As a proud physiotherapist trained at Obafemi Awolowo University (OAU), Ile-Ife, I often celebrate the uniqueness of my alma mater. However, Ile-Ife, being a relatively smaller and less urbanized town in the 1980s, offered limited exposure to patients with type 2 diabetes. During my training, the subject of diabetes was confined to theoretical discussions, including a memorable anecdote from a professor about a hypoglycemic patient revived with a Coca-Cola drink during his studies in Canada.
In the 1980s and early 1990s, the prevalence of diabetes in Nigeria was minimal, and awareness was limited. A 2014 study titled Diabetes Mellitus in Nigeria: The Past, Present, and Future noted that “little was known about the condition in the early 1990s”. By contrast, when I started my career in the U.S. in 1994, the Centers for Disease Control and Prevention (CDC) had already declared diabetes a national epidemic, with 7.7 million Americans (6% of the population) diagnosed. Today, the prevalence of diabetes in the U.S. has skyrocketed to 38.1 million adults, representing 14.1% of the population in 2021. Despite enormous financial investments—$412.9 billion annually in direct and indirect costs—the epidemic persists.
Globally, the World Health Organization (WHO) reports a staggering increase in diabetes cases from 200 million in 1990 to 830 million in 2022. If diabetes were a country, it would have the third-largest population, trailing only China and India. Between 2021 and 2045, global expenditures on diabetes are projected to exceed one trillion U.S. dollars annually. Yet, unlike the COVID-19 pandemic, there has been little public outcry despite the ongoing devastation caused by diabetes.
Understanding Type 2 Diabetes
According to the WHO, type 2 diabetes is a condition where the body fails to use insulin properly, leading to high blood sugar levels if untreated. Unlike infectious diseases, diabetes does not involve pathogens and thus cannot be addressed with antibiotics or antifungal drugs. Modern medicine, rooted in the germ theory, often operates under the assumption of “rest and recovery,” which conflicts with the active lifestyle changes required to manage diabetes.
The conventional understanding of diabetes focuses on insulin resistance—the inability of resting muscles to effectively clear glucose from the bloodstream. However, glucose uptake during physical activity bypasses insulin dependency, highlighting the crucial role of exercise in diabetes management. A sedentary lifestyle perpetuates insulin resistance, while intentional physical activity can improve muscle sensitivity to insulin and aid glucose regulation.
The Physiotherapy Perspective
In collaboration with Prof. Joseph Balogun, I co-authored a study proposing that type 2 diabetes represents a persistent “fed state,” where chronic high blood sugar levels block the metabolic benefits of the fasted state. This metabolic dysfunction, exacerbated by excessive energy intake and inactivity, drives systemic inflammation and downstream complications such as strokes, heart disease, and amputations. Current medical approaches, relying heavily on insulin and related drugs, often promote weight gain and fat storage, perpetuating the problem rather than addressing its root causes.
Physiotherapists are uniquely positioned to intervene. As a profession born from the challenges of polio and wartime rehabilitation, physiotherapy specializes in non-drug therapeutic interventions. By promoting intentional physical activity and lifestyle changes, physiotherapists can help patients reduce systemic inflammation, improve glucose regulation, and achieve better long-term outcomes.
The Nigerian Context
With Nigeria’s population projected to surpass that of the U.S. by 2050, the country faces a growing diabetes epidemic. The Diabetes Association of Nigeria (DAN) estimates that 6–8 million Nigerians (5.7% of the population) live with diabetes, with two-thirds undiagnosed. Rising insulin costs—up 400% in recent years—further exacerbate the crisis, making traditional treatment approaches unsustainable.
In contrast, recent trends in diabetes care in Western countries emphasize medications like sodium-glucose cotransporter-2 inhibitors and GLP-1 receptor agonists, which promote weight loss and cardiovascular benefits but remain prohibitively expensive and inaccessible to most Nigerians.
A Call to Action
At a diabetes prevalence of 5.7%, Nigeria mirrors the U.S. diabetes epidemic of 1994. However, Nigeria lacks the financial resources to replicate Western medication-driven strategies. Instead, a collaborative approach between physicians and physiotherapists—integrating short-term drug interventions with physiotherapy-led lifestyle changes—offers a viable, cost-effective solution. By focusing on measurable outcomes such as weight loss, blood sugar control, and improved cardiovascular health, Nigeria can address the root causes of diabetes and prevent its devastating complications.
Physiotherapists played a critical role in combating polio through rehabilitation and collaboration with pediatricians. Today, we must rise to the challenge of diabetes with the same determination and innovation, proving that non-drug therapeutic interventions can transform lives and curb this growing epidemic.
Mukaila Kareem, a doctor of physiotherapy and physical activity advocate writes from the USA and can be reached via makkareem5@gmail.com
