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With diabetes now one of the burdens of  affluence among most Nigerians, its presence in a patient portends even greater danger as TB may just be lurking in the corner writes Kingsley Obom-Egbulem

Some diseases may not have come close to the dwelling places of most Nigerians but for a change in their  life style occasioned primarily by an increase in income and status. Diabetes is one of such diseases and its  affecting and claiming the lives of millions of Nigerians  albeit silently.

Diabetes is a disease that causes high level of glucose in the blood. People with diabetes lack insulin which is needed for the control  blood sugar.And due to inadequate insulin production they need to be on insulin injection for life.

There are two types of diabetes; Type 1 usually develops in childhood and requires lifelong injection of insulin, while Type 2  develops in middle age( causing kidney, eye, and nerve damage.) It may not  have symptoms and usually can be controlled by diet and drugs if detected early.

For those "who have arrived",it might just be wise to add a lifestyle of regular check ups to the "chop ups"

“Diabetes is both a disease of poverty and affluence especially in Africa and I can say without any fear of contradiction that some people wouldn’t have had diabetes if not  for the fact that the food they eat and how they live changed with an increase in their income”, says Dr. Anthonia Ogbera ,Head ,Endocrine Department at the Lagos State University Teaching Hospital(LASUTH),Ojo.

Consultant Endocrinologist at the Lagos University Teaching (LUTH)Dr. Olufemi Fasanmade seem to agree with her.

“Overseas ,obesity is a disease of the poor. The rich are slim while the obese are apparently poor but here one of the signs that you have arrived is your size and when you are slim it’s a sign that you are not eating well and that’s is why we have people who are really sick but would not admit it until it is too late just because of the picture our society have painted about a healthy person”, say Fasanmade.

Most Nigerians are now living in urban centres with its attendant change in lifestyle and diets. African foods ,vegetables and fruits which are readily accessible and affordable in the rural areas become a thing of the past the moment families migrate to rural areas. With that comes also a change in diet as well as lack of time to exercise and work out due to the busy nature of urban life. This perhaps explains why half a million Lagosians are believed to be living with diabetes according to information from the Sonny Kuku Foundation(KSF).

An aversion for check up

The matter is worsened by poor  health seeking behaviour as a result of high cost of accessing quality medical care and checkups. “And after several years of  not checking your  blood pressure(BP) or monitoring your blood sugar level the next thing  is that the person begins to present with signs of diabetes and  when you tell them they have diabetes they wonder and ask you ‘how come’, they hardly believe it, but that’s the fact,” says Ogbera.

According to a study carried out in LASUTH in 2006 on the burden of diabetes in Lagos alone, about 140 to 160 patients already diagnosed with diabetes are catered for on weekly basis and 25% percent of people with diabetes already have diabetes related complications by the time they are diagnosed of the disease.

It is believed that diabetes accounted for 1 in 6 hospital admissions in Nigeria and 1 in 6 persons admitted for the disease eventually die of diabetes related complications.Over half a million Lagosians are said to be living with diabetes

Unlike infectious diseases,diabetes  does not ‘jump’  on  anyone as it takes time to develop in a perosn. The tendency for it to develop can be checked or prevented. Early onset of diabetes can also be detected and complications prevented through regular checkups. However, some doctors believe that the poor health seeking bahaviour of Nigerians is responsible for this.

Dr. Femi Olaleye of Optimum Healthcare Services is of the view that the average Nigerian would ordinarily  not seek  for medical attention and when he is ill, he would not bother much so long as his appetite, sex life and bowel movement are not affected by the illness.

“This attitude is commonly seen in regions where there is poverty and lack of access to free healthcare services. The decision-making capabilities of the poor man are eroded to a point where he lives in hope that his medical condition will ameliorate miraculously as long as the condition does not affect what he considers as his primary functions which are; eating, excreting and enjoying sex. But we know that the definition of good health is not the absence of disease but the maintenance of physical and mental well-being of the body and the prevention of diseases. But it costs money to maintain health and prevent diseases”, says Olaleye.

It also pays to eat with discretion and be sure to check your waistline and body mass:Pic:CDC

Staying healthy in the face of competing demands according to Olaleye is a major challenge for most Nigerians. “We have gradually over-priced healthcare services out of the reach of the average Nigerian, and as result, the demand for our kind of healthcare services are plummeting. Our patients are now seeking ’cheaper’ alternatives, which sadly in some cases, are very fatal and continues to lead to loss of lives.”

Even for those who can pay for a checkup, there is still an attitude that is anti-checkup and this has a role to play in case detection rate of diabetes and similar disease of lifestyle.

The Link with Tuberculosis(TB)

One of the challenges of living with diabetes is the risk of being infected with TB. In 2008,a survey of TB patients receiving treatment at the LASUTH showed that the prevalence of under-diagnosed diabetes was 6%. And for most endocrinologists, this trend is a worrisome reality that needs to be given some measure of attention. Hence the SKF made it a subject of focus at its recent public seminar in Lagos.

Titled; “the Emergence of Diabetes Mellitus in Tuberculosis”, the seminar was to raise awareness on the relationship between diabetes and TB such that screening for diabetes in TB patients will be mandatory.

But Dr. Dan Onwujekwe, Senior Research Fellow and TB clinician at the Nigerian Institute of Medical Research(NIMR),Lagos said the reverse should be the case. “Most doctors would agree with me that diabetes lowers the immune system  and affects the body’s ability to cope with diseases  and so you become prone to infections; and not just that, the TB bacterial thrives in sugar environment hence, we will rather advice that those currently treating diabetes  should screen regularly for TB because they are highly susceptible”.

While it may sound like a case of which comes first;between the egg and chicken, whichever way it is tagegd, emergence of diabetes in TB patients or emergence of TB in diabetes patients are frightening combination the Nigerian healthcare system should be bothered about and starts responding to.

Sadly, most TB treatment  programmes in Nigeria are donor driven initiatives most of which do not incorporate diabetes detection and treatment, hence Onwujekwe’s counsel  for those currently treating diabetes to go for TB screening regularly since the treatment is free.

But the implication of treating TB in a person with diabetes is enormous. “TB patients with diabetes can actually have their blood sugar increased when they commence TB treatment due to the effects of Isoniazid one of the drugs used in TB treatment”, says Fasanmade.

One way to address this burden according to Fasanmade is through a co-location of treatment centers for diabetes, TB,HIV and AIDS . “That way ,we can ensure that diabetes patients  can also have the opportunity to access TB diagnoses and care within the same facility”.

Perhaps, this might just be one way out of the woods. But the greater responsibility rests on our health system as it is currently configured with no template for  such co-intervention. The potentials are there however, especially with the successes recorded in  TB/HIV co-response.

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