There are 1.7 million Nigerians with diabetes type 1 and type 2, according to the International Diabetes Federation. That figure is about the same as the population of Bayelsa State.
The life of a man or woman with type 2 diabetes in Nigeria is one regular visit to doctors, tests and expensive medication taking either as tablets or injections. It is a life fraught with financial, physical and emotional stress. But there is emerging evidence that this does not have to be so. Research in the past couple of years points conclusively to the fact that type 2 diabetes can be reversed.
Roy Taylor wrote in the American Diabetes Association’s Diabetes Care Journal that: “Type 2 diabetes has long been regarded as inevitably progressive, requiring increasing numbers of oral hypoglycemic agents [diabetic medication that lowers blood glucose levels] and eventually insulin, but it is now certain that the disease process can be halted with restoration of normal carbohydrate and fat metabolism.”
The diagnostic criteria for a diabetic, as stated by the World Health Organisation (WHO), is a blood glucose level of 6.5 per cent and higher. Hence, adults diagnosed as belonging to this group, once they are able to get their blood glucose levels below six per cent or 42 mmol/mol over a specific and discernible period of time, whilst not taking medication, can be said to have reversed their diabetes or can be classified as having put diabetes in remission.
So, how exactly can an adult with elevated blood glucose levels reverse this condition?
Experts have recently argued that the answer lies in a new understanding based on extensive research findings on just how diabetes type 2 is caused. The new argument of leading endocrinologists is simply that diabetes is a problem of FAT. Not just physical fat because, as we know, thin people with a body mass index (BMI) less than 18.5 per cent can also have diabetes. This new understanding of FAT focuses on fat in the liver. When there is too much liver fat due to excess calories or one’s propensity to store fat around organs, the liver responds to insulin poorly by producing too much glucose. But the problem does not stop there. As too much liver fat passes onto the pancreas, it causes insulin-producing cells to fail.
New research findings from leading endocrinologists recommended weight loss as the key strategy for reducing liver fat. Research shows that “losing less than one gramme of fat from the pancreas through diet can restart the normal production of insulin, reversing type 2 diabetes [and] this reversal of diabetes remains possible for at least 10 years after the onset of the condition”. The guidance for recommended weight loss, as identified by a study is 15kg or 10 per cent of a person’s body weight. In doing this, experts argue that fat is reduced from the liver and pancreas thus returning their normal function and thus normal insulin production. Some studies even show “a profound fall in liver fat content resulting in normalisation of hepatic insulin sensitivity within seven days of starting a very low-calorie diet in people with type 2 diabetes.” Mr Taylor, a professor, argues that if you lose weight and keep the weight off in the future, you will, in fact, be rid of diabetes. Low-calorie diets, alternative day routine fasting, low carbohydrate diets or simply, diet and exercise are all recommended for fighting fat and type 2 diabetes.
Why so many have not tried
So, given this great possibility of reversing diabetes, why are more people not making the recommended lifestyle changes? Why do people still spend millions of Naira to purchase medication and/or experiment with traditional medicine options?
The answer is simple: it is difficult to achieve and maintain reversal.
Another reason is the perception of diabetes as a chronic condition that is degenerative and leading to death. For example, a recent study which explored the psychological aspects of diabetes among adult Nigerians noted their negative perception and lack of commitment to achieving self-management of diabetes. The perception identified was the “fear of dying from hypoglycemia, frustration and a perceived lack of control over the progression of the disease.” Indeed, this correlates with global studies which observe that most diabetics perceive their illness as being “progressive and incurable.” So, while diabetics view their condition as treatable, they perceive it as not curable, thus giving them a feeling of helplessness.
Today, there are about 488 different licensed medication worldwide that serve the single purpose of lowering blood glucose levels for type 2 diabetics. However, experts note most diabetes medications are aimed at treating the symptoms and complications of the disease and not its cause. “The goal of most diabetes drugs is to prevent the problems diabetes causes, like excessive thirst, hunger, urination, irritability and weakness and fatigue …. they do relieve these symptoms, but they do it without making the body more receptive to insulin, which is the cause of 95 per cent of all cases of type 2 diabetes.”
Diet and exercise can, however, do this, for those who want to go beyond treating the symptoms of type 2 diabetes. For those who do achieve reversal, it is of physical, psychological and financial benefit to not only the adult diabetic but also his or her entire family and the community in Nigeria.
From an expert
Jokotade Adeleye, a lecturer in the Endocrinology unit, College of Medicine, University of Ibadan and, said the organisation of diabetes care in Nigeria is largely unsatisfactory at present. A multi-centre study of 531 persons with diabetes revealed that the majority of patients (nearly 70 per cent) did not achieve the recommended targets for glycemic control and control of coexisting cardiovascular risk factors. The knowledge of diabetes care among health care providers in Nigeria is generally poor at primary and secondary levels. Consequently, Mrs Adeleye said, the rate of referrals to teaching hospitals is very high and the ambience of many clinics at tertiary hospitals attending to people with diabetes in Nigeria is an overpopulated and understaffed clinic.
While emphasising the centrality of management, more specifically, Mrs Adeleye said “self-management of diabetes is integral to good outcomes. Patient education is key, we work closely with a group of nurses who largely handle the bulk of our diabetes education. Every newly presenting patient to the outpatient clinic is referred to that unit, as well as patients on the inpatient services. Follow up patients can also access the Health Educator Nurses thereafter. Unfortunately the number of nurses there are few, compared to the patient load. This has necessitated them also having group sessions alongside one on one sessions.”
She said further that “the state of diabetes in Nigeria is now considered a disease of public health significance in Nigeria. In a national survey of non-communicable diseases in Nigeria published in 1992, the age-adjusted prevalence rate of diabetes mellitus was 2.2 per cent. The International Diabetes Federation (IDF) estimates the crude prevalence of diabetes mellitus in adult Nigerians to be 2.0 per cent. This data is based on extrapolation of data from other neighbouring African countries, but the burden is believed to be actually larger than that. A recently published systematic review and meta-analysis of studies on the prevalence of diabetes mellitus amongst Nigerians reported an overall pooled prevalence of 5.77 per cent.”
Mrs Adeleye further added that “the majority of Nigerians pay out-of-pocket for their health care. Diabetes mellitus has become an increasingly important cause of morbidity and mortality in Nigeria. The most common causes of morbidity and mortality on the inpatient service in the hospital where I work are diabetic foot ulceration and its attendant consequences, hyperglycemic emergencies, diabetes-related infections and cerebrovascular disease. The morbidity and mortality are often exacerbated by the late presentation and inability to afford the cost of care. Chronic kidney disease and visual loss resulting from diabetes are also increasingly common. I believe other centres have observations similar to ours.”
She concluded by reiterating the importance of self-care. “Our unit is a strong advocate of patient education and it is of immense benefit to our patients. Apart from in-house training of this group of nurses, we desire and seek further opportunities in other centres with considerable experience in this area to enable them to receive further training and exposure to update their knowledge.”