Diabetes is a condition characterised by high blood sugar levels due to the absence or improperly functioning insulin. Insulin is a biological hormone produced by the pancreas which is important in the breakdown of blood glucose. From the definition, there are two major types of diabetes; diabetes type 1 and type 2. Diabetes type 1 occurs when there is a complete absence of insulin while type 2 occurs in states where inadequate insulin is produced or where there is peripheral insulin resistance necessitating increased insulin requirement. Over 90% of the cases in Kenyan population is type 2 diabetes which is manageable through diet and lifestyle modification.
Approximately 415 million people aged 20-79 years (8.8%) worldwide are estimated to have diabetes with about 75% living in low- and middle-income countries. If these trends continue, by 2040 one adult in ten will have diabetes with the highest prevalence in Sub-Saharan Africa. The estimated prevalence of diabetes type 2 in Kenya is 1.2-10.2% with many undiagnosed cases (2/3 of people living with diabetes). What the International Diabetic Federation has demonstrated in the 7th Edition Atlas is a state of impending disaster if the society does not respond. The society includes the government, the NGOs and all stakeholders. As opposed to infectious diseases which can be completely managed by immunisation and antibiotics, diabetes is a lifestyle disease that requires a multi-pronged approach.
(Note: All the statistics were drawn from International Diabetic Federation Atlas 7th edition)
WHO IS AFFECTED?
Diabetes does not discriminate age or social class. Type 2 diabetes, however, occurs mostly in middle aged obese individuals. Type 1 diabetes can affect even young children less than five years. Pregnant women can develop a transient type of diabetes called gestational diabetes which resolves after delivery.
WHAT CAUSES DIABETES?
Diabetes has a multifactorial aetiology varying depending on the types. Type 1 diabetes has a strong genetic causation and autoimmune background. Type 2 diabetes is a lifestyle disease which is strongly linked to obesity, a diet rich in fats and carbohydrates, sedentary life and familial predisposition. Pregnancy is strongly linked to gestational diabetes which occurs in a group of pregnant women, especially in the second trimester. Certain drugs have also been linked with diabetes causation such as glucocorticoids, atypical antipsychotics and thiazides.
HOW DOES IT PRESENT?
Diabetes has an insidious onset. This means that for the first few years of life, individuals live a relatively normal life without symptoms. They may present with weight loss, increased thirst, increased urination and increased eating. These are not severe symptoms which may be ignored or treated by self-medication. Ultimately, the individuals may come down with the blurring of vision, kidney failure, loss of consciousness and even coma. This is the time when most people seek medical attention. The management of the patients at this time is difficult and most of the time they progress to develop complications such as joint disorders, diabetic foot, peripheral nerve disease, blindness, sexual dysfunction, heart disease and stroke. Early diagnosis and control of blood glucose reduce the rate of progression to complications but unfortunately the majority of the patients present late.
HOW IS DIABETES MANAGED?
People have a poor concept concerning diabetes management. It is a life long condition that can only be effectively managed by motivated clients, healthcare providers and effective support infrastructure. The patient plays the biggest role in management because lifestyle modification is key to achieving glycemic control. Healthcare providers are important in diagnosis, drug prescription, dosage adjustment, patient education and managing complications. An effective system for diabetic management is lacking in Kenya despite various programs having been launched. Kenya Diabetes Management and Information Centre is one of the programs doing a great job in a multidisciplinary approach to diabetes. Other NGOs such as MERCK and Novo Nordisk are taking front line in tackling diabetes treatment and prevention. The government of Kenya has undertaken a crucial role in developing infrastructure but the impact is yet to be seen. There is a big gap in primary health care when it comes to managing chronic diseases including diabetes yet these are the group who first come in contact with the majority of the patients.
PREVENTION OF DIABETES
Diabetes can be prevented through proper diet and exercises. It is estimated that regular exercise can reduce the risk of developing diabetes by 28%. Dietary changes should include a diet rich in green leafy vegetables and limited intake of sugary drinks.
An effective civil education program incorporating media, health care providers, patients and policy makers need to be developed. Many people have little information regarding diabetes management and prevention (54%) according to a research done by Kiberenge et al. in 2010. The other obstacle that is facing the Kenyan population especially the rural population is the unwillingness to change their lifestyles. This was demonstrated in 2011 by Maina et al. in a study which concluded that only 28% of the population were willing to modify their lifestyles. There is a big gap in this section and a social overhaul needs to be instigated.