November 14 was the World Diabetes Day. The annual event is the world’s largest diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public and political spotlight. Dr Jean Nepo Utumatwishima (pictured right), a diabetes research fellow with the USA’s National Institute of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK-USA), who is also the current director-general of Ruhengeri Referral Hospital spoke to Healthy Times’ Hudson Kuteesa about the burning issues in Rwanda and Africa in the fight against the disease.
Data from the International Diabetes Federation (IDF) says there will be a 140 per cent increase in diabetics in Africa by 2040 if nothing is done. What is the cause of this trend?
The International Diabetes Federation (IDF) estimates that type 2 diabetes will increase at a rate of 140 per cent because many people are not screened today for pre-diabetes. In 2040, this pre-diabetes will have become diabetes. Another reason that is not highly regarded is that even those screened are using screening tests that are not optimal in African descent populations such as fasting plasma glucose and glycosylated hemoglobin (A1C). The sensitivity to diagnose pre-diabetes is 30 per cent for Fasting plasma glucose and 55 per cent for A1C. With these tests many people are left undiagnosed. In 2040, there is a risk that many people will be diagnosed with advanced diabetes. Another likely cause of diabetes increase is early life under nutrition because of different wars that create famines in many African countries. Research has proven that malnutrition in early life is an independent risk factor of type 2 diabetes.
What can be done to avert the increase in diabetes cases?
To stop this 140 per cent projection, African health leadership must first be aware that diabetes is a disease that can be prevented using simple measures like early screening before one has become diabetic. The Diabetes Prevention Programme (DPP) done in US has found that people who were screened and found with pre-diabetes and put on lifestyle interventions did not develop diabetes at the rate of 60% after 10 years of follow up. Health providers must also screen diabetes using both fasting plasma glucose and A1C to maximise the detection chances. Countries like Rwanda which are screening in health centres and have initiatives like the car-free day are doing great. Physical exercise is one way to delay the onset of diabetes as obesity or overweight double the risk.
Another burning issue is that Africa has the highest number of people living with undiagnosed diabetes. How dangerous is this?
The IDF estimates 67 per cent of Africans live with undiagnosed diabetes. This means that people in Africa do not go for health checkups before it is too late. Many Africans go to health care providers after symptoms have arrived like polyuria, polydipsia and polyphagia. When the symptoms have arrived, it is too late and it means the patient has kidney problems, eye problems and is at risk of losing a limb due to micro vascular problems. Medics say there is inefficiency in the way diabetes tests are carried out in Africa.
As I have explained above, to decrease the burden of type 2 diabetes we need to do pre-diabetes screening in our people. Fasting plasma glucose and A1C are not doing a great job in Africans. We need to combine them and to initiate another test called Glycated Albumin, which detects diabetes in non-obese people.
Going by WHO surveys, Rwanda is one of the countries which have not provided their own data on diabetes prevalence to IDF. How does this affect the fight against the disease and what can be done?
Sub-Saharan Africa has 37 countries. Among the 37, only 12 countries provide accurate data which IDF accepts for estimating prevalence of diabetes. Rwanda is one of the remaining 25 countries without data. It is not good for a country not to have reliable data about a serious public health problem like diabetes. It does not help in health decision making to address it. Rwanda will soon start an IDF guided diabetes registry which will give us reliable estimates of diabetes prevalence to complement the WHO STEP survey done in 2013 which has shown that diabetes prevalence of 3 per cent in Rwanda.
How does diet contribute to diabetes?
The issue of fast foods especially in middle income families is huge. Simple foods and drinks like sodas, French fries, rice, Irish potatoes, bread and others are full of calories. When you eat them regularly without physical exercise, you gain much weight, a big belly full of visceral fat which contributes more than 90 per cent to type 2 diabetes. A good nutrition set must be 50 per cent vegetables, 25 per cent proteins and 25 per cent carbohydrates. This regime and regular physical exercise prevents diabetes.