By Ofori Zephaniah

For many people, diabetes begins quietly.

There may be no dramatic warning, no sudden pain and, in some cases, no obvious symptoms at all. Yet while a person goes about their daily life, persistently high levels of glucose in the blood can gradually damage the heart, blood vessels, eyes, kidneys and nerves.

That quiet progression is one reason diabetes has become an important public-health concern—not only globally, but in Ghana.

According to the World Health Organization (WHO), the number of people living with diabetes worldwide increased from approximately 200 million in 1990 to 830 million in 2022. Among adults aged 18 years and older, the global prevalence increased from 7% in 1990 to 14% in 2022. WHO also reports that more than half of adults aged 30 years and older living with diabetes were not taking medication for the condition in 2022.

Diabetes occurs when the body cannot produce enough insulin or cannot effectively use the insulin it produces.

Insulin is a hormone produced by the pancreas. One of its major functions is to help glucose move from the bloodstream into cells, where it can be used for energy.

When insulin is absent, insufficient or ineffective, glucose accumulates in the blood. Persistently elevated blood glucose—known as hyperglycaemia—can eventually damage organs and tissues.

There are several types of diabetes. Type 1 diabetes occurs when the immune system destroys the insulin-producing cells of the pancreas. Type 2 diabetes occurs when the body becomes resistant to insulin and/or does not produce enough insulin. Gestational diabetes develops during pregnancy and can increase health risks for both mother and child

The Ghanaian situation deserves particular attention.

The 2023 Ghana WHO STEPS survey found that 5.2% of the population had elevated fasting blood glucose. Among people aged 60–69 years, the figure rose to 12.7%. The prevalence was also higher among urban respondents, at 6.1%, compared with 3.9% among rural respondents.

Importantly, elevated fasting blood glucose should not automatically be interpreted as confirmed diabetes. It is a measurement indicating abnormal glucose regulation and may signal an increased risk of diabetes. Diagnosis requires appropriate clinical assessment and testing.

The IDF Diabetes Atlas 2025 estimated that approximately 317,400 adults aged 20–79 years were living with diabetes in Ghana in 2024, with an estimated 78.7% undiagnosed.

These figures highlight why diabetes detection and public awareness matter.

While not every case of diabetes is caused by lifestyle, the way we eat, move, sleep and spend our daily lives can influence the risk of developing type 2 diabetes.

Modern life can make unhealthy patterns easy to adopt. A person may spend most of the day sitting, travel primarily by car or motorbike, consume highly processed foods and sugary drinks regularly, and have little time for physical activity.

Over months and years, these patterns can contribute to excess body weight, insulin resistance and other metabolic changes associated with type 2 diabetes.

A sedentary lifestyle is one of the important modifiable risk factors for type 2 diabetes.

Spending long periods sitting at work, studying, watching television or using a phone or computer, while getting little physical activity, reduces the amount of energy the body uses.

Regular physical activity helps the body use glucose more effectively and improves insulin sensitivity. WHO recommends that adults undertake 150–300 minutes of moderate-intensity aerobic physical activity per week, or an equivalent amount of vigorous activity, together with muscle-strengthening activities on at least two days per week.

Physical activity does not have to mean going to a gym. Walking, cycling, dancing, active household work, recreational sports and other forms of movement can contribute.

Soft drinks, energy drinks, sweetened juices and other sugar-sweetened beverages can contain substantial amounts of free sugars.

Regularly consuming large quantities of these drinks can increase overall calorie intake and contribute to excess weight gain. Excess body weight is an important risk factor for type 2 diabetes.

The issue is not that consuming one sugary drink will suddenly cause diabetes. The concern is habitual, high consumption over time, particularly when combined with low physical activity and an overall energy-dense diet.

Water and unsweetened beverages can therefore be useful alternatives for everyday hydration.

A diet frequently dominated by highly processed, energy-dense foods can make maintaining a healthy weight more difficult.

Examples can include frequent consumption of foods high in refined carbohydrates, saturated fats, salt and added sugars, particularly when these replace vegetables, fruits, legumes, whole grains and other nutrient-rich foods.

This does not mean that every processed food must be completely eliminated. The concern is the overall dietary pattern and frequency of consumption.

Regularly consuming more calories than the body requires can result in gradual weight gain. Excess body fat, particularly around the abdomen, is associated with increased insulin resistance and a higher risk of type 2 diabetes.

Learning to recognise appropriate portions and including vegetables, legumes, whole grains and other fibre-rich foods can help support a healthier dietary pattern.

Heavy alcohol consumption can contribute to weight gain and may interfere with several metabolic processes.

Alcoholic beverages can also add substantial calories to a person’s diet, particularly when combined with sugary mixers.

Reducing excessive alcohol consumption is therefore relevant to overall metabolic health.

Smoking is associated with an increased risk of developing type 2 diabetes.

Nicotine and other chemicals in tobacco can affect the body’s metabolism and may contribute to insulin resistance. Quitting tobacco is therefore beneficial not only for preventing cardiovascular and respiratory diseases but also for reducing diabetes risk.

Sleep is sometimes overlooked when discussing diabetes prevention.

Poor sleep and insufficient sleep have been associated with metabolic disturbances and an increased risk of type 2 diabetes. Irregular schedules, long working hours, night shifts and excessive screen use late at night can contribute to inadequate sleep.

Maintaining a regular sleep schedule and getting adequate sleep should therefore be considered part of a broader healthy lifestyle.

Stress itself is not a simple direct cause of diabetes. However, long-term stress can influence behaviours and biological processes that affect diabetes risk.

For example, someone experiencing persistent stress may become less physically active, sleep poorly or rely more heavily on alcohol, tobacco or high-calorie foods.

Addressing stress through healthy coping strategies, physical activity, social support and appropriate professional help can contribute to overall wellbeing.

It is important not to turn diabetes prevention into a blame game.

A person can develop type 2 diabetes despite having what appears to be a healthy lifestyle. Genetics, age, family history, previous gestational diabetes, certain medical conditions and medications can also influence risk.

Likewise, having obesity or an unhealthy lifestyle does not mean that a person will definitely develop diabetes.

Lifestyle factors influence risk; they do not determine an individual’s destiny.

One of the most persistent misconceptions about diabetes is that eating sugar directly causes the disease.

The reality is more complicated.

Diet can influence diabetes risk, particularly when a person’s overall dietary pattern contributes to excess body weight and metabolic problems. But diabetes cannot be explained simply by saying that someone “ate too much sugar.”

Type 2 diabetes is associated with several factors, including overweight and obesity, physical inactivity, increasing age and genetic susceptibility.

Uncontrolled diabetes can have serious consequences.

WHO reports that diabetes can cause blindness, kidney failure, heart attacks, stroke and lower-limb amputation. In 2021, diabetes and diabetes-related kidney disease were responsible for more than 2 million deaths globally, while high blood glucose contributed to approximately 11% of cardiovascular deaths.

The damage often develops gradually.

High blood glucose can damage small blood vessels supplying the eyes and kidneys. It can also damage nerves, particularly in the feet and legs. Damage to larger blood vessels increases the risk of cardiovascular disease.

Some common symptoms of diabetes include:

 Excessive thirst, frequent urination, increased hunger, unexplained weight lost, persistent tiredness, blurred vision , slow-healing wounds, recurrent infections.

However, symptoms are not a reliable screening method because type 2 diabetes can develop with few or no noticeable symptoms.

Someone who feels perfectly healthy may still have abnormal blood glucose.

That is why appropriate testing is important, particularly for people with risk factors or those advised by a healthcare professional to undergo screening.

Reducing the risk of type 2 diabetes does not require an extreme diet or expensive fitness programme.

It can begin with realistic, sustainable changes:

• Move more: Walk, cycle, exercise, dance or participate in sports regularly.
• Eat more whole foods: Include vegetables, fruits, legumes, whole grains and other high-fibre foods.
• Reduce sugary drinks: Make water and unsweetened beverages more common choices.
• Watch portion sizes: Avoid consistently eating more than the body needs.
• Maintain a healthy weight: If overweight, even modest weight loss can improve metabolic health.
• Avoid tobacco: Do not smoke or use tobacco products.
• Limit excessive alcohol consumption.
• Prioritise adequate sleep.
• Get tested: Especially if you have risk factors or are advised by a healthcare professional to do so.

The goal is not perfection. The goal is a healthier pattern repeated over time.

Diabetes awareness campaigns often become more visible around World Diabetes Day on 14 November, but diabetes education should not be limited to one day or one month.

Awareness should mean that people understand what diabetes is, recognise possible symptoms, know where to seek testing and understand why treatment should not be abandoned simply because symptoms improve.

It should also mean reducing the stigma surrounding people living with the disease.

For health authorities, awareness needs to be accompanied by accessible screening and diagnosis, affordable medicines, reliable supplies of essential treatments and continued patient education.

For families, support matters. A person living with diabetes may need encouragement to take medication as prescribed, attend medical appointments, maintain healthy habits and monitor their condition.

The global numbers are large, but they should not make diabetes seem inevitable.

WHO states that diabetes can be treated and that many of its consequences can be prevented or delayed through appropriate diet, physical activity, medication and regular screening and treatment for complications.

For Ghana, the message is equally important.

Do not wait for complications before taking diabetes seriously.

Know the risk factors. Pay attention to symptoms. Get appropriate blood-glucose testing when indicated. If diagnosed, follow the treatment plan provided by qualified health professionals.

And perhaps most importantly, replace myths with knowledge.

Diabetes may be a chronic disease, but early detection, appropriate treatment and healthier lifestyles can make a substantial difference.

The choices we make every day can influence our health tomorrow—but diabetes prevention is not about blame. It is about knowledge, access, support and action.