The industrial revolution marked a stark turn; sugar escaped its natural bounds, becoming a driving force of economic growth and a dark catalyst for the slave trade. Our Senegambian forebears last saw their homes from Kunta Kinteh and Goree Island before being forced into the sugar fields that would sweeten the world’s palates, setting a tragic historical precedent.
Today, this legacy casts a long shadow. Refined sugar, once a rarity, now dominates our diets in excess, with its rapid absorption straining our metabolic health and paving the way for disease. It’s a bitter twist that the labor-intensive crop of our ancestors is now linked to cycles of illness and premature death, underscoring a profound mismatch between our engineered food environment and our body’s ancient physiology.
Overview of the Gambian Context:
In The Gambia, awareness of diabetes among citizens is worryingly basic. The condition, a complex interplay of genetics and lifestyle, goes beyond the label ‘sugar disease.’ Type 2 diabetes, more prevalent than the autoimmune Type 1, quietly infiltrates many lives, often going unnoticed until it’s well established.
The rise of non-communicable diseases, including diabetes, is a growing concern in The Gambia, with significant increases in related deaths noted between 2008 and 2011. By 2018, diabetes contributed to 34% of all deaths, a figure that’s expected to grow. The World Health Organization warns that diabetes could affect 4% of Gambians by 2030, highlighting the urgent need for improved awareness and education.
Lifestyle changes, such as diet and exercise, are key to prevention. Knowledge is power, and understanding diabetes can lead to better self-care and management. However, studies on diabetes awareness are scarce, especially population-based research in Sub-Saharan Africa. One 2013 study in The Gambia revealed diabetes awareness among patients, but its findings are not widely applicable.
To confront the diabetes crisis in The Gambia, it’s crucial to elevate the general understanding of the disease. This knowledge can drive effective interventions, leading to better prevention and management, and ultimately, a healthier nation.
The Public Health Challenge:
In The Gambia, the grasp of diabetes among the general populace falls dramatically short. A healthcare system plagued by disunity exacerbates this knowledge gap, with a lack of coordinated care often being the norm. Complicating matters further is the cultural hesitance to acknowledge and actively manage chronic illnesses like diabetes. All too often, these conditions are resigned to fate or misconceived as transient rather than the persistent health commitments they truly are.
This aversion goes beyond simple unawareness; it’s woven into the social fabric, tangled with stigmas and myths that dominate the collective mindset. Such attitudes lead to a reactive, rather than proactive, approach to a condition that is, for many, manageable and frequently preventable. Consequently, a perilous pattern has emerged where medical help is sought predominantly in emergencies, not through ongoing, preventative care.
My intermittent practice in The Gambia has laid bare the detrimental consequences of this disjointed system. It reverberates with tales of patients who recall being told they had “febarri sucurr” (a colloquial term for sugar disease), yet their healthcare journey seldom progresses beyond an initial prescription of Metformin 500mg, often issued without a digital health record or memory of the prescribing physician. Adding to the challenge is the pharmacy clerk, who might lack any knowledge of medication therapy management or the fact that Metformin should not be started without first assessing kidney function. Shocking to many, if you or someone you know was prescribed Metformin without a creatinine level test-which is crucial for assessing kidney function-or an A1C test, then the treatment has been and continues to be uninformed.
Demystifying Diabetes:
Type 1 diabetes is an autoimmune disorder where the body’s immune system mistakenly attacks and destroys insulin-producing cells in the pancreas. This means individuals with Type 1 diabetes produce little to no insulin, which is necessary for transporting glucose from the bloodstream into cells. The diagnosis of Type 1 diabetes is often made in children and young adults and involves checking blood sugar levels, insulin autoantibodies, and sometimes, C-peptide levels which reflect insulin production.
Type 2 diabetes, on the other hand, is a metabolic disorder characterized by insulin resistance, where the body’s cells do not respond effectively to insulin, or insulin production eventually wanes. Over time, high sugar levels in the blood can lead to various health complications. It is more common in adults but is increasingly seen in children due to rising obesity rates.
Understanding these differences and the nuances of diagnosis is crucial, especially as many cases of Type 2 diabetes progress without noticeable symptoms, and individuals remain undiagnosed until complications arise. Regular screening, especially for those with a family history or risk factors for Type 2 diabetes, is vital for early detection and management.
Family History and the Four Horsemen:
Understanding your family’s health history is crucial in assessing risk for hereditary diseases like diabetes. This is particularly vital for couples planning to start a family, as gestational diabetes during pregnancy signals an increased risk of Type 2 diabetes for both mother and child later on.
Knowing the health patterns in your families helps foresee potential health issues. Diabetes, alongside cardiovascular disease, cancer, and neurodegenerative disease-the “four horsemen” of health-can run in families. Early recognition of these patterns is key to proactive health management and lifestyle adaptations to counter these risks.
For those with a family history of diabetes, adopting healthy habits is critical. It means choosing balanced meals and active play for children to prevent obesity, a significant diabetes risk factor. Such proactive health measures from early life can offer children a stronger defense against diabetes, ensuring a healthier future free from chronic disease.
Steps to Empowerment:
In The Gambia, practical self-care and proactive health management are critical in combating the rising tide of diabetes and other chronic diseases. The first practical step is to unearth one’s family health history, which can often provide early warning signs of predispositions to conditions like diabetes. Understanding the health battles faced by previous generations can offer invaluable insights and inform personalized prevention strategies.
The next vital action is to initiate one’s health care journey by regularly tracking three fundamental health metrics: blood pressure, blood glucose levels, and body composition. These numbers serve as a personal health barometer, alerting individuals to potential health issues before they become crises.
Regular health assessments can lead down one of three paths:
Normal readings, which should not lead to complacency but rather a commitment to maintaining healthy lifestyle habits centered around a balanced diet and regular physical activity.
Borderline readings (Pre-Diabetes), which serve as a wake-up call to the imminent risk of metabolic or cardiovascular diseases, demanding immediate and concrete lifestyle adjustments and possibly medical interventions.
A diabetes diagnosis, where the A1c test becomes essential. Without regular monitoring of A1c levels-ideally every three to six months-diabetes management is akin to navigating in the dark.
Effective diabetes management requires a triad approach: clinical evaluation, pharmaceutical intervention, and nutritional guidance. Treatment is incomplete without addressing all three aspects, ensuring that each individual has a tailored management plan that addresses their unique health profile.
The Pharmacist’s Corner:
Pharmacological intervention is a cornerstone in the battle against diabetes, with non-adherence to medication being a swift courier to complications. Among the arsenal for diabetes management, Metformin stands out for its ability to reduce glucose production in the liver, improving insulin sensitivity and glucose uptake by the body’s tissues. Yet, its full potential remains under-tapped due to issues such as limited availability and the scourge of counterfeit medications that plague the Gambian market.
Sulfonylureas like glipizide and glibenclamide also play a significant role by stimulating the pancreas to release more insulin. However, they come with the caveat of an increased risk of hypoglycemia-a condition where blood sugar drops to dangerously low levels, leading to symptoms like shaking, confusion, and, in severe cases, loss of consciousness.
As for the A1c%-the three-month average of blood glucose levels-it dictates the urgency and intensity of treatment. For some, this may mean the introduction of insulin therapy to directly counteract high blood sugar levels.
Amidst the landscape of tried-and-tested medications, newer treatments like GLP-1 agonists and SGLT2 inhibitors such a Ozempic and Mounjaro make waves in the medical community. However, their current role in Gambia is more of a mirage than an oasis, with accessibility and cost rendering them more fantasy than viable option.
There’s an amusing yet troubling trend where some patients ditch proven diabetes meds for the supposed ‘natural’ sugar-busting prowess of Moringa teas and exotic roots. These herbal hopefuls, fueled by tall tales rather than tangible trials, often crumble when reality hits hard. And surprise-when sugar levels spike, the herbal hawkers are nowhere to be found, certainly not dashing to the rescue with a kidney in hand or refunds for remedies that fell flat.
Ultimately, managing diabetes isn’t about the lore of herb sellers; it’s about tangible, science-backed treatments. Let’s turn the page from the folklore of natural fixes to the certainty of medical facts. When it comes to a sugar surge, trust in the steadfast guard of medications and medical experts, not the wispy words of the root-slinging brigade.. Bala Musa or Ya Fatou is never bedside at Edward Francis Small Teaching Hospital during a diabetes crisis, nor will they ever have a kidney to spare when one needs it due to diabetes-induced kidney failure.
A Personal Call to Action:
As we observed World Diabetes Day yesterday November 14th, it’s time for a resolute vow to halt the tide of diabetes that is crippling our nation. It’s a bitter reality that in countries with robust health systems, amputations due to diabetes are rare, yet in our community, it’s become a grim and frequent outcome.
Innovarx stands committed to combating Non-Communicable Diseases because I’ve lived through the pain they inflict. My grandmother, the late Aja Fatim Mbenga of Half-Die Banjul, succumbed to the complications wrought by diabetes and hypertension at 56-years before her grandchildren could bask in the fullness of her love and wisdom. Her story is not unique; diabetes mercilessly cuts short the lives and potential of countless Gambians.
In the collective effort to combat Non-Communicable Diseases (NCDs), particularly diabetes, various institutions outside the government are making significant strides. Innovarx’s initiative, “What’s Your Number,” and subsidized pricing for medications like Metformin are driven by a commitment to democratize access to healthcare. Since 2019, Innovarx has ensured that no Gambian pays for a diabetes screening, with a strong focus on activities in rural communities. However, Innovarx is not alone in this endeavor. Institutions like Westfield Clinic are actively participating in the fight against diabetes with their annual free screening taking place this Saturday, November 18th, from 8 am to 1 pm at their facility—an opportunity the public is encouraged to seize. Furthermore, non-profits such as the Solace Foundation are playing a crucial role in increasing early detection, emphasizing the collaborative approach needed to address the growing NCD challenge.
With the wealth of information, technologies such as Continuous Glucose Monitoring (CGM), and medications at our disposal, we can change this narrative. It requires a pact, both from us as individuals and collectively as a healthcare community, to prioritize prevention and diligent management. Let’s harness our resolve and resources to ensure that diabetes no longer robs us of our elders, our traditions, and our future. Together, we can write a different story-one of triumph over diabetes, not defeat.
In peace, love, and good health,
Dr. IDB.
For more information, follow the work of Dr. Badjie and his Innovarx WOW team on www.igh.gm and on social media @innovarxglobal @drIsmailBadjie. Ismail is also the author of newly released book “LIFE AS A HYPHEN” available at Timbooktoo Bookstore and Kairo Cafe (Fajara).
Disclaimer: The information provided in this article is for general understanding and does not constitute a diagnosis. For specific concerns or detailed health advice, always consult your designated healthcare professional.
