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Curbing The Risk Factors Of Diabetes Mellitus



In the next 10 years, stakeholders have predicted that if government and Africans in general do not begin to think of prevention and taking care of the already diabetic patients, Diabetes Mellitus (DM) would increase by 156 per cent, which means about 28 million people will have diabetes. No doubt, DM has assumed a pandemic proportion worldwide, in terms of prevalence, morbidity and mortality especially in developing countries like Nigeria with poor healthcare infrastructure and funding.  A professor of Medicine and Endocrinology, from faculty of Medicine and Biomedical Sciences, University of Yaounde1, Cameroon, Jean-Claude Mbanya, said available statistics indicate that there are about 14 million people living with diabetes in Africa.  Mbanya said in the next 10 years, if Africans don’t begin to think of prevention and taking care of diabetic patients, it will increase by 156 per cent, which means about 28 million people will have diabetes. He said: “In Cameroon, about five to six per cent of people above 25 years, have diabetes, that is, almost one million people are living with diabetes.  “In Nigeria, the number of people living with diabetes is huge and that is not the problem, the problem is that people who are susceptible to developing diabetes are higher, which is about 10 per cent. That means in five to 10 years, if we do nothing to curb the risk factors of this set of the population, about 50 per cent of them would develop diabetes.

“You see why, in terms of projection, we projected that 156 per cent increase in the next 10 years of type 2 diabetes in Africa.” Citing data collected in 2016 from some African countries like Algeria, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Egypt, Kenya, Madagascar, Morocco, Nigeria, Senegal, South Africa and Tunisia in an International Diabetes Management Practice Study (IDMPS) tagged “wave 7 for Africa,” Mbanya, revealed that only few people living with diabetes are achieving treatment clinical goals in Africa.  According to him, less than 5 per cent of people with either Type 1 or Type 2 DM are achieving glycaemic target, the blood test routinely performed in people with diabetes to measure their hemoglobin level and how well their diabetes is being managed over time.  He listed three top reasons people with type 2 diabetes are not achieving glycaemic goals as: lack of diabetes education, lack of insulin titration (the right insulin dosage prescribed by the physician) and lack of experience in self-management while people with type 1 diabetes are not also achieving control due to fear of hypoglycaemia (low level of blood glucose), lack of insulin titration and lack of diabetes education. Prof. Mbanya noted that living with and managing diabetes is distressing for people with diabetes. According to him, 45 per cent of people with diabetes have emotional distress due to their diabetes while 14 per cent of people with the condition report having likely depression. Experts said diabetes impacts upon daily life for people with diabetes, noting that 39 per cent of people with diabetes reported that their diabetes medication routine interfered with the ability to live a normal life while 56 per cent reportedly felt very worried about the risk of hypoglycaemia. “African patients with diabetes are not well controlled and we know when we don’t control diabetes, it develops complications. It is more expensive to treat or manage the complications, than buying the drugs that would help to prevent complications in the first place.
“So what we should be talking about is that we should invest more in the management and treatment of diabetes and to do more in the prevention of people entering the diabetes chain. Invest in diabetes care and save more in the future,” Mbanya added.

Speaking on what can be put in place to prevent diabetes, Mbanya said, people need to exercise.  He said, “When I said exercise, i don’t mean people jogging on the roads, I mean being physically active.
“People who are obese, people who do not control their diets and people who have a positive family history of diabetes have an extreme high chances of developing diabetes when they are 40 and above, but they can do things that would help to decrease their chances of developing diabetes. They need to eat healthy, walk more and then exercise more. But how can we control DM? Health professionals said our choice of food is important in preventing diabetes.  Indeed, the listed our eating habits and what we eat, how often we embark on exercise and other physical activities as part of the ways of controling the menace of diabetes. Gabriel Olaide is a consultant. He said to combat the menace, “we have to be able to consume what we called the African diet like pounded yam, ogbono soup and lots of vegetables, rather than buying foods in ‘Can’ that makes us to put on weight and can cause cancer, so fighting diabetes is a whole of government control, multi sectoral approach and not just the ministry of health.
“The ministry of health is there to open clinics, train doctors and ensured that those who already have the disease, do not develop complications. “It is also government’s responsibility to take care of the health of its population. Why should children be dying in Nigeria because they lack insulin? How do you celebrate your national day in Nigeria? Party! Stop one National day celebration, and then use the money to buy insulin for children who need it for five or 10 years.  “We should learn to prioritize our choices. We are making the wrong choices by not taking care of the health needs of our population. We should change that paradigm.”

He stressed that adherence to medication improves glycaemic control. In a presentation titled “Management of Hypertension in Diabetes” Prof. Felicia Anumah, an endocrinologist and Dean, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja cited hypertension as a common condition that coexist with type 2 diabetes , adding that it is a clear risk factor for atherosclerotic cardiovascular disease (ASCVD), a general term for hardening of the arteries. According to her, in Type 1 DM, hypertension often results from underlying kidney disease while it coexists with other cardiometabolic risk factors in type 2 DM. “For every 1 per cent rise in HbA1c there is an 18 per cent rise in risk of cardiovascular events and a 28 per cent increase in peripheral arterial disease. “Good glycaemia control in patients with DM and treatment of comorbid factors can delay the onset or prevent the progression of micromacro vascular disease. “It is critical that type 2 diabetes mellitus be treated aggressively with a combination of diet, exercise and anti-diabetic drugs to a level of HbA1c ≤ 7%. And a BP < 130/80 mmHg should be the goal in order to prevent cardiovascular and renal complications. She urged doctors to systematically assess all patients with diabetes for cardiovascular risk factors. Registered Dietician Nutritionist, Patience Chimah, while speaking on the role of the patient and care giver in diabetes care said there is no single diet for Diabetic patients, adding that they need to make healthy food choices, understand portion sizes and learn the best times to eat and this affects family life in general. Chimah said this would help patient to control weight and achieve good blood sugar control, cholesterol and even blood pressure. According to her, managing diabetes successfully by patient Involves food, exercise and medication. “We need to plan food intake and insulin/drugs to manage blood sugar. There is a need for balance between food and insulin/drugs. “Too much food (or too little insulin/oral drugs) can increase blood sugar. Too little food (or too much insulin/ oral drugs) can lower blood sugar. Regular physical activity lowers blood sugar and improves the way insulin works.

“For most people, this means finding ways to move around for at least 30 minutes more nearly every day.” She stressed the need not to restrict people with diabetes to a particular type of food. “Until recently, people living with diabetes were prescribed a diet low in all types of carbohydrates and rich in proteins and fats. The use of whole grains, legumes, and fruits was discouraged because of their complex starch and sugar content which were transformed into glucose during digestion. “Your meal plan should include approximately 50 -60 per cent, carbohydrates e.g. cereals, grains, yam, potato, corn, honey; 20-30 per cent fat e.g. milk, cheese, butter, vegetable oil, 15-20 per cent protein e.g. meat, fish, chicken are an importantpart of a healthy meal plan. Meanwhile, In a bid to check the attendant reduction in the quality and quantity of life of persons living with Diabetes (PLWD), now more than ever, experts at the one-day Diabetes Summit, however advocated a comprehensive coverage of diabetes in the National Health Insurance Scheme (NHIS) to assist people living with the disease in view of the inability of a majority of patients to achieve control according to international guidelines. In a communique issued at the end of the one-day summit, the experts recommended a comprehensive coverage of diabetes in the NHIS to assist people living with the disease in view of the inability of a majority of patients to achieve control according to international guidelines.  They said NHIS coverage should include diabetes screening, diagnosis, treatment and the management of complications often associated with the disease. They recommended adequate provision of essential drugs for Nigerians living with the disease. The experts also called for the provision of care on the Healthcare plan for the indigent, disadvantaged and vulnerable people living with diabetes.




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