It’s World Diabetes Day

• 415 million have diabetes worldwide

• Could rise to 642 million by 2040

• More Nigerians down with foot complication

• Expert advocates structured self monitoring of blood glucose for patients

The world marks the 2016 World Diabetes Day today amidst statistics showing that that one in eleven adult around the world, or about 415 million people, are currently living with the disease.

And it is spreading fast. The international Diabetes Federation says the figure of adults with diabetes will rise to 642 million by 2040 even as one in two adults  (46%) with diabetes remain undiagnosed.

With the theme “Eyes on Diabetes” this year’s edition of WDD focuses on promoting the importance of screening to ensure early diagnosis of type 2 diabetes an treatment to reduce he risk of serious complications.

The theme was vigorously canvassed n Nigeria by Nigeria Health Online, Africa’s premium online health newspaper in partnership with Rainbow Specialist Medical Centre, a leading private hospital in the country rendering specialised services in endocrinology and metabolism. Actively supported by Roche Products Limited Diabetes Care and Eli Lilly, the team embarked on free blood glucose screening of the Nigerian public and visited some  media houses where a large number of journalists and workers in the media industry were offered free blood glucose screening.

The second phase of the programme was held on Wednesday November 9 with a media roundtable and the Rainbow Specialist Annual Boot camp for people living with diabetes.

In a presentation at the roundtable,  Dr Afokoghene  Isiavwe, Consultant Endocrinologist & Medical Director, Rainbow Specialist Medical Centre Lagos and Project Coordinator, Diabetes Podiatry Initiative Nigeria, emphasised the importance of screening as highlighted by the 2016 WDD theme, saying screening of people with diabetes ensures  early detection of complications and the avoidance of poor outcomes.

She noted that diabetes is often picked up late among Nigerians and many people already have complications at diagnosis. She disclosed that 50% of newly presenting  patients with Type 2 diabetes would have developed one or more complications at diagnosis such as intermittent claudication (3%), retinopathy  (21%) and ischemic skin changes to feet (6%). Also, about 35% o such patients would have developed hypertension, 18% would have developed abnormal ECH, 1% for stroke or TIA  while 20% would have developed erectile dysfunction among others.

Dr. Isiavwe

Dr.  Isiavwe described diabetes foot complications as a pivotal event in the life of a person with diabetes and a marker of serious disease and comorbidities.  According to her, 85% of diabetic related foot amputations are preceded by foot ulcer, 75% of which  are preventable. She however told the participants that  up to 25% of persons living with diabetes will develop a foot ulcer.

“Without early and optimal intervention, the wound can rapidly deteriorate, leading to amputation of the affected limb, sometimes death,” she further said.”50% of patients will have their other limb amputated within two years of a major amputation. The relative five-year mortality rate after limb amputation is at least 50% (compared mortality rates of lung cancer (86%), colorectal cancer (39%), breast cancer (23%), Hodgkins disease (18%) and prostate cancer (8%)

“A history of Diabetes Foot Ulcer gives a 40% greater 10-year mortality rate than in people with diabetes alone,” She further said.

Dr. Isiavwe also said that the current prevalence of DM in Nigeria is not known. What is known however is that  amputation rate is 42%-53% in various centers with mortality rate as high as 50% in some centers.

She gave some tips to people living with diabetes and members of the Lagos Chapter of Diabetes Association of Nigeria (DAN) at the forum, urging them to take proper care of their diabetes to avoid serious complications.

• Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help. Be more active.
• Ask your doctor if you need special shoes.
• Keep your feet clean with daily washing in clean water.
• After washing make sure you dry your feet , especially in-between the toes.

In another presentation, the Accu-Check Strategic Account Manager, Roche Products Limited Diabetes Care, Mrs Folashade Olufemi Ajayi urged Nigerians living with diabetes to embrace the structured self monitoring of blood glucose (SMBG) in the control of their diabetes.

Mrs Olufemi-Ajayi

Mrs Olufemi-Ajayi told the participants that the Haemoglobin Ab1c (often abbreviated as HbA1c)  blood test which is routinely  performed in people with diabetes to know how well the disease is controlled, as important as it is in diabetes management, is not enough to fully determine how an individual’s diabetes is controlled.

“Structured SMBG and systematic data analysis can help people with diabetes make lifestyle changes and inform therapeutic decision-making,” she submitted.

She listed some of the advantages of SMBG, most of which a patient will not get by relying on HbA1c alone.  These include the fact that SMBG helps to Identify hypoglycemic event,  Identifiy postprandial blood glucose excursion, has dynamic relationship between insulin and resulting glucose level; has effects of different meals and snack and effects of physical activity

“Patients have immediate access to the information; it encourages patients to become more involved in their own management and reduces dependence on health care professionals. It iincreases patient motivation to keep blood glucose within target, helps ID and correlate symptoms of hyperglycaemia and hypoglycaemia with blood glucose values. It supports and guides decision making with regards to changes to meals, activity and medication.

“Self-monitoring enables patients to achieve appropriate metabolic control, avoiding hypoglycemia and reducing the likelihood of developing long-term complications of hyperglycemia such as blindness or renal failure,” Mrs Olufemi-Ajayi said.