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.
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 no fewer than 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.
Experts said the disease, which could remain undetected for years without symptoms, was now killing more Nigerians than malaria, HIV and tuberculosis combined.
An Endocrinologist, Prof. Michael Olamoyegun, said diabetes killed 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 characterised 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 existed – Type 1, Type 2 and Gestational Diabetes.
” Type 1 diabetes, which occurs due to absolute deficiency of insulin, is seen mainly in younger age group, usually less than 30 years, although occasionally in adulthood.
“It is found in about five to ten per cent of all individuals with diabetes.
“This group is managed with insulin injections since the body no longer produces insulin.”
The endocrinologist said Type 2 diabetes represented 90 to 95 per cent of individuals with diabetes, stressing it occurred when insulin was not able to function well in the body.
He also noted that it usually occurred in older individuals who had family history in first-degree relatives.
Olamoyegun, also the Secretary General of the Association of Clinical Endocrinologists of Nigeria (ACEN), added that hypertension, overweight or obesity and sedentary lifestyles were contributory risk factors.
He said it is usually managed with oral medications, dietary control and occasionally with insulin.
On gestational diabetes mellitus, he said it was first detected in pregnancy, saying it complicated about 7.5 to 12 per cent of all pregnancies.
He explained that diabetes in pregnancy made it high risk as it could worsen outcomes for mother and foetus.
On prevalence, he said the 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 seven per cent, that is 11 million adults older than 18 years, in Nigeria have diabetes.
“Most people with diabetes are unaware of their status.
“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,” he said.
“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 some of the 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 five 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.
“Also, stroke and kidney failure,” said Olamoyegun
The endocrinologist further explained that diabetes was the commonest cause of adult-onset blindness and leading cause of kidney failure.
He added that it was 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 the biggest complications of the comdition, he said they were diabetic foot ulcers, blindness, kidney failure, heart failure, dementia and sexual dysfunctions.
Olamoyegun further said that at least one in three patients with diabetic foot ulcers admitted into hospitals in Nigeria ended up with amputation.
He added that approximately one in five individuals with diabetic foot ulcers died during hospital admission.
“Recent findings showed diabetes ranks as commonest cause of kidney failure in some tertiary hospitals in Nigeria,” he said.
On some 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 governments to strengthen primary healthcare through trained personnel and reliable supplies, as well as early diagnosis and referral.
The consultant urged governments to support healthier school meals and affordable nutritious foods.
Olamoyegun also advised on the need 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.
Similarly, Dr Roseline Akande, a Public Health Physician, LAUTECH Teaching Hospital, Ogbomoso, said Nigeria carried the highest burden of diabetes in sub-Saharan Africa.
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 per cent,” she said.
She noted that this translated to estimated 8.02 million Nigerians, or roughly one in every 14 adults.
The public health physician said the figure was nearly double what the International Diabetes Federation previously reported and could nearly double by 2045.
On Oyo State, Akande cited a 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 were rising, she attributed it to globalisation and urbanisation.
“The effects of globalisation, urbanisation with the attendant industrial explosion, family history of diabetes, the consequences of life style modification and nutrition, have 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 westernised diets worsens issue.
According to her, poor health seeking behaviour among young adults especially accessing preventive services is contributory.
On screening programme, Akande confirmed that Project 10 Million had been organised across Nigeria including Oyo State.
She noted that a state-wide campaign introduced by Oyo State Government targeted hundreds of thousands for free blood pressure and blood sugar checks.
She noted that screening facilities were also available in both public and private health facilities in Oyo State.
On workable solutions, the public health physician said improved knowledge could encourage preventive measures.
She noted that 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 also relevant policies to reduce burden.
Further highlighting the impact of diabetes, Dr Temilade Adeyanju, a Consultant Cardiologist at UCH, Ibadan, said “Diabetes damages heart muscles and vessels via persistent chronic inflammatory states leading to atherosclerotic changes.
“Diabetes mellitus presents a chronic inflammatory state that can directly affect the heart muscles and vessels leading to atherosclerotic changes and fibrosis.
“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.
However, she said that on stroke and heart failure, majority were caused by systemic hypertension but that diabetes increased the 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 rechecked at least once per annum,” she stated.
This is necessary as diabetes could remain undetected for years without obvious symptoms, said Dr Muyiwa Oguntunde, a Family Physician at 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 a patient may present with fever and assume it was malaria, but symptoms like excessive urination at night, excessive thirst and unexplained weight loss should make one consider diabetes.
“One important point is that not every fever is malaria or typhoid,” he noted.
On yearly test, he said a simple test, the blood glucose test (fasting blood glucose) – HbA1c, was a 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 that patients believe herbal preparations were safer simply because they were in their natural state.
“Diabetes is not a condition that should be treated by trial and error,” he advised.
“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.
“Delayed diagnosis, unpredictable ingredients, drug interactions, kidney and liver injury and progression of complications are dangerous.”
On first-step management, Oguntunde said management could begin at primary-care level without waiting for specialist.
He also advised on affordable lifestyle modification, including reducing sugary drinks and encouraging balanced meals with locally available foods.
According to him, metformin is often an affordable first-line option provided renal function is 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.
On nutrition for diabetes management, Abdulsalami Olayinka, Assistant Director of Dietetics, UCH, Ibadan, said that no single food automatically worsened diabetes.
According to him, what matters is the type of food, quantity consumed, frequency and how it is combined.
The dietician explained that some foods had 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 contained large amounts of rapidly absorbed sugars and could cause sharp increases in blood glucose.
“White rice is refined carbohydrate with relatively low fibre and large portions without vegetables and protein can increase blood glucose.
“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 could increase blood glucose depending on flour used, preparation method and accompanying soup.
Olayinka said that indigenous foods where important but educating patients on moderation, appropriate portions and healthier combinations were critical. (NAN
