Reducing the diabetes burden in Ghana

I am still on diabetes. I will be using materials from the websites of the World Health Organisation (WHO) and the Interna­tional Diabetes Federation (IDF).

For many of you on social media, you would have noticed that my posts on cocoa consump­tion since November 14, 2024, has been on diabetes.

November 14 is World Diabetes Day. The theme for 2024 “Break­ing barriers, bridging gaps,” under­pins a commitment to reducing the risk of diabetes, and ensure that all people who are diagnosed with diabetes have access to equitable, comprehensive, affordable and quality treatment and care. This piece will focus on the first com­mitment, that is, to reduce the risk of diabetes.

International Diabetes Feder­ation (IDF)

In 2021, the International Di­abetes Federation (IDF) findings revealed that 537 million people were diagnosed with diabetes mel­litus (DM) globally. This number is anticipated to increase to 643 million by 2030 and 783 by 2045. According to the IDF only 50 per cent of people with DM have been diagnosed. Also three in four peo­ple with diabetes live in low- and middle-income countries.

Diabetes, a chronic lifelong disease that leads to uncontrolled blood sugar levels because the body can no longer produce or use the insulin it produces efficiently.

The complications of diabetes include kidney damage, nerve damage, stroke, heart attack, lower-limb amputation, and eye disease that can result in blindness. Africa has the lowest investment rate in diabetes care worldwide, at only one per cent of the region’s health expenditure. The cost of controlling diabetes has increased by 316 per cent over the last 15 years, such that over 966 billion dollars are spent globally every year (International Diabetes Federation, 2021).

World Health Organisation (WHO)

The burden of T2DM and its complications are significant as it causes severe disabilities, reduced quality of life, and mortality, imposing substantial economic burdens on societies and govern­ments. Health systems are also traditionally designed to deal with acute, infectious diseases, without sufficient attention paid to chronic diseases like diabetes. Managing diabetes requires a sustained effort to balance physical health activity, healthy diet, mental well-being. It requires comprehensive prevention strategies to address risk factors including obesity, poor diet and physical activity, combined with community engagement to ensure good support systems and reduced stigma.

In an important step forward at the Seventy-fourth session of the WHO Regional Committee for Africa in August this year, African Member States endorsed WHO’s Framework for the Implementa­tion of the Global Diabetes Com­pact (GDC) in Africa. This among others seeks to integrate diabetes care into broader health systems in a multi-sectoral approach. It provides a roadmap for countries to strengthen diabetes prevention, diagnosis and care, especially at primary health care level.

Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM)

There are two main types of diabetes namely Type 1 diabetes mellitus (T1DM) and Type 2 diabe­tes mellitus (T2DM). In T1DM there is absolute lack of insulin and therefore the person affected depends on exogenous insulin. In T2DM, there is inadequate secretion of insulin and/or insulin resistance particularly of the liver, skeletal and adipose tissues. A per­son with T2DM typically requires oral medication which sometimes is supplemented with insulin ther­apy. Over 90 per cent of persons with diabetes have T2DM.

Insulin Resistance

Insulin resistance is identified as the impaired biologic response of target tissues to insulin stimulation. All tissues with insulin receptors can become insulin resistant, but the tissues that primarily drive insulin resistance are the liver, skeletal muscle, and adipose tissue. Insulin resistance impairs glucose disposal, resulting in a compen­satory increase in beta-cell insulin production and hyperinsulinemia.

The metabolic consequences of insulin resistance include hyper­glycaemias, hypertension, dyslipi­daemias, hyperuricemia, elevated inflammatory markers, endothelial dysfunction, and a prothrombotic state (a predisposition to clotting). Insulin resistance is considered to precede the development of T2DM by 10 to 15 years.

The development of insulin resistance typically results in impaired glucose disposal into insulin-resistant tissues, especially skeletal muscle. Consequently, in the presence of excess calorie con­sumption, more insulin is required to traffic glucose into these tissues. The resultant hyperinsulinemia further contributes to insulin re­sistance. In addition to T2DM, the disease spectrum associated with insulin resistance includes obesity, cardiovascular disease, non-alco­holic fatty liver disease (NAFLD), metabolic syndrome, and polycys­tic ovary syndrome (PCOS).

Lifestyle Modifications

Lifestyle modifications should be the primary focus when treating insulin resistance. These include physical exercises, reduced alcohol intake, weight reduction and diet. The healthy plate concept intro­duced by various health promotion boards worldwide emphasizes a healthy and balanced meal. A sin­gle meal should comprise a quarter plate of carbohydrates (25%), a quarter plate of protein (25%), and half a plate of fruits and vegeta­bles (50%).

Polyphenols

Fruits and vegetables are vital sources of nutraceuticals and functional foods as they are lower in calories yet rich in dietary fibre and phytochemicals like poly­phenols. This can help diversify the intake of nutrients beneficial for various human physiological processes. Polyphenols are com­pounds that are naturally abundant in plant-based sources like fruits, vegetables, legumes, and cereals. Nutritional intervention with calo­rie reduction and avoidance of car­bohydrates that stimulate excessive insulin demand is a cornerstone of treatment.

Compromised carbohydrate me­tabolism leading to hyperglycaemia is the major metabolic disorder of T2DM. Reformed digestion and al­tered absorption of carbohydrates, exhaustion of glycogen stock, en­hanced gluconeogenesis (produc­tion of glucose from non-carbohy­drate sources) and overproduced hepatic glucose, dysfunction of β-cell of the pancreas, resistance to insulin in peripheral tissue, and impaired insulin signalling path­ways are important reasons for hyperglycaemia and development of T2DM.

Oxidative Stress

Type 2 diabetes mellitus (T2DM) is an auto-inflammatory disease that is associated with oxidative stress and insulin resistance. The increased production of reactive oxygen species (ROS) or a reduced capacity of the ROS scavenging antioxidants leads to abnormal changes in intracellular signalling and result in chronic inflammation and insulin resistance.

Mediators of oxidative stress and inflammation activate various transcriptional and metabolic path­ways that lead to T2DM pathogen­esis and its associated complica­tions. Prevention of ROS-induced oxidative stress and inflammation is an important therapeutic strategy to prevent the onset of T2DM and diabetic complications.

Polyphenols as Antioxidants

A healthy diet is a major lifestyle factor that greatly influences the incidence and development of T2DM. Polyphenols, the most abundant antioxidants in the diet, have attained considerable interest due to their potential pharmaco­therapeutic properties and ability to promote health and reduce the risk of non-communicable diseases including T2DM.

Cocoa is an excellent source of polyphenols. Regular consumption of polyphenol-rich cocoa should be seen as critical in our preven­tive strategies to curb the diabetes burden in the country.

BY DR. EDWARD O.

AMPORFUL

CHIEF PHARMACIST

COCOA CLINIC