Diabetes Mellitus: How Covid-19, high cost of insulin affect diabetics in Bauchi

Charly Agwam FASLN

Although there's no comprehensive national data yet that captures the number of deaths of diabetics resulting from COVID-19 complications in Nigeria; several studies show that there is a tremendous increase in prevalence in the epidemiology of Diabetes Mellitus (DM) in recent years.


In a paper titled 'Prevalence and Risk Factors for Diabetes Mellitus in Nigeria: A Systematic Review and Meta-Analysis', Uloko et-al observed in their meta-analysis that 11.2 million Nigerians (1 out of every 17 adults) are living with the disease. The research showed that populations previously unaffected or minimally affected by diabetes mellitus are now reporting soaring prevalence figures, which poses a real challenge to health financing by governments and non-governmental organisations.


"The modest improvement in living standards witnessed over the past few years in Nigeria has resulted in the ageing of its populace. Insulin resistance tends to worsen with advancing age. This, coupled with decreased physical activity among the aged increases the risk of type 2 diabetes," the research reads in part. "Among the risk factors for DM found in our study, unhealthy dietary habits was the most prevalent, which is not surprising considering the proliferation of fast food outlets in many cities across the country. An unhealthy diet consisting mainly of high-fat, energy-dense foods contribute to the development of obesity and diabetes mellitus."


According to the World Health Organisation (WHO), diabetes mellitus is a metabolic disorder of chronic hyperglycemia characterised by disturbances to carbohydrate, protein, and fat metabolism resulting from absolute or relative insulin deficiency with dysfunction in organ systems. It is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.


WHO further explained that: there are two main forms of the disease; people with type 1 diabetes typically make none of their own insulin and therefore require insulin injections for survival. People with type 2 diabetes, the form that comprises some 90 percent of all cases, usually produce their own insulin but not enough, or are unable to use it properly. People with type 2 diabetes are typically overweight and hardly move around.


This report is the third in a three-part story series on drug-use which was sponsored by the African Science Literacy Network (ASLN), to bridge the gap in science communication and raise awareness about the importance of science misconceptions.


Lamenting the high cost of insulin, Alhassan Ali, a type 2 diabetic who disclosed that he's been living with diabetes for 15 years told our fellow that he lost two of his diabetic friends to COVID-19 complications two months ago after they tested positive for the virus in Bauchi, Nigeria. 


"This period has been the most challenging for me since I was diagnosed with this disease 15 years ago. Two months ago, I lost two of my very close friends who were also diabetic to COVID-19 complications. And, that's apart from many other diabetic patients I know who got infected with the virus and didn't survive it.


"It's a difficult time in every sense of the word. On average, the monthly cost of insulin is N10,000 ($26), that's more than 30 percent of the minimum wage in the country. If you spend that much on only insulin, what will be left in your purse to attend to other needs?" he queried rhetorically. "It is even more difficult in this pandemic because everything in the market is now more expensive than it was before COVID-19."


Ishaya Haruna, father of an eleven-year-old type 1 diabetes patient living in one of Bauchi suburban areas, revealed that his son who was diagnosed with the disease last year could not keep up with the recommended daily dose of insulin because of the financial implication.


He said, "My son was diagnosed with diabetes late last year and was placed on a recommended daily single dose of insulin but the reality is that we can not afford it. I wish I could follow the doctor's prescription to the latter, but I can't because of my meagre income. I will gladly welcome government subsidy so that everyone living with the disease would be able to afford it. It is even more difficult to afford the drug now than it was before COVID-19." 

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In a paper titled 'Prevalence and Risk Factors for Diabetes Mellitus in Nigeria: A Systematic Review and Meta-Analysis', Uloko et-al observed in their meta-analysis that 11.2 million Nigerians (1 out of every 17 adults) are living with the disease. The research showed that populations previously unaffected or minimally affected by diabetes mellitus are now reporting soaring prevalence figures, which poses a real challenge to health financing by governments and non-governmental organisations.


"The modest improvement in living standards witnessed over the past few years in Nigeria has resulted in the ageing of its populace. Insulin resistance tends to worsen with advancing age. This, coupled with decreased physical activity among the aged increases the risk of type 2 diabetes," the research reads in part. "Among the risk factors for DM found in our study, unhealthy dietary habits was the most prevalent, which is not surprising considering the proliferation of fast food outlets in many cities across the country. An unhealthy diet consisting mainly of high-fat, energy-dense foods contribute to the development of obesity and diabetes mellitus."


According to the World Health Organisation (WHO), diabetes mellitus is a metabolic disorder of chronic hyperglycemia characterised by disturbances to carbohydrate, protein, and fat metabolism resulting from absolute or relative insulin deficiency with dysfunction in organ systems. It is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.


WHO further explained that: there are two main forms of the disease; people with type 1 diabetes typically make none of their own insulin and therefore require insulin injections for survival. People with type 2 diabetes, the form that comprises some 90 percent of all cases, usually produce their own insulin but not enough, or are unable to use it properly. People with type 2 diabetes are typically overweight and hardly move around.


This report is the third in a three-part story series on drug-use which was sponsored by the African Science Literacy Network (ASLN), to bridge the gap in science communication and raise awareness about the importance of science misconceptions.


Lamenting the high cost of insulin, Alhassan Ali, a type 2 diabetic who disclosed that he's been living with diabetes for 15 years told our fellow that he lost two of his diabetic friends to COVID-19 complications two months ago after they tested positive for the virus in Bauchi, Nigeria. 


"This period has been the most challenging for me since I was diagnosed with this disease 15 years ago. Two months ago, I lost two of my very close friends who were also diabetic to COVID-19 complications. And, that's apart from many other diabetic patients I know who got infected with the virus and didn't survive it.


"It's a difficult time in every sense of the word. On average, the monthly cost of insulin is N10,000 ($26), that's more than 30 percent of the minimum wage in the country. If you spend that much on only insulin, what will be left in your purse to attend to other needs?" he queried rhetorically. "It is even more difficult in this pandemic because everything in the market is now more expensive than it was before COVID-19."


Ishaya Haruna, father of an eleven-year-old type 1 diabetes patient living in one of Bauchi suburban areas, revealed that his son who was diagnosed with the disease last year could not keep up with the recommended daily dose of insulin because of the financial implication.


He said, "My son was diagnosed with diabetes late last year and was placed on a recommended daily single dose of insulin but the reality is that we can not afford it. I wish I could follow the doctor's prescription to the latter, but I can't because of my meagre income. I will gladly welcome government subsidy so that everyone living with the disease would be able to afford it. It is even more difficult to afford the drug now than it was before COVID-19." 


National Chairman, Diabetics Association of Nigeria (DAN) Dr Muhammed Alkali urged the government to expand the national healthcare programme to include rural dwellers and give subsidies for diabetic drugs while also calling for more sensitisation and awareness campaign to increase awareness about diabetes mellitus in the country. 


"I am aware of many diabetic patients that died from COVID-19 complications. In my hospital, I witnessed the death of a few that died from COVID-19 complications, and they had diabetes. And, we have reports from our meetings that most of our members died in this period than at any other time in recent history. All the data related to COVID-19 are compiled centrally, and I am sure that by the time the government releases the data, we would see the impact of COVID-19 on people with diabetes. Nevertheless, reports we have gotten from other hospitals, indicate that there are quite a number of diabetes patients that have died during this period.


"One major thing is that government needs to accelerate the actual enrollment of the National Health Insurance Scheme (NHIS) to reach people, particularly those in the rural areas. Sometimes, no matter how much subsidy you give, because of our peculiar situation (you know, Nigeria is one of the countries with low per capita income), it may not get to those who actually need the relief because, for some people, to raise that minimum amount is a problem. So I suggest that NHIS should be expanded to cover as many people as possible.


"Government should also increase its own commitment to creating awareness. We have seen that up to two-thirds of people living with diabetes in Nigeria are not even aware that they have the disease. People should be encouraged to go for screening to know their status; that way, they will know very early before complications set in. If we do that, we will be able to reduce the level of death and morbidity that are associated with the disease. It is even better if they make it a national policy that everyone must be tested for diabetes mellitus, at least, people will benefit from knowing their status even if the tests come out negative," he noted. 


We may not know the full extent of how COVID-19 and high cost of insulin have impacted people with diabetes in Bauchi and other parts of the country yet, but it is not in doubt that a lot of lives will be saved if the people and their government take proactive measures to protect those living with diabetes and other non-communicable diseases.


Reference

Uloko, A.E., Musa, B.M., Ramalan, M.A., Gezawa, I.D., Puepet, F.H., Uloko, A.T., Borodo, M.M. and Sada, K.B., 2018. Prevalence and risk factors for diabetes mellitus in Nigeria: a systematic review and meta-analysis. Diabetes Therapy, 9(3), pp.1307-1316.

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