Prof. GC Onyemelokwe, Chairman Expert Committee on Non-Communicable Disease of the FMOH
Prof. TO Johnson, Father of Diabetes
Prof. Efedaye Ohwovoriole, President of diabetes Association of Nigeria
Dr OA Fasnmade, Consultant Endocrinologist, LUTH
Dr OA Talabi, Consultant Physician, State hospital, Abeokuta
Dr AG Bakari, Director of Residency Program, ABUTH, Zaria
Dr EA Anteyi, Consultant Nephrologist and Deputy Director of Clinical Services, National Hospital, Abuja
Dr EK Chuhwak, Consultant Endocrinologist, University of Jos
Lady EU Okonkwo, Registrar Medical Laboratory Scientists of Nigeria
Dr (Mrs) FO Alli, Consultant Physician & Cardiologist, Lagoon Hospitals, Lagos

Media

The Guardian newspaper - Ben Ukwoma
This Day newspaper - Agha Ibiam
Channels TV - Teresa Essien
FRCN - Dorothy & Muibi
The Sun newspaper - Agaptus Anaele
Vanguard newspaper - Sola Ogundipe
Pharmanews - Kalu

Key Issues

Diabetes is not just a disease but a metabolic syndrome that spares no organ and no discipline/specialty
Heterogeneous group of disorders
- Chronic hyperglycaemia
  (FBG > 126 mg/dl, 7.0 mmo/l)
- Deficiency of Insulin
  relative or absolute
Types of Diabetes
- Type 1 (juvenile diabetes) 10%
- Type 2 diabetes (adult onset) 85%
- Others
  - Gestational diabetes
  - Secondary diabetes
Diabetes is an emerging epidemic of our time in Nigeria
- Changes in lifestyle, urbanization and modernization as well as genetic factors are responsible for this explosion
Presentation
- Classical symptoms
  - Polyuria - frequent urination
  - Polydipsia - frequent thirst
  - Polyphagia - excessive eating
  - In explainable weight loss
  - Complications
- Asymptomatic
Untreated or poorly managed
- early death or complications
Reduced Quality of Life
Triggers of diabetes
- Early triggers
  - Early foetal events
  - Poor antenatal care
  - Infant malnutrition
  - Low birth weight
  - Nutritional stunting
  - Childhood stunting
- Cultural/western nutritional habits
  - Substituting breast feeding for artificial feeding
  - Sedentary lifestyle
  - Obesity
- Coca-colonization
- Simple sugars consumption associated with insulin resistance
- Soft drinks in Nigeria have high sugar content
New concepts in non Communicable Disease
- A continuum - from womb to disability to death
Prevalence
- Prevalence and incidence studies
  - Few in Nigeria
  - Use of estimates
  - Use of nieghbours' values
- More than 7million cases in Africa as at 2003
- 3.2% in Lagos as at 2003
- By 2030 we will have more than 300million cases worldwide
Major Complications of Diabetes
- Peripheral neuropathy
- Autonomic neuropathy
- Systemic hypertension
- Cardiovascular complications
- Erectile dysfunction
- Ocular cataract
- Diabetic retinopathy
- Diabetic nephropathy
- Diabetic foot gangrene
Burden of Diabetes
- Medical burden
- sheer number of PWDs
- Economic Costs
- Indirect Costs
- Psychosocial Costs
Management
- DM requires multifaceted aggressive management to prevent or slow down complications
- It is not uncommon to require multiple therapeutic agents in the quest for overall wellbeing
- With good 24 hour metabolic control the cost benefit is immense to patient and healthcare providers
General Targets for Control
- Ideal body weight to make BMI 20 - 25
- Ideal waist circumference of <102 for males and < 88cm for women
- Ideal blood pressure <130/80mmHg
- Aglycosuria, round the clock euglycaemia
- HDL >50mg/dL in men and >45mg/dL
- Total cholesterol <150mg/dL, TG <100
- Glycated Haemoglobin < 7%
Treatment Options
- Oral antidiabetic drugs
- Injectables
- Cure of diabetes?
  - Pancreatic transplants
  - Islets transplant
  - Artificial pancrease
  - Insulin prophylaxis for type 1
Benefits of Azulix 2MF (Glimepiride + Metformin Combination)
- Patients who are inadequately controlled on monotherapy
- Obese patients
- Diabetics with dyslipidemia
Way forward
- Education
  - Risk factors
  - Patient structured education
  - Education of spouse and family
  - Education of colleagues at work or school
  - Use of pamphlets, audiovisuals, etc
  - Training of patients, nurses and doctors in the use of newer devices
  - Full patient empowerment, which includes
    - Self urine glucose and ketones monitoring
    - Self blood glucose and lipid monitoring
    - Self drug handling and administration
    - Self blood pressure monitoring
    - Patient -physician cooperation in meeting goals and in management decisions
    - Home care for chronic complications
- Policy Formulations
  - National policy on health promotion
  - National policy on NCD
- Partnerships
  - Government
  - Private sector
  - Academia
  - Media

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