Diabetes mellitus is now on the increase worldwide and diabetic foot complications, though preventable, are a leading cause of admission, amputation and mortality in diabetic patients worldwide. The president, Diabetes Association of Nigeria (DAN), Dr. Mohammed Alkali, in this interview with ODIRI UCHENUNU, gives insight into the challenges of the disease in Nigeria and the way forward.
What is the current statistics of Nigerians living with diabetes mellitus?
As a current exco, we are looking at the current situation where we have an overwhelming majority of Nigerians living with diabetes. We currently have about five million Nigerians that are living with diabetes and the most scary thing is that about 1.56 million where discovered in 2015 alone. This indicates that we have a lot of undiagnosed diabetes patients in the country. We also have to deal with young people living with diabetes in the country. We have juvenile diabetes now in Nigeria; it is an emerging disease. You will see people that are less than 17 years being diagnosed. In fact, we have seen cases of people diagnosed of diabetes at infancy. This is really scary because the issue of diabetes is that it is not only a disease that is just sugar but the complications. You have issues of it affecting the eyes, kidney, hypertension, foot disease and heart disease. So when you are talking about the issues relating to diabetes, you are talking about issues that are related to the whole parts of the human body.
Diabetic foot complications are a leading cause of admission, amputation and mortality in diabetic patients worldwide, how many people are living with diabetic foot complications in Nigeria?
First of all, I will like to say that we don’t have much research, and I want to use this medium to plead with our researchers to do more. It is difficult to give the figure of people living with ulcers and amputation but we can talk about the percentage. The recent studies indicate that out of the people living with diabetes in Nigeria, 9.5 percent of them have diabetes ulcers. Diabetes ulcer is the extreme of diabetic foot disease. Before it reaches ulcer, it passes through a stage, and remain in that stage for two to three years before getting to the ulcer stage. So if research has been done to cover those early stages, the percentage would have been reduced. If you apply that percentage with the population of infected people, we will be talking of a large number of people living with diabetes ulcers.
What are the major causes of diabetes mellitus?
People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. The most important thing is that most of Nigerians that are living with diabetes have type II diabetes. Type II diabetes is all about life-style modification. Nigerians are now leading a lot of sedentary lifestyle, which is the major cause of diabetes mellitus.
How can we prevent diabetes mellitus?
Majority of Nigerians don’t exercise. The World Health Organization (WHO) has recommended that adults above the age of 18 require that they should indulge in at least one hour of active exercise in the day. How many of us do that? Even our children can play computer game from morning till night without doing any active exercise. Some of our schools don’t have play ground and to crown it all, we eat refined foods; sugar has become parts of our diets. Recent reports by health organizations have now classified sugar as the major causes of most diseases plaguing mankind and not cholesterol. We can indeed prevent diabetes mellitus by life-style modification.
As the president of DAN, what type of policy are you advocating for in respect to diabetes mellitus?
Diabetes Association of Nigeria, (DAN) is the umbrella body of diabetes activities in Nigeria. The main issue that we are dealing with as an association is to promote the socio-economic wellbeing of diabetes patients in the country, to disseminate any useful information and knowledge in respects of diabetes and to improve the diabetes care in Nigeria.
What do you think individual, stakeholders, NGO and government can do?
There is need for us to do more on educating Nigerians on the issue of diabetes mellitus. As a policy maker, diabetes drugs are very expensive. Government needs to subsidize. We cannot leave everything for the government to do; we also need to look for alternative sources of funding like health insurance scheme. The policy on diabetes in the National Health Insurance Scheme (NHIS) is not conducive for diabetes patients. Though few diabetic drugs are covered in the scheme, but if you look at hospital statement on complications, the current policy on health insurance covers only 14 days of hospital admission. If somebody has diabetes complications, that person needs to stay for not less than three months in the hospital. If somebody requests for insulin, how much insulin does he gets from the health insurance scheme? So the core issue of the insurance scheme policy has to change, and it can start by increasing the coverage. Then government has to look at other sources of subsidizing drugs. What I mean by subsidizing drugs is that we need to look at our import duty on our diabetes drugs. Why can’t we borrow from other countries by giving incentives to our indigenous companies to produce generic drugs that would become available? We need to do that. The federal government has to look at the issue of diabetes beyond policies within hospitals. Diabetes is all about education. We need to have a robust education for patients where necessary stakeholders have to be involved. This is not the job for only health workers, the families of the diabetes patients need to be involved. So we need to review all policies and then come out with a general policy in respect of diabetes by the government.
The truth of the matter is that if we have been training people to start even from the primary level, it will go a long way in preventing the disease from taking place in the first place. That is why I am advocating for a large number of diabetes educators, having a national policy on diabetes foot care. But one thing that we are not good at in Nigeria and we have to start doing is that, we should start sponsoring loan to people. It is not only the executive that can sponsor a loan. Pressure groups can identify an area, and sponsor a loan. It will go a long way in reducing the burden of diabetes in Nigeria.