Management of type two diabetes in Nigeria


By Zahra SimpaDLHA Volunteer and Freelance Writer with medical review and editorial support by the Datelinehealth Africa Team.


Management of T2D






Type 2 diabetes is the 7th leading cause of mortality worldwide (1). Globally, 463 million people are living with diabetes. This figure is estimated to rise to 700 million by 2045. (2)


Diabetes is most prevalent in urban areas and developing countries. The burden of diabetes mellitus is incredibly high in Nigeria. Diet and lifestyle are potent risk factors for diabetes mellitus.


Diabetes is a disease that affects your psychological, emotional, and physical well-being. With more than 80% of deaths associated with diabetes occurring in Africa, (1) proper sensitization on management awareness is paramount.


As the increase in the mortality of diabetes over the years has been related to a lack of proper self-care by patients, (3) caregivers in general have a need to prioritize patient education and encourage patients to practice self-management to reduce mortality. 


This article will provide enlightened information about the causes, management, and prevention of type 2 diabetes in Nigeria.



What is diabetes?


Diabetes is a metabolic disorder of body carbohydrates, proteins, and lipids. It occurs when the pancreas cannot produce enough insulin to control the body's blood sugar. 


The pancreas is an organ in the abdomen that lies behind the stomach. It produces several chemical substances (enzymes and hormones) that help in digestion of food and regulate sugar level in blood, including insulin.


Insulin is a hormone that controls and maintains blood sugar at a standard level. Its action helps to prevent a high blood sugar/glucose level from occuring.


A high glucose level is also known as hyperglycemia. Elevated glucose level can be due to minimal or no insulin in the blood, as in type 1, or low insulin levels or insulin resistance in type 2. 


Elevated blood sugar (Hyperglycemia) disrupts the structure and functions of the cardiovascular system, and contributes to heart diseases among many other disorders.


Over 65% of deaths from diabetes are associated with cardiovascular complications. Two thirds of deaths from diabetes will be from cardiovascular complications, especially in urban areas. (1)


Poor self-care leads to cases like amputations, eye diseases, and destruction of the blood vessels.


Diabetic retinopathy (disease of the eyes due to diabetes) is the primary cause of adult blindness in diabetic patients. Diabetic patients are 6 times more prone to cataracts and 1.4 times more prone to open-ended glaucoma



What are the different types of diabetes mellitus?


There are three main types of diabetes mellitus. They are:

  • Type 1 diabetes mellitus (T1D) 


It is typically seen in children and occurs due to insulin deficiency or complete absence of insulin.

It was formerly known as insulin-dependent diabetes and childhood/juvenile-onset diabetes. It's not as complex as type 2 diabetes. Thus, daily administration of insulin is paramount to managing this disease.

The leading cause and why it occurs in children is still unknown.

  • Type 2 diabetes mellitus (T2D) 


It was conventionally known as adult-onset diabetes.

More than 95% of people with diabetes have type 2 diabetes. (1)

T2D prevents your body from using insulin efficiently or prevents insulin from exerting its action in the blood. This is more deadly than type 1 diabetes, resulting in microvascular and macrovascular complications.

In some cases, T2D can be hereditary. 

  • Gestational diabetes


Gestational diabetes occurs when blood glucose levels are above normal but below the diagnostic range of diabetes. It mainly occurs during pregnancy, and these women are at a high risk of complications during and after pregnancy. Their children may also be at risk of developing type 2 diabetes. 



How common is type 2 diabetes in Nigeria?


In the early 80s and 90s, Nigerians knew little about diabetes. Studies conducted during the 1960’s indicated the prevalence of diabetes in Nigeria as less than 1%.


Between 1988 and 1998, the prevalence was estimated to be 0.8%-2.8%, with most patients having type 2 diabetes. Currently, a best estimate of 8 - 10% has been proposed. (3)


A study on the knowledge and self-care methods amongst a population in Nigeria found that 78% believed that diabetes was due to poisoning, and 70% checked their glucose levels by tasting urines or looking for ants around their urine. (4)


T2D is the most prevalent type of diabetes, accounting for 90%-95% of endocrine clinic visits in Nigeria. (4) 


Nigeria currently has the highest case of T2D in the sub-Saharan region.


Since 50% of Nigerians are urban dwellers and live in suburban areas, obesity, diet, and lifestyle are major risk factors for type 2 diabetes. 



How do I know that I may have type 2 diabetes? 


Most times, people live with diabetes undiagnosed. However, when your blood sugar becomes uncontrollably high, you may begin to experience one or several of these symptoms:  (5. 6) 

  • Nausea
  • Extreme thirst
  • Restlessness and tiredness
  • Frequent urination that may lead to dehydration
  • Blurred vision
  • Unintentional weight loss
  • Diabetic coma: Feeling of drowsiness and loss of consciousness due to excessively high blood sugar


If you have any of these symptoms, it is very important that you see your doctor to be fully checked out and possibly diagnosed for T2D.



How is type 2 diabetes diagnosed? 

Laboratory diagnosis of T2D

Laboratory tests for the diagnosis of T2D. Click on image to enlarge. Credit.


So, when you see your doctor and speak about what brought you to visit, your doctor will ask many questions from you that will include the details of you present condition, your family, work history and medications history, etc.


You doctor will then examine you generally while paying special attention to your eyes, heart, blood pressure and nerve sensations. Your doctor may then order any of the following tests to confirm a diagnosis of T2D.

  • Hemoglobin A1C (HbA1c): If the laboratory test result is above 48 mmol/mol (6.5%), you are considered to be in the diabetic range. Note that a result below this figure does not exclude a diabetes diagnosis if other glucose tests are positive.  


  • Fasting blood sugar: This test is usually performed early in the morning after an overnight fast of about 8 - 12 hours of not consuming any food. Blood is taken from a vein in your body and blood sugar level is tested. If the level is 126 mg/dl and above, you are considered to be in the diabetic range.


  • Oral glucose tolerance test: For this test, you will be given a specific volume and concentration of sugar to drink and your blood sugar level is then determined two hours after. If your result is 200 mg/dl and above, you are also considered to be in the diabetic range.


Note that if you are initially diagnosed as having type 2 diabetes, it is important to repeat the tests that were performed at least one more time to confirm that your initial results are correct and valid before treatment is started.


Also note that the standards for the laboratory diagnosis of gestational diabetes are different from what are described above.


Watch the video below to learn more about how T2D is diagnosed

Video-Diagnosis of T2D

Click on image to view video on “How do I know if I have type 2 diabetes”.



What are the common complications of type 2 diabetes?


The three broad types of complications observed in T2D include:  


  • Macrovascular diseases 


They are diseases like stroke, heart attacks, and other arterial diseases. They occur in T2D due to its effect on the large blood vessels in the body.


The risk of these diseases is high in people with co-occurring high blood pressure. (7)


  • Microvascular complications


These complications are associated with damage to the smaller blood vessels in different organs of the body.


They cause damage to the eyes, kidneys, and brain. People who are 50 years old and diabetic usually begin to experience vision loss. 


  • Diabetic foot 


In this condition, the nerves of the foot are damaged and blood supply to the leg is reduced.


You may become numb to pain associated with injuries. The injuries also may take time to heal, and the tissues begin to die. 


Sometimes amputation is the next step to prevent further damage to the foot tissues.


Foot injuries have been known to occur in 25% of new diabetic patients and are responsible for 43% of hospital deaths. 



What causes type 2 diabetes?


The simple answer to this complex question is “Insulin resistance”.


To understand what the term insulin resistance means, let us first learn what insulin is and how it works.


Insulin is a chemical substance in the body called a hormone. It is produced by special cells in the pancreas and released into the bloodstream. The pancreas is an important organ that is found lying behind the stomach in the abdomen. 


Insulin regulates sugar level in blood at any given moment. When you consume carbohydrates, your blood sugar level rises and insulin is released immediately to distribute these sugars into other body cells, like the liver. So, when insulin is absent, these sugars stay in the bloodstream at a high concentration and, thus, lead to high levels of blood sugar (hyperglycemia). 


In the case of type 2 diabetes, insulin is present, but this process doesn't have any effect. It doesn't act on blood sugar. Your doctor might refer to this as "insulin resistance." The pancreas might substitute and manage blood sugar levels, but it stops after a while. And this leads to excess sugar in the blood. 


Watch the video below to learn more about T2D and its causes.

Vedio-What is T2D?

What is type 2 diabetes? Click on image to view



What are the risk factors for type 2 diabetes?


Various factors may predispose you to T2D. Some of these include:

  • Sedentary lifestyle: Lack of adequate exercise
  • Overweight or obesity
  • Alcohol consumption
  • Smoking
  • Genetics: It may run in your family
  • Drugs that may alter blood sugar level



How is type 2 diabetes managed in Nigeria?


Managing type-2 diabetes is vital to reducing its morbidity and mortality impact.


Diabetes is a financially consuming disease in Nigeria due to high out-of-pocket costs and low availability of health insurance coverage. 


The general approaches to T2D management in Nigeria as elsewhere, include a combination of clinical (medications) and non-clinical care (diet and exercise) to prevent and reduce the long-term acute complications of type 2 diabetes. 


  • Clinical treatment


Oral hypoglycemic (glucose lowering) drugs are recommended to help reduce blood glucose levels and prevent long-term complications.

Different oral hypoglycemic medicationssu

Varieties of oral glucose reducing medications. Click on image to enlarge.


The five classes of these drugs with examples in each class are listed below. Some of the drugs may not be readily available or affordable in Nigeria. (1)

  • Biguanides
    • Metformin
  • Sulphonylureas,
    • Chlorpropamide
    • Tolbutamide
    • Tolazamide
    • Glimepiride
    • Glibenclamide
  • Thiazolidinediones
    • Rosiglitazone
    • Pioglitazone
    • Glargine (Insulin derivate)
  • Meglitinides
    • Repaglinide
    • Nateglinide
  • Alpha-glucosidase inhibitors
    • Acarbose
    • Miglitol


Injectable insulins are used to supplement oral glucose lowering drugs in T2D when the oral drugs alone (used with diet and exercise) fail to control blood sugar level adequately.


Like oral hypoglycemic, injectable insulins are also available in different types depending on how quickly they work, when they peak, and how long they last.


Insulin analogues like insulin lispro form the majority of injectable insulin in common usage worldwide, though human insulin are still available.


It is best to talk with your doctors about which medication is best you.


  • Non-clinical self-management


Dietary management

Dietary management is essential in T2D self-management. (1, 3) However, your doctor will tailor your diet recommendation to your body mass index and weight.

As a person with diabetes, your diet is one of the core pillars in managing glycaemic levels. 

In Nigeria, it is a widespread belief to avoid a particular class of food, e.g., carbohydrates, as it contributes to the increase in sugar levels.

However, diets should be distributed evenly amongst all food classes, especially for patients who are obese and need to lose weight.

Carbohydrates should make up 50%-60% of your diet, proteins should take 15%-20%, and fats, 15%-25% of total daily calories.

Note that there is no standard diet for people with diabetes. Consult your nutritionist or doctor to personalize your diet. 


Regular exercising has shown a significant impact in reducing blood sugar levels.

Most Nigerians view exercise as a weight loss instrument alone.

According to a 2010 study, (8) individuals with type 2 diabetes should perform at least 150 minutes of moderate-intensity aerobic exercise and at least 90 minutes of vigorous aerobic exercise per week. It also helps to reduce cardiovascular complications. 

Glucose monitoring

Own a glucose meter to frequently check your glucose level. 

Smoking abstinence

People living with diabetes should abstain from smoking because it increases blood sugar.

This is due to the high nicotine level, which distorts insulin activity. (9) It increases your chances of heart complications, kidney and eye diseases.

Alcohol reduction/abstinence

Many alcoholic beverages like beer and mixed drinks contain high levels of carbohydrates per serving size.

The carbs are in turn metabolized and turned into sugar, which may spike your blood sugar level upwards. Consequently, it is important for people with T2D to drink in moderation or better still abstain from high carbohydrates and sugar containing alcohol as possible.



Can I prevent type 2 diabetes?


Yes, you can prevent and or delay the onset and complications of T2D by controlling such modifiable risk factors like:

  • Getting adequate daily exercise. 
  • Eating healthy.
  • Shedding weight.
  • Reducing stress.
  • Drinking lots of water.
  • Abstaining from smoking.
  • Drinking alcohol in moderation

It’s better to prevent diabetes than manage it.  




The burden of type 2 diabetes in Nigeria is probably much higher than currently reported and the trends in its management varies between urban, semiurban and rural locations. 


Patient education is generally poor, especially in the rural and suburban regions and the use of unproven alternative medical treatments are high due to its affordability. 


A lot still needs to be done in sensitization and awareness of self-management of type-2 diabetes in the country. 


You can prevent and or delay the consequences of the type 2 diabetes and live a healthy and fulfilling life if you do the following things:

  • Practice the tips of diabetes self-care that are described in this report
  • Take your medications as prescribed by your caregiver if needed
  • Get regular professional checkups,  



1. Tella EE, Yunusa I, Hassan JH. et al. Prevalence, contributing factors and Management Strategies (Self-Management Education) of Type 2 Diabetes Patients in Nigeria: A review. Intl J Diabetes Clin Res (2021) 8:148.

2. Oluma, A., Abadiga, M., Mosisa, G., & Etafa, W. Magnitude and predictors of poor glycemic control among patients with diabetes attending public hospitals of Western Ethiopia. PloS one, 16(2), e0247634 (2021)

3. Ogbera, A. O., & Ekpebegh, C. Diabetes mellitus in Nigeria: The past, present and future. World Journal of Diabetes, 5(6), 905-911 (2014)

4. Jackson, I. L., Adibe, M. O., Okonta, M. J., & Ukwe, C. V. Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharmacy Practice, 12(3) (2014)

5. Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Type 2 diabetes: Overview. Updated Oct. 22, 2020.  Accessed May 5, 2023.

6. WHO. Diabetes. April 23, 2023. Accessed May 5, 2023.

7. Rafael Simo, Cristina Hernandez. Treatment of Diabetes Mellitus: General Goals and Clinical Practice Management. Revista Espanola de Cardiologa. Vol.55, issue 8 (2002). 845-860.

8. Mostafa, S. A., Davies, M. J., Srinivasan, B. T., Carey, M. E., Webb, D., & Khunti, K. Should glycated haemoglobin (HbA1c) be used to detect people with type 2 diabetes mellitus and impaired glucose regulation? Postgraduate medical journal, 86(1021), 656–662 (2010).

9. CDC. Smoking and Diabetes. Updated June 20, 2022. Accessed May 5, 2023.




Published: June 1, 2023

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