ECONOMIC AND SOCIAL COSTS OF DIABETES

Worldwide, the economic costs of diabetes are quite substantial. This is because as a disease that affects virtually all the body organs, manag­ing it presents quite a considerable challenge to both the healthcare system and the individual so affected. The large number of people with undiagnosed diabetes and those with diagnosed but uncontrolled disease, who are in grave danger of life threatening complications, poses a great chal­lenge to even the best of healthcare systems. The goals of diabetes care – that is, the goals an individual with diabe­tes must reach and maintain as regards blood sugar levels and other parameters, are not being met in the vast majority. Hence, there is a large body of people with diabetes incu­bating economically costly and socially devastating diabe­tes complications.

Diabetes is a leading cause of new onset blindness, end-stage kidney disease and amputation of limbs not related to accidents and other trauma. Managing any of these complications does not come cheap. For example, when poorly controlled diabetes leads to kidney disease that will require dialysis, an average of N90,000 would be re­quired on a weekly basis to keep such an individual alive. Diabetes is also associated with a substantially increased risk of death in both men and women with a three-to-five­fold increase in those between ages 45 to 64 and twofold-to-threefold increase in those aged 65 to 74.

Those with diabetes are two-to-four times more likely to experience heart attack or stroke than are people without diabetes. Stroke is a much more common occurrence in Nigerians with diabetes than heart attacks, which is also now being seen commonly. Diseases such as stroke and heart attacks and other diseases that affect the heart and the blood vessels are the commonest cause of death in those with diabetes. Other common causes of death in­clude low blood sugar levels and extremely high blood sugar levels. Both situations are referred to as diabetic emergencies. The complications of diabetes present a significant public health problem because diabetes is the leading cause of new onset blindness in those aged 20 to 74 years. It is known that approximately 90 per cent of these cases of blindness could have been prevented by improved blood sugar control, annual eye examinations and early treatment. Cataract, the commonest cause of reversible blindness, is twofold higher in those with dia­betes than in those without diabetes. A lot of people with diabetes have diabetes related disabilities, which may lead to some degree of social exclusion. These disabilities and impairments that they suffer from are also known to increase with duration of diabetes and age and are more in those that are economically disadvantaged. These dis­abilities are known to dramatically lower their rates of employment, cause increased rates of absenteeism, lead to increased use of healthcare services, and increased rates of hospital admissions. All the foregoing is known to lead to a higher degree of discrimination in the workplace against them. In those with diabetes but without diabetes-related disabilities however, there is no known increased propensity for absenteeism and they are known to be able to hold their own like others without diabetes.

The economic cost of managing diabetes is high. It is known to be as high as three and half times higher than the cost of managing other diseases. Apart from the di­rect costs related to hospital admissions and medications, indirect costs like lost productivity and premature mor­tality are also high. Intangible costs like reduced life ex­pectancy, reduced quality of life can however not have a monetary value attached to them.

Of utmost importance in diabetes care is the educa­tion of the person with diabetes about self-management. Once such an individual is so empowered, they are able to competently manage their diabetes and greatly reduce the risk of developing complications of diabetes and di­abetes-related disabilities. Good self-management of dia­betes will include changes in behaviour and adjustments of some ingrained habits. Making these changes is known to be tough. If done successfully, the effects are salutary. Healthcare providers are also to provide and foster an environment that supports the person with diabetes and reinforces their sense of self-efficacy and responsibility.

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