Diabetes situation in Nigeria amidst global health agenda

Nigerians are currently groaning under a rising prevalence of diabetes mellitus. A recent meta-analysis reported that approximately 5.8% (about 6 million) of adult Nigerians are living with diabetes. This figure has been likened to a tip of an iceberg as it is estimated that two-thirds of diabetes cases in Nigeria are yet undiagnosed. This scenario which applies to most low and middle income countries has not only resulted in an increase in the burden of diabetes complications and deaths, but has also put a significant strain on the already weak health systems in this sub-region.

In 2017, the Lancet Diabetes & Endocrinology published a significant Commission on diabetes in sub-Saharan Africa, shedding light on the management challenges of diabetes on the continent. The Commission highlighted issues such as limited data on diabetes burden, availability and affordability of medicines, shortage of healthcare workers, and underprepared health systems. Five years later, sub-Saharan African countries face even more challenging circumstances, including the impact of COVID-19, economic recession, and indirect effects of conflicts.

The emergence of the COVID-19 pandemic has affected millions of individuals worldwide. While the region was not ravaged by COVID-19 after initial projections, diabetes remains a significant risk factor for severe COVID-19 outcomes in Africa, as shown by hospital-based mortality analyses.

The ongoing conflict in Ukraine also poses an additional threat to diabetes management in Nigeria. Nigeria, like many African countries heavily rely on imports from Russia and Ukraine, particularly for wheat, grain, and fertilizers. Disruptions in these imports have led to rising food prices, negatively impacting the health and well-being of populations, particularly the poor. These socioeconomic effects place an additional burden on individuals and families with diabetes who already bear significant out-of-pocket healthcare expenses.

To address the challenges faced in managing diabetes in sub-Saharan Africa, it is crucial to prioritize equity in global responses. This includes ensuring access to COVID-19 vaccines, as well as medications and technologies for diabetes treatment and management. The provision of essential care for diabetes should be included in Universal Health Coverage (UHC) programmes, aligning with the Sustainable Development Goal (SDG) Target 3.8. National health insurance schemes, as exemplified by Ghana and Rwanda, can serve as models for other countries in the region.

Meaningful involvement of junior diabetes professionals from sub-Saharan Africa in high-level strategic meetings is essential to shaping the future of diabetes care in the region. Their voices and contributions should be heard in forums such as the WHO Expert Committee on Diabetes, the Global Diabetes Compact forum, and the Lancet Diabetes & Endocrinology Commission on Diabetes in sub-Saharan Africa.

Also, concerted efforts to institute optimal diabetes care are required. These would entail the implementation of holistic strategies aimed at diabetes prevention through risk factor identification and lifestyle modification, as well as optimal glycemic control among subjects already living with diabetes. Landmark clinical trials have demonstrated that optimal glycemic control can prevent many of the diabetes related complications in both type 1 and type 2 diabetes. Implementing these strategies requires among other factors, a knowledgeable and motivated diabetes care workforce.

Diabetes specialists are arguably the most competent regarding diabetes care owing to their special training in this discipline. Regrettably this cadre of healthcare manpower is grossly in short supply in many low income countries. In Nigeria for instance, diabetes specialist to population ratio is estimated to be as low as 1 to 600,000. Furthermore, most of the specialists practice in tertiary healthcare centres which are usually located in the cities. Consequently, primary care physicians otherwise called general practitioners constitute the largest diabetes care medical manpower. Besides, a chronic care model built on primary healthcare systems in which a huge burden of care is placed on the primary care physicians has been advocated for low and middle income countries.

It has been demonstrated that the quality of diabetes care provided by primary care physicians is related to their diabetes knowledge. Therefore, to be able to live up to this responsibility of providing optimal diabetes care, primary care physicians ought to possess sufficient diabetes care knowledge and skills. These include knowledge of diabetes risk factors, diagnosis, clinical and laboratory evaluation, metabolic monitoring, screening for diabetes related complications and prompt referral to specialists.

There is also need to development of a simplified diabetes management algorithm by the Diabetes Association of Nigeria in collaboration with ministries of health which should be made available to all primary care doctors and the establishment of mentorship programs whereby a group of primary care physicians in a defined local community are assigned to a diabetes specialist for prompt access to professional advice.

Okeke writes from the Centre for Social Justice (CSJ) Nigeria

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