The impact of diabetes continue to be felt in the tropics, the disease affects all population however it’s worse or rather common among the elderly. The changing trend recently can be attributed to the westernization of the tropics and technological advancements. Diabetes is no longer confined to the developed nations of the temperate zone but has attained epidemic proportion in developing nations of the tropics as well. This is attributable to the low-rate of disease detection and limited access to preventive and therapeutic measures. Tropical regions of the world comprising large part of Asia, most of Africa and Latin American harbors a large population with diabetes mellitus than other regions in the world.  Even so, diabetes is not often considered when enumerating the major “tropical “diseases by world health organization. The chronic and insidious nature of the disease and the misplaced (yet wide spread ) belief that the disease is a preserve of the prosperous temperate zone, underlies this misconception. A glance at the latest statistics released by international diabetes federation, revealed that the prevalence rate in the tropics now rival or even surpass those of the develop western nations in the temperate zone.  All in all, more than 75% of the world’s population with diabetes resides in low and middle income countries, almost exclusively located in the tropics and subtropics. 

 

The term diabetes mellitus describes a metabolic disorder of multiple etiology characterize by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, action or both, WHO 1999. It may present with characteristic symptoms such as thirst, polyuria, blurring of vision, weight loss, to mention but a few.  In severe situation, stupor, coma and absence of effective treatment, death. The first widely accepted classification of diabetes mellitus was published by WHO in 1980 into two major category IDDM(type 1), NIDDM(type 11) and others which included malnutrition related diabetes, impaired glucose tolerance as well as gestational diabetes mellitus. 

 

WHO recently estimate indicates that there are 171million people in the world with diabetes in the year 2000 and this is projected to rise to 366 million by 2030, about a decade from now. Diabetes which is a condition primarily defined by the level of hyperglycemia giving rise to risk of microvascular damages( retinopathy, neuropathy, nephropathy), is associated with reduce life span, significant morbidity due to specific diabetes related micro and macro-vascular complications which diminished quality of life. The American Diabetes Association,  ADA, estimated the national cost of diabetes in USA 2002 to be $132 billion, increasing to 192 in 2020.  

There are considerable differences between diabetes in the tropics and the rest of the world however less attention has been paid to type ii, occurring in the tropics but it is the most common in this region as is the case in the rest of the world. Much of the research in tropical type has been carried out and they present with certain distinctive features such as development of the disease at younger age, and lower level of obesity compared to white Caucasians. The prevalence of undiagnosed diabetes mellitus is also high with nearly more than three out of five individuals in certain part of rural areas in Africa with diabetes unaware of their condition. The development at a younger age mean many of these individuals will suffer complications during the prime of their productive lives which have serious economical consequences. 

 

Nigeria faces additional problems in its efforts against the disease including poor level of awareness of disease among the population, unavailability of modern diagnostic and therapeutic modalities, trained healthcare personnel, cultural and religious factors and consequently poor control of diabetes. 

 

Nigeria represent a classical example of the epidemiologic transition facing many countries in the tropics. As improvement in the public health system, wide spread immunization programs, have minimized but not completely eliminated the threat of infectious diseases. Improved life expectancy which is  welcome dividend of this achievement, has had some unexpected unwanted consequences in the emergence of life style disease like diabetes. The presence of this dual burden of disease placed policy makers in an unenviable position. They need to devote sufficient resources to the management and prevention of non communicable diseases while ensuring that the hard won gains in the battle of infectious diseases are not frittered away. Several nations in the tropics are faced with this dilemma, while some in sub-Saharan African are far behind the epidemiological transition where infectious diseases still hold sway. However, its only a matter of time before they too will have to prepare to combat the rising tide of diabetes and other non communicable diseases. 

 

Epidemiological transitions occurs not only in nations as a whole but also in population subgroup within nations. 

 

In developed nations today, diabetes is chiefly a disease of the under privileged such as ethnic and racial minority group who tend to neither be aware or have access to healthy eating and lifestyle patterns. In contrast, diabetes in developing nations tends to affect the prosperous sections of the society, who have regular access to high calorie diet and mechanized transport system of transportation and who are employed in physically undemanding occupations. However, it is worrying to note that the prevalence rate of diabetes have started rising even among low and middle class, this is attributable to improve social mobility, reliable supply of refined food grain and mechanization of even the most menial of occupation has transformed the lifestyle of the poorer section of society. However, this have not been accompanied by increase awareness of healthier lifestyle, healthy food options and facilities for recreational physical activities remain sadly out of the reach for most people. Thus as the more prosperous section of the society becomes increasingly aware of the consequences of their lifestyle, the prevalence of diabetes will perforce decline in them: the poorer section of society exposed to cheap and high calories with no opportunity to burning of this Calories will increasingly fall prey to diabetes and other lifestyle diseases, the treatment which they can ill afford. 

 

Fortunately, there are now sufficient evidences to show that diabetes can be prevented (or at least delayed) in population at risk by promotion of healthy behaviors such as dietary modifications and regular physical activities. The consequences of allowing the epidemic of diabetes to progress in the vast number of individuals at risk undoubtedly justify the time and expenses likely to be incurred in these efforts. The time to act is now!!! 

 

About The Author 

Evaborhene, Aghogho Nelson is a medical practitioner, an advocate of health for all, writes from Warri, Nigeria.