffective policies from the government and compounded by the players or operators, “ she lamented.
These scenarios are just a tip of the iceberg. Diabetes is a growing public health emergency in Nigeria and the high number of people living with the disorder without access to proper treatment and care is particularly worrisome.
Diabetes care is poorly coordinated and millions of Nigerians are living with undetected diabetes and even for those that have been diagnosed, just a fraction is receiving proper care and treatment.
In Nigeria, diabetes is common and particularly burdensome because the cost of treatment and care is borne mainly by individuals who pay out of pocket. The high cost of treatment is a major cause for concern. More than five million Nigerians are living with diabetes, even as more than half of those affected are unaware that they have the disease.
The inadequacy of diabetes screening programmes across the 36 States and the Federal Capital Territory, FCT, Abuja, is a factor to contend with. Health watchers say an explosion in the number of diabetic patients along with the lifelong complications is imminent except urgent measures taken to address the trend.
The International Diabetic Federation, IDF, describes diabetes mellitus as one of the largest global health emergencies of the 21st century, largely because of its severe and deadly consequences.
The complications are severe it affects practically every organ of the body, resulting in loss of vision, dental problem, kidney failure, cardiovascular disease, lower limb amputation, sexual dysfunction, among others, when not properly controlled. Sadly this is the situation many Nigerians living with diabetes are facing today.
Experts say that the focus of attention on diabetes in Nigeria is not commensurate with the magnitude of the problem mainly because access to medical care as well as effective management and control are below par.
“Diabetes places an extra burden on the individuals and families affected, especially for the majority of patients unable to access quality health care,” said Prof Femi Fasanmade. an endocrinologist at the Lagos University Teaching Hospital, LUTH.
He notes that part of the problem is late presentation to the health care centre. The typical diabetes patients do not report to hospital until when they have developed advanced disease making treatment and care difficult or ineffective.
From the 10th (2021) edition of the International Diabetes Federation, IDF, Diabetes Atlas, that showcases the 2020-2045 Diabetes report, the total number of people living with diabetes in Nigeria Rose from 3.05 million in 2011 to 3.6 million in 2021, and is projected to reach 4.94 million in 2030 and 7.98 million in 2045.
From the report, the number of persons with undiagnosed diabetes in Nigeria is expected to exceed 1.93 million by December, 31, 2021 (53.3 percent increase), while the number of people with impaired glucose tolerance is estimated to rise from 9.41 million in 2021 to 11.98 million in 2030 and 18.79 million in 2045.
Worse still, the economic and financial impact of diabetes on related expenditure per person in Nigeria has been rising steadily over the years. Diabetes depends poverty and hunger for the family. The cost of drugs and monitoring devices have gone beyond reach.
Treatment of diabetes per person rose from an average cost of N60,000 in 2011 to N300,000 in 2021, and is expected rise above N500,000 in 2030 and over N1.0 million by 2045 according to the IDF. In addition, the total diabetes related health expenditure in the country is expected to gross N745 billion in 2021 This would shoot up to over N1.07 trillion in 2030 and reach N1.59 trillion by 2045 according to the IDF.
The steady increase of diabetic foot, a major complication is equally worrisome. Only very few people living with diabetes possess basic knowledge and information about the disorder even as reliable support for diabetic foot care programmes are largely unavailable, leading to poor outcomes for the patient.
The financial burden of diabetic foot problem is paramount. Direct costs of treating diabetic foot ulcer has gone up to over N2 million, which is more than a five-fold increase even as the current minimum wage has only gone up to N30,000.
The outlook for Nigeria is particularly grim. More than 1 in 3 people with diabetes will develop a complication of the eyes known as diabetic retinopathy while those that develop diabetic foot risk suffering nerve damage and end up losing their limbs to amputation.
With the majority of patients financing their medical bills out of pocket, several diabetic patients fail to adhere to their medications and tests. Only 1 in 5 of the patients perform self–blood glucose monitoring among other tests. Several patients resort to unorthodox treatment as a result.
A Consultant Endocrinologist and diabetes expert, Dr Afoke Isiavwe, who is the Medical Director of Rainbow Specialist Medical Centre, Lagos, regrets that diabetes is not getting the attention it deserves in Nigeria.
Isiavwe who decried the current situation whereby a lot of Nigerians are living with undetected diabetes warns that the problem would get worse. “We need to address the situation urgently. It is affecting the poor, the rich, the young and the old. What we need to do is set up centres that offer free screening and care for diabetes,” she argued.
The need for attention to check the severe social, emotional, and psychological implications of diabetes foot ulcers and amputations cannot be over stressed.
According to Isiavwe: “All health professionals should have the knowledge and skills to help individuals and families manage diabetes. It is important that every clinic is set up to provide appropriate care and to know when to refer patients to the endocrinologist/diabetes specialist.”
In the views of Professor Felicia Anumah, Professor of Medicine and Endocrinology/Dean of Clinical Sciences, University of Abuja, ignorance is leading the delay in diagnosis. “Currently, the cost of treating diabetes in Nigeria amounts to between N300,000 and N500, 000 and when complications such as diabetic foot ulcers and kidney failure occur, the cost rises to over N1. 5 million to N2.0 million, “ Anumah lamented.
“Endocrinologists and diabetologists are few in the country, and with the proliferation of uncertified alternative therapy, fake drugs and suboptimal adherence of patients to recommended lifestyle and pharmacological agents, the outcomes are often poor.
“There is insufficient empowerment, many diabetes patient have series of unmet needs for treatment, and blood sugar monitoring. Nigeria runs an out of pocket system with 76 percent of the total health expenditure.”
Coping with diabetes
Diagnosis: Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.
Treatment: Treatment involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Maintainance of blood glucose control, particularly for people with type 1 diabetes who require insulin. People with type 2 diabetes can be treated with oral medication, but may also require insulin. Also maintain blood normal pressure control and ensure foot care.
Prevention: Adopt simple lifestyle measures such as maintaining healthy body weight, being physically active eating a healthy diet, avoiding sugar and saturated fats intake and avoiding tobacco use. Go for regular screening for early signs of diabetes-related kidney disease and treatment.