The Kenya Diabetes Management and Information Centre (DMI Centre) has urged government to prioritize Diabetes screening on pregnant women to arrest Gestational Diabetes. This is in alignment to the World Diabetes Day theme for 2017-“Women and Diabetes- our right to a healthy future”.
The Centre has also called for the enactment of a policy that would ensure all pregnant mothers get free blood sugar screening alongside the normal free maternity profile to rule out Diabetes.
According to Dr. Nancy Ngugi, Consultant Physician and Endocrinologist and DMI Centre Chairman and the doctor in charge of the Diabetes Unit at Kenyatta National Hospital (KNH), early diagnosis of Gestational Diabetes Mellitus (GDM) will prevent diabetes complications during pregnancy.
This is in both the mother and the baby. Dr. Ngugi told Health Business Magazine in an interview that, “A blood sugar test should be done on all pregnant women at 24-28 weeks of pregnancy. Women with high blood sugars should be educated on the appropriate diet and put on appropriate treatment. She said that this early detection and appropriate management of GDM will have enormous benefits to the baby and mother in increasing their life expectancy and quality of life.
Women who are at risk of developing (GDM) are mainly those over 25yrs or older, have a close relative with diabetes, are overweight especially if the Body Mass Index(BMI) is 30 or higher, have had a big baby before (birth weight more than 4.1kg), have polycystic ovarian syndrome (PCOS), have had GDM before. One in every seven pregnant women has gestational diabetes, but many do not have access to screening, education, treatment and care. One in every 10 women is living with diabetes according to the International Diabetes Foundation(IDF).
After birth, Dr.Ngugi says, “Glucose levels usually return to normal. However, women with GDM have a substantially higher risk (50%) of developing type 2 diabetes later. They need regular blood sugar testing after delivery to detect the development of type2 diabetes early before complications of diabetes occur.
Dr. Ngugi told Health Business Magazine: “The cost of managing diabetes is high and most people cannot afford it” She strongly advocates that the National Health Insurance Fund (NHIF) comes up with a package that caters for people living with diabetes to enable them have access to quality healthcare.
Diabetes is a lifelong non-communicable disease. The condition is characterized by high blood sugar resulting from lack of or insufficient production of insulin, insulin resistance (inaction) or both. Our body needs glucose (from food) to make energy. The entry of glucose to the body cells is facilitated by a hormone called insulin. It acts like a key that opens the body cells for glucose to enter and produce energy.
When cells do not take up glucose, it overflows and floods the blood system. This is then referred to as high blood sugar or hyperglycemia. There are 3 main types of Diabetes. In type 1, the body’s immune system attacks and destroys the cells that produce insulin. In Type 2 which is the commonest, the body fails to produce enough insulin or the body’s cells fail to react to insulin ( insulin resistance) or both. GDM is Diabetes diagnosed in the second or third trimester in a woman who, prior to pregnancy, did not suffer from Diabetes.
It typically resolves after delivery. The cause of type 1 diabetes is largely unknown. A majority of patients worldwide have type 2 usually as a result of poor lifestyle habits. The Cabinet Secretary of Health, Dr. Cleopa Mailu in his World Diabetes Day message said, “Diabetes Me l l i t u s h a s become both a local and global p a n d e m i c .
Every Kenyan has a story of grief to tell about a loved one living with diabetes. 1 in every 11 people globally are living with diabetes. It is alarming to note that more than 50% of adults (20-79 years) with diabetes are undiagnosed and present late for treatment with long term complications that are difficult to treat.”
He further said: “Diabetes is responsible for the majority of renal failures (leading to dependency on dialysis), lower limb amputations, secondary blindness and is also a major cause of strokes and heart attacks. Diabetes leads individuals, families and communities into poverty owing to the high and catastrophic costs of treatment, missed job opportunities and premature mortality”.
Dr Ngugi says that the common symptoms of diabetes include frequent urination, intense hunger and thirst, unusual weight loss, weight gain, fatigue, numbness, tingling in hands and feet, cuts and bruises which take long to heal and male erectile dysfunction but advises an annual blood sugar test instead of waiting for symptoms that come too late especially for those wih type 2 diabetes.
According to Mrs. Eva Muchemi the Executive Director of ED DMI Centre ”Majority of Type 2 diabetes cases result from excess body weight, physical inactivity and poor nutrition, excessive alcohol use, tobacco use and stress.” Mrs. Muchemi calls for increased education on healthy lifestyles and stress management.
“Fast foods are a major challenge to healthy feeding habits. with the increase of fast food outlets and even some by the roadsides, parents opt for already processed, deep fried and packaged food which is not healthy,” she said.
The DMI Centreis a diabetes patient empowering and networking community based organization founded in 1999. with the objective of creating awareness in diabetes and its management.
The Centre also empowers people with diabetes, provides screening on diabetes, hypertension & body weight, raises funds to support projects, facilitates training among peer educators & health care providers and conducts research to assist in the management of diabetes.
The Centre’s Mission is: The Centre develops documents and delivers comprehensive programmes for creating public awareness in and for prevention, diagnosis and management of diabetes. The organization advocates for increased awareness of healthy diets in schools and at homes and encourages people to grow and eat vegetables .
“TheCentre also runs awareness campaigns in 102 schools and colleges in Nairobi and Mombasa through the Diabetes Walk. It also raises awareness through the Promoting Healthy Living in Schools project that has run in 20 schools in Narok, Machakos, Isiolo, Kirinyaga and Nairobi. The schools teach class five pupils how to eat healthy, appreciate physical activity and grow vegetables in sack gardens to supplement diets at home”, Mrs. Muchemi said.
Burden of Diabetes
Dr. Ngugi says that diabetes mainly affects the most active economic age (39-69years) which impacts greatly on the economy of Kenya. “The burden is related to health system costs incurred by society in managing the disease, indirect costs resulting from productivity losses due to patient disability, premature mortality and time spent by families taking care of the patient,” she said.
The MOH STEPS Survey 2016 on NCDs estimates that 3.2% of the Kenyan population is living with diabetes in Kenya. About 73 per cent of them are undiagnosed. According to IDF, diabetes is the primary cause of blindness in adults aged 20 to 74 years. Ajoint 2016 report by World Health Organization (WHO) and Lancet indicates one in every 17 Kenyans has diabetes.
It further says that 650,000 to 1.5 million Kenyans suffer from undiagnosed diabetes.- ask Dr. Kibachio Dr. JosephKibachio, Head of Division of Non- Communicable Diseases (NCDs), Ministry of Health terms NCDs as a cross sectoral problem that needs behaviour change. “80 percent of causative factors are socio development issues while health issues account for only 20 percent of NCDscausative factors.”
“Being of a healthy size is looked down upon”,Dr. Kibachio told Health Business Magazine, adding that, “Our grandfathers used to consider big body stature as a sign of affluence while small-bodied individuals were perceived to be struggling in life. It is still the belief for most people in the rural areas. We need to change the way we think and the way we look at things,” Dr. Kibachio said “The Head of NCDs advises Kenyans to embrace indigenous foods as they are healthier.
Challenges
According to Dr. Ngugi many health professionals and diabetes specialists are in Nairobi depriving of Kenyans in the rural areas off service provision. “Government needs to train sub-specialists in the county hospitals to help reduce numbers of patients coming to KNH from other counties,” she said.
There is need to train more diabetes specialist nurses to work in county hospitals. County referral hospitals should have a full functional diabetes unit for management and care of diabetes patients in the country, Dr.Ngugi said. Dr.Kibachio proposes that hospitals in Kenya establish wellness clinics.
“Hospitals need to create platforms for wellness centers and not only concentrate on treating patients,” he said. “TheCentre also runs awareness campaigns in 102 schools and colleges in Nairobi and Mombasa through the Diabetes Walk. It also raises awareness through the Promoting Healthy Living in Schools project that has run in 20 schools in Narok, Machakos, Isiolo, Kirinyaga and Nairobi. The schools teach class five pupils how to eat healthy, appreciate physical activity and grow vegetables in sack gardens to supplement diets at home”, Mrs. Muchemi said.