Beware Diabetes – a Message for World Diabetes Day 2010.

Colin Alert

Barbados

Beware Diabetes – a Message for World Diabetes Day 2010.
Dr. C. V. Alert.
Family Physician.

The Right. Hon David Thompson, the late Prime Minister of Barbados, died from cancer of the pancreas on October 23rd 2010.

Many people across the Caribbean are dying from another disease in which the pancreas is the main organ involved: that disease is diabetes mellitus (simply diabetes). In Barbados, for example, with a population of 280 000 individuals, it is estimated that over 36 000 (or about 13%) of the population are affected by diabetes. It may be at least half of these individuals either don’t know that they have diabetes, or are not having the condition adequately managed.

In the 1990’s an audit of the medical services available to diabetic patients in our public and private sectors done by the Ministry of Health and the Chronic Disease Research Centre identified significant deficiencies in the quality of care. No significant effort was directed towards improving these services, and another audit done by the Family Medicine Unit, Faculty of Medical Sciences, Cave Hill Campus of UWI in 2005 found (not surprisingly) that many of the deficiencies persisted. Again, there was no significant effort directed towards improving the status quo.

Since inadequately managed diabetes can have a significant negative impact on life expectancy, estimated to shorten life expectancy by as much as 15 years on average, then we can project that over the coming weeks, months and years a few thousand patients with diabetes will die prematurely. Diabetes will maintain its position near the top of the list as one of our leading causes of death annually, and maintain its position as a disease that could be better treated, or even prevented, if sufficient attention is placed in these directions.

Since similar audits were done in Trinidad and Tobago, Jamaica and Tortola, British Virgin Islands (BVI), it was formally documented that diabetes and its management was/is a big problem right across the Caribbean.

On September 15th 2007 there was an injection of optimism that Caribbean governments were willing to direct efforts at tackling the chronic non-communicable diseases (NCDs), including diabetes, in a head-on manner. On that day Caribbean Prime Ministers met in Port-of-Spain, Trinidad, for a summit dedicated to the NCDs, and produced the Declaration(s) of Port-of-Spain.
Among the declarations: That our Ministries of Health, in collaboration with other sectors, will establish by mid-2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80% of people with NCDs would receive quality care and have access to preventive education based on regional guidelines. Mid 2008? We are long past the mid-2008 deadline suggested by this declaration, and the Ministry of Health in Barbados has chosen to keep secret any progress that is being made in this direction, two and a half years after the deadline.
Thus, with non-existent screening programs and inadequate medical care available to persons with diabetes, many people across Barbados and the Caribbean will continue to suffer and die from this dangerous disease.
A pound of cure, it is said, is not as good as, and is certainly more expensive than an ounce of prevention. In the case of diabetes the ‘pound of cure’ relates to the treatment of people with the disease, including medical visits and medication. The ready availability of channels of American television allows many people to view advertisements of the newest drugs available for the treatment of diabetes; unfortunately our National Drug Formularies cannot (in most cases) afford these newer drugs. To date, we have not been able to reduce the number of amputations annually in diabetics whose feet get infected. We have a growing number of patients requiring dialysis (in the public sector costing taxpayers over $10000 per person per month) because their kidneys have been damaged by diabetes. Diabetes is responsible for about half of our patients who go blind annually. And diabetes is not an innocent bystander in the large number of patients who have heart attacks or strokes annually: in fact having diabetes increases the likelihood that the patient does not ‘live to fight another day’ after the heart attack or stroke.
So this disease of the pancreas is as costly as it is deadly: one can count the cost in dollars, or in lives, eyes, brains, hearts, kidneys or legs.
The ‘ounce of prevention’, as far as diabetes is concerned, relates to lifestyle, in large part our eating and exercise habits. “We eat too much, and we exercise too little”: we are lickerish and lazy. Reversing this has to be the responsibility of every individual, and every family.
A local medical trial called the Barbados Diabetes Intervention Study (BDIS), done in 1996/7, showed that adults who were at high risk for diabetes (because they were relatives of diabetics, and diabetes runs in families) could reduce that risk by participating in a Healthy Lifestyle program, involving regular exercise and healthy eating. Compared to similar studies done abroad which follows individuals for a few years, this study only involved a three month ‘intervention’ period and a re-evaluation after one year. Nonetheless, testing showed that most participants had a reduced chance of becoming diabetic even after this short intervention. So preventing diabetes is a reality for adult Barbadians, and by extension adult Caribbean people, if efforts are made to follow a healthy lifestyle.
So the message for the Caribbean for World Diabetes Day 2010 is to focus on prevention: don’t drink, don’t smoke, follow a diet that includes lots of fruit and vegetables (but excludes fried, greasy and salty foods), and follow a plan that allows at least 30 minutes for daily activity. The activity could be formal exercise, such as running or jogging, skipping or going to the gym, or playing games. The activity could be washing the car, sweeping the driveway, raking up leaves, or mowing the lawn. Getting out of the bus two stops earlier (or later) allows some extra walking before you get home. Drink water instead of sweetened drinks.
It is not possible to truly replace our late Prime minister who succumbed to one disease of the pancreas; similarly, it is not possible to replace the lives or limbs that were lost, and that we continue to lose, to another disease in which the pancreas has a central role, that of diabetes mellitus. But we do have a shot at preventing diabetes in the first place, eliminating the damage that occurs once the disease sets in. When one realizes the large numbers of individuals that are potentially at risk for becoming diabetic – roughly twice the number that already have it, or about 72 000 people in the case of Barbados – then the need for urgent preventive measures becomes even more apparent.