COMMENTARY

I Was Shocked by What You Don't Have

Ethiopia Sees Rising Diabetes Rates but Limited Supplies for Treatment

Anne L. Peters, MD, CDE; Ahmed Reja, MD, MPhil

Disclosures

December 19, 2011

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Dr. Anne Peters: Hi. I'm Dr. Anne Peters. Today I'm in Dubai at the International Diabetes Federation (IDF) meetings, and I'm interviewing a friend from Ethiopia, Dr. Ahmed Reja, who is an Assistant Professor, Department of Internal Medicine, at the Addis Ababa University in Ethiopia; he is also the President of the Ethiopian Diabetes Association. But all those titles aside, he is a dear friend whom I just visited in Ethiopia. I'd like you to talk some about the state of diabetes in Ethiopia.

Dr. Ahmed Reja: Sure, thank you -- happy to be here, Anne. You know, diabetes was not a priority health problem for Ethiopia until very recently. But over the past few years, we have witnessed a huge increase in the number of patients with diabetes, both type 1 and type 2, but more so type 2. And the Minister of Health has now drafted a strategic framework for the prevention and control of chronic noncommunicable diseases, of which diabetes is one. So, we hope that diabetes care will improve. But, until now, the care that we are rendering for our patients is really very minimal. We have different constraints like lack of insulin or intermittent availability of insulin. Monitoring of blood sugar is really very much limited to very, very few people. But now we are working with various organizations to improve diabetes care. In fact, recently we have started a program for children whereby we are providing free insulin, free meters, free tests, and so on. So we are starting this program in 12 cities of the country. We are trying to include close to 1000 children and adolescents with type 1 diabetes.

Dr. Peters: That's a wonderful program. So, just for those of you from other countries: I was shocked to some degree by what you don't have. For instance, not having insulin for many people with type 1 diabetes means their average life expectancy after diagnosis is what, about 7 months?

Dr. Reja: Absolutely.

Dr. Peters: It's just horrible. And you haven't had things I take for granted, like you said, self-monitoring of blood glucose, hemoglobin A1c tests... I mean, there are all sorts of things you don't have. But what you do have, which really struck me when I was there, is this wonderful group of people who are committed not only to helping to educate people but also to getting funding to help support your programs. And then you've got a space in your hospital where you're starting your wonderful diabetes clinic, where I think you're going to be able to do ever-increasing quality of diabetes care. So, I would say that there is at least some hope for what you all are developing in Ethiopia.

Dr. Reja: Absolutely, Anne. And one other program that we have started is screening for diabetic retinopathy, and we are going to screen for diabetic retinopathy in 5 main university hospitals all over the country. We are going to provide laser therapy for our patients at Black Lion Hospital, which you have seen. As you rightly said, we are doing whatever we can despite the difficulties. And that's the most important thing. We shouldn't always lament our deficiencies but should really do something that is possible within our limits.

Dr. Peters: To what do you ascribe this epidemic of sorts of type 2 diabetes? Is it occurring in the poor and the middle class? Do you think it's because of the population surviving famine, that they now have the "thrifty gene"? What are your theories?

Dr. Reja: It is a combination of both, because you see diabetes in very, very poor farmers who have subsistence farming only. And you would say, "Why would this farmer have diabetes?" In fact, this is what they ask us always: "I'm a farmer, I'm a poor person, how can I have diabetes?" After all, they believe diabetes is a disease of the rich.

Dr. Peters: Right.

Dr. Reja: But it's not true. It's not true. And we also see diabetes in the rich people in towns. But I think the majority of the increase in diabetes is due to lifestyle change. When I grew up in Addis, there were very few pastry shops. Now, at every corner you see very many pastry shops, fast foods, and so on. So I think it's a combination of lifestyle change and also some predisposition, maybe genetically, the so-called "thrifty genotype," because when people are exposed to abundance, then the pancreas tends to fail. As an example of this, there was a study done in one area in Ethiopia where there was a lot of famine, and this was among pregnant ladies. We found a prevalence of 3.7% in that rural area. So, maybe it has to do with malnutrition and so on. But it's a combination.

Dr. Peters: It sounds like a multifactorial process.

Dr. Reja: Yes, that's right.

Dr. Peters: So, my one last question is: What do you learn, what do you do at IDF meetings? What do you think the big take-home message is for you from this meeting?

Dr. Reja: The IDF is a fantastic venue of experts, researchers, scientists, and so on. When we come to IDF, we really learn a lot. We learn a lot about the new drugs, the GLP-1s and so on, the new armamentarium for the treatment of type 2 diabetes, new formulations of insulin. But more than that, we also interact. We share experiences with other national societies and associations. So, we learn. In fact, yesterday we had a very important symposium on sharing our experience in childhood diabetes care, and many people were very encouraged by what we are doing, and they really wanted to emulate our project. So, it's a fantastic venue to share ideas, to get new ideas.

Dr. Peters: That's wonderful. I'm so proud of you for all that you're doing, and I look forward to hearing of all sorts of wonderful things that are going to be happening in the next few years in Ethiopia. And I hope to get to come visit again.

Dr. Reja: It's great to be associated with you, Anne. Thank you very much.

Dr. Peters: Thank you.

This has been Dr. Anne Peters from Medscape. Thank you for listening.

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