Metabolic and Clinical Significance of Diabetes Mellitus Type 2; Implication for Rising Prevalence in Nigeria

Abstract

Type 2 diabetes mellitus (DM2) is now a global epidemic which is also ravaging developing countries including Nigeria. Its impact in the country is significant with the disease found to impact on hospital admissions, mortality and life expectancy of patients. Previous investigations done in Nigeria showed that DM2 patients have poor glycaemic controls with resultant high levels of disease morbidity and mortality. This was demonstrated by consistently elevated mean HbA1c levels (> 8.0%) in Nigerian diabetics over a decade of assessment of care of the patients. Similarly the prevalence of diabetic retinopathy rose by more than 200% between 1989 and 2008. Diabetic morbidity which is underpinned by hyperglycaemia is associated with diabetic retinopathy, nephropathy, foot ulcers and other clinical conditions such as hyperlipidaemia, altered sympathetic system, bone disorders, infertility, defective body sodium handling and renal compromise. Some investigators believe that persons of African ancestry are more susceptible to some diseases associated with DM2. This includes documented increased renal glomerular hyperfiltration in patients of African ancestry. The disease complications are linked to metabolic derangements which if properly understood and managed, may help to reduce the impact of the rising prevalence of DM2 in Nigeria. Furthermore, if the Nigerian medical team is aware of the peculiar susceptibility of blacks to DM2 complications, they will be able to apply appropriate treatment for improved care, despite rising disease prevalence.