It is clear that diabetes is a growing health issue, but how do we fight this chronic condition, especially in a developing region?
What strategies can we use to help manage the current burden of diabetes and prevent a devastating future upsurge?
Diabetes is a health condition that is of tremendous concern across the globe. However, it is of particular concern to a much higher degree in developing countries (1).
The staggering prevalence of the condition in Nigeria is an issue of concern that requires urgent attention as it ranks as the highest statistically in Africa (2).
Type 1 Diabetes occurs when the pancreas fails to make insulin, whereas Type 2 diabetes occurs when the body is resistant to insulin and as a result, the level of insulin in the body drops (3).
The root of Type 1 diabetes is uncertain, however, type 2 diabetes is associated with a number of factors which can increase risk, including weight, age & lifestyle (3).
The rural regions of Nigeria see about 0-2% of diabetes cases in contrast with the urban regions which have a greater proportion of cases ranging from 5-10% (4-6).
Shockingly, a terrifying 2 million cases of diabetes are unidentified in Nigeria. In addition, over 100,000 deaths could be associated with diabetes in 2013 (7).
Detrimental health effects can arise as a consequence of diabetes, for example, it has been connected with the re-emergence of other health conditions in Nigeria such as stroke, erectile dysfunction, tuberculosis, and the final stage of kidney disease (8-11). Some of this could potentially be attributed to diabetes having the ability to destroys tissues as it escalates over time (2). Type 2 diabetes makes up most of the cases in Nigeria (12-14). Many type 1 cases go unidentified therefore, they are sadly undiagnosed due to factors such as deprivation and people not having medical insurance (12-14).
With the general state of income in Nigeria and with around 62% of Nigerians earning less than $1000 US dollars per year, it does not come as a shock that only a small percentage of Nigerians engage in monitoring their blood glucose levels (15). In some medical institutions, patients were even unaware of the medication they were consuming (1,15). In Nigeria, although diabetes is not particularly prevalent in children, there has been some evidence suggesting that the proportion of children and teenagers suffering from this condition is increasing moderately with time (16).
With the introduction to the condition out of the way, one could say the massive elephant in the room is probably - so what now? You are probably curious, how can we slay this dangerous dragon?
Here are four approaches outlined below:
One aspect which can be considered very important in attempting to combat the onset of diabetes is managing diet (17). Maintaining optimally healthy dietary practices can help to regulate glucose levels which consequently can reduce the risk of issues associated with diabetes in both short and long-term circumstances (1). For example, it has been pointed out by the American Diabetes Association that individuals who are classified as having diabetes or are prediabetic should be informed about nutrition as a part of medical nutrition therapy (17). They should also cooperate with a medical professional to regulate health levels and create a personalised diet for the patient. Also, taking into consideration some of the food they are fond of to allow them to continue to enjoy eating and help keep up the prolonged continuation of these practices (17).
The Diabetes Association of Nigeria (DAN) emphasises actions that can be taken such as delivering education to people early on in life, explored in a book they released (18). For example, incorporating learning about health in schools, in particular, drawing focus on elements including exercise and nutrition (18). The strategy of informing people in this area has the potential to help people understand better how their diet and lifestyle can affect their risk of diabetes (18).
The umbrella called ‘telehealth’ encompasses a wide area called ‘telemedicine’ which focuses on the administration of information about health and giving medical care remotely by utilising technology (19). Telemedicine is a concept that has been proposed as a possible solution for helping to tackle and manage diabetes, especially to bridge the gap in gaining access to facilities and medical professionals (20). More specifically, it can be utilised as a way of serving communities within developing countries by providing them with fundamental healthcare services and aiding the process of bridging the gap between rural regions and the larger cities which typically have more specialised medical institutions (21).
Research studies investigating telemedicine as a management tool for diabetes for type 2 diabetes have generally used similar processes to those used for the management of type 1 diabetes as well, such as consultations through the phone (20). In addition, processes involve sending over glucose data to healthcare providers and receiving an interpretation based on the information (20). The results of a research study looking into the effectiveness of an educational initiative to spread diabetes awareness and regulation of blood sugar in people with type 2 diabetes, showed a decrease in blood sugar after participation in video consultations straight after the educational initiative (22). In addition, the same result was maintained after the last conference for 3 months (22).
Furthermore, telehealth has been recognised as being useful for helping unique populations of people who have diabetes (19). For example, the results of a telemedicine program which involved examining the eyes via remote screening showed positive results by decreasing the necessity for high-risk patients to consult eye specialists and additionally lowered the wait times in a Los Angeles healthcare system (23). Overall, these results help shed a positive light on the idea that telemedicine has the potential to successfully improve the standard of medical services delivered as a result of the plethora of tools that now exist (20). However, it is important to bear in mind that its success relies on the cooperation of healthcare professionals and the optimism of patients to embrace innovation (20).
Another area which can be considered important in trying to help manage and prevent the onset of diabetes is engagement in physical activity (24). Participation in physical activities can result in a variety of positive alterations in the body which can impact important factors including sensitivity to insulin and overall glycemic control (25, 26). A variety of apps have been created to help the process of keeping track of physical activity easier, for example, pedometers and wristbands that incorporate technology such as sensors (24). The apps help provide a way for individuals to monitor activities, set targets and obtain useful feedback so they can understand how they are doing (27). Both research and the promotion of exercise tools help to emphasise the significance of physical activity in helping to prevent long-term conditions in general, as well as its added benefit on other aspects such as mental health (28, 29).
The availability of online portals and educational resources can be used as a method to deliver important information to help individuals understand diabetes better (24). This enhanced understanding can then lead people to understand how to manage the condition better. These methods can be considered as beneficial as they are not typically difficult to use, can help save money and are usually more readily available to access from different locations at a convenient time for the individual (24).
Ultimately, tackling diabetes and attempting to manage the current burden in Nigeria is a complex process. There are multiple layers to effectively tackling the disease and a multifaceted approach is likely required, with the integration of key aspects of technology and education. Education is likely to play a significant part in a variety of approaches, especially in a developing environment. Furthermore, cooperation with health professionals, educators and bodies/organisations such as The Diabetes Association of Nigeria (DAN) is necessary to facilitate change. There is great hope for the future with more research and technological development which can unveil new possibilities along with added enthusiasm to push for a healthier Nigeria.
by Tasnim Tayo
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