“Fighting Covid-19 should not make us lose sight of other health challenges. World Diabetes Day is a key moment to draw attention to this chronic disease, which increasingly threatens the lives of Africans, ”recalled Dr. Matshidiso Moeti, WHO Regional Director for Africa. on the occasion of world diabetes day.
A sneaky evil that darkens
Diabetes is progressing, rapidly. In 2019, He killed more than 360,000 people in sub-Saharan Africa, according to the International Diabetes Federation (IDF) and nearly three quarters of these deaths are in people under the age of 60, the highest proportion in the world. for this age group. The projections are alarming: the number of diabetics is expected to drop from 19.4 million in 2019 to nearly 29 million in 2030 and 47 million in 2045, according to IDF. Most worrying is the number of people living with undiagnosed diabetes, around 60%. “We need to change this by investing in the early detection, prevention and treatment of diabetes,” says Dr. Moeti.
Often diagnosed too late, the damage is already there … The consequences can be dramatic: blindness, kidney failure, heart attacks, stroke and amputation of a lower limb. Fortunately, these deleterious effects can be avoided with early diagnosis and treatment. The disease occurs when the pancreas does not produce enough insulin (type 1 diabetes) or when the body does not use the insulin it produces (type 2), the most common, effectively.
Food too fatty and too sweet
For type 2 diabetes – 90% of cases – risk factors, such as obesity and cardiovascular disease, inexorably increase in Africa with an increasingly sedentary lifestyle and consumption of excessively rich foods in sugar, fat and salt. Obesity affects 2.5% of adults in Burundi and up to 26.9% of adults in Seychelles. Thus, screening and healthy eating are the first gatekeepers to stem the dramatic consequences that arise when diabetes is not managed.
Covid and diabetes don’t mix
“At the start and at the peak of the Covid-19 pandemic, health services dedicated to diabetes were particularly under strain,” comments the World Health Organization (WHO). On the ground, the NGO Santé Diabète, established in Mali, Burkina Faso and the Comoros, had to react quickly. “We have implemented actions adapted to the context. In Mali and Burkina Faso, with patient associations, we have launched an SMS campaign aimed at diabetics, so that they have the correct Covid / diabetes information, on the importance of monitoring treatment, the risks in the event of unbalanced diabetes and the imperative of rapid treatment in the event of Covid. Nearly 3,000 diabetic patients in Mali and Burkina Faso have received these SMS. Finally, those who wished were able to register on a whatsapp exchange platform to benefit from teleconsultations and follow-up, ”explains Stéphane Besançon, director of Santé Diabète. “The diabetic has no more risk of catching the Covid, but he develops more serious forms especially if his diabetes is not balanced. It must therefore be taken care of quickly, ”he recalls. In South Africa, diabetics represent 50% of hospitalized Covid-19 patients.
Risk of breakage
From the start of the pandemic, with the closure of borders, the question of the supply of treatment and equipment for diabetes monitoring (glucometer, strips) arose. Supply difficulties were already reported in some countries, when the WHO, in collaboration with the laboratory Novo Nordisk, was able to send to 29 African countries a donation of insulin and glucagon sufficient to cover a period of six months. “To avoid stock shortages, we asked for an inventory of pharmacies and hospitals. Carried out by the Ministry of Health, we were able to launch an urgent resupply on time thanks to the help of our partners, ”says Stéphane Besançon.
For this World Day, the World Health Organization (WHO) has chosen the theme “Nurses and diabetes”. Nursing staff play a central role in the management of diabetes: from screening, to regular check-ups, to psychological support and advice for adopting a healthy lifestyle. Unfortunately, sub-Saharan Africa remains largely under-resourced with only 10 nurses and midwives per 10,000 inhabitants. Suffice to say that they are overwhelmed! “Nurses and other health workers need support to play their role in the prevention and management of diabetes. This support includes training, the provision of equipment and the establishment of favorable working conditions, ”writes Dr Matshidiso Moeti for Africa. Strangely, this message resonates so well in Europe …
Engagement
“In the longer term, with the increasing burden of diabetes in African countries, more investment will be needed to include noncommunicable diseases in essential health service packages and to ensure a continued supply of essential medical products. such as insulin, ”she continues.
For once, the future is full of hope. At its next assembly in May, WHO will launch the Global Compact against Diabetes. “A new initiative which will make it possible to structure and harmonize our complementary actions aimed at reducing the burden of this disease”, explains Tedros Adhanom Ghebreyesus, Director General of the WHO. On the treatment side, the focus will be on improving access to diabetes drugs and technologies, particularly in low- and middle-income countries. “The key to the success of this Pact will be alignment and united action in all sectors – public, private and philanthropic,” he argues. Another good news, rejoices Stéphane Besançon: “France will also support the resolution for universal access to insulin”.
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