The burden of diabetes in the country has nearly doubled over the past decade, with prevalence rising from 1.4 percent in 2014 to 2.6 percent in 2023, according to the World Health Organisation (WHO) and the Ministry of Health.
Diabetes, a largely preventable condition, often triggers life-threatening complications, inflicts profound suffering, and results in loss of livelihood due to sickness.
The chronic disease is also very expensive to treat, with the country spending upwards of Shs2.2 trillion annually to treat the condition, according to a 2023 Economic Policy Research Centre (EPRC) report. Mr David Kimuli, 62, is one of the people living with diabetes.
When the first symptoms appeared, Mr Kimuli didn’t suspect diabetes. He often felt unusually cold during the day and weak, assuming it was malaria.
After a year of misdiagnosis and getting the wrong treatment, Mr Kimuli finally went to Mulago Hospital for a full medical check-up. There, he was diagnosed with Type 1 diabetes and immediately started insulin treatment in 1997.
‘When I started taking insulin, it wasn’t easy. I had symptoms of ringworm on my skin, my vision became blurry, and learning to inject myself was very hard,’ he adds.
Adjusting to life with diabetes came with major lifestyle and dietary changes. ‘It is very expensive to maintain a proper diet,’ he observes.
‘Back then, Mulago services were free, but I had to stop taking honey, soda, normal bread, pineapples, and sugarcane, resorting to salt bread and other food types depending on your blood sugar level and the type of diabetes you have.’
In the early years of treatment, insulin reactions were a major challenge to him. Mr Kimuli adds that beyond the medical struggles, social and workplace stigma made the journey even harder.
‘I would sweat so much and had to move everywhere with a glucometer. The body takes time to adjust, where you can get insulin reactions. Some workplaces see you as a burden and do not give you space once they realise you are diabetic,’ he says.
Despite the challenges, Mr Kimuli has learned to live positively with diabetes. After 28 years of daily injections and strict dietary monitoring, he has mastered his condition and continues to manage it with discipline.
Mr Kimuli’s story is not isolated. His story mirrors Uganda’s escalating diabetes crisis. From 2014 to 2023, prevalence nearly doubled from 1.4 percent to 2.6 percent, according to data from the WHO and the Ministry of Health.
But statistics also show strong variation of the prevalence of high blood glucose (a pointer to diabetes) across regions.
In the central region, it rose from 2.1 percent to 5.2 percent, eastern from 1.1 to 3 percent, northern (1.3 percent to 2.2 percent), and western (1.5 percent to 2.7 percent). This means northern and western Uganda had some of the slowest rates of increase in high blood sugar prevalence.
Prevalence of high blood sugar in urban areas rose from 2.3 percent to 3.6 percent, while in rural areas it spiralled from 1.3 percent to 3.2 percent. This indicates that the gap in the prevalence of high blood sugar is narrowing between the two settings as urbanisation increases in the country.
Dr Fressera Bunjo Muyinga of Aga Khan University Hospital, Nakawa Specialty Centre, explains the biology. ‘Diabetes is a condition where the body can’t produce enough insulin or can’t use the insulin effectively, causing a rise in blood sugar,’ she says.
Insulin is a hormone produced by the pancreas, which shuttles glucose into cells for energy.
‘Type 1 diabetes stems from autoimmune destruction of our pancreas, leading to low production of insulin. This is purely genetic, purely autoimmune, and is not something you can acquire because of lifestyle changes,’ Dr Muyinga explained.
Dr Kenneth Luzinda, a physician at Nakasero Hospital, delves deeper. ‘Diabetes is a disease in which there is a change in the way the body manages its nutrients. For most of us, we tend to think of it as only sugar, but generally, lots of other nutrients get affected,’ he adds. He says type 1 diabetes can affect children as young as one year old, and these patients are started on insulin injection immediately.
But the commonest is Type 2 diabetes. Dr Muyinga says Type 2 diabetes, the dominant form of diabetes, arises from ‘insulin resistance… the things that you do every day, the food you eat, lack of exercise… but also genetics.’
Dr Luzinda sheds more light. ‘Usually, it (Type 2 diabetes) happens in people who become big (fat). The actual process that happens here is that the pancreas is producing enough insulin, but because the body is too big and there’s a lot of fat, the insulin does not do its job,’ he explains.
‘So, the underlying problem is that the body fails to respond. But there is also gestational diabetes, which afflicts some pregnant women, some persisting post-delivery,’ he adds.
Dr Luzinda explains that in gestational diabetes, the pregnant woman manifests symptoms of diabetes.
‘The pregnancy puts a strain on the insulin-producing cells in the pancreas, and they fail to be sufficient or the pregnancy results in the body producing antibodies that prevent the insulin from working,’ he explains.
Signs, symptoms, and treatment
Dr Muyinga says symptoms of diabetes include frequent urination, thirst, hunger, and numbness.
‘Type 2 diabetes only presents with minor symptoms. Sometimes people find out by going for a general check-up and the doctor finds they have diabetes,’ she explains, emphasising the importance of routine check-ups.
She reveals that her 89-year-old grandmother is still thriving after 20 years of diagnosis with diabetes by adhering strictly to guideline. The adherence includes taking the medication as prescribed and avoiding diets she is restricted from.
‘You have to take your medication every day unless a doctor tells you otherwise. If you don’t take action, you can experience kidney failure, get visual impairment, delayed healing, amputation, frequent infection, heart disease, among others,’ she adds.
The economic loss
A 2023 analysis report by Ms Madina Guloba and other researchers from the EPRC indicates that in 2022, up to Shs2.2 trillion was spent on medication, treatment, and management of complications of diabetes. Households bear the largest financial burden (Shs1.7 trillion).
The researchers further note that the government expenditure of Shs435b on diagnosed Type 2 Diabetes patients accounted for 13 percent of the Ministry of Health budget.
Why is it rising
The doctors believe urbanisation and globalisation, which led to the import of Western habits, are largely to blame.
Dr Diana Ssewanyana, operations manager at Aga Khan University Hospital Nakawa Specialty Centre, laments: ‘We used to say non-communicable diseases like diabetes are diseases of the rich. This is because the rich used to sit in the cars, they don’t walk because they are rich, they go to supermarkets and they go for fast foods, they buy the sodas every day,’ she observes.
‘At lunch time, you have a soda, dinner, and you have another soda with the meal. That is what increases the risk of developing these conditions, like diabetes. These processed foods, some of which are expired,’ she adds.
Dr Ssewanyana says processed foods have eclipsed traditional diets to our disadvantage. She narrates her experience in Dubai, UAE where a passion fruit costs Shs10,000, but it is cheap in Uganda, yet some Ugandans dismiss the fruits or their juice as ‘for the poor’ and instead go for soda or other processed foods.
Dr Ssewanya also emphasises the demonisation of walking. She says many people have shunned walking, fearing poverty perceptions, while leaders are also failing to model change.
‘Just imagine if you’re told that for you not to have to pay the millions of shillings that you expect to pay when you suffer from a disease, it’s just a walk. How cheap is walking!’ she wonders.
Dr Luzinda says excess calories from staple foods like matooke, posho, and processed foods like sodas accumulate as fat, causing insulin resistance.
Solutions
The experts say solutions demand multifaceted action. First, promote prevention through education and lifestyle shifts. Dr Ssewanyana urges leadership by example.
‘Just imagine if one day you took the initiative and said to all of us, the celebrities, we are going to walk, we are walking, but we are not broke. We park our cars and walk,’ she says.
‘Sometimes leadership is about living by example. If they can do this, they can cause a lot of influence. If you go to developed countries, I have seen the President of France, for example, going on the street, riding a bike. He is the President,’ she adds.
The doctors say schools should emphasise balanced diets for learners and discourage processed foods (junk food), integrate physical education, and do campaigns to increase awareness of the general population about these conditions.
Dr Luzinda calls for workplace reforms.
‘Can we provide healthy foods at our cafeterias? Can we have the education from that workplace that targets the risk factors for diabetes so that people are aware?’ he suggests.
‘And when we are eating, can we know that the workplace might provide at least one or two periods of time where people can get up and do something physical. Messengers can be put away so that people walk around and take some stairs.
‘People can avoid using the lift. But also, some places can actually create time for group sessions, such as aerobics and gyms, and even provide those facilities or subscriptions. Can we have periodic screens that are initiated at work, where people can be screened? Then, if found, people are treated,’ he adds.
He says workplaces should put in place a support system for people with diabetes.
‘The support for such diseases or risk factors is not just drugs and doctors. It also involves other psychological things and social things that can be put in place,’ he explains.
‘Because these diseases not only affect the physical body, but they also affect how you are perceived in society. How you perceive your environment. You have to swallow pills, sometimes at work. And sometimes you might have to take days off when you are unwell,’ he adds.