WORLD DIABETES DAY AND THE RISK AMONG NIGERIANS

World Diabetes Day is celebrated every year on November 14. The Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes poses. It became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. World Diabetes Day is celebrated worldwide by the over 200 member associations of the International Diabetes Federation in more than 160 countries and territories, all Member States of the United Nations, as well as by other associations and organizations, companies, healthcare professionals and people living with diabetes and their families.

The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its member associations. It engages millions of people worldwide in diabetes advocacy and awareness. The International Diabetes Federation chooses new theme by each year to address issues facing the global diabetes community. Diabetes Education and Prevention is the World Diabetes Day theme for the period 2009-2013. Activities organized each year include, Radio and television programmes, jingles and promos, Sports events, Free screenings for diabetes and its complications, Public information meetings, Poster and leaflet campaigns, Diabetes workshops and exhibitions, Press conferences, Newspaper and magazine articles, Events for children and adolescents, etc.

Diabetes is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Basically, there are three main types of diabetes. The first results from the body's failure to produce insulin, and requires the person to inject insulin or wear an insulin pump. The second results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. And the third form, occurs when pregnant women without a previous diagnosis of diabetes develop a high blood glucose level.

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vessels. Diabetes could also double the risk of health complications, which include affecting blood vessel formation in the retina of the eye that can lead to visual symptoms, reduced vision, and potentially blindness. Diabetes also has impact on the kidneys, which can lead to scarring changes in the kidney tissue, loss of small or progressively larger amounts of protein in the urine, and eventually chronic kidney disease that may lead to dialysis. It also impacts the nervous system, most commonly causing numbness, tingling and pain in the feet and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputation.

Causes of diabetes are partly inherited or due to lifestyle factors. The inherited diabetes is usually triggered by certain infections. A genetic element in individual susceptibility to some of these triggers has been traced to particular genotypes which are described as self" identifiers relied upon by the immune system. However, even in those who have inherited the susceptibility, the disease seems to require an environmental trigger. The second type is unrelated to genes but lifestyle factors due to obesity, diet, physical inactivity among others.

In recent years, there has been a dramatic increase in diabetic cases around the world, despite the intensified effort on education and preventive measures regularly promoted by the relevant associations to mitigate the scourge of the disease. According to Williams Textbook of Endocrinology survey, globally as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is increasing rapidly, and by 2030, this number is estimated to almost double, based on research findings released by Wild S, Roglic G, Green A, Sicree R, King H in 2004 in their research titled "Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030”. Even though this projection may pose some technical questions, but the fact remains that the global prevalence of Diabetes is on the increase. As at the end of 2011, the International Diabetes Federation (IDF) published that 366 million persons are living with this disorder and that if nothing is done, this figure could rise to 540 million in the near future.

The menace of Diabetes is more common and prevalent in the more developed countries. According to a survey in 2010, almost one Chinese adult in ten has diabetes. The study estimated that more than 92 million Chinese adults have the disease, with another 150 million showing early symptoms, based on a report broadcasted by BBC on March 25^th, 2010. Similarly, the report indicated that the incidence of the disease is increasing rapidly; a 2009 study found a 30% increase in 7 years. For at least 20 years, diabetes rates in North America have been increasing substantially. In 2010, nearly 26 million people have diabetes in the United States, of whom 7 million people remain undiagnosed. Another 57 million people are estimated to have prediabetes, based on a survey by the Centers for Disease Control and Prevention(CDCP).

According to other researches, the greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030. A research conducted by Gale, Jason in November, 2010 titled "India’s Diabetes Epidemic Cuts Down Millions Who Escape Poverty" and taken on Bloomberg, the disease affects more than 50 million Indians, equivalent to 7.1% of the nation's adults, and that the disease kills about 1 million Indians a year. The increase in incidence in developing countries may not be unconnected to the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet.

In Nigeria, Six million Nigerians are estimated to be living with diabetes while deaths associated with the disease are projected to increase by 52% by the year 2015. This statistics was revealed by Erdoo Apeh, who is the Brand Development Manager of DeeDoo Nigeria, Pharm. on Sunday 15^th November at a news conference, as part of the organization’s activities to mark this year’s World Diabetes Day Awareness Campaign. Apeh added that The World Health Organization (WHO) has estimated that about 6 million people are reported to be affected with diabetes while six in every 10 Nigerians are at risk of having the disease because of their life style, eating habits and nonchalant attitude towards comprehensive and routine medical checkups. Corroborating Mr., Apeh’s statistics, the Health Reform Foundation of Nigeria (HERFON), had also declared that diabetes is likely to cause more deaths than imagined in Nigeria. The body said it is a major cause of deaths arising from non-communicable diseases (NCDs). The foundation also declared in a projection that death through diabetes in Nigeria will account for 52 percent in 2015.

The good news however, is that all forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. But both types 1 and 2 are determined as chronic, which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal as possible, without causing hypoglycemia is another form of treating the disease. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications, as well as possibly insulin, in type 2 diabetes).

To be able to tackle the dangerous trend of this killer disease, patient education, understanding, and participation is very vital, since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. Attention should also be paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. According to The Diabetes Prevention Program (DPP), a major federally funded study of 3,234 people at high risk for diabetes, showed that people can delay and possibly prevent the disease by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week and healthier eating.

As a preventive measure it is advised that anyone aged 45 years or older should consider getting tested for diabetes, especially if you are overweight. If you are younger than 45, but are overweight and have one or more additional risk factors (see below), you should consider getting tested. To reduce the spread of the disease, there are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. It is therefore important to intensify awareness creation among the public that every person should see it as a duty on their part to ensure responsible living and lifestyle modifications. This is a huge responsibility on the part of Government and individuals involved in Diabetes work to double effort.

Apart from awareness creation, governments and instituted authorities have other crucial roles to play in reducing the risk of the spread of diabetes in the world. Countries that are concerned about their citizens already have programmes and policies to that effect. For instance The United Kingdom has predicted that the National Health Service could be spending as much as 16.9 billion pounds on diabetes mellitus by 2035, a figure that means the NHS could be spending as much as 17% of its budget on diabetes treatment by 2035. Therefore, Nigeria among other countries should take cue from UK’s effort.

It would be recalled that in September of 2011, there was an extra ordinary meeting of the United Nations General Assembly where Diabetes was considered along with other non communicable diseases as a global challenge. The President of Nigeria was in attendance, but since then, we have not noticed any action being coordinated by the Government to address the challenges of diabetes in Nigeria.

Therefore, it is imperative for the government through the Ministry of Health to immediately collaborate with Diabetes Association of Nigeria (the umbrella body of all groups handling Diabetes) to implement some modern techniques introduced by International Diabetes Federation like Diabetes Conversation Map Education Program, which is currently in use in over 160 countries of the World who are members of IDF. Introduce Guidelines for Diabetes management to public and private hospitals in Nigeria in order to have uniform standards of practice and care. It is also important that all non-governmental organizations working in the area of Diabetes to complement such efforts so as to have documented evidence for statistical records, awareness creation, as well as bringing about effective networking among healthcare providers and persons living with Diabetes in Nigeria. The work ahead for everyone involved in Diabetes care and advocacy in Nigeria is enormous. Other Countries have gone far, we seem not to have started, but it is possible to still create an impact before the year 2020, to reduce our estimated prevalence rate.