Several days from now, on 14 November, the world will commemorate World Diabetes Day (WDD). WDD was established in 1991 by the International Diabetes Federation (IDF), an umbrella organization of over 230 national diabetes associations in 170 countries and territories, and the World Health Organization (WHO), a specialized agency of the United Nations (UN) concerned with international public health, in order to raise awareness about rising diabetes rates worldwide.
November 14 was selected as the date for WDD since that is the birthday of Sir Frederick Banting, who co-discovered insulin, along with Charles Best, in 1922. In 2006, the UN made WDD an official UN-recognized annual international day through the passage of UN Resolution 61/225. With WDD representing an important opportunity to raise awareness and spread the message about diabetes, this article provides a general overview of the disease and a brief snapshot of diabetes within Eritrea.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin that it produces. Insulin is a hormone that regulates blood sugar (it also has many other roles). Hyperglycaemia, which is an increased concentration of glucose in the blood, is a common effect of uncontrolled diabetes and over time it leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
There are two principle forms of diabetes: Type 1 and Type 2. Type 1 diabetes, previously known as insulin-dependent, juvenile, or childhood-onset, is characterized by deficient insulin production and requires daily administration of insulin. While this form develops most frequently in children and adolescents, it is increasingly being found among adults. At present, the cause of Type 1 diabetes is not known and it is not preventable with current knowledge. The second main form of diabetes, Type 2 diabetes, results from the body’s ineffective use of insulin. Type 2 diabetes, formerly called non-insulin-dependent, or adult- onset, comprises the large majority of people with diabetes around the world, and it is largely the result of excess body weight and physical inactivity. Although Type 2 diabetes occurs most frequently in adults, it is increasingly being noted in adolescents as well.
Diabetes has significant consequences; it is a major cause of blindness (about 2.6% of global blindness can be attributed to diabetes), kidney failure, heart attacks and strokes (adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes), and lower limb amputation (through the increased chance of foot ulcers and infection). However, relatively simple and easy lifestyle measures have been shown to be effective in preventing or delaying the onset of Type 2 diabetes, including: achieving and maintaining a healthy body weight; being physically active; eating a healthy, balanced diet (e.g. increasing fruits and vegetables while avoiding sugar and saturated fats intake); and avoiding the use tobacco.
According to the WHO, the number of people with diabetes quickly rose from approximately 108 million in 1980 to 422 million in 2014. During the same period, the global prevalence of diabetes among adults over 18 years of age increased from about 4.7% in 1980 to 8.5% in 2014 (WHO 2018). Although the prevalence and impact of diabetes has dramatically increased around the world, the trend is especially pronounced within Sub-Saharan Africa (SSA), posing significant health and socio-economic consequences. The rapid rise in diabetes across SSA is spurred, in large part, by growing and aging populations, considerable changes in lifestyle and eating habits, such as increased exposure to high-calorie, processed foods, rapid urbanization, and changing work practices (e.g. more people spending their working days sitting down). In 2015, the IDF estimated that there were 14-16 million adults living with diabetes in the region, with the highest prevalence of diabetes found in adults aged 55 to 64. Of note, less than half of those with diabetes in SSA are diagnosed – the highest proportion in the world – and of those that are diagnosed, only about 10% are receiving treatment. Ominously, SSA is also expected to have the largest percentage increase in the incidence of diabetes of any region in the world in the coming years.
Over the years, Eritrea, a low-income, developing country in the Horn of Africa, has made considerable improvements in healthcare. However, partly as a result, chronic diseases, such as diabetes, are on the rise in the country. Diabetes is one of the leading causes of morbidity and mortality of adults in Eritrea and estimates suggest a national prevalence of approximately 3.06%. A total of 78,686 new cases and 926 deaths related to the condition were reported between 1998 and 2013, and diabetes accounted for 2.7% of total reported deaths in 2013. Not only has the incidence of diabetes in the country risen, there is also an increasing amount of disabilities linked to amputations, as well as diabetic retinopathy and blindness. It is not farfetched to suppose that, if left unaddressed, diabetes and its complications have the potential to reverse some of the significant health gains made by Eritrea in recent years
As with much of the rest of the SSA region, relevant risk factors associated with the growth of diabetes in Eritrea include slowly changing dietary habits, such as augmented food quantities, the introduction and consumption of refined, processed or fast foods and high salt intake, growing urbanization, reduced physical activity, and a shift toward sedentary lifestyles or occupations.
Importantly, Eritrea provides support and treatment to all diabetics. For example, insulin, syringes, visual test strips, and other relevant education materials are all distributed to patients by the Eritrean National Diabetes Association, which was established in 1996, and the Ministry of Health. As well, with Eritrea possessing a large diaspora population, many patients frequently receive medicines or health supplies from family or friends abroad. Those with diabetes or associated risk factors may also turn to traditional or herbal medicines (e.g. plants with therapeutic properties). Generally, these are cheap, easily accessible, and readily available from various local shops, within large markets, or from traditional healers (usually community elders), and people often learn about them from friends or relatives. While some of these traditional and herbal medicines can support positive outcomes, it is important to also keep in mind that they can be problematic because the safety and efficacy of the majority of herbal and traditional therapies have not been thoroughly investigated, they remain unregulated, users may be unaware of potential adverse side effects, and their use may be ineffective or dangerous in combination with doctor prescribed medications.
For developing countries such as Eritrea, diabetes is not only an increasingly significant public health issue, it also poses significant socio-economic consequences, with the potential to leave families in poverty and burden an already limited healthcare system. Therefore, it is imperative to ensure appropriate actions are taken, such as improving screening rates, in order to prevent and control its progress or complications. Ultimately, effective prevention and early treatment will result in a range of benefits, including considerable savings on the costs of treatment, complications, and disability, economic growth generated by a healthy working population, and allowing people to lead full and happy lives.