How Town Planners Can Help Reduce Diabetes as Nigeria Records High Risk

Ololade Adeyanju with NAN/

 

Town planners have a role to play in controlling diabetes that is killing about 425 million people in the world, say medical experts at the 2018 Sanofi Diabetes Summit in Lagos last Thursday.

While critically examining the rising incidence of diabetes in Nigeria and the African region at the summit, the experts raised the alarm that more persons are still coming down with the disease if measures are not put in place to address the situation.

Stressing the importance of exercise in the control of diabetes, Prof. Jean-Claude Mbaya, Professor of Medicine and Endocrinology, University of Yaounde, Yaoundé, Cameroon said: “Preventing diabetes also involves the Ministry of Town and Urban Planning, for instance. How we build our roads, cities and schools is extremely important because you have to build cities with sidewalks, side roads with bicycle lanes; these are some of the ways we can improve.

“Individually, people need to exercise, I don’t mean just jogging on the road; I mean being physically active. We have to walk more, but in a city like Lagos, how can you walk more?’’

Explaining what the disease is all about, the Diabetes Research Institute, University of Maimi, U.S., says everybody needs carbohydrate foods because they provide our body with its main source of energy.

When we eat these foods, which include bread, cereal, pasta, rice, fruit, dairy products and starchy vegetables, the body breaks them down into glucose.

The glucose moves around the body in the bloodstream; some of it is taken to our brain to help us think clearly and function.

The remaining glucose is taken to the cells of our body for energy and also to our liver, where it is stored as energy that is used later by the body.

In order for the body to use glucose for energy, insulin is required; insulin is a hormone that is produced by the beta cells in the pancreas.

Insulin works like a key to a door; it attaches itself to “doors’’ on the cell, opening them to allow glucose to move from the bloodstream, through the door and into the cell.

If the pancreas is not able to produce enough insulin (insulin deficiency) or if the body cannot use the insulin it produces (insulin resistance), glucose builds up in the bloodstream (hyperglycemia) and Diabetes Mellitus develops.

Diabetes Mellitus means high levels of sugar (glucose) in the bloodstream and in the urine and its complications affect the eyes, kidneys, nerves, heart and blood vessels and may eventually lead to death.

Concerned by the rising incidence of diabetes in the country and region, they jointly called for improved awareness of the condition, as well as the provision of care on the health care plan for the indigent, disadvantaged and vulnerable people living with diabetes in Nigeria.

Prof. Mbaya said: “In Cameroon, we’re accounting for a population of about 20 to 21 million people with almost one million people suffering from diabetes.

“In Nigeria, it is almost the same percentage when you calculate the percentage based on the right percentage of the population; it is huge.

“However, the problem is that the rate of people who are susceptible to developing diabetes is higher at about 10 per cent; which means that in five to 10 years, if the risk factors in the population are not curbed, about 50 per cent of them will develop diabetes.”

Mbaya added that fighting diabetes was a whole of government concern with a multi-sectoral approach.

His words: “It is every government’s responsibility to take care of the health of its population and so, we should hold our government responsible.

“ Fighting diabetes is not only for the Ministry of Health; the ministry of health is there to open clinics, train doctors and make sure that those who already have the disease do not develop complications

“Preventing diabetes also involves the Ministry of Town and Urban Planning, for instance.

“How we build our roads, cities and schools is extremely important because you have to build cities with sidewalks, side roads with bicycle lanes; these are some of the ways we can improve.

“Individually, people need to exercise, I don’t mean just jogging on the road; I mean being physically active, we have to walk more but in a city like Lagos, How can you walk more?’’

He called for prioritisation of choices saying: “Measures should be put in place for prevention because it is easier to prevent than to treat or manage.

“We spend a lot of money on things that can be forgone thereby mortgaging the lives of our people; we are making the wrong choices by not taking care of the health of our population.

“We should change that paradigm and if the government does not change the paradigm, we resolve not to vote them to power,’’ Mbanya, who is also a past president of the International Diabetes Federation told NAN.

Another Professor of Endocrinology, Prof. Sam Dagogo-Jack, said urbanisation, sleeplessness, stress, depression and carbon monoxide in the atmosphere are part of risk factors associated with the rising cases of diabetes in Nigeria and the world at large.

Dagogo-Jack, who is of the University of Tennesse, Health Science Centre, U.S., said that HIV, tuberculosis, high blood pressure, antibiotics use, obesity, overweight and environmental influences also contribute to rising incidence of diabetes.

Dr Olufemi Fansamade of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, agreed that the reason why people are more susceptible to diabetes now was our changing lifestyle.

“Before, we used to be very physically active; people were healthy, trim and do a lot of walking but presently, very few people walk.

“The roads that are bad are also not helping and people use excuses like rain, rough roads and driving not to exercise.

“Children are getting bigger than before and schools are getting smaller in size just as fields are disappearing,’’ he said.

Fasanmade added: “So many schools don’t even have a playing field; before, children used to play at 1 p.m., 2 p.m. or 3 p.m.; they still go for an extra lesson and on getting home again they do homework.

“Nowadays, children spend time playing games on their phones and laptops.

“So, we are becoming less physically active and that is reflecting in the increase in weight of children and adults, leading to increased rate of diabetes and hypertension.

“There is an urgent need to change the narrative.’’

On treatment options, the endocrinologist said it was individualised.

“There are many drugs to choose from, there is a lot of lifestyle changes and lifestyle even differs from a person to a person.

“So the lifestyle changes are individualistic, the medications are also individualistic,’’ he said.

Prof. Felicia Anumah, also a professor of endocrinology at the University of Abuja, said that diabetes education was very important to empower patients.

“We need to educate them about risk factors, physical activities, about diet, about foot care.

“The only option as far as diabetes is concerned is prevention and that is why sensitisation is important,’’ she said.

Also, Patience Chima, a Registered Dietitian and Nutritionist, said diabetic patients, as well as their relations, need to make healthy food choices, understand portion sizes and learn the best times to eat.

“This helps patients to control weight and achieve good blood sugar control, cholesterol and even blood pressure.

“Managing diabetes successfully by patients involves food, exercise and medication; we need to plan food intake and insulin/drugs to manage blood sugar.’’

“There’s also the need for balance between food and insulin/drugs; too much food (or too little insulin/oral drugs) can increase blood sugar; too little food (or too much insulin/oral drugs) can lower blood sugar,’’ Chima said.

“Regular physical activity also lowers blood sugar and improves the way insulin works,’’ Chima said.

Ms Folake Odediran, the General Manager, RX and Country Chair, Sanofi Nigeria and Ghana, said that although various stakeholders were making tremendous contributions in their respective spheres to improve treatment outcomes, there still exists gaps.

“These gaps are in terms of policy direction, public awareness, advocacy, patient education, diagnosis, infrastructure and overall capacity of the health care system to effectively manage this disease.

“As leaders in diabetes care, Sanofi will continue to prioritise public-private partnerships and initiatives that support speedy attainment of universal health coverage for diabetes patients,’’ Odediran said.

Nigeria is one of the 32 countries of the International Diabetes Federation (IDF) African region.

According to IDF, 425 million people have diabetes in the world and more than 16 million people in the AFR Region; by 2045 it will be around 41 million. There are an estimated 1,702,900 cases of diabetes in Nigeria in 2015.

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