Important considerations in the care of diabetic patients in a developing country (Nigeria).

Much attention has been focused on the clinical pattern of diabetes mellitus in developing countries. This has its peculiarities especially with regard to tropical pancreatic diabetes, the aetiopathogenesis of which remains speculative. However, more than the clinical pattern of the disease itself, it is the social, economic, and cultural circumstances within which the disease is managed and coped with that give it its "tropical" distinctiveness. Factors of illiteracy, poverty, lack of adequate shelter or source of safe drinking water, poor environmental sanitation, cultural misconceptions about diseases, scarce health resources, non-availability of drugs or their prohibitive cost, the sale of fake drugs, and of course the ubiquitous traditional and faith healers with their 'miracle cures', all combine to create a milieu which is hostile to the optimal management of a chronic lifelong disease like diabetes mellitus. This review focuses on these oft neglected aspects of diabetes because without due attention to them, the successful management of the diabetic patient in most developing countries will remain elusive.