Dr Nancy Ngugi
Consultant Physician , Endocrinologist

Diabetes is a chronic metabolic condition characterized by hyperglycemia, that occurs as a result of lack of insulin or insulin sensitivity.

 Type
Diabetes
 Type
Diabetes
 Gestational Diabetes
 Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)

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Physical inactivity
Obesity
Unhealthy diet
Increasing age
Family history of diabetes
Ethnicity
Poor nutrition during pregnancy affecting the developing child

Symptoms of Diabetes
Type 2 diabetes is often without symptoms in its early stages. That’s the reason there are 50% of people with
Type 2 diabetes are unaware of their disease.
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 feeling tired and weak
Polyuria, nocturia recurrent infections blurred vision weight-loss excessive hunger and thirst symptoms of peripheral neuropathy slow healing wounds

 Diabetes:
-RBS >11.1 mmol/ l
-FBS > 7.0 mmol/l
-HbA1c >6.5%
 If the RBS is > 5.6 mmol/l and < 11.1 then do the
FBS or OGTT
 OGTT- 75 g CHO in 250mls of water

Normal
IFG
IGT
Diabetes
FBS (Mmol/l)
<6.1
6.1-6.9
<6.1
>7.0
2 hrs post prandial
(mmol/l)
<7.8
<7.8
7.8-11.1
>11.1

Macrovascular
Stroke
Microvascular
Diabetic eye disease
(retinopathy and cataracts)
Heart disease and hypertension
2-4 X increased risk
Peripheral vascular disease
Renal disease
Erectile Dysfunction
Peripheral Neuropathy
Foot problems
Meltzer et al. CMAJ 1998;20(Suppl 8):S1-S29.

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The primary treatment for type 2 diabetes is exercise and diet.
The aim of pharmacological management is to reduce the risks of complications from diabetes through;
Glycemic control:
 Insulins
 Oral agents
BP control
Cholesterol control
Aspirin
Smoking cessation
Moderate alcohol intake

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Screening for type 2 diabetes and people with no symptoms is recommended for:
 Overweight children who have other risk factors for diabetes, starting at age 10 and repeating every 2 years
 Overweight adults (BMI greater than 25) who have other risk factors
 Adults over 45, repeated every 3 years
 Those with a history of gestational diabetes
Maintain a healthy body weight and keep an active lifestyle to help prevent type 2 diabetes.

Africa
Eastern Mediterranean and Middle East
Europe
North America
South and Central America
South-East Asia
Western Pacific
37.7
51.2
+36%
25.1
39.9
+59%
IDF. Diabetes Atlas 5rd Edition – 2011
52.6
64.0
+22%
14.7
28.0
+90%
32.8
59.7
+83%
71.4
120.9
+69%
131.9
187.9
+42%
Worldwide:
366 million people in 2011
552 million projected for 2030
51% increase
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Type 2 DM is increasing in every country
80% of people with DM live in low and middle income countries
Most people with DM are between 40 to 59 years of age
183 million people (50%) with DM are undiagnosed
DM caused 4.6
million deaths in 2011
78,000 children develop type 1 diabetes every year
280 million people with IGT in 2011, will increase to
398 million in 2030
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Prevalence of diabetes
 2.7% in rural areas
 10.7% in urban areas
Prevalence of IGT/IFG
 8.8 % in rural areas
 14.4 % in urban areas
53% of all hospital admissions are due to Non
Communicable Diseases of which 28% due to
Diabetes
Increasing cases of childhood diabetes
Increasing cases of gestational Diabetes
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Adult diabetic clinic attendance in 2011 (Jan- Dec) new pts revisits
Main clinic (Fri) 448 2530
Mini clinic ( Mon-Fri) 153 5190
Pead diabetic/ endo
(Tue clinic)
178 683
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Kenya national diabetes strategy 2010-2015
National clinical guidelines for management of diabetes
National diabetes educators manual
Diabetes comprehensive care manual
Diabetes prevention and management: A guide for community health workers
Kenya Diabetes Study group (KDSG)- Diabetes
Manual

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MoMS and MoPHS in conjunction with DMI
(NGO) with funding from WDF
-diabetes education and awareness project (2005-2008)
-diabetes comprehensive care project-DCC (2009-2013)
-mobile foot clinic project-MFC (2009-2012)
-changing diabetes in children-CDIC (2010-2015)
National diabetes registers
National insulin registers
Rockefeller foundation- DMI - diabetes awareness and screening project
Others projects by CDC, APHRC, Diabetes Kenya.

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Diabetes medical camps –by Safaricom-DMI, Diabetes Kenya,
Pharmaceuticals companies , hospitals
Diabetes children's camps-Safaricom, Johnson and Johnson
Diabetes training-Diabetes Kenya, Handicap international
Patient support groups
Diabetes educators programs
Nutrition-diabetes programs
Diabetes education through audio, radio and print
SMS web portal diabetes support programs-Tuzungumzie kisukari (DMI-WDF) English - SMS “subscribe” to - 0710 840
337, Swahili “jisajili” to - 0710 840 337

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The diabetes fraternity has invested a lot in setting up structures for the national diabetes care centers country wide
Over 70 diabetes comprehensive care centers
(provincial, district and sub district hospitals
UoN and KNH diabetologists have improved the curriculum in diabetes medical training
Diabetes education training programs, diabetic foot training, diabetes awareness and screeningworld diabetes day (14 th November)
Diabetes and Endocrinology center