Diabetes remains major cause of renal failure

Apr 12, 2011 News

…as Health Ministry intervenes with HbA1c test

The cause of end-stage renal failure in about 45 percent of all patients throughout the world and is linked primarily to diabetes. This is according to renowned Nephrologist, Professor George Nicholson, who said during a recent interview that the projected number of diabetics in the world is expected to double by 2035 over what the figure was at the turn of the century.

Professor George Nicholson

“That is an enormous workload and it is going to increase the load of patients unless we do something,” according to Dr Nicholson who heads the Caribbean Dialysis Inc. in Barbados.
He revealed that type two diabetes which occurs mainly in middle aged individuals is the most common form of the disease as opposed to juvenile diabetes which is found in children and is of a different cause altogether.
Type Two diabetes, he said, is related to obesity and “as we know the world is getting fatter… ‘Big is beautiful’ is spreading like a virus and it is frightening. Caribbean women and men are trying to look like the American women and men and the British they are catching up too.”
According to Professor Nicholson, some persons have chosen to accept the obesity situation as a genetic dilemma, a notion he has entirely debunked. He has regarded the situation as one that is environmental, adding that “if a child grows up in an environment and people are over-eating that child will start to do the same.”
The situation has progressed to such an extent, according to Professor Nicholson, that teenagers are no longer being diagnosed with juvenile diabetes. He explained that in the past when an individual around the age of 50 was found to be obese it was likely that they would be diagnosed with Type Two diabetes.
However, from the mid-1960s a new phenomenon emerged, Professor Nicholson noted, whereby “increasingly we started to see MODY which means Maturity Onset Diabetes in the Young. It is beginning to appear in persons in their 40s, under 40 and even in teenagers.”
“This is what is happening and that is what makes it so scary and the only thing we can do to reverse this trend is to encourage people to be engaged in activities (exercise) and watch what they are eating and how much they are eating.”
Guyana is however poised to arrest this challenge with the formation of the Guyana Kidney Foundation which came into being a few months ago with the expert support of Professor Nicholson and a number of other reputable personalities both in the medical field and the business community.
The Foundation has been fully endorsed by the Ministry of Health in recognition of the fact that diabetes is continuing to increase as a global pandemic.
According to Minister Ramsammy, countries across the world have been reporting an increase in the impact of the disease. He said that in Guyana, diabetes represents a serious public health problem — 40,000 persons live with the disease and perhaps another 20,000 that have not been diagnosed.
“In spite of our continuing efforts to make people aware of the dangers, people continue to ignore the warnings from the Ministry of Health and from health care providers,” according to the Minister.
Regarding this existing state of affairs as one of “major concern,” Minister Ramsammy aided by the Ministry’s Chronic Disease Department has been meeting and discussing the problem of diabetes with community groups across the country.
Meetings have already been held in Regions Four, Five, Six and Eight and there are plans for discussions with a group of senior police officers in Georgetown on Friday.

Crucial
intervention
At a community meeting in West Berbice, Minister Ramsammy announced plans for easier access to a test that has become an important part of a quality clinical management programme for diabetes.
The introduction of HbA1c testing is a part of an expanded programme to add new services to improve the clinical management of diabetes around the country.
It is viewed as one of the interventions being added to the package of services for diabetics in the public sector health clinics.
HbA1c is however not a new test but it was not widely available in Guyana. It was only available in the private sector and is relatively costly. In an attempt to address the scourge of diabetes, the Ministry of Health is now making it possible for persons being treated in the public sector to have full access.
HbA1c is a test that looks at glucose (sugar) control over a period of time and is a better indicator of diabetes control than the everyday testing for blood glucose (sugar) level. HbA1c levels in the blood are good indicators for persons who are likely to develop complications. Research has demonstrated that persons with HbA1c levels of greater than seven percent are likely to develop major complications and suffer from adverse outcomes, such as foot amputations, eye diseases, kidney diseases and heart diseases.
While the test is available at the Georgetown Public Hospital Corporation (GPHC), the Ministry has established a referral service whereby all Regional Hospitals and District Hospitals would send specimens for testing at the National Public Health Referral Laboratory and the results would be sent back within one week.
As the programme expands, the Regional Hospital Laboratories would be developed with capacity for HbA1c testing, according to Minister Ramsammy.
Initial analysis of the tests have revealed that people with overt foot problem have HbA1c levels much higher than diabetic persons that have not yet developed foot problems. Patients in the Diabetic Foot Clinic (DFC) at the GPHC had an average HbA1c level of 9.11 percent compared to patients in the regular Diabetic Clinic (without foot problem at this time) who had an average HbA1c level of 7.77 percent.
“Clearly, the availability of HbA1c results can be used by health care providers to evaluate patients better and to project which of the patients are progressing towards complications, resulting in adverse events and even premature death,” the Minister noted.
As such, the Ministry of Health is promoting HbA1c testing for all diabetics at least twice per year.