World fights to stamp out rising diabetes cases as Kenya faces growing pain

For many years, lifestyle diseases such as diabetes, heart ailments and cancers have been associated with the rich. But the diseases are now stalking the poor.

Even more worrying is the increase in obesity among Kenya’s poorest urban women at about seven times higher than the richest urban females. This group is at a risk of developing diabetes and hypertension or are already suffering from it.

The International Diabetes Federation (IDF), which represents sufferers, notes that about 775,000 Kenyans have diabetes and that the numbers are rising, and many more do not know that they have the disease.

“We estimate that more than 50 per cent of adult Kenyans have the disease yet they are not aware of it. They are the ones that give me sleepless nights,” Dr Joseph Kibachio, the head of the non-communicable disease (NCD) control unit at the Health ministry told Business Daily.

Reuben Magoko, a sufferer, who is the chairman of the Kenya Defeat Diabetes Association, knows too well the pain of living with the disease. Mr Magoko says he was a healthy energetic man when he was in his 30s. Then he began to drastically lose weight, feel thirsty frequently and have problems with his vision.

After eight years of suffering and numerous hospital visits, Mr Magoko was eventually diagnosed with type 2 diabetes.

In this condition, the pancreas produces sufficient insulin— a hormone that regulates sugar levels. But for a myriad of reasons, the body becomes resistant to it hence leading to an increase in blood sugar levels.

It is this type 2 diabetes that is the leading contributor to the rise of NCDs such as heart ailments that are worrying governments globally.

For instance the number of people affected by diabetes in sub-Saharan Africa alone is projected to double from 12 to 24 million within the next two decades, driven by rising numbers of people with excessive body weight and obesity—as was the case with Mr Magoko. Research shows obesity is reaching endemic proportions globally and westernisation takes root and poor countries like Kenya have not been spared.

World Health Organisation statistics indicate that over 25 per cent of the Kenyan adult women population is overweight or obese.

Mr Magoko says he led a reckless lifestyle. “I didn’t really care about my diet. I was an alcoholic who loved roasted meat and ate without moderation. I paid the price and would not want this to happen to other people.”

Dr Fredrick Otieno, a consultant physician and diabetes expert at Kenyatta National Hospital warns that the rampant unhealthy lifestyles have bred an obese society that is extremely vulnerable to diabetes.

“And this is now not just an adult problem. I have seen children in their teens presenting with type 2 diabetes which is very worrying.”

Type 2 disease differs from type 1 diabetes which is characterised by high sugar levels as a result of the body’s inability to produce sufficient insulin. The cause of this abnormality is unknown. It cannot therefore be prevented.

“When you have a lot of sugar which the body cannot absorb or use up, it becomes very toxic to your system,” explains Dr Otieno.

Some of the adverse health effects of raised blood sugar levels include strokes, heart complications, hypertension, liver impairment, kidney failure, blindness and knee amputations resulting from nerve damage.

Whereas type 2 diabetes previously occurred mostly in older people between the ages of 55 to 60, doctors are now raising the alarm over increasing incidence of the disease among young Kenyans.

“It is now becoming more common to see people in their early 30s with this chronic ailment,” says Dr Nancy Ngugi, a consultant endocrinologist at Kenyatta National Hospital.

Doctors attribute this crisis to lifestyle changes that are increasingly predisposing young people to diabetes risk factors.

“People are consuming excess carbohydrates and fat from fast foods, processed diets and beverages like soft drinks and alcohol,” says Dr Otieno.As this happens, he adds, many people lead sedentary lifestyles and so the excess sugar is not used by the body.
“They drive or are driven to work. Then they sit on their desks all day and fail to exercise afterwards.’’

But someone can still develop diabetes without being overweight or obese. For instance, states Dr Ngugi, high stress levels are also predisposing young people to the disease.

“Many youngsters are impatient with themselves. They want to get rich fast and make millions quickly. They drive themselves hard and become even more stressed if they cannot meet their goals.”

When the body is under duress, she explains, it releases stress hormones (such as excess adrenaline and cortisol) that impede the functioning of insulin.

The Health ministry has warned that without adequate measures to reduce risk factors, Kenya will continue witnessing an influx in diabetes cases which spells doom for the country’s social and economic development.

The increasing number of diabetes cases will further overburden the struggling healthcare system. It is estimated that the disease causes about 15,000 deaths annually in the country.

The IDF warns that whereas the number of diabetic patients is expected to go down in Europe and America over the coming years, countries in sub-Saharan Africa like Kenya will register more cases.

“Majority of these new cases will be people of working age who instead of being tax contributing members of the society, will become a burden due to illness or loss of life from diabetes,” said Sir Michael Hirst, president of IDH.

He added: “Due to its strong impact on the poor, diabetes is no longer just a health problem but a development issue.”

The Health ministry is looking at prevention and proper management of the disease —for those that already have it —to reducing the diabetes burden in Kenya.

Doctors urge people to undergo blood sugar tests so as to determine whether they have diabetes or not.

Early diagnosis and treatment of the disease prevents the development of life threatening diabetes-related complications like cardiovascular disease and organ failure.

But access to treatment is still a major hurdle for most Kenyans with diabetes as drugs and synthetic insulin required to manage the condition come at a cost which a majority of poor populations cannot afford.

As the world marks Diabetes day, the IDH president urges governments to adopt fiscal policies on healthy diets, restrict advertising of junk food and promote healthy lifestyles in school curriculums.

“I spend Sh200 on insulin which usually lasts for about three weeks. And for each purchase, my bus fair will be Sh500,” says Joseph Thuo, 23, a resident of Kiambu who has lived with type 1 diabetes for a decade now.

The health facility that he goes to sells the insulin at a subsidised rate. But in counties without such financing models, the cost of the drug shoots up to about Sh500.

He notes that rampant stock-outs of insulin often dent the pockets of diabetic patients as they are forced to buy it from private pharmacies whose prices are much higher.

“When there is no insulin in government facilities, they raise prices as they know we can’t live without insulin. We just have to buy it.”

Once someone has been diagnosed with diabetes he requires regular monitoring and tests to prevent catastrophic diabetes-related ailments like heart problems and kidney failure.

“But the majority of our patients never come back as they can’t afford consultation fees and associated medication and laboratory costs. That’s why we are losing many of them,” says Dr Ngugi.

Glucose meters (glucometres) which measure blood sugar levels at different times of the day are also essential to the management of the disease. But many patients just dream of having one.

The machine costs about Sh3,500. A patient also needs to buy strips at Sh30 each for conducting tests.

“For every use, say three times a day, you need a fresh strip. It’s hard to financially sustain this. So I just do without it,” says Mr Thuo who works as a part-time teacher in Kagaa village.

Dr Kibachio states that Health ministry plans to offer diabetes treatment at heavily subsidised rates or at no cost to vulnerable groups under the National Health Insurance Fund (NHIF) outpatient scheme.

“But counties can also think of other innovative financial mechanisms to address this challenge. It’s cheaper to treat the disease itself but very expensive to treat other conditions that are caused by it such as heart complications. So they will be making a wise investment.”

Through public-private partnerships with pharmaceutical companies like Novo Nordisk, the Health ministry is setting up diabetes centres across the country with an aim of taking treatment services to the grassroots.

Prof Gerald Yonga, a consultant cardiologist and researcher notes that one project that has helped diabetes sufferers is the Base of the Pyramid Project.

Since 2012, it has provided insulin access to more than 2,600 patients and as a result, the cost of a month’s supply dropped by more than two thirds, down to about Sh600. Every month, one hundred–plus facilities now host days devoted specifically to diabetes and local patient support groups.

This project partners the Health ministry and the Royal Danish Embassy with the Kenya Defeat Diabetes Association as well as a number of faith-based health organisations and Novo Nordisk, the world’s largest manufacturer of insulin.

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