Is diabetes a ticking time bomb in Nigeria? “The bomb,” says one doctor, “has already exploded.”

Professor Felicia Anumah apologised for being two minutes late. She had just stepped off a live television set -a segment on hypertension- and was calling from Abuja. Her voice is soft, unhurried. We had not spoken properly in some time. She did not mention it. She picked up the work as if no gap had occurred, which I came to understand is not politeness but principle: she has spent thirty years practising alongside patients who disappear and return, who mean well and fall short, who show up again when they can. What matters to her is the showing up.

She gets straight to it. She teaches, she treats patients, she runs a Master’s programme, she leads a national foot care initiative, she sits on policy committees, she writes books, she appears on television. She said it herself, almost as an aside: she has been working with the Federal Ministry of Health for fifteen years. She knows every policy document on non-communicable diseases. She was a technical partner in most of them.

The gap between policy and practice

“We have beautiful documents,” she says. There is a brief pause. “But implementation remains a challenge.”

Nine words that contain more than they appear to, from someone who has spent thirty years trying to close the distance between the document and the ward. It is the story of non-communicable diseases in Nigeria.

Nigeria has an estimated 11 million people living with diabetes. In 2024, more than 55,000 of them died from it – a conservative estimate. Professor Olufemi Fasanmade, Unit Head of Endocrinology at Lagos University Teaching Hospital, has been tracking that number as it climbs year on year, from 48,375 in 2021 to where it stands today. “The numbers are just the leaves,” he says. “The root causes still need to be addressed: more effort on preventing dysglycemia at every level, through diet, exercise and lifestyle change.”

The root causes are not complicated to name, even if they are enormously difficult to fix. Rapid urbanisation, shifting diets, the ubiquity of sugar-sweetened beverages (SSBs). In addition, diabetes is a disease that progresses in silence and often announces itself through its complications- more than half of Nigerians living with diabetes do not know it yet. 

And then there is the cost. Since 2023, the cost of insulin in Nigeria has risen by more than 200%. The country still runs an out-of-pocket healthcare system. Patients pay for every drug, every test, every visit, from their own pockets, and when they cannot pay, they stop coming. Anumah describes this with the directness of someone who watches it happen every week: families going into poverty around a single diagnosis, patients skipping doses, dropping out of clinics, reappearing only when a complication has progressed beyond what anyone can easily reverse.

The bomb has already exploded”

Prof. Felicia Anumah

I suggested to her, at one point in our conversation, that diabetes in Nigeria felt like a ticking bomb. She did not agree with my framing. “The bomb,” she said, “has already exploded. There is no day we don’t have a stroke in the emergency, from hypertension or diabetes or from both. Heart attacks. Kidney failures. For me, the bomb has already exploded.”

She said it the way a good doctor delivers bad news: calmly, clearly, looking you in the eye.

What makes Anumah different from many of the people who describe this crisis is that she has spent thirty years refusing to only describe it.

She is a Professor of Medicine and Endocrinology at the University of Abuja and Director of its Centre for Diabetes Studies. She is also, among other things, Member of the Technical Working Group for Non-Communicable Diseases (NCDs) in Nigeria, and a consultant to WHO in diabetes.

In 2021, Nigeria’s First Lady, Dr Aisha Buhari, commissioned and equipped a diabetes and endocrine centre at the University of Abuja Teaching Hospital -the first of its kind in the country. She named it after Anumah. A sign that her work had not gone unnoticed. She is, in the understated way of people who have built things, one of the most consequential figures in diabetes care on the continent.

Fasanmade, who has known her work for years from his vantage point in Lagos, puts it simply. “She has blazed the trail on diabetes education, foot care and advocacy,” he says. “She has set the standard, and become a rallying point for what genuine multidisciplinary diabetes care can look like in Nigeria.”

Training the missing link

The thing Anumah is building right now, the thing she believes the world is not yet seeing, started in June 2023 in a lecture room at the University of Abuja.

Nigeria, like most of sub-Saharan Africa, has never had certified diabetes educators. The doctor in the consulting room sees thirty, forty, fifty patients a day. He does not have time to sit with someone newly diagnosed and explain, at the depth that explanation requires, what the diagnosis means, what will happen if it is not managed, and how to live with it without going bankrupt in the process. That conversation, the one that determines whether a patient understands their condition well enough to manage it, has been falling into the gap between what doctors have time to do and what patients need to hear.

Anumah decided to train the people who would fill that gap. In partnership with Diabetes Africa, she developed Africa’s first Master’s degree in Diabetes Education at the University of Abuja, an 18-month programme combining virtual lectures with clinical training across four major teaching hospitals. The first cohort of seventeen students, physicians, pharmacists, dietitians, nurses, an ophthalmologist, a dermatologist, sits their final exams in July. A third cohort will be recruited before the end of the year. Two civil servants from the Federal Ministry of Health are in the second cohort.

Fasanmade understands why a Master’s degree achieves something a short course never could. “In Nigeria, paper qualifications still carry enormous weight,” he says. “Short courses with certificates are not taken seriously because they don’t count towards promotion or professional ranking. A Master’s degree has the potential to change that.”

Anumah has written to the Minister of Health to argue that a formal cadre of certified diabetes educators needs to be recognised and resourced within the health system. The degree is the proof of concept. The graduates, when they walk out in July, are the argument she will take to government.

Empowering the patient to be in charge of this disease is so important”

Prof. Felicia Anumah

“The medication is one part,” she says, “but empowering the patient to be in charge of this disease is so important. We want the patient to be their own doctor, maybe 50%. The healthcare provider does the other 50%.”

Saving limbs

Training that other 50% is a lifelong project, and among its most urgent chapters is diabetic foot care, an area where better clinical knowledge directly translates into fewer amputations. Anumah has made it one of her priorities.

She leads the Diabetic Foot Nigeria Initiative, sits on the board of the Pan-African Diabetes Foot Study Group, and is Nigeria’s representative to D-Foot International. In April 2026 she co-organised a three-day conference in Abuja with faculty from India, Egypt, South Africa, Tanzania and Rwanda, drawing nearly 100 participants. One session, offered free of charge, was held specifically for plastic, orthopaedic and vascular surgeons. The aim was to bring into the room the people who had largely been absent from the conversation about limb loss.

Collaboration between endocrinologists and surgeons is what saves limbs”

Prof. Felicia Anumah

“We wanted them to understand they are part of the strategy,” she says. “Collaboration between endocrinologists and surgeons is what saves limbs.”

At her own institution, that collaboration has produced the most striking figure in this conversation. When Anumah’s multidisciplinary foot group began its work at UATH, the amputation rate among patients presenting with diabetic foot problems was 50%. Today it stands at 10%, the lowest recorded figure at any centre in Nigeria. The Endocrine and Metabolism Society of Nigeria has since mandated other tertiary facilities across the country to adopt the UATH model.

Others have tried, Fasanmade notes, with less dramatic results, because replication requires institutional capacity, local infrastructure, and the political will of whoever is running the centre. What Anumah did in Abuja was to persuade an institution to reorganise itself around a different idea of what diabetes care should look like.

What the statistics miss

Towards the end of our conversation I asked her about a patient she thinks about. She said she has many, but she always returns to one.

He was 34 years old. A university graduate, unemployed, unmarried. He had been living with diabetes for twelve years before he first reached a tertiary care facility. Two years before that, surgeons had already amputated one leg. When he arrived at Anumah’s unit, the other leg was failing. He had no money. Her team treated him with whatever they could find within the unit itself, trying to hold the limb long enough. Eventually the orthopaedic surgeons concluded it was not going to work. He refused amputation. He and Anumah both understood why. It was the only limb he had left.

One morning she arrived on the ward and found his bed empty. She asked what had happened. He died yesterday, the ward manager said.

“That is the plight of the common Nigerian with diabetes,” Anumah says. “The resources to care for them are not there. Complications come. And at the end of the day, morbidity and mortality end the story.”

She pauses. “This is what motivates me to keep advocating for quality diabetes care. To prevent, at least to some extent, the complications. One of them, the one with the highest economic cost, is limb loss.”

She is thirty-five years into this work. She is still advocating. She still has a dream she has not yet managed to build: a National Diabetes Institute for Nigeria, government-funded, coordinating prevention and management across every level of care, making diabetes a stated national priority.

“If we had that,” she says, “it would mean the government had prioritised diabetes in Nigeria. It would mean patients are prioritised. It would mean diabetes does not have to be a death sentence.”

She said that, too, without drama. Like someone who has been waiting a long time for something she knows is coming.

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Diabetes Africa has partnered with the University of Abuja since 2021 to support the development of Africa’s first Master’s degree in Diabetes Education. To find out more about Diabetes Africa’s work across the continent, visit diabetesafrica.org.