2022 WDD: Beyond rhetoric, any hope for people suffering with illness?

A report from the World Health Organization (WHO) says the prevalence of diabetes is increasing among people of all ages, and many people in developing countries are battling with managing the condition every 20 minutes.

Sadly, many Nigerians are living with the condition, with many unaware that they have it while others grapple with pain, hospitalization, and taking medications.

However, the world has continued to celebrate World Diabetes Day (WDD) annually on Nov. 14 to raise awareness of the growing burden of the disease, and the theme for 2022 is "Access to Diabetes Education."

But has the annual commemoration raised the desired awareness and provided strategies to prevent and manage the condition? Is there hope for people living with the condition?

Dr. Uwajeh Raalueke, the President of the Medical Women's Association of Nigeria in Taraba State, gave an overview of the causes of diabetes and the management of the condition.

She says diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves.

Raalueke, who is also the acting Head of the Department of Internal Medicine at Taraba State Specialist Hospital, Jalingo, says a person can be tested for diabetes using tests that measure blood glucose (sugar) levels.

"These tests include glycated hemoglobin (HbA1c), fasting blood sugar (FBS), oral glucose tolerance testing (OGTT), and random blood sugar (RBS) tests."

"Normal HbA1c is 5.7 percent, while >6.5 percent is indicative of diabetes; normal FBS is 5.5 mmol/L, while 7 mmol/L is indicative of diabetes."

"Normal OGTT is 7.8 mmol/L, while 11.1 mmol/L is indicative of diabetes, and an RBS 11.1 mmol/L is indicative of diabetes," she explained.

On the health problems of diabetes, she says it can cause acute (immediate) or chronic (long-term) problems if not properly managed.

"High sugar levels in your blood over a long period of time can seriously damage your blood vessels." If your blood vessels are not working properly, blood cannot travel to the parts of your body it needs to.

"This means your nerves will not work properly and that you will lose feeling in parts of your body."

"Once you have damaged blood vessels and nerves in one part of your body, you are more likely to develop similar problems in other parts of your body."

"Long-term problems develop gradually, leading to serious damage if they go unchecked and untreated."

Raalueke says the cause of most types of diabetes is unknown, but in all cases, sugar builds up in the bloodstream because the pancreas produces little or no insulin or because the body's tissues are resistant to the effects of insulin.

She says "insulin is a hormone produced by the pancreas, a gland located behind the stomach, and this hormone helps to regulate blood sugar levels."

"Insulin cannot cure diabetes, but it is used to treat type 1 diabetes and manage hyperglycemic states in other types of diabetes."

Explaining further the relationship between diabetes and insulin and whether insulin can cure diabetes, she says diabetes occurs when the body doesn't use insulin properly or make enough insulin.

"In type 1 diabetes, autoantibodies attack the insulin-producing cells of the pancreas, resulting in little or no insulin production and elevated blood sugar levels."

"In type 2 and other types of diabetes, the body is resistant to the effects of insulin, resulting in elevated blood sugar levels."

Raalueke listed some of these problems as eye problems (retinopathy), explaining that diabetic retinopathy can result in vitreous hemorrhage, retinal detachment, glaucoma, and, if untreated, blindness.

Another issue, she says, is diabetes foot problems, which are serious and can lead to amputation if untreated.

Others, she adds, are "nerve damage, which can affect the feeling in your feet, and raised blood sugar, which can damage circulation, making it slower for sores and cuts to heal."

"High blood sugar over a long period can damage blood vessels, and this can lead to heart attacks and strokes."

"Diabetic kidney disease (nephropathy) and nerve damage (neuropathy) can make it harder for the nerves to carry messages between the brain and every part of the body, so it can affect how we see, hear, feel, and move."

She says there is also the issue of gum disease and other mouth problems, as well as sexual problems in both women and men: decreased sensation, vaginal thrush, and urinary tract infections (UTI) in women, and erectile dysfunction in men.

"There is an increased risk of developing certain cancers, like pancreatic cancer, and psychiatric problems like depression and dementia."

"Acute problems can occur at any time, and these include hypoglycemia, hyperosmolar hyperglycemic state (occurs only in type 2 DM), and diabetic ketoacidosis."

Raalueke says these three states require immediate treatment as they are life-threatening conditions.

On the types of diabetes a person is at risk for, she explains that it depends on one's age, sex, family history, and medical history, among others, as one can be at increased risk of developing type 1 diabetes, type 2 diabetes, or gestational diabetes.

On the treatment of diabetes, she says it depends on the type of diabetes, how well the blood glucose level is managed, and other existing health conditions.

She says, "Type 1 diabetes is treated with insulin, a healthy diet, and physical activities."

"Treatment for T2DM can include medications (both for diabetes and for conditions that are risk factors for diabetes), insulin, and lifestyle changes such as losing weight, making healthy food choices, and being physically active."

"In gestational diabetes, if the blood glucose level is not too high, initial treatment might be modifying the diet and getting regular exercise."

"If the target goal is still not met or the glucose level is very high, insulin therapy is usually initiated," she said.

The boss of the medical women's association further explains that oral medications and insulin work in one of these ways to treat diabetes: they stimulate the pancreas to make and release more insulin and slow down the release of glucose from the liver.

"It blocks the breakdown of carbohydrates in the stomach or intestines so that body tissues are more sensitive and helps to get rid of body glucose through increased urination."

"Foot care in diabetic patients is a very important aspect in their management.

"Diabetics are advised to inspect their feet daily, wash daily with warm water and mild soap, pat them dry with a clean towel, and moisturise if the feet feel rough or dry, but don't moisturise between the toes."

On how to help prevent diabetes, she says Type 1 diabetes is not preventable, but other types of diabetes can be prevented.

"To prevent diabetes, we need to know the risk factors that predispose an individual to developing the disease."

"These risk factors include family history of diabetes; being black, Hispanic, or Asian; being overweight or obese; having high blood pressure; having low HDL cholesterol; and having high triglyceride levels."

"Others are excessive alcohol consumption, being physically inactive, being age 45 or older, having gestational diabetes, having polycystic ovarian syndrome, having a history of heart disease or stroke, and smoking."

"We don't have control over risk factors like family history, age, sex, or race, but we can prevent diabetes by eating healthy diets, being physically active, working toward achieving a healthy weight, lowering stress, and limiting alcohol intake."

Raalueke advised men to drink no more than two beverages containing alcohol a day, while women should drink no more than one.

According to her, getting an adequate amount of sleep (typically 7 to 9 hours), quitting smoking, and taking medications as directed by a healthcare provider to manage existing risk factors for heart disease (like high blood pressure and cholesterol) will reduce the risk of developing Type 2 diabetes.

On managing diabetes better, the expert says diabetes affects the whole body, and to best manage it, one needs to take steps to manage the risk factors.

The risk factors, she says, include keeping your blood glucose levels as close to normal as possible by following a diet plan, taking prescribed medication, and increasing your activity level.

"Maintaining blood cholesterol (HDL and LDL levels) and triglyceride levels as near the normal ranges as possible, and blood pressure of not more than 140/90 mmHg.

"You hold the keys to managing your diabetes by taking your diabetes medications as prescribed." taking all other medications to treat any risk factors (high blood pressure, high cholesterol, and other heart-related problems and other health conditions) as directed.

"Keeping yourself well-hydrated (water is your best choice). If you smoke, quit. Seeing your doctor regularly to monitor your diabetes and to watch for complications," Raalueke advised.

Meanwhile, the Diabetes Association of Nigeria (DAN) has advised families to own glucometers at home to enable them to quickly and easily ascertain their glucose levels.

The National Secretary of the association, Mr. Bernard Enya, made the call in Calabar in commemoration of the 2022 World Diabetes Day (WDD).

A glucometer is a medical device for ascertaining the approximate concentration of glucose in the blood.

A blood glucose test is a blood test that screens for diabetes by measuring the level of glucose (sugar) in a person's blood.

Enya, who doubles as the chairman of DAN in Cross River, said Nigerians didn't need to be university graduates to be able to use and understand the results of a glucometer.

He added that knowing the result will help them know if their sugar level is high, normal, or low.

The chairman also said that Cross River was performing poorly in the care of diabetes and needed to do more.

According to him, awareness is poor, and the state lacks desk officers for non-communicable diseases like diabetes

to coordinate government interventions against the disease and gather data.

"One major problem in Cross River is the unavailability of data, and we all know that without data, a government cannot plan."

"Also, the state does not have desk officers for diabetes and other non-communicable diseases, so there is no coordination across the 18 local government areas."

"This has led to many non-governmental organizations (NGOs) doing the same thing, which is essentially screening without looking at treatment and effective data collection," he said.

He also said some of the few works done on the disease in the state were only done in the Southern Senatorial District where University of Calabar Teaching Hospital (UCTH) is located.

Enya added that the situation makes it difficult for patients from the central and northern parts of the state to benefit due to the distance to Calabar.

While appealing to Nigerians to cultivate healthy lifestyles to prevent diabetes, he called on the government to have an annual diabetes intervention plan.

On her part, Mrs. Felicita Opata, the president of the Lions Club, District 404A2, said the club carried out diabetes awareness activities in collaboration with the Endocrinology, Diabetes, and Metabolism Unit of the UCTH.

She added that "we had a walk this morning from the Lions Park to our Diabetes Center in UCTH, and there, we are carrying out free screenings on blood glucose, eye health, blood pressure, hepatitis, and the distribution of some drugs."

"However, I urge the state government to also key into this project and support it for us to reach out to more diabetic patients in the state and procure more kits for screening.''

Ms. May Ikokwu, Chief Executive Officer of Save Our Heritage Initiative (SOHI), says early testing and detection are paramount in the management of diabetes for normal living.

Ikokwu said this on the occasion of the 2022 World Diabetes Day in Abuja.

She explained that the theme for this year's celebration, "Access to Diabetes Education," underpins the larger multi-year theme of "Access to Care."

She advocated for preventive interventions, especially dieting, saying that diabetes could be triggered by diets.

Ikokwu, who described diabetes as the body's ability or inability to produce the required amount of insulin to control glucose levels in the blood, said there are broadly two types of diabetes.

"According to medical experts, type 1 diabetes requires the daily administration of artificial insulin by means of injection or an insulin pump.

"Type 2 is more generally managed by a combination of dietary control and medication in the form of tablets," she said.

According to her, replacing most of the carbohydrates in a normal diet with vegetables is recommended.

She added: "Fonio (Digitaris exilis, a West African cereal), tamarind, moringa, ewedu, bitter leaf, and baobab are types of African superfoods that can effectively reduce blood sugar and fight diabetes."

Ikokwu stressed the need for regular monitoring of sugar levels in the body to avert diabetes, saying that the equipment is inexpensive and available at most pharmacies.

She advised: "It is important that development work continues to ensure people with the condition can live as normal a life as possible."

The SOHI boss said, "Diabetes can affect anyone, irrespective of age, with complications like blindness and so many other issues."

The WDD should,therefore, not be a day for rhetoric, but rather, more practical measures must be introduced and implemented all year round by the government, stakeholders, and everyone else so as to raise the desired awareness of what needs to be done, collectively and individually, for better prevention, diagnosis, and management of the condition. 

By Abiemwense Moru